Seroprevalence of COVID-19 IgG Antibody in Resident and Fellow Physicians in Milwaukee, Wisconsin: Analysis of a Cross-Sectional Survey.

PURPOSE: Medical trainees are likely at differential risk of exposure to COVID-19 per respective clinical activity. We sought to determine the seroprevalence of COVID-19 antibody (Ab) among resident and fellow physicians with varying degrees of exposure to COVID-19. METHODS: A cross-sectional study of Milwaukee-based resident and fellow physicians, encompassing December 2019-June 2020, was conducted. Relevant variables of interest were ascertained by survey and payroll data, and Abbott ARCHITECT Ab test (index cut-off of ≥1.4) was performed. Descriptive statistics were generated, with 95% CI calculated for the study's primary outcome of seroprevalence. RESULTS: Among survey respondents (92 of 148, 62%), 61% were male, 44% were non-White, mean age was 31 years, 94% had no underlying conditions, and 52% were either family or internal medicine residents. During the study period, ≥32% reported cough, headache, or sore throat and 62% traveled outside of Wisconsin. Overall, 83% thought they had a COVID-19 exposure at work and 33% outside of work; 100% expressed any exposure. Of those exposed at work, 56% received COVID-19 pay, variously receiving 69 mean hours (range: 0-452). Ultimately, 82% (75 of 92) had an Ab test completed; 1 individual (1.3%; 95% CI: 0.0-3.9) tested seropositive, was not previously diagnosed, and had received COVID-19 pay. CONCLUSIONS: The low Ab seroprevalence found in resident and fellow physicians was similar to the concurrently reported 3.7% Ab-positive rate among 2456 Milwaukee-based staff in the same integrated health system. Ultimately, COVID-19 seroconversion may be nominal in properly protected resident and fellow physicians despite known potential exposures.

Preliminary Evidence Supporting a Novel 10-Item Clinical Learning Environment Quick Survey (CLEQS).

BACKGROUND: The clinical learning environment (CLE) is a priority focus in medical education. The Accreditation Council for Graduate Medical Education Clinical Learning Environment Review's (CLER) recent addition of teaming and health care systems obligates educators to monitor these areas. Tools to evaluate the CLE would ideally be: (1) appropriate for all health care team members on a specific unit/project; (2) informed by contemporary learning environment frameworks; and (3) feasible/quick to complete. No existing CLE evaluation tool meets these criteria. OBJECTIVE: This report describes the creation and preliminary validity evidence for a Clinical Learning Environment Quick Survey (CLEQS). METHODS: Survey items were identified from the literature and other data sources, sorted into 1 of 4 learning environment domains (personal, social, organizational, material) and reviewed by multiple stakeholders and experts. Leaders from 6 interprofessional graduate medical education quality improvement/patient safety teams distributed this voluntary survey to their clinical team members (November 2019-mid-January 2021) using electronic or paper formats. Validity evidence for this instrument was based on the content, response process, internal structure, reliability, relations to other variables, and consequences. RESULTS: Two hundred one CLEQS responses were obtained, taking 1.5 minutes on average to complete with good reliability (Cronbach's α ≥ 0.83). The Cronbach alpha for each CE domain with the overall item ranged from 0.50 for personal to 0.79 for social. There were strong associations with other measures and clarity about improvement targets. CONCLUSIONS: CLEQS meets the 3 criteria for evaluating CLEs. Reliability data supports its internal consistency, and initial validity evidence is promising.

Implementing an Interprofessional Anti-Racism Training With Community Partners During a Pandemic: Outcomes and Recommended Strategies.

BACKGROUND: Motivated by racial injustice and COVID-19 disparities, health care and medical education are accelerating efforts to address racism and eliminate health disparities. METHODS: In consultation with a community partner, an interprofessional physician-led team prioritized and completed an 8-hour anti-racism training adapted for online delivery during a pandemic. RESULTS: Sixty-four percent of enrollees (25/36) completed the survey, 98% rated the training as valuable, 92% would recommend it to a colleague, 88% reported it would improve their clinical care, and 68% thought their ability to create an inclusive environment increased. DISCUSSION: Virtual anti-racism training is a valuable learning experience. Tools for adapting trainings on high-risk or emotionally charged topics to a virtual format are offered by participants and session leaders.

White Coat Ceremony as a Professional Identity Formation Activity in a United States Family Medicine Residency Program.

INTRODUCTION: White coat ceremonies (WCCs) in medical school mark the transition of students to medicine, beginning their professional identity formation as a physician. However, a literature/web search revealed a paucity of residency-focused WCCs. METHODS: A 90-minute Family Medicine Residency (FM) WCC was designed to support residents' professional identity formation as a specialty physician. Through faculty narratives and brief histories of the white coat and the specialty, the WCC concludes with new residents donning their specialty embroidered white coats. A brief e-survey was sent to attendees, and WCC leaders were debriefed to determine the value and key elements of WCC. RESULTS: Seventy-nine percent of survey respondents (34/43) agreed that the WCC is an important transition event for residents' identity while reaffirming FM values for faculty/staff. WCC leaders identified critical steps for initiating a WCC. CONCLUSION: A resident WCC formally marks the transition to specialty physician identity. LESSONS LEARNED: Ceremony structure will evolve over time.

Hemoptysis: diagnosis and management.

Hemoptysis is the spitting of blood that originated in the lungs or bronchial tubes. The patient's history should help determine the amount of blood and differentiate between hemoptysis, pseudohemoptysis, and hematemesis. A focused physical examination can lead to the diagnosis in most cases. In children, lower respiratory tract infection and foreign body aspiration are common causes. In adults, bronchitis, bronchogenic carcinoma, and pneumonia are the major causes. Chest radiographs often aid in diagnosis and assist in using two complementary diagnostic procedures, fiberoptic bronchoscopy and high-resolution computed tomography, which are useful in difficult cases and when malignancy is suspected. The goals of management are threefold: bleeding cessation, aspiration prevention, and treatment of the underlying cause. Mild hemoptysis often is caused by an infection that can be managed on an outpatient basis with dose monitoring. If hemoptysis persists, consulting with a pulmonologist should be considered. Patients with risk factors for malignancy or recurrent hemoptysis also require further evaluation with fiberoptic bronchoscopy or high-resolution computed tomography. In up to 34 percent of patients, no cause of hemoptysis can be found.