Using contact-based education to destigmatize opioid use disorder among medical students.

CONTEXT: All first- and second-year (i.e., pre-clinical) medical students at a large, Midwestern medical school with three campuses were invited to participate in a two-arm, parallel educational study comparing the efficacy of two types of curricular interventions. Students at the main campus attended the modified contact-based education panel or the didactic lecture in person, while students at the two distance campuses attended the modified contact-based education or lecture remotely using the University's videoconferencing system. Impact: A total of 109 students participated in the study (average age 24.2 years (SD = 2.6), 64.2% female, 79.8% white, 56.0% second-year students, 67.9% attended on main campus, lecture = 52 participants, modified contact-based = 57 participants). Baseline responses were similar across groups. Following the session, participants in both interventions rated drug abuse (percent increase = 21.2%, p < .001) and prescription drug diversion (percent increase = 7.6%, p = .004) as more serious problems. Participants from both interventions expressed increased confidence in caring for patients with OUD (percent increase = 45.5%, p < .001) and increased interest in pursuing MAT training (percent increase = 21.5%, p = .04). Both curricular interventions were equally effective at reducing OUD stigma with a significant 8.2% decrease in total stigma scores and a large effect size (p < .001, ηp2 = .34). Lastly, participants with lower post-assessment OUD stigma scores were more likely to indicate that they would pursue additional training to provide MAT (p = .02). Lessons learned: Exposure to opioid-specific education with a focus on MAT and recovery, regardless of education type, positively affected opioid-related postgraduate intentions and reduced OUD stigma. Notably, these findings suggest that there are multiple efficacious techniques to reduce OUD stigma during preclinical training.

A survey study of occupational pain and injury in ophthalmic plastic surgeons.

PURPOSE: To determine factors associated with pain/injury related to practicing ophthalmic plastic and reconstructive surgery. METHODS: A 29-question electronic survey was sent to the American Society of Ophthalmic Plastic and Reconstructive Surgery's listserv. The Chi-Squared Automatic Interaction Detector technique was used to generate a decision tree using SPSS software. The levels of dendograms were limited to 8. Significance was pre-established at α = 0.05. RESULTS: One hundred thirty surveys were completed, and 72.5% reported pain associated with operating, 80.9% reported use of loupe magnification, 68.7% reported use of a headlight, 42.5% reported modification of their operating room practice, and 9.2% reported stopping operating due to pain or spine injury. Most respondents regularly exercise, with 55.7% characterizing the amount of exercise as less than necessary; 60.8% and 57.3% agreed that loupe use and headlamp use, respectively, can lead to spine problems.Chi-Squared Automatic Interaction Detector analysis found that 62.7% (n = 47) with neck pain had modified their operating room practice, compared with 13.5% (n = 7) without pain (χ = 30.42; df = 1; p < 0.001); All surgeons that had to stop operating (n = 9) had tried modifying their operating room practice; over half (57.6%, n = 38) of practicing surgeons had changed their operating room practice (χ = 6.09; df = 1; p = 0.014). The majority who exercised 5 hours or less had modified their operating room practice (70.2%, n = 33), compared with 26.3% (n = 5) who exercised more. CONCLUSIONS: Many oculoplastic surgeons experience discomfort due to operating, and an alarming minority have stopped operating due to pain or neck injury. Participants identified loupe and headlamp use as a special concern.

A "U-shaped" Curve: Appreciating How Primary Care Residency Intention Relates to the Cost of Board Preparation and Examination.

INTRODUCTION: The shortage of primary care physicians in the United States has warranted an investigation into how medical education debt and other factors influence medical students' interests in primary care (PC) residencies. However, sparse research has studied how the cost of board preparation and examination relates to career choice. The objective of this study was to determine if there is an association between the cost of preparing and sitting for board examinations and the intention to enter a PC residency for osteopathic medical students. METHODS: We postulated that students who incurred higher financial costs from preparing and sitting for board examinations would be more likely to be interested in non-primary care (NPC) residencies. Using a non-experimental survey design, this study asked respondents to evaluate the following: "I plan to enter a Primary Care Residency (Family Medicine OR General Internal Medicine OR Pediatrics)" using a Likert scale. Respondents were also asked to select which board examination(s) and pertinent resource(s) they had purchased. Total costs were calculated per student. RESULTS: A total of 25,852 osteopathic medical students received the survey, of which 1,280 students responded to and completed it, yielding a 4.95% response rate. The distribution of respondents' intentions to pursue a primary care residency and costs spent yielded a "U" shaped curve. Respondents who Strongly Agreed and Strongly Disagreed to the statement "I plan to enter a Primary Care Residency" spent $5,744 and $5,070 on board-preparation and examination, respectively. No statistically significant differences were found between the cost of preparing and sitting for board examinations and the intention to enter primary care residencies when individuals were grouped by year in school and gender. CONCLUSIONS: Because competitive NPC specialties have relatively higher salaries, we suspected that students who intended to pursue these specialties would have had higher financial costs from board examination and preparation compared to students who intended to pursue PC residencies such as family medicine. Our findings further illustrate these specific educational costs do not correlate with students' stated intentions to enter primary care residencies. As efforts continue to determine a solution for the primary care physician shortage, it becomes clearer that the focus must also encompass non-financial influences that shape career choice.

The Cost of Board Examination and Preparation: An Overlooked Factor in Medical Student Debt.

Objective Board examinations in undergraduate medical education are imperative for competency assessment and a standard licensure process. While the cost of attendance and mean indebtedness of medical students have been quantified, the financial burden experienced by medical students from board preparation and examination has never been quantified. Materials and methods A total of 290 fourth-year osteopathic medical students from 38 osteopathic medical schools completed an anonymous survey that asked them to select the resources they had purchased for board preparation. Along with demographic information, respondents were asked which board examinations they had taken during their medical school education. The price for each resource was located by going to the resource website and finding the "list price" of a brand-new copy/version of that resource. If a price was not found, a current Amazon.com "list price" was utilized. These prices best approximate the maximum a student would spend per resource. Response and statistical analysis such as analysis of variance, post hoc comparison (Scheffé and Bonferronis test), and chi-square tests were conducted using the Statistical Package for Social Sciences (SPSS) Statistics, version 25.0 (IBM SPSS Statistics, Armonk, NY). Results This study found that osteopathic medical students spent, on average, $7,499 (s.d.=$2,506) for board preparation and examination. This cost when isolated is $3,370 for the cost of taking board examinations and $4,129 for the cost of board preparation. Respondents from the West were found to spend most at $9,432, while students from the Northeast spent the least, $7.090. Additionally, non-traditional medical students, those who matriculated after the age of 30 were found to spend more than individuals who began when they were under the age of 25 or between the ages of 25-30. The two most commonly used resources for both Level 1/Step 1 and Level 2/Step 2 examinations were COMBANK and UWorld.  Conclusions/relevance This study is the first of its kind to quantify the mean cost of board preparation and examination in undergraduate medical education at $7,499. When considering the mean indebtedness of the osteopathic graduating class of 2017-2018, 2.94% of medical education debt can be attributed to the cost of board preparation and assessments. As competitiveness for graduate medical education increases, individuals will spend more money to ensure a competitive board exam performance, a key selection factor. Stakeholders in undergraduate medical education are encouraged to further understand the interplay between medical student debt and the cost of board examinations and preparation.

Influence of Future Prescribers' Personal and Clinical Experiences With Opioids on Plans to Treat Patients With Opioid Use Disorder.

CONTEXT: Recreational use of opioids is a growing problem in the United States, particularly in the Midwest. Educators have called for inclusion of pain- and opioid-specific courses in health professional school curricula, yet more research is needed to address future prescribers' beliefs, experiences, and postgraduate plans related to opioids. OBJECTIVE: To examine health professional students' perceived severity of the opioid crisis and opioid-related beliefs, experiences, and postgraduate plans. METHODS: Using a descriptive, cross-sectional design, researchers evaluated health professional students from 3 academic programs (nurse practitioner [NP], physician assistant [PA], and doctor of osteopathic medicine [DO]) using a 25-item survey that assessed perceived opioid crisis severity and opioid-related beliefs, experiences, and postgraduate plans. Demographics of respondents were assessed using descriptive statistics and frequencies. Responses were compared between academic programs with 1-way analysis of variance or Kruskal-Wallis tests, and relationships between students' experiences and postgraduate plans were assessed. RESULTS: A total of 491 students (mean [SD] age, 27.2 [5.4] years; 62.7% female; 68.2% DO students) participated in the survey (response rate, 40.4%). The opioid crisis was perceived to be severely impacting the health care system (mean [SD] score, 79.7 [16.8] out of 100), and most respondents (415 [84.5%]) reported that opioid use affected their communities. Clinical experience varied by program, with NP students (75 [81.5%]) reporting the most experience treating acute overdose. Most respondents (317 [64.6%]) agreed that their postgraduate practice would involve caring for patients addicted to opioids; however, only 232 students (47.3%) felt confident in their ability to treat patients with addiction. Experiences managing acute overdose and handling drug-seeking behavior were positively associated with a belief that postgraduate work would involve working with patients with addiction (U=38,275.5, Z=5.92, P<.001; U=25,346.0, Z=4.94, P<.001) and confidence in treating patients with opioid addictions (U=36,806.5, Z=4.96, P<.001; U=23,765.5, Z=3.66, P<.001). CONCLUSION: Although health professional students had similar beliefs and perceptions regarding the opioid crisis, there were notable differences between academic programs. Students with clinical opioid experiences were more likely to plan on working with patients addicted to opioids and be confident in treating these patients. Thus, the inclusion of experiential learning in the medical curricula may be beneficial for both students and their future patients.

Measuring Medicaid Expansion's Impact on an Academic Medical Center's Emergency Department.

Medicaid expansion's impact has been studied on national and statewide levels with respect to the patient outcomes, access to health services and uncompensated care. The objective of this study was to examine the effect of the Medicaid expansion on an emergency department (ED) at a large, academic center by evaluating changes in total charges, services rendered, types of providers, number of visits, and length of stay. Findings from this study include more males frequenting the ED for health services and a bottleneck in operations with an average waiting time in the ED increasing by 17%. Additionally, Medicaid recipients required non-emergent services that could be delivered by primary care providers, albeit at the ED, with average total charges for Emergency Medicine services seeing a statistically significant reduction with increases in average total charges for Family Medicine. While Medicaid expansion provided more individuals with coverage, a large academic medical center adapted in concordance.

Exploring the Associations Among Nutrition, Science, and Mathematics Knowledge for an Integrative, Food-Based Curriculum.

BACKGROUND: Explore associations between nutrition, science, and mathematics knowledge to provide evidence that integrating food/nutrition education in the fourth-grade curriculum may support gains in academic knowledge. METHODS: Secondary analysis of a quasi-experimental study. Sample included 438 students in 34 fourth-grade classrooms across North Carolina and Ohio; mean age 10 years old; gender (I = 53.2% female; C = 51.6% female). Dependent variable = post-test-nutrition knowledge; independent variables = baseline-nutrition knowledge, and post-test science and mathematics knowledge. Analyses included descriptive statistics and multiple linear regression. RESULTS: The hypothesized model predicted post-nutrition knowledge (F(437) = 149.4, p < .001; Adjusted R = .51). All independent variables were significant predictors with positive association. CONCLUSIONS: Science and mathematics knowledge were predictive of nutrition knowledge indicating use of an integrative science and mathematics curriculum to improve academic knowledge may also simultaneously improve nutrition knowledge among fourth-grade students. Teachers can benefit from integration by meeting multiple academic standards, efficiently using limited classroom time, and increasing nutrition education provided in the classroom.

Applying mathematical concepts with hands-on, food-based science curriculum.

This article addresses the current state of the mathematics education system in the United States and provides a possible solution to the contributing issues. As a result of lower performance in primary mathematics, American students are not acquiring the necessary quantitative literacy skills to become successful adults. This study analyzed the impact of the FoodMASTER Intermediate curriculum on fourth-grade student's mathematics knowledge. The curriculum is a part of the FoodMASTER Initiative, which is a compilation of programs utilizing food, a familiar and necessary part of everyday life, as a tool to teach mathematics and science. Students exposed to the curriculum completed a 20-item researcher-developed mathematics knowledge exam (Intervention n=288; Control n=194). Overall, the results showed a significant increase in mathematics knowledge from pre- to post-test. These findings suggest that students engaged in food-based science activities provided them with the context in which to apply mathematical concepts to an everyday experience. Therefore, the FoodMASTER approach was successful at improving students' mathematics knowledge while building a foundation for becoming quantitatively literate adults.

Food-based Science Curriculum Increases 4th Graders Multidisciplinary Science Knowledge.

Health professionals and policymakers are asking educators to place more emphasis on food and nutrition education. Integrating these topics into science curricula using hand-on, food-based activities may strengthen students' understanding of science concepts. The Food, Math, and Science Teaching Enhancement Resource (FoodMASTER) Initiative is a compilation of programs aimed at using food as a tool to teach mathematics and science. Previous studies have shown that students experiencing the FoodMASTER curriculum were very excited about the activities, became increasingly interested in the subject matter of food, and were able to conduct scientific observations. The purpose of this study was to: 1) assess 4th graders food-related multidisciplinary science knowledge, and 2) compare gains in food-related science knowledge after implementation of an integrated, food-based curriculum. During the 2009-2010 school year, FoodMASTER researchers implemented a hands-on, food-based intermediate curriculum in eighteen 4th grade classrooms in Ohio (n=9) and North Carolina (n=9). Sixteen classrooms in Ohio (n=8) and North Carolina (n=8), following their standard science curricula, served as comparison classrooms. Students completed a researcher-developed science knowledge exam, consisting of 13 multiple-choice questions administered pre- and post-test. Only subjects with pre- and post-test scores were entered into the sample (Intervention n=343; Control n=237). No significant differences were observed between groups at pre-test. At post-test, the intervention group scored (9.95±2.00) significantly higher (p=.000) than the control group (8.84±2.37) on a 13-point scale. These findings suggest the FoodMASTER intermediate curriculum is more effective than a standard science curriculum in increasing students' multidisciplinary science knowledge related to food.

Causal factors implicated in research misconduct: evidence from ORI case files.

There has been relatively little empirical research into the causes of research misconduct. To begin to address this void, the authors collected data from closed case files of the Office of Research Integrity (ORI). These data were in the form of statements extracted from ORI file documents including transcripts, investigative reports, witness statements, and correspondence. Researchers assigned these statements to 44 different concepts. These concepts were then analyzed using multidimensional scaling and cluster analysis. The authors chose a solution consisting of seven clusters: (1) personal and professional stressors, (2) organizational climate, (3) job insecurities, (4) rationalizations A, (5) personal inhibitions, (6) rationalizations B and, (7) personality factors. The authors discuss the implications of their findings for policy and for future research.

Absolute band counts in febrile infants: know your laboratory.

It was the impression of 1 of the authors that band counts in febrile infants < or =60 days of age were much higher as reported from the clinical laboratory at Children's Hospital Medical Center of Akron, Ohio, than they had been at Strong Memorial Hospital in Rochester, New York. Absolute band counts (ABC) from 119 febrile infants < or =60 days of age seen in the emergency department of Children's Hospital Medical Center of Akron for whom blood culture results were known were obtained retrospectively and compared with results from a prospective study conducted in Rochester. In Akron, 45% of the infants had elevated band counts and 16% had no other risk factor for serious bacterial infection compared with 5.9% and 1.4%, respectively, in Rochester. The ABC can vary widely from laboratory to laboratory. The clinician must use caution when using the ABC as a criterion for identifying infants at low risk for serious bacterial infection.