Case Report: A Child With Omental Infarction.

BACKGROUND: Omental infarction (OI) is a rare cause of acute abdominal pain, which is benign and self-limited. It is diagnosed by imaging. The etiology of OI is either idiopathic or secondary and due to torsion, trauma, hypercoagulability, vasculitis, or pancreatitis. CASE REPORT: Here, we present a case of OI in a child with acute severe right upper quadrant pain. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Correct diagnosis of OI via imaging can prevent unnecessary surgery.

Feasibility of an Antiracism Curriculum in an Academic Pulmonary, Critical Care, and Sleep Medicine Division.

Background: Structural health inequities and racism adversely affect patient health and the culture of academic medicine. Formal training to educate fellows and faculty on antiracism is lacking. Objective: Our objective was to design, implement, and assess the feasibility and preliminary efficacy of a year-long antiracism curriculum within a pulmonary, critical care, and sleep medicine division. Methods: This was a pre- and postintervention observational study conducted between July 2020 and June 2021. The curriculum was offered during an allotted educational meeting time slot at a single-center pulmonary, critical care, and sleep medicine division at a large academic institution to fellows and faculty. The curriculum consisted of 13 1-hour virtual interactive workshops delivered by local experts in diversity, equity, and inclusion topics. Surveys assessed knowledge on racism in medicine; opinions, understanding, and comfort surrounding race and racism in medicine; as well as additional questions to solicit feedback on the curriculum itself via visual analog scale and write-in comments. Results: Before initiating the curriculum, 74% (n = 28) of respondents reported interest in an antiracism curriculum, and the majority (95%, n = 36) believed that discrimination affects medical staff and patients. Respondents reported only moderate comfort in talking about race (median, 58; interquartile range 41-70 on visual analog scale 0-100, where 100 is strongly agree with "I feel comfortable talking about race"). The postintervention survey demonstrated stability of the belief of the presence of racial discrimination and a 15% increase in self-directed learning about related topics. Although knowledge related to the use of race in medical algorithms improved, 14% fewer participants reported interest in continuing to engage in a division-wide structured antiracism curriculum. Conclusion: Implementation of a curriculum on justice, equity, diversity, and inclusion within a fellowship program is feasible and addresses an unmet need within graduate medical education.

How Should Clinicians Respond to Race-Based Algorithms as Sources of Iatrogenic Harm?

Some clinical algorithms use race as an epidemiological shorthand to "correct" for health determinants that are clinically influential but also variable because they are historical, social, cultural, or economic in origin. Such "correction factors" are both clinically and ethically relevant when their use reinforces racial essentialism and exacerbates racial health inequity. This commentary on a case in which the original vaginal birth after cesarean calculator is used argues that this and similar race-based algorithms should be considered sources of iatrogenic harm by undermining decision sharing in patient-clinician relationships and Black birthing peoples' rights to self-determination.

Medical Student Perspectives on the Ethics of Pelvic Exams Under Anesthesia: A Multi-Institutional Study✰.

OBJECTIVE: Pelvic examinations under anesthesia (EUAs) are routine components of gynecologic surgery and often used to educate students about female pelvic anatomy. This multi-institutional survey study aims to describe students' experiences with conducting educational pelvic EUAs and their attitudes around the ethics of informed consent for these exams. DESIGN: An anonymous survey of Likert and open-text response questions about institutions' practices around educational pelvic EUAs was sent to medical students. SETTING: Medical schools included Vanderbilt University School of Medicine, Indiana University School of Medicine, Emory University School of Medicine, University of New Mexico School of Medicine, Meharry Medical College, and Warren Alpert Medical School of Brown University. PARTICIPANTS: A total 305 medical students who had completed their obstetrics and gynecology (OB/GYN) clerkship between June 2019 and March 2020 filled out the survey (33% response rate). RESULTS: Overall, 84% of students performed at least 1 pelvic EUA during their clerkship. Of the 42% (142) of students that observed patient informed consent processes most or every time, 67% reported they never or rarely witnessed an explicit explanation that a medical student may perform a pelvic EUA. Analysis of open-text responses found that students wanted to uphold patient autonomy but felt they did not have the personal autonomy to object to performing pelvic EUAs that they believed were unconsented. They faced significant emotional distress when consent processes were at odds with their personal ethos and professional ethical norms. Students favored more standardized and explicit patient consent processes for educational pelvic EUAs. CONCLUSIONS: While students regularly perform pelvic EUAs, their involvement is inconsistently disclosed to patients, causing significant distress to students and risking erosion of students' attitudes about upholding patient autonomy and informed consent. Medical institutions must develop consistent, ethical, and patient-centered processes for trainee disclosure around pelvic EUAs.

Impact of Teaching Sexual Health Education on Medical Students.

BACKGROUND AND OBJECTIVES: Physician discomfort, embarrassment, and perceived lack of time and/or training all play a role in preventing physicians from discussing sexual health with patients. Past research shows this discomfort begins in medical school. We aimed to determine whether teaching sexual health education increases medical students' self-efficacy in discussing sexual health topics with adolescents. METHODS: We emailed a retrospective pre/postsurvey to all medical students who taught sexual health education in a local middle school through Sex Ed by Brown Med (N=61). RESULTS: Participation in Sex Ed by Brown Med improves self-efficacy in discussing nine sexual health topics and in performing nine advanced interviewing skills relevant to sexual health in a retrospective analysis using self-reported data. CONCLUSIONS: Programs similar to Sex Ed by Brown Med may be useful in improving medical students' ability to adequately care for their patients' sexual health by making future clinicians more comfortable when discussing the important topic of sexuality, and concurrently providing evidence-based comprehensive sexual health education to middle school students. Further research is needed to determine the impact of our program (and similar programs) before disseminating this model of sexual education.

A Case of Acute Esophageal Necrosis.

Acute esophageal necrosis (AEN) is a rare condition that impacts the distal esophagus after a vascular insult. In this case report, we describe a patient with multiple comorbid conditions presenting with shock from gastroenteritis who subsequently developed AEN complicated by refractory strictures.