Medical student perceptions of an initial collaborative immersion experience.

Recent reviews of interprofessional education (IPE) highlight the need for innovative curricula focused on longitudinal clinical learning. We describe the development and early outcomes of the initial clinical experience (ICE), a longitudinal practice-based course for first-year medical students. While IPE courses focus on student-to-student interaction, ICE focuses on introducing students to interprofessional collaboration. Students attend 14 sessions at one of 18 different clinical sites. They work directly with different health professionals from among 17 possible professions, including nurses, pharmacists, social workers, and respiratory, occupational, and physical therapists. Between 2015 and 2016, 167 students completed the course, and 81 completed the end-of-course evaluation. Students agreed or strongly agreed that ICE meaningfully contributed to their understanding of healthcare teams and different professional roles (86%), improved their understanding of healthcare systems (84%), improved their ability to communicate with healthcare professionals (61%), and improved their ability to work on interprofessional teams (65%). Select themes from narrative comments suggest that clinical immersion improves understanding of professional roles, helps students understand their own future roles in healthcare teams, and increases awareness of and respect for other professionals, with the potential to change future practice. ICE may be a template for other schools wishing to expand their current educational offerings, by engaging learners in more authentic, longitudinal clinical experiences with practicing healthcare professionals.

Multiorgan eosinophilic infiltration after initiation of clozapine therapy: a case report.

BACKGROUND: The eosinophilic response to clozapine is well described in the literature, causing a variety of responses, from serositis to colitis. However, there are not case reports describing a clozapine-induced marked eosinophilia resulting in multiorgan dysfunction. CASE PRESENTATION: In this case report, we describe a 24 year old Caucasian male who presented with severe systemic eosinophilia resulting in eosinophilic GI tract infiltration, myocarditis, pericardial and pleural effusions with dramatic improvement following drug withdrawal. CONCLUSIONS: Clozapine associated eosinophilia should be suspected in the setting of eosinophilic infiltration of multiple organs.

SAFEST: Use of a Rubric to Teach Safety Reporting to Pediatric House Officers.

BACKGROUND: Among the many modalities of error detection in academic pediatric hospitals, patient safety reporting is an important component, particularly for unexpected events. Residents recognize the importance of reporting but cite some barriers to doing so. A rubric was developed to guide resident reporting and streamline information gathering in patient safety reports. The rubric used the acronym SAFEST as a reminder to include 6 key elements:1. Staff involved in the incident.2. Actual event description.3. Follow-up initiated.4. Effect on patient.5. Standard of care described.6. To-do/suggestions for improvement. OBJECTIVES: This study was designed to determine if the addition of this educational rubric into a standard quality improvement curriculum improves the consistency of information documented in patient safety reports as a subset of a larger quality improvement project aimed at improving safety reporting. METHODS: A team of faculty members analyzed individual resident error reports for adherence to the 6 tenets of the SAFEST mnemonic. RESULTS: From April to October of 2014, 2015, and 2016, a convenience sample of 131, 110, and 132 reports, respectively, were extracted and analyzed. For the rates of reporting "staff involved" and "standard of care," the differences over time were significant, both with P values < 0.001. After training, residents were 2.2 times more likely to report on the "staff involved" in the error and 1.8 times more likely to report the "standard of care." DISCUSSION: These results describe successful education on a rubric designed to improve the content of patient safety reports.

The Interprofessional Clinical Experience: Introduction to Interprofessional Education Through Early Immersion in Health Care Teams.

INTRODUCTION: The ability to collaborate as a member of interprofessional teams is essential for patient care and a core competency for students in health professions education. We developed a yearlong course, the Interprofessional Clinical Experience (ICE), to introduce first-year medical students to team-based aspects of the health care environment and provide them with a foundation upon which later experiences can grow. METHODS: The course uses experiential learning and critical reflection through reflective writing to orient students to working with care teams. Students receive assessments from faculty and various health care professionals. The course requires students to describe the roles and responsibilities of a variety of health care professionals, utilize effective communication with other health professionals on health care teams, demonstrate the ability to work on an interprofessional team, and examine their own and others' perspectives by engaging in self-directed learning and reflective practice. RESULTS: Annual course evaluations revealed that the majority of students agreed or strongly agreed that ICE contributed to their understanding of the health care team's roles and improved their ability to communicate with health care professionals, their understanding of health care systems, and their ability to work on an interprofessional team. The course also provides curricular content for the newly implemented Liaison Committee for Medical Education's accreditation requirement on interprofessional collaborative skills. DISCUSSION: The first implementation of this resource demonstrated that students met the educational objectives of the ICE and gained a better sense of the health care system and teams.

Iodine Deficiency and Hypothyroidism From Voluntary Diet Restrictions in the US: Case Reports.

Iodine deficiency is rare in the United States today, and this is largely due to the effectiveness of iodization in the general food supply. Recent trends among specific populations of children in the United States include adopting food restrictions, such casein-free and gluten-free diets. Although the effect of these types of diets on overall nutrition status and certain micronutrients has been studied in children with autism spectrum disorder, the effect of these limitations on iodine levels in children has not been assessed. We present here 2 cases of iodine deficiency resulting from severe food restriction and associated primary hypothyroidism. In 1 case a classic presentation with a goiter was seen. These children were able to discontinue thyroid hormone treatment once iodine levels were normalized. There were no adverse events or unanticipated outcomes. The occurrence of these cases of iodine deficiency in the United States points to the need for thyroid function testing in children with severe food restrictions, especially those who have limited exposure to dairy, baked goods, and table salt.

Assessing the validity evidence of an objective structured assessment tool of technical skills for neonatal lumbar punctures.

BACKGROUND: The lumbar puncture (LP) is a procedural competency deemed necessary by the Accreditation Council for Graduate Medical Education and the Emergency Medicine and Pediatric Residency Review Committees. The emergency department (ED) is a primary site for residents to be evaluated performing neonatal LPs. Current evaluation methods lack validity evidence as assessment tools. OBJECTIVES: This was a pilot study to develop an objective structured assessment of technical skills for neonatal LP (OSATS-LP) and to document validity evidence for the instrument in regard to five sources of test validity: content, response process, relation to other variables, inter-rater reliability, and consequences of testing. METHODS: Pediatric residents were videotaped in the fall of 2011 for comparison of faculty evaluation of resident performance during a neonatal LP using a video-delayed format. Residents completed a demographic experience survey evaluating relations to other variables. Content and response process validity was obtained through expert panel meetings and resulted in the following seven domains of performance for the OSATS-LP: preparation, positioning, analgesia, needle insertion, cerebrospinal fluid (CSF) collection, management of laboratory studies, and sterility. t-tests assessed significance between level of training, previous intensive care unit experience, and residents' self-assessed confidence in comparison with their total performance score. The inter-rater agreement of the OSATS-LP was obtained using the Fleiss' kappa for each domain. RESULTS: Sixteen pediatric residents completed the simulation with six raters evaluating each resident (96 ratings). The domains of sterility and CSF collection had moderate statistical reliability (κ = 0.41 and 0.51, respectively). The domains of preparation, analgesia, and management of laboratories had substantial reliability (κ = 0.60, 0.62, and 0.62, respectively). The domains of positioning and needle insertion were less reliable (κ = 0.16 and 0.16, respectively). Individuals who had completed one or more rotations in the neonatal intensive care unit (NICU) had a higher total score (12.5 vs. 16.9; p < 0.01). The residents' own perception of ability to perform an LP unsupervised did not result in a higher total score. CONCLUSIONS: The OSATS-LP has reasonable evidence in four of the five sources for test validity. This study serves as a launching point for using this tool in clinical environments such as the ED and, therefore, has the potential to provide real-time formative and summative feedback to improve resident skills and ultimately lead to improvements in patient care.