Develop Your CORE2 for Career Flourishing: A Career Development Workshop for Hospitalists.

Introduction: Appreciative inquiry harnesses an individual's strengths to realize positive change, and a flourishing-focused mindset emphasizes engagement, social connectivity, and seeking meaningful work. Though the impact of these models on physician well-being and career planning has been evaluated in graduate medical education, their integration into career development initiatives for faculty has been limited. We designed a workshop to nurture hospitalist career development, based on our CORE2 conceptual framework (character strengths, overall vision, role assessment, explicit goals, and evaluation). Methods: We presented the workshop at the 2022 and 2023 Society of Hospital Medicine (SHM) annual conferences. This 1.5-hour workshop comprised four modules and three small-group activities designed to help participants identify their signature character strengths, draft a professional vision statement, prioritize professional roles, and develop SMART goals aligned with these roles. Results: At the 2023 SHM annual conference, 36 participants attended the workshop, and 32 (89%) completed pre- and postworkshop surveys. After workshop completion, participants' self-assessed familiarity with their signature character strengths, knowledge of evidence-based principles to develop SMART goals, and confidence in their ability to write a vision statement and SMART goals all increased significantly (p < .05). Discussion: This workshop provides a valuable framework for self-directed longitudinal career development and reflection. We build on prior curricula on educator identity formation by guiding participants from identity definition to professional vision development to professional role evaluation to aligned goal creation and iterative evaluation. Our workshop's principles are readily generalizable to clinician-educators across medical disciplines.

Missing Voices: What Early Career Hospitalists View as Essential in Hospital Medicine-Focused Education.

OBJECTIVES: Acknowledging that a successful career in hospital medicine (HM) requires specialized skills, residency programs have developed hospital medicine-focused education (HMFE) programs. Surveys of Internal Medicine residency leaders have described HMFE curricula but are limited to that specialty and lack perspectives from early career hospitalists (ECHs) who recently completed this training. As such, we surveyed multispecialty ECHs to evaluate their preferences for HMFE and to identify gaps in standard residency training and career development that HMFE can bridge. The objectives of our study were to describe multispecialty ECH needs and preferences for HMFE and to identify gaps in standard residency training and career development that HMFE can bridge. METHODS: From February to March 2021, ECHs (defined as hospitalists within 0-5 years from residency) were surveyed using the Society of Hospital Medicine's listserv. Respondents identified as having participated in HMFE or not during residency (defining them as HMFE participants or non-HMFE participants). RESULTS: From 257 respondents, 84 (33%) ECHs met inclusion criteria. Half (n = 42) were HMFE participants. ECHs ranked clinical hospitalist career preparation (86%) and mentorship from HM faculty (85%) as the most important gaps in standard residency training and career development that HMFE can bridge. Other key components of HMFE included exposure to quality improvement, patient safety, and high-value care (67%); provision of autonomy through independent rounding (54%); and preparation for the job application process (70%). CONCLUSIONS: Multispecialty ECHs describe HMFE as positively influencing their decision to pursue a hospitalist career and increasing their preparedness for practice. HMFE may be particularly well suited to foster advanced clinical skills such as independent rounding, critical thinking, and self-reflection. We propose an organizing framework for HMFE in residency that may assist in the implementation and innovation of HMFE programs nationwide and in the development of standardized HMFE competencies.

Breathing, Obstruction, Restriction, and Gas Exchange: A Pulmonary Function Testing Interpretation Framework for Novice Learners.

Pulmonary function testing (PFT) is a common method of assessing patients with respiratory symptoms, yet exposure to PFT is variable throughout medical training. Therefore, incorporating a dedicated approach to teaching PFT into the formal medical education curriculum can ensure that trainees become familiar with both the relevant physiologic principles involved in interpreting PFT results and the indications for performing PFT in clinical practice. In this "How I Teach" article, we present breathing, obstruction, restriction, and gas exchange (BORG), a novel, small-group workshop designed to teach novice learners a sequential framework for PFT interpretation. The BORG workshop comprises two segments: a whiteboard minilecture that illustrates the BORG framework and a case-based worksheet whereby learners apply this approach to sets of PFTs with increasing difficulty. Our workshop is grounded in two cognitive psychology frameworks: the cognitive theory of multimedia learning and the dual-process theory. We provide three figures and four supplementary videos to illustrate our workshop's design and delivery, as well as both learner and instructor versions of our BORG worksheet. Last, we address three PFT concepts that have challenged us as instructors and provide evidence-based teaching scripts. The BORG workshop can be used by medical educators working with medical students and residents as a means of helping learners progress along the continuum from a basic understanding of spirometry to independent analysis and interpretation of PFTs to application of PFT results to medical decision making.

Wegener's Granulomatosis Presenting as a Parapharyngeal Mass.

BACKGROUND: Wegener's Granulomatosis (WG) is classically characterized by the triad of sinonasal, pulmonary, and renal manifestations. However, a growing body of research has demonstrated that atypical head and neck pathologies including retropharyngeal and parapharyngeal lesions are often the presenting feature of patients found to have WG. CASE: This report describes the hospital course of a patient who presented with a parapharyngeal mass with secondary superior cervical chain compression and Lemierre's Syndrome. We discuss how a stepwise approach involving a multidisciplinary team led to the diagnosis of WG. CONCLUSIONS: To our knowledge, this report is the first description of a patient presenting with a parapharyngeal mass causing superior cervical chain compression with simultaneous Lemierre's Syndrome who was ultimately diagnosed with WG. We highlight how the early consideration of WG in patients with atypical head and neck lesions refractory to multiple treatment regimens can led to an expeditious diagnosis and the coordination of appropriate short-term and long-term care.

Thyroglossal Duct Remnant with Follicular Hyperplasia Presenting After Total Thyroidectomy.

BACKGROUND: The thyroglossal duct fails to involute in up to 7% of adults, creating a thyroglossal duct remnant (TGDR) attached to the hyoid bone. Thyroid malignancies have been reported in approximately 1% of TGDRs. In previous reports of TGDR carcinoma, patients had radiographic evidence of a TGDR at initial clinical presentation. Alternatively, hypertrophy of a TGDR is well described in patients with hypothyroidism because of the growth of functional ectopic thyroid tissue. We present the case of a patient who had no radiographic evidence of a TGDR prior to thyroidectomy but presented 14 months after surgery with a recurrent cervical mass. CASE REPORT: A 58-year-old female underwent total thyroidectomy for micropapillary thyroid cancer. Fourteen months later, she presented with an enlarging cervical mass. She underwent a Sistrunk procedure, and surgical pathology revealed a TGDR with compensatory glandular hypertrophy. CONCLUSION: To our knowledge, this is the first report of a TGDR follicular adenoma initially appearing as a result of compensatory thyroid glandular hypertrophy following total thyroidectomy for a micropapillary thyroid carcinoma. Our case presented a novel clinical dilemma regarding the best management for a patient with a new TGDR along with a recent history of micropapillary thyroid cancer.

Efficacy of a Human Papillomavirus Vaccination Educational Platform in a Diverse Urban Population.

IMPORTANCE: Human papillomavirus (HPV) is a preventable disease that plays a causative role in a significant proportion of malignant neoplasms of the head and neck. Inner-city populations are at risk for HPV-related oropharyngeal cancer, are least likely to receive HPV vaccination, and report a lack of information regarding HPV. OBJECTIVE: To determine whether an educational platform affects knowledge, attitudes, and practices regarding HPV vaccination in an inner-city community. DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study, conducted from March 1 to December 31, 2014, surveyed 128 participants at multiple inner-city community centers regarding their knowledge of, attitudes toward, and practices regarding HPV vaccination before and after a brief educational presentation. No eligible individuals refused to participate in the educational session. Surveys were excluded from analysis if they were incomplete. INTERVENTIONS: Participants completed two 20-question surveys separated by a 15-minute educational session on HPV-related disease, including a short PowerPoint presentation. MAIN OUTCOMES AND MEASURES: Presence of statistically significant differences in survey scores before and after the educational session. RESULTS: Eighty-six participants met eligibility criteria (61 male [70.9%]; 68 with a high school education [79.1%]). Baseline knowledge of HPV, its causal association with cancer, and the existence of a vaccine against HPV were poor: of a total composite score of 20, the mean knowledge score before the educational session was 9.69. Participants' self-rated knowledge regarding HPV disease and vaccination improved significantly as a result of the educational session; the absolute increase in mean knowledge composite score from before the educational session to after the session was 3.52 (17.6%) (95% CI, -2.87 to 9.92; P < .01). Attitudes regarding government involvement in vaccination did not change as a result of the educational session (composite attitudes score before the educational session, 16.57 of 28; score after the session, 15.22; P = .98). Participants' intent to vaccinate their children increased significantly following the educational presentation: before the presentation, 34 respondents (40%) intended to have their children vaccinated; after the presentation, 60 (70%) intended to do so (P = .002). CONCLUSIONS AND RELEVANCE: Lack of knowledge regarding HPV vaccination and unwillingness to undergo vaccination contribute to low rates of HPV vaccination within urban populations. Community-based educational sessions successfully teach the link between HPV and various cancers, provide information regarding the risks and benefits of vaccination, and increase participants' willingness to vaccinate their children against HPV. Attitudes regarding government involvement in health programs are resistant to change.

Hypopharyngeal Airway Surgery for Obstructive Sleep Apnea: Morbidity in the Early Postoperative Period.

STUDY OBJECTIVE: To determine if hypopharyngeal surgery for obstructive sleep apnea is associated with significant morbidity in the early post-operative period. METHODS: Patients with a diagnosis of obstructive sleep apnea who underwent hypopharyngeal surgery at a tertiary care facility between November 2012 and September 2013 were included in this study. Surgical outcomes were assessed from medical records review and a 14 question telephone survey. Results: Twenty-two patients underwent hypopharyngeal surgery for obstructive sleep apnea (OSA). No patient experienced intra-operative complications, post-operative O2 desaturation <90%, prolonged admission for inadequate pain control, pulmonary edema, or airway compromise requiring re-intubation. Post-operative complications included one episode of nasal hemorrhage, one infection requiring hospitalization, and one episode of dehydration treated with IV fluids. 25% of patients experienced some degree of post-operative dysphonia, and 87.5% of patients experienced post-operative dysphagia. The average rating for post-operative pharyngeal pain was 3.5 of 10 by week 3 and 1.75 of 10 by week 4. Most patients described decreased snoring (93.75%), improved feeling of overall health (75%), and increased daytime energy (62.5%). All patients undergoing hypopharyngeal airway surgery were discharged within 23 hours. CONCLUSION: Hypopharyngeal surgery is a safe and well tolerated procedure for the treatment of OSA. Our findings suggest that hypopharyngeal surgery may be performed on an outpatient basis.

Rapid identification of Candida albicans in blood by combined capillary electrophoresis and fluorescence in situ hybridization.

A CE method based on whole-cell molecular labeling via fluorescence in situ hybridization was developed for the detection of Candida albicans in whole blood. Removal of potentially interfering red blood cells (RBC) with a simple hypotonic/detergent lysis step enabled us to detect and quantitate contaminating C. albicans cells at concentrations that were orders of magnitude lower than background RBC counts ( approximately 7.0 x 10(9) RBC/mL). In the presence of the lysed blood matrix, yeast cells aggregated without the use of a blocking plug to stack the cells. Short (15 min) hybridizations yielded bright Candida-specific fluorescence in situ hybridization signals, enabling us to detect as few as a single injected cell. The peak area response of the stacked Candida cells showed a strong linear correlation with cell concentrations determined by plate counts, up to approximately 10(7) CFU/mL (or approximately 1 x 10(4) injected cells). This rapid and quantitative method for detecting Candida in blood may have advantageous applications in both human and veterinary diagnostics.