The Impact of a Paracentesis Clinic on Internal Medicine Resident Procedural Competency.

Background: Competency in paracentesis is an important procedural skill for health care practitioners caring for patients with decompensated cirrhosis. It is estimated that 97,577 paracentesis procedures were performed between 2010 and 2012 across 120 academic medical centers and 290 affiliated hospitals. Methods: Due to limitations of resources at the Central Texas Veterans Affairs Hospital, a paracentesis clinic was created to give patients improved access to this procedure which is staffed by a supervising physician and internal medicine residents. We evaluated resident competency via survey and change in the number of paracentesis procedures performed with the utilization of this clinic. Results: Thirty-three residents completed the survey. The total mean number of paracentesis sessions participated in was 4.8. It was found that during training, 79% met conditional independence in performing this procedure with a high level of comfort by rotating through this clinic. It was also found that the number of procedures performed by internal medicine residents significantly increased with the addition of this clinic. Conclusions: A dedicated paracentesis clinic with internal medicine resident involvement can increase resident paracentesis procedural independence, the number of procedures available and performed, and procedural comfort level by the end of training.

COVID-19 online medical education and outcomes on Internal Medicine In-Training Examination scores.

Background: COVID-19 presented a unique opportunity to explore new methods to deliver medical education virtually due to requirements for social distancing. We provided webcams and microphones in each of our core teaching team rooms. We used existing teleconferencing systems with share screen, polling, and audio/video capabilities to continue fostering a group learning environment. Methods: The Internal Medicine In-Training Examination (IM-ITE) was used as a surrogate measurement of the effectiveness of virtual medical education, comparing composite scores from 2015 to 2019 (pre-COVID, in-person conference) to 2020 (post-COVID, virtual conference) for each postgraduate class. Results: No statistically significant differences between the mean or median scores on the IM-ITE were noted for all three classes. Conclusion: Although COVID-19 presented many challenges to residency programs across the United States, our pilot study demonstrated that virtual medical education did not result in lower IM-ITE scores and may be an innovative solution to bridge the education gap during COVID-19.

Selection of abstracts from Baylor Scott & White Health Central Texas Scholars Day.

Baylor Scott & White Health Central Texas displayed the diversity and growth of scholarly pursuits during Scholars Day, which debuted online on May 6, 2022. Residents and fellows, medical students, nurses, and research staff were among those showcasing their scholarly activity in areas such as medical innovation, clinical vignettes, research, and quality improvement. A selection committee chose 34 abstracts-16 select podium, 18 rapid fire. In addition, 66 abstracts were included as electronic poster presentations, an increase of 20 from 2021. Residency and fellowship program directors nominated presentations for the Excellence Awards. The Scholarship Committee chose four to receive travel awards to support the presentation of each project at a national meeting. Excellence Awards were granted to Nada A. Mohamed, MD, Irfan Shehzad, MD, Abirami Subramanian, MPH, MD, and Hadley K. Young, MD. A selection of abstracts is presented here.

An olfactory neuroblastoma presenting as posterior reversible leukoencephalopathy syndrome.

Olfactory neuroblastomas are rare malignancies of the nasal and sinus cavities. They have been associated with paraneoplastic syndromes due to secretion of adrenocorticotropin hormone (ACTH) or antidiuretic hormone. These associated paraneoplastic syndromes can present with a wide variety of symptoms that can make diagnosis of the underlying tumor difficult. Here we present the case of a 23-year-old woman who had a seizure due to the development of posterior reversible leukoencephalopathy syndrome because of secondary hypertension due to Cushing's syndrome, which was in turn found to be due to ectopic ACTH production from a metastatic olfactory neuroblastoma.

Selection of abstracts from Baylor Scott & White Health Central Texas Scholars Day.

Baylor Scott & White Health Central Texas displayed the diversity and growth of scholarly pursuits during Scholars Day, which debuted online on May 7, 2021. Residents and fellows, medical students, nurses, and research staff were among those showcasing their scholarly activity in areas such as medical innovation, clinical vignettes, research, and quality improvement. A selection of Scholar Day abstracts is presented here.

Selection of abstracts from Baylor Scott & White Health Central Texas Scholars Day.

Baylor Scott & White Health Central Texas displayed the diversity and growth of scholarly pursuits during Scholars Day on May 3, 2019. Residents and fellows, medical students, nurses, and research staff were among those showcasing their scholarly activity in areas such as medical innovation, clinical vignettes, research, and quality improvement. A selection committee chose 32 abstracts-12 select podium, 20 rapid fire. In addition, 60 abstracts were included as electronic poster presentations. Residency and fellowship program directors nominated presentations for the Excellence Awards. The scholarship committee chose four to receive travel awards to support the presentation of each project at a national meeting. Excellence Awards were granted to Jasson Abraham, MD, Jerry Fan, MD, Veronica Lozano, MD, and Chhaya Patel, MD. A selection of abstracts is presented here.

Splenic abscess complicating endoscopic retrograde cholangiopancreatography.

We present a case of splenic abscess as a probable complication following endoscopic retrograde cholangiopancreatography (ERCP). Based on a literature review, there have been 11 documented cases of splenic injury following ERCP; however, only one of those involved splenic abscess. Proposed mechanisms of injury and abscess are likely a combination of complicating factors, including manipulation of the endoscope in patients with a history of chronic pancreatitis and/or previous abdominal surgeries.

Factors associated with performance in an internal medicine clerkship.

The purpose of this retrospective study was to examine the relationship between demographic and educational variables and student performance on an internal medicine (IM) clerkship in order to target areas for educational intervention and potential early remediation. This study examined data associated with third-year medical student performance (N = 505) during the IM clerkship at Baylor Scott & White, Temple/Texas A&M Health Science Center College of Medicine from 2005 to 2011. Multiple regression analysis (N = 341) showed that a model containing the following variables was significantly associated with scores on the National Board of Medical Examiners (NBME) subject exam, accounting for 46.5% of the variance: Objective Structured Clinical Exam (OSCE), Medical College Admissions Test (MCAT), US Medical Licensing Exam (USMLE) Step 1, second-year grade point average (GPA), and clinical evaluation. A model containing USMLE Step 1, clinical evaluation, and NBME was significantly associated with OSCE score, accounting for 30% of the variance. Additionally, a model containing age, MCAT score, undergraduate GPA, NBME subject exam score, and OSCE was significantly associated with clinical evaluation score, accounting for 22% of score variance. Age accounted for the most unique variance in clinical evaluation score. Gender and IM interest group were not significantly associated with any outcome variable. In conclusion, in contrast to previous studies in the field, we did not find a significant association between undergraduate GPA and NBME score. Our findings supply further evidence that the OSCE, typically believed to be a clinical performance exam, actually assesses a broader set of domains. Interest group membership did not confer any academic benefit to medical students in IM clerkships in our study.

Rheumatoid meningitis associated with infliximab.

We present a patient who had rheumatoid meningitis while on infliximab, a tumor necrosis factor alpha (TNF-α) inhibitor, which initially presented as transient ischemic attacks. Although our patient had been stable on infliximab for several years, her neurologic symptoms improved when her infliximab was held due to active infection and then recurred after reinitiation of therapy. Rheumatoid meningitis is exceedingly rare; however, there have been several other reports of rheumatoid meningitis developing in patients on TNF-α inhibitor therapy.

Rupture of a left internal mammary artery during cardiopulmonary resuscitation.

We present a rare case of a left internal mammary artery rupture during cardiopulmonary resuscitation (CPR). This case demonstrates that intrinsic cardiac/vascular injuries can occur even with manual CPR, and each patient should be monitored closely, considering the very subtle signs that can clue the physicians into the diagnosis.

Melanoma to the heart.

Malignant melanoma is the third most common skin cancer yet has the highest mortality rate due to its predilection for metastasis. While the diagnosis of antemortem melanoma with cardiac metastasis is relatively uncommon, diagnosing malignant melanoma itself by first identifying a cardiac metastasis is even more rare. This vignette describes an antemortem diagnosis of melanoma in a 50-year-old woman through identification of metastasis to multiple sites, including the tricuspid valve.

Comparison of documentation and evidence-based medicine use for non-ST-segment elevation myocardial infarction among cardiology, teaching, and nonteaching teams.

Non-ST-segment elevation myocardial infarctions (NSTEMI) are common and cause significant morbidity and mortality. Following evidence-based medicine (EBM) guidelines is one way to ensure that these patients are cared for appropriately. This pilot study examined data from patients with NSTEMI to assess both documentation quality and use of EBM across multiple teams. Medical records were reviewed for significant differences in documentation quality in areas including history and physical exam, treatment, and inpatient mortality. While total documentation quality and mortality were not significantly different between groups, cardiology teams adhered to evidence-based recommendations more often than other teams.