Simulation vs RISE UP: A Comparative Study of Approaches for Teaching Emergency Medicine Trainees How to Manage Microaggressions.

PURPOSE: Microaggressions are discriminatory actions or words targeted at people for their perceived or expressed identities. The study aimed to address the critical need for training emergency medicine (EM) resident-physicians to manage microaggressions. The authors compared the effectiveness of the Realizing Inclusion and Systemic Equity in Medicine: Upstanding in the Medical Workplace (RISE UP) curriculum from Inova Children's Hospital and a simulation (SIM) curriculum created by a research team specifically for this study. The new SIM curriculum was guided by the original RISE UP curriculum but incorporates simulation as a learning tool. These 2 educational modalities were selected based upon previous literature showing their efficacy as tools in medical education. METHOD: Through a collaboration with residency leadership, EM residents were recruited to participate in a comparison study in which they received either the RISE UP or newly created SIM curriculum as part of their regular simulation training. Pre- and post-intervention surveys assessed perceived knowledge on handling microaggressions. A follow-up survey was sent one month post-intervention to evaluate retention of self-reported knowledge. RESULTS: Out of 81 eligible residents, 69 residents participated: 37 in the new SIM curriculum group, 32 in the RISE UP curriculum group. Participants in both groups self-reported significant improvements in perceived knowledge immediately post-intervention. At the 1-month follow up, both intervention groups retained higher levels of perceived knowledge. Additionally, while both curricula were effective, the RISE UP group showed slightly higher retention rates of self-reported knowledge compared to the SIM group, although this difference was not statistically significant. CONCLUSIONS: Both the SIM and RISE UP curricula were effective in improving resident knowledge about handling workplace microaggressions, with participants in the RISE UP curriculum showing marginally better retention of skills. Implementing such educational programs may enhance workplace awareness and response to microaggressions among EM residents.

Acute Toxin-mediated Rhabdomyolysis During Treatment With Trimethoprim-sulfamethoxazole.

Rhabdomyolysis is a condition in which skeletal muscle breakdown causes the release of intracellular components into the bloodstream - defined as elevations in serum creatine kinase levels. The etiology of rhabdomyolysis is varied and may be the result of toxin-mediated mechanisms or metabolic derangements, or they may develop secondary to other conditions such as seizures, trauma and prolonged immobilization. In this case, we present a patient with suspected acute toxin-mediated rhabdomyolysis in the setting of trimethoprim-sulfamethoxazole (TMP-SMX) therapy for urinary tract infection. To our knowledge, this marks the fifth case report of an otherwise healthy patient diagnosed with rhabdomyolysis thought to be secondary to TMP-SMX.

High cell density attenuates reactive oxygen species: implications for in vitro assays.

In vitro cell-based assays are an essential and universally used step in elucidation of biological processes as well as in drug development. However, results obtained depend on the validity of protocols used. This statement certainly pertains to in vitro assays of oxidative stress. The holy grail of in vitro models is reliability and predictability of outcomes that relate to a single variable like addition of hydrogen peroxide or xanthine oxidase. Without such validated outcomes, comparison of results among different laboratories is not possible. Achieving this goal requires a thorough understanding of the complex interplay between the cells, their environment, and the experimental assays. Furthermore, as this knowledge is attained, it must be disseminated and used to update and standardize existing protocols. Here, we confirm and extend the effect of pyruvate and cell density on in vitro oxidative stress assays. Cell viability was assessed using a colorimetric assay measuring the reduction of a tetrazolium salt (XTT) into a colored formazan dye. Extracellular hydrogen peroxide concentrations were measured using the foxp3 assay. We confirmed a previously reported finding that pyruvate, a common ingredient in cell culture media, acts as an extracellular scavenger of reactive oxygen species. We also demonstrated that cell density directly correlates with resistance to oxidative stress in tissue culture. It is theorized that the protective effect due to cell density predominantly relates to intracellular factors such as reduced glutathione and extracellular factors such as catalase.