RESUMEN
BACKGROUND: Medical students are turning to new and expanding web-based resources for learning during their psychiatry clerkships; however, there have not been concomitant efforts by educators to utilize web-based tools to promote innovative teaching. OBJECTIVE: Utilizing a free learning platform (Psy-Q) created by our team, we sought to explore how digital technology may engage medical student learners, promote colearning between educators and medical students, and support sustainability of web-based platforms through crowdsourcing. METHODS: Between 2017 and 2019, seven medical schools offered access to the platform during medical students' psychiatry clerkships. Use of the web-based platform was voluntary and not monitored or related to clerkship evaluation. Medical students completed a paper and pencil assessment of the platform at the end of their clerkship. Anonymous and aggregated website use data were gathered in accordance with institutional review board approval. RESULTS: A total of 203 medical students across seven distinct psychiatry clerkships completed the survey. Of these students, 123 (60.6%) reported using the platform and reported accessing a mean of 45 questions. The most common device used to access the platform was a laptop and the second most common was a smartphone. The most common location to access the platform was home and the second most common was the hospital. Although few students contributed new questions, website utilization data suggested that all rated the quality and difficulty of the questions. Higher quality questions were medical students' main suggestion for further improvement. CONCLUSIONS: Our results suggest the feasibility and potential of educator- and learner-created web-based platforms to augment psychiatry education and develop relevant accessible resources in the digital sphere. Future work should focus on measuring objective educational outcomes of question taking and writing, as well as optimizing technology and exploring sustainable trainee-faculty partnership models for the creation and curation of content.
RESUMEN
BACKGROUND: Substance use disorders (SUDs) are known to cause or complicate treatment of many types of cancers. OBJECTIVES: We sought to systematically assess rates of current SUDs among patients currently in treatment for cancer. METHODS: The National Veteran Health Administration administrative data from fiscal year 2012 were used to compare veterans with both cancer and comorbid SUDs to veterans with cancer but no SUDs and those with a SUD but no cancer. Bivariate comparisons and multivariate logistic regression were used to compare groups on sociodemographic characteristics, medical and mental health diagnoses, service use, and psychotropic and opioid medication fills. RESULTS: Of 482,688 veterans with cancer diagnoses, 32,037 (6.64%) had a comorbid SUD diagnosis. Veterans with cancer and a SUD had more medical and psychiatric disorders than those with cancer alone, a greater risk of homelessness, and a greater use of both mental and medical health services, with 60% receiving mental health outpatient treatment. These veterans had fewer differences from veterans with SUDs only, although they were older and had more medical illnesses. Notably the cancer SUD group had higher rates of hepatic disease and received a greater number of opioid prescriptions than both veterans with cancer alone and veterans with SUD alone. CONCLUSIONS: Veterans with cancer and SUD showed a specific risk for liver disease and a higher use of opioids. Collaborative teams involving oncology, palliative care, and psychiatry may be best able to address the challenge of providing adequate and safe opiate pain control for this vulnerable population.