Effects of the pandemic on adolescent and caregiver attitudes towards telemedicine use.

BACKGROUND: Telemedicine use increased during the COVID-19 pandemic. We compared both adolescent/caregiver attitudes towards telemedicine pre- and intra-pandemic. MATERIALS AND METHODS: In a tertiary care setting with a large remote catchment area, we conducted qualitative analysis of structured interviews with dyads of 11 to 18-year-old patients and their caregivers using NVivo during the pandemic and compared the findings to our previous research [1]. RESULTS: We enrolled 14 dyads (35 ± 27 in-person visits and 4 ± 3 telemedicine visits per participant) and compared these with 11 dyads before the pandemic. Adolescents' mean age was 15.2 ± 2.1 years (range 11.2 - 18.2). The median distance to our medical center was 184.8 km (range 3.9 - 1,214 km, 6 dyads > 100 km). While the preferred ratio of telemedicine to in-person visits was 2 : 1 in caregivers (like pre-pandemic), many emphasized telemedicine as the safer option. Interestingly, adolescents preferred more in-person visits during the pandemic (1 : 1 ratio) compared to pre-pandemic (2 : 1 ratio). Qualitative analysis identified two main themes: consultation-specific factors and contextual factors. Consultation-specific factors were more valued during in-person visits, especially by adolescents. Consultation-specific factors remained the same pre- and post-pandemic, however, adolescents more often emphasized comfort, communication, and personal connection for in-person visits during the pandemic. Contextual factors were valued for telemedicine by adolescents and caregivers, and telemedicine was identified as the norm during the pandemic. Interestingly, the two main contextual themes pre-pandemic: frustration with technological aspects of telemedicine and adolescents not taking telemedicine seriously, disappeared during the pandemic. No disadvantages for telemedicine in the contextual factors were identified during the pandemic. CONCLUSION: The COVID-19 pandemic changed the user-expressed attitudes (especially among adolescents) on the transfer to telemedicine for chronic care.

Outcomes of inquiry-based learning in health professions education: a scoping review.

Background: Open inquiry-based learning (IBL) that aims to foster higher-level thinking, is defined by students formulating their own questions and learning through exploration. The present study aimed to summarize the breadth of metrics used to evaluate health professions trainees in open IBL curricula. Methods: We conducted a scoping review to identify publications detailing trainee outcomes in open IBL initiatives in health professions education. We queried five databases and included studies which described interventions with five phases of IBL (orientation, conceptualization, investigation, conclusion, and discussion). We completed abstract and full text reviews in duplicate. Data were collated and summarized. Results: From 3030 record, 21 studies were included in the final extraction (k = 0.94), with nine involving physician trainees and twelve involving nursing trainees. Three studies used validated data collection tools to measure student inquiry behavior, and a single study used a validated data collection tool to measure critical thinking abilities. Most studies (n = 11) reported trainee self-reported satisfaction or perceived gain of skills as the primary outcome. All four studies using validated tools reported high scores in inquiry behaviors at the end of the curriculum and results on critical thinking skills were mixed. One study collected serial data, while remaining studies collected pre-post or post-only data. Conclusion: IBL has the potential to cultivate a climate of curiosity among health professions learners. However, studies have relied heavily on subjective outcomes. Limited studies reported standardized measures of inquiry behaviors suggest favorable results. Curriculum innovations using IBL could make use of existing tools to better understand their impact on students' inquiry-oriented skills.

Contexte: L'apprentissage libre par le questionnement, qui vise à favoriser une réflexion de haut niveau, se définit par le fait que les étudiants formulent leurs propres questions et apprennent par l'exploration. La présente étude visait à faire l'inventaire des méthodes utilisées pour évaluer les étudiants des professions de la santé dans les programmes qui ont recours à l'apprentissage libre par le questionnement. Méthodes: Nous avons effectué une étude une revue exploratoire pour recenser les publications traitant des résultats des étudiants inscrits dans des programmes de formation dans une professionde la santé qui appliquent la méthode de l'apprentissage libre par le questionnement. Nous avons interrogé cinq bases de données et inclus les études qui décrivaient des interventions portant sur cinq phases de l'apprentissage par le questionnement (orientation, conceptualisation, investigation, conclusion et discussion). Nous avons procédé à l'examen des résumés et du texte intégral par deux lecteurs indépendants. Les données ont été colligées et résumées. Résultats: Sur 3030 documents, 21 études ont été incluses dans l'extraction finale (k=0,94), dont neuf concernaient des étudiants en médecine et douze des étudiants en sciences infirmières. Les auteurs de trois études ont utilisé des outils de collecte de données validés pour mesurer le démarchede recherche des étudiants, et ceux d'une seule étude ont employé un outil de collecte de données validé pour mesurer les capacités de réflexion critique. La plupart des études (n = 11) ont avancé comme résultat principal la satisfaction des étudiants ou l'amélioration ressentie de leurs compétences. Les quatre études réalisées à l'aide d'outils validés ont fait état de scores élevés en matière de démarche de recherche à la fin du programme, tandis que les résultats concernant les capacités de réflexion critique étaient mitigés. Dans l'une des études, les données avaient été recueillies de façon longitudinale et dans les autres, avant et après ou seulement après. Conclusion: L'apprentissage par le questionnement a le potentiel de cultiver la curiosité chez les apprenants des professions de santé. Cependant, les études recensées se sont largement appuyés sur des critères subjectifs. Des études limitées qui présentaient des mesures standardisées de la démarche de recherche des étudiants et ont montré des résultats favorables. Pour leurs innovations pédagogiques faisant appel à l'apprentissage par le questionnement, les programmes peuvent recourir aux outils de mesure existants pour mieux comprendre l'impact de cette méthode sur l'aptitude des étudiants au questionnement.

Across the Twitter-verse: Is Twitter an equitable tool in academic medicine? A scoping review.

The goal of this study was to investigate what is known about the demographic characteristics of Twitter influencers in academic medicine. We conducted a literature search and scoping review exploring the demographic characteristics of Twitter influencers in academic medicine. Included studies evaluated Twitter influence by any metric and reported associated demographic characteristics. There were no date or language restrictions. Data points included metrics of influence, demographics, and study characteristics. From 1656 records, thirteen met inclusion criteria. Influence was variably defined based on followers, measures of centrality, measures of engagement, or through third-party software. Studies were conducted at single time points and relied heavily on facial recognition for classification of sex or gender, with no studies exploring race as a variable of interest. Twitter influencers in academic medicine were found to be disproportionately male: significantly fewer influencers were female at all levels of professional status. Two studies identified more female influencers among trainee populations. Female users were less likely to develop influence based on followers, retweets, likes, or other measures of engagement at academic meetings, despite equal or greater representation at these meetings. Results on associations between Twitter influence and number of publications or h-index varied considerably. No included studies explored race or ethnicity in relation to Twitter influence, which presents a significant gap in the literature. Our findings highlight the need for larger, user-engaged studies of inequities related to social media influence in academic medicine, especially as social media is increasingly incorporated into academic portfolios.

Transient hyponatremia of prematurity caused by mild Bartter syndrome type II: a case report.

BACKGROUND: Bartter syndrome subtypes are a group of rare renal tubular diseases characterized by impaired salt reabsorption in the tubule, specifically the thick ascending limb of Henle's loop. Clinically, they are characterized by the association of hypokalemic metabolic alkalosis, hypercalciuria, nephrocalcinosis, increased levels of plasma renin and aldosterone, low blood pressure and vascular resistance to angiotensin II. Bartter syndrome type II is caused by mutations in the renal outer medullary potassium channel (ROMK) gene (KCNJ1), can present in the newborn period and typically requires lifelong therapy. CASE PRESENTATION: We describe a case of a prematurely born female infant presenting with antenatal polyhydramnios, and postnatal dehydration and hyponatremia. After 7 weeks of sodium supplementation, the patient demonstrated complete resolution of her hyponatremia and developed only transient metabolic alkalosis at 2 months of age but continues to be polyuric and exhibits hypercalciuria, without development of nephrocalcinosis. She was found to have two pathogenic variants in the KCNJ1 gene: a frameshift deletion, p.Glu334Glyfs*35 and a missense variant, p. Pro110Leu. While many features of classic ROMK mutations have resolved, the child does have Bartter syndrome type II and needs prolonged pediatric nephrology follow-up. CONCLUSION: Transient neonatal hyponatremia warrants a multi-system workup and genetic variants of KCNJ1 should be considered.