Henoch-Schönlein Purpura (IgA Vasculitis): Rapid Evidence Review.

Henoch-Schönlein purpura, now called immunoglobulin A (IgA) vasculitis, is a systemic, immune complex-mediated, small-vessel leukocytoclastic vasculitis characterized by nonthrombocytopenic palpable purpura, arthritis, and abdominal pain. It is the most common vasculitis in children but can also occur in adults. Diagnostic testing is required only to exclude other etiologies of purpura, to identify renal involvement, and, if indicated, to determine its extent with biopsy. Imaging or endoscopy may be needed to assess organ complications. IgA vasculitis spontaneously resolves in 94% of children and 89% of adults, making supportive treatment the primary management strategy. However, a subset of patients experience renal involvement that can persist and relapse years later. Additional complications can include gastrointestinal bleeding, orchitis, and central nervous system involvement. Systematic reviews have shown that steroids do not prevent complications and should not be used prophylactically. However, randomized trials have demonstrated success with high-dose steroids, cyclosporine, and mycophenolate in treating glomerulonephritis and other complications. Long-term prognosis depends on the extent of renal involvement. Six months of follow-up is prudent to assess for disease relapse or remission.

The Associations Between Clerkship Objective Structured Clinical Examination (OSCE) Grades and Subsequent Performance.

Construct: We investigated the extent of the associations between medical students' clinical competency measured by performance in Objective Structured Clinical Examinations (OSCE) during Obstetrics/Gynecology and Family Medicine clerkships and later performance in both undergraduate and graduate medical education. BACKGROUND: There is a relative dearth of studies on the correlations between undergraduate OSCE scores and future exam performance within either undergraduate or graduate medical education and almost none on linking these simulated encounters to eventual patient care. Of the research studies that do correlate clerkship OSCE scores with future performance, these often have a small sample size and/or include only 1 clerkship. APPROACH: Students in USU graduating classes of 2007 through 2011 participated in the study. We investigated correlations between clerkship OSCE grades with United States Medical Licensing Examination Step 2 Clinical Knowledge, Clinical Skills, and Step 3 Exams scores as well as Postgraduate Year 1 program director's evaluation scores on Medical Expertise and Professionalism. We also conducted contingency table analysis to examine the associations between poor performance on clerkship OSCEs with failing Step 3 and receiving poor program director ratings. RESULTS: The correlation coefficients were weak between the clerkship OSCE grades and the outcomes. The strongest correlations existed between the clerkship OSCE grades and the Step 2 CS Integrated Clinical Encounter component score, Step 2 Clinical Skills, and Step 3 scores. Contingency table associations between poor performances on both clerkships OSCEs and poor Postgraduate Year 1 Program Director ratings were significant. CONCLUSIONS: The results of this study provide additional but limited validity evidence for the use of OSCEs during clinical clerkships given their associations with subsequent performance measures.

Cardiac Rehabilitation: Improving Function and Reducing Risk.

Cardiac rehabilitation is a comprehensive multidisciplinary program individually tailored to the needs of patients with cardiovascular disease. The overall goals focus on improving daily function and reducing cardiovascular risk factors. Cardiac rehabilitation includes interventions aimed at lowering blood pressure and improving lipid and diabetes mellitus control, with tobacco cessation, behavioral counseling, and graded physical activity. The physical activity component typically involves 36 sessions over 12 weeks, during which patients participate in supervised exercise under cardiac monitoring. There are also intensive programs that include up to 72 sessions lasting up to 18 weeks, although these programs are not widely available. Additional components of cardiac rehabilitation include counseling on nutrition, screening for and managing depression, and assuring up-to-date immunizations. Cardiac rehabilitation is covered by Medicare and recommended for patients following myocardial infarction, bypass surgery, and stent placement, and for patients with heart failure, stable angina, and several other conditions. Despite proven benefits in mortality rates, depression, functional capacity, and medication adherence, rates of referral for cardiac rehabilitation are suboptimal. Groups less likely to be referred are older adults, women, patients who do not speak English, and persons living in areas where cardiac rehabilitation is not locally available. Additionally, primary care physicians refer patients less often than cardiologists and cardiothoracic surgeons.

Over-the-Counter Medications in Pregnancy.

Many pregnant women take over-the-counter (OTC) medications despite the absence of randomized controlled trials to guide their use during pregnancy. Most data come from case-control and cohort studies. In 1979, the U.S. Food and Drug Administration began reviewing all prescription and OTC medications to develop risk categories for use in pregnancy. Most OTC medications taken during pregnancy are for allergy, respiratory, gastrointestinal, or skin conditions, as well as for general analgesia. Acetaminophen, which is used by about 65% of pregnant women, is generally considered safe during any trimester. Cold medications are also commonly used and are considered safe for short-term use outside of the first trimester. Many gastrointestinal medications are now available OTC. Histamine H2 blockers and proton pump inhibitors have not demonstrated significant fetal effects. Nonsteroidal anti-inflammatory drugs are generally not recommended in pregnancy, especially during organogenesis and in the third trimester. There are even fewer data regarding use of individual herbal supplements. Ginger is considered safe and effective for treating nausea in pregnancy. Topical creams are considered safe based on small studies and previous practice. All OTC medication use should be discussed with patients, and the effects of the symptoms should be balanced with the risks and benefits of each medication. Because of the expanding OTC market, formalized studies are warranted for patients to make a safe and informed decision about OTC medication use during pregnancy.

A Model Curriculum For New Faculty Coaches in Undergraduate Medical Education.

OBJECTIVES: Coaching is an interactive process of performance improvement accomplished by fostering a coachee's ability to critically self-evaluate, create goals, and develop a plan for action. It is being increasingly used in medical education, both at the undergraduate and graduate levels. The American Medical Association (AMA) recommends robust faculty development for any coaching program. Our institution created a mandatory coaching program for students starting in August 2022 with 22 faculty coaches. METHODS: We used Kern's 6-step model for curriculum development to create our institution's faculty development for coaches. This manuscript describes the process of development, implementation, and early program evaluation for the curriculum for faculty coaches for the first 4 months of our mandatory coaching program. The objectives and teaching strategies are outlined. Our program evaluation consisted of immediate and follow-up surveys of faculty attendees. RESULTS: Content in the faculty development program describing the medical student curriculum, assessment, and student resources improved faculty perceived knowledge and confidence. Specific training in coaching skills, including a simulation using standardized students was used and found to be essential. We offer lessons learned from our coaches regarding timing and content for any faculty development curriculum for new coaches. CONCLUSIONS: Considerations for future faculty development curricula for academic coaching programs include timing of the faculty development, content consideration after three coaching sessions, and potential content additions and deletions. The curriculum outlined can be taken and immediately adapted for any school of medicine embarking on a coaching program for students.

The Power of Faculty Development: The Impact on Teaching a Procedural Skill Framework.

BACKGROUND: Teaching outpatient procedures is a skill often overlooked in faculty development. This oversight may lead to faculty employing a haphazard approach. Competency in procedural skills is inherent, and acquiring proficiency in procedural skills is necessary across all medical specialties, with some centers moving toward a blended simulation-based approach rather than the traditional Halstedian "see one, do one, teach one" mantra. While both formats have their pros and cons, they share the unifying concept of performance-based assessments and a standardized method for teaching procedures, which has typically been lacking a formal framework. OBJECTIVE: This study aimed to implement and evaluate the impact of teaching an educational technique in a multidisciplinary faculty education workshop about the Sawyer framework for psychomotor skill acquisition. METHODS:  An interactive 90-minute workshop through the Uniformed Services University Faculty Development Program was developed and presented from February 2021 to October 2023 at multiple military treatment facilities. Participants enrolled in the workshop either by online registration or by walking in on the day of the workshop. A postworkshop survey was collected voluntarily. Through the survey, participants self-evaluated their current teaching strategy and made changes to their future strategy based on the framework they learned during the workshop. This was a mixed methods approach with quantitative survey data that were analyzed using Microsoft Excel (Microsoft Corporation, Redmond, WA) and qualitative data through thematic analysis using a constructivist inductive approach. RESULTS:  There were 52 sessions with a total of 570 participants across 22 unique specialties. The response rate was 50%. Before the workshop, 22% of responding participants had no teaching strategy, and 49% had a partial but not explicit strategy for teaching. After the workshop, 89% of respondents answered that they would either implement a new or modify an existing strategy. Ninety-three percent of respondents reported that the Sawyer method was applicable to their future teaching. The overall themes from participants were that this procedural framework allowed for personal improvement in clear communication, individualized learner-centered teaching, and improved intentionality of teaching procedures. CONCLUSION:  Almost two-thirds of the faculty did not have a formal teaching method before this course, which is consistent with current data. Implementing a standardized framework for teaching procedures through faculty development workshops for multidisciplinary medical faculty educators can improve the educational quality of procedural skills.

A Common Trajectory Toward a Professional Identity as a Faculty Developer.

BACKGROUND AND OBJECTIVES: Professional identity formation is a complex construct that continually evolves in relation to an individual's experiences. The literature on educators identifying as faculty developers is limited and incompletely addresses how that identify affects other identities, careers, and influences on teaching. Twenty-six health professionals were trained to serve as faculty developers within our educational system. We sought to examine the factors that influence the professional identity of these faculty developers and to determine whether a common trajectory existed. METHODS: We employed a constructivist thematic analysis methodology using an inductive approach to understand the experiences of faculty developers. We conducted semistructured recorded interviews. Coding and thematic analysis were completed iteratively. RESULTS: We identified eight primary themes: (1) initial invitation, (2) discovery of faculty development as a professional activity, (3) discovery of educational theory, skills, and need for more education, (4) process of time and experience, (5) fostering relationships and community, (6) transfer of skills to professional and personal roles, (7) experiences that lead to credibility, and (8) sense of greater impact. CONCLUSIONS: An individual's journey to a faculty developer identity is variable, with several shared pivotal experiences that help foster the emergence of this identity. Consideration of specific programmatic elements to support the themes identified might allow for a strategic approach to faculty development efforts in health professions education.

Making allyship visible: evaluation of a faculty development DEI curriculum.

Undergraduate medical learners from historically marginalized groups face significant barriers, which was made concrete at our institution when a student presented her research indicating that Black students felt unsure about which faculty members to approach. To better support our students, we used Kern's model for curriculum development and a critical pedagogy approach to create a Faculty Allyship Curriculum (FAC). A total of 790 individuals attended 90 workshops across 16 months and 20 individuals have completed the FAC. A majority of participants reported they felt at least moderately confident in their ability to teach learners who are underrepresented in medicine, mentor learners who are different than they are, and teach allyship topics. An informal content analysis of open-ended responses indicated changes in awareness, attitude, insight, and use of language and being more likely to display advocacy. For others considering creating a similar program, partnering with an existing program allows for rapid implementation and reach to a wide audience. We also recommend: beginning with a coalition of willing learners to quickly build community and culture change; ensuring that the curriculum supports ongoing personal commitment and change for the learners; and supporting facilitators in modeling imperfection and upstanding, 'calling in' rather than 'calling out' learners.

Well-being at a Military Medical School and Implications for Military Retention.

INTRODUCTION: Physical and psychological well-being play a critical role in the academic and professional development of medical students and can alter the trajectory of a student's quality of personal and professional life. Military medical students, given their dual role as officer and student, experience unique stressors and issues that may play a role in their future intentions to continue military service, as well as practice medicine. As such, this study explores well-being across the 4 years of medical school at Uniformed Services University (USU) and how well-being relates to a student's likelihood to continue serving in the military and practicing medicine. METHODS: In September 2019, 678 USU medical students were invited to complete a survey consisting of three sections-the Medical Student Well-being Index (MSWBI), a single-item burnout measure, and six questions regarding their likelihood of staying in the military and medical practice. Survey responses were analyzed using descriptive statistics, analysis of variance (ANOVA), and contingency table analysis. Additionally, thematic analysis was conducted on open-ended responses included as part of the likelihood questions. RESULTS: Our MSWBI and burnout scores suggest that the overall state of well-being among medical students at USU is comparable to other studies of the medical student population. ANOVA revealed class differences among the four cohorts, highlighted by improved well-being scores as students transitioned from clerkships to their fourth-year curriculum. Fewer clinical students (MS3s and MS4s), compared to pre-clerkship students, indicated a desire to stay in the military. In contrast, a higher percentage of clinical students seemed to "reconsider" their medical career choice compared to their pre-clerkship student counterparts. "Medicine-oriented" likelihood questions were associated with four unique MSWBI items, whereas "military-oriented" likelihood questions were associated with one unique MSWBI item. CONCLUSION: The present study found that the overall state of well-being in USU medical students is satisfactory, but opportunities for improvement exist. Medical student well-being seemed to have a stronger association with medicine-oriented likelihood items than with military-oriented likelihood items. To obtain and refine best practices for strengthening engagement and commitment, future research should examine if and how military and medical contexts converge and diverge throughout training. This may enhance the medical school and training experience and, ultimately, reinforce, or strengthen, the desire and commitment to practice and serve in military medicine.

The association between specialty match and third-year clerkship performance.

PURPOSE: The United States is experiencing an accelerating physician shortage, especially within primary care. Medical educators are actively seeking ways to predict student specialty match and workforce requirements. Previous studies investigating specialty match have focused on factors known at the time of matriculation. This study examined whether third-year clerkship performance could be used to predict specialty match later in medical school. METHOD: The authors evaluated the clerkship performance of 802 students graduating from the Uniformed Services University between 2007 and 2011. They examined the relationship of students' clerkship grades and National Board of Medical Examiners' clinical subject examination scores to specialty match. In addition, the authors combined student performance in family medicine, internal medicine, and pediatrics to create composite variables and assessed their associations with the match. RESULTS: Among 802 students, 339 (42.4%) students matched to primary care specialties. There was a positive association between higher family medicine (Odds ratio [OR] 1.65, 95% confidence interval [CI] 1.05, 2.59), general surgery (OR 1.91, 95% CI 1.22, 2.99), internal medicine (OR 2.17, 95% CI 1.35, 3.49), and pediatrics (OR 2.59, 95% CI 1.52, 4.43) clerkship grades and students matching into family medicine, general surgery, internal medicine, and pediatrics, respectively. Only family medicine showed a weak correlation between higher National Board of Medical Examiners' scores and specialty match. CONCLUSIONS: Higher clerkship performance in four of six Uniformed Services University third-year clerkships is associated with matching into the corresponding specialty. Clerkship performance provides a potential tool for educators in counseling students and predicting future specialty match.

COVID-19 vaccine insights: The news beyond the headlines.

Here is key intelligence on the recommended primary series, boosters, breakthrough infection, adverse events, special population vaccination, vaccine myths, and what the future might hold.

Meeting the needs of clinician-educators: An innovative faculty development community of practice.

BACKGROUND: Requirements for faculty development for clinician-educators continue to increase. The number of faculty with experience delivering faculty development, however, remains limited. To overcome our deficit of faculty developers, we created a train-the-trainer programme. We recognised, however, that our plan would not meet the ultimate goal for our programme: Creating faculty developers to meet the faculty development needs of a large, dispersed system. We report on the creation and nurturing of faculty development community of practice (CoP), which we believe could be a solution for many academic systems struggling to engage busy clinicians, mature the teaching abilities of clinician educators, and meet the needs of their accrediting institutions. APPROACH: We developed a faculty development CoP with a mission of promoting educational expertise and excellence and ensuring continuous growth of the members of our COP and broader faculty. EVALUATION: A programme evaluation was performed consisting of two elements: The impact on the organisation (workshop and learner related metrics) and the impact on the CoP members (survey). We observed notable outcomes: Delivery of high quality workshops to faculty, attainment of leadership positions, and increases in motivation, networking, skills, confidence, and opportunities available to members. IMPLICATIONS: Innovations to create and sustain structured faculty development programmes for clinician-educators are needed. The development and nurturing of a CoP of faculty developers resulted in benefits both for the organisation and CoP members and may be a solution for large academic systems struggling to meet their faculty development demands.

A practical guide to appendicitis evaluation and treatment.

Which clinical findings most reliably point to appendicitis? How do the 3 primary clinical scoring systems compare? When is it time to order imaging studies?

Melanoma: An FP's guide to diagnosis and management.

This review details the latest recommendations on dermoscopy and excision techniques, indications for sentinel lymph node biopsy, and Tx options.

A Faculty Development Model for Academic Leadership Education Across A Health Care Organization.

Academic leadership in undergraduate and graduate medical education requires a specific set of leadership and managerial skills that are unique to academic leadership positions. While leadership development training programs exist for traditional leadership roles such as department chairs, executives, and deans, there are fewer models of leadership training specifically geared for academic leadership positions such as program and clerkship directors, and designated institutional officials. There are academic programs at the national level, but there is sparse literature on the specific decisions required to create such programs locally. With growing regulatory and accreditation requirements as well as the challenges of balancing the clinical and educational missions, effective leadership is needed across the spectrum of academic medicine. To meet this need for the military health care system in the United States, we used Kern's six-step framework for curriculum development to create a 1-week academic leadership course. This paper describes the process of development, implementation, outcomes, and lessons learned following the initial 3 years of courses. Specific discussions regarding who to train, which faculty to use, content, and other elements of course design are reviewed. The course and process outlined in the paper offer a model for other organizations desiring to establish an academic leadership course.

The Ripple Effect: A Train-the-Trainer Model to Exponentially Increase Organizational Faculty Development.

This article was migrated. The article was marked as recommended. INTRODUCTION: Faculty development is a key component of undergraduate and graduate medical education and is required for accreditation. Many institutions face the challenges of training large numbers of faculty at multiple locations on a recurring basis. In order to meet the faculty development demands of our organization, we implemented a train-the trainer model of faculty development. METHODS: A train-the-trainer program was created using deliberate practice as the theoretical framework. The primary goals of the program were to enhance content knowledge and develop facilitation skills of the participants (called faculty trainers). Two separate cohorts received 40 hours of in-person training consisting of attending the faculty development workshops as a learner, providing feedback to course faculty, facilitating and participating in journal club sessions on relevant content, and practicing facilitation and receiving feedback on the workshops. Cohorts 1 and 2 were trained on how to deliver 6 and 7 workshops, respectively. An additional 16 hours of training and further feedback occurred when faculty trainers delivered the workshops at outside institutions. RESULTS: Twenty-nine faculty trainers from 15 specialties and subspecialties were trained, including 18 in the first cohort (January 2018) and 14 in the second cohort (February 2019) with 3 who participated in both cohorts. From January 2018 to January 2020, faculty trainers delivered 298 workshops to 3742 attendees at 25 locations. For the faculty trainers, 1477 evaluations were completed with 1031 (88.1%) rated as excellent, 141 (9.5%) rated as good, and 8 (0.5%) as average. There were no fair or poor ratings. DISCUSSION: Our train-the-trainer program effectively developed a community of national faculty developers. Faculty trainer output was substantial and early evaluations of performance were positive. The model outlined in this paper serves as a potential sustainable model for other institutions desiring to train a cadre of faculty developers for their organization.

Early identification of struggling learners: using prematriculation and early academic performance data.

INTRODUCTION: A perennial difficultly for remediation programmes in medical school is early identification of struggling learners so that resources and assistance can be applied as quickly as is practical. Our study investigated if early academic performance has predictive validity above and beyond pre-matriculation variables. METHODS: Using three cohorts of medical students, we used logistic regression modelling and negative binomial regression modelling to assess the strength of the relationships between measures of early academic performance and outcomes-later referral to the academic review and performance committee and total module score. RESULTS: We found performance on National Board of Medical Examiners (NBME) exams at approximately 5 months into the pre-clerkship curriculum was predictive of any referral as well as the total number of referrals to an academic review and performance committee during medical school (MS)1, MS2, MS3 and/or MS4 years. DISCUSSION: NBME exams early in the curriculum may be an additional tool for early identification of struggling learners.

Teaching Clinical Precepting: A Faculty Development Workshop Using Role-Play.

Introduction: Precepting is when a medical educator listens to a learner's presentation and must teach and assess the learner while rendering safe patient care. A popular framework for this type of educational encounter is the one-minute preceptor model, which can work for learners at all skill levels. This workshop was created to develop skills of all teaching faculty, regardless of medical specialty, in precepting. Methods: The workshop is based on Kolb's experiential learning theory. A PowerPoint presentation delivers the core abstract concepts. The PowerPoint allows for discussion of participants' prior precepting experiences, including both challenges and successes. The workshop ends with role-plays for participants to practice their skills and a facilitated debrief to aid individual reflection. Twelve role-plays were created for use in the workshop; these were then reviewed by someone in the matching specialty to enhance authenticity. Participants completed a survey after the workshop to evaluate the session. Results: This presentation was delivered 26 times to 392 participants at 16 different teaching hospitals. Twenty-one different medical specialties and subspecialties were represented. Ninety-seven percent of participants stated they would use the information presented in the workshop often or daily. There were conflicting comments about the role-plays. The negative comments centered around (a) personal difficulty participating in the role-plays and (b) the role-plays not being related to the learning. Discussion: Discussion and role-play can be an effective way to instruct educators in use of the one-minute preceptor as a framework for teaching.

Lessons of Leading Organizational Change in Quality and Process Improvement Training.

Physicians operate in complex health care systems where leading change is an important competency, often practically implemented in process and quality improvements. This case describes a deployed junior officer leading change through a process improvement. It aligns the plan, do, study, act model with Kotter's model of leading organizational change.