Are We Really Retaining URiM Faculty in Academic Medicine?

INTRODUCTION: Previous studies have identified the need to improve recruitment and retention of faculty who are underrepresented in medicine (URiM); however, it is unclear to what extent medical schools have been able to sustain growth and retain URiM faculty representation. METHODS: Numbers of URiM faculty at each AAMC medical school from 2012 to 2021 were obtained from the Association of American Medical Colleges Faculty Administrative Management Online User System database. Year-over-year percent change was calculated for each school and year of the study period for all URiM faculty, junior URiM faculty, and senior URiM faculty. Pearson's correlation was used to compare percent change in 1 year to the previous and subsequent years for all three groups. Pearson's correlation coefficients were also used to compare percent change between junior and senior URiM faculty for the same, previous, and subsequent years. RESULTS: The percentage change for URiM faculty at all ranks between adjacent years occurring from 2012 to 2021 was weakly and negatively associated (r = - 0.06, p value = 0.03). There was significant positive correlation between the percent change in junior URiM faculty and senior URiM faculty in the same year (r = 0.11) and previous year (r = 0.09). DISCUSSION: URiM faculty growth in 1 year is not sustained in the next year. More research is needed to better understand efforts at retention of URiM faculty in academic medicine.

The hip fracture assessment tool: A scoring system to assess high risk geriatric hip fracture patients for post-operative critical care monitoring.

INTRODUCTION: Intensive care unit risk stratification models have been utilized in elective joint arthroplasty; however, hip fracture patients are fundamentally different in their clinical course. Having a critical care risk calculator utilizing pre-operative risk factors can improve resourcing for hip fracture patients in the peri­operative period. METHODS: A cohort of geriatric hip fracture patients at a single institution were reviewed over a three-year period. Non-operative patients, peri­implant fractures, additional procedures performed under the same anesthesia period, and patients admitted to the intensive care unit (ICU) prior to surgery were excluded. Pre-operative laboratory values, Revised Cardiac Risk Index (RCRI), and American Society of Anesthesiologists (ASA) scores were calculated. Pre-operative ambulatory status was determined. The primary outcome measure was ICU admission in the post-operative period. Outcomes were assessed with Fisher's exact test, Kruskal-Wallis test, logistic regression, and ROC curve. RESULTS: 315 patient charts were analyzed with 262 patients meeting inclusion criteria. Age ≥ 80 years, ASA ≥ 4, pre-operative hemoglobin < 10 g/dL, and a history of CVA/TIA were found to be significant factors and utilized within a "training" data set to create a 4-point scoring system after reverse stepwise elimination. The 4-point scoring system was then assessed within a separate "validation" data set to yield an ROC area under the curve (AUC) of 0.747. Score ≥ 3 was associated with 96.8 % specificity and 14.2 % sensitivity for predicting post-op ICU admission. Score ≥ 3 was associated with a 50 % positive predictive value and 83 % negative predictive value. CONCLUSION: A hip fracture risk stratification scoring system utilizing pre-operative patient specific values to stratify geriatric hip patients to the ICU post-operatively can improve the pre-operative decision-making of surgical and critical care teams. This has important implications for triaging vital hospital resources. LEVEL OF EVIDENCE: III (retrospective study).

Pebble to the Metal: A Boulder Approach to Enrichment for Danio rerio.

Zebrafish are an established and widely used animal model, yet there is limited understanding of their welfare needs. Despite an increasing number of studies on zebrafish enrichment, in-tank environmental enrichment remains unpopular among researchers. This is due to perceived concerns over health/hygiene when it comes to introducing enrichment into the tank, although actual evidence for this is sparse. To accommodate this belief, regardless of veracity, we tested the potential benefits of enrichments presented outside the tank. Thus, we investigated the preferences and physiological stress of zebrafish with pictures of pebbles placed underneath the tank. We hypothesized that zebrafish would show a preference for enriched environments and have lower stress levels than barren housed zebrafish. In our first experiment, we housed zebrafish in a standard rack system and recorded their preference for visual access to a pebble picture, with two positive controls: visual access to conspecifics, and group housing. Using a crossover repeated-measures factorial design, we tested if the preference for visual access to pebbles was as strong as the preference for social contact. Zebrafish showed a strong preference for visual access to pebbles, equivalent to that for conspecifics. Then, in a second experiment, tank water cortisol was measured to assess chronic stress levels of zebrafish housed with or without a pebble picture under their tank, with group housing as a positive control. Cortisol levels were significantly reduced in zebrafish housed with pebble pictures, as were cortisol levels in group housed zebrafish. In fact, single housed zebrafish with pebble pictures showed the same cortisol levels as group housed zebrafish without pebble pictures. Thus, the use of an under-tank pebble picture was as beneficial as being group housed, effectively compensating for the stress of single housing. Pebble picture enrichment had an additive effect with group housing, where group housed zebrafish with pebble pictures had the lowest cortisol levels of any treatment group.

Racial Disparities in Selected Complications and Comorbidities among People with Type 2 Diabetes.

Type 2 diabetes (T2D) is a growing public health concern, disproportionately impacting racial and ethnic minorities. Assessing disparities is the first step towards achieving the translation goal to reduce disparities in diabetes outcomes, according to the Centers for Disease Control and Prevention (CDC)'s Division of Diabetes. We analyzed the data of patients (18+ years) diagnosed with T2D between 1 January 2012 and 31 March 2017, using the electronic health records of the University of Texas Medical Branch at Galveston. We compared the crude rate and age-standardized rate (using direct method) of selected micro- and macrovascular complication rates, associated obesity, and insulin dependence among racial and ethnic groups. Our sample included 20,680 patients who made 394,106 visits (9922 non-Hispanic White patients, 4698 non-Hispanic Black patients, and 6060 Hispanic patients). Our results suggest a higher risk of acquiring macrovascular (hypertension, ischemic disease, and stroke) and microvascular (renal, ophthalmic, and neurological) complications in Black patients compared to non-Hispanic White and Hispanic patients. The rates of stage I or II obesity were higher in Black patients compared with White and Hispanic patients. The rates of insulin use rather than oral hypoglycemics were also higher in Black patients than White and Hispanic patients. The disparities in terms of the higher susceptibility to complications among Black patients are possibly linked to the socioeconomic disadvantages of this population, leading to poorer management. Prevention strategies are warranted to reduce the incidence of T2D complications in racial minorities.

Increased utilization of the hybrid procedure is not associated with improved early survival for newborns with hypoplastic left heart syndrome: a single-centre experience.

OBJECTIVES: The primary objectives were to examine utilization of the Hybrid versus the Norwood procedure for patients with hypoplastic left heart syndrome or variants and the impact on hospital mortality. The Hybrid procedure was 1st used at our institution in 2004. METHODS: Review of all subjects undergoing the Norwood or Hybrid procedure between 1 January 1984 and 31 December 2022. The study period was divided into 8 eras: era 1, 1984-1988; era 2, 1989-1993; era 3, 1994-1998; era 4, 1999-2003; era 5, 2004-2008; era 6, 2009-2014; era 7, 2015-2018 and era 8, 2019-2022. The primary outcome was in-hospital mortality. Mortality rates were computed using standard binomial proportions with 95% confidence intervals. Rates across eras were compared using an ordered logistic regression model with and adjusted using the Tukey-Kramer post-hoc procedure for multiple comparisons. In the risk-modelling phase, logistic regression models were specified and tested. RESULTS: The Norwood procedure was performed in 1899 subjects, and the Hybrid procedure in 82 subjects. Use of the Hybrid procedure increased in each subsequent era, reaching 30% of subjects in era 8. After adjustment for multiple risk factors, use of the Hybrid procedure was significantly and positively associated with hospital mortality. CONCLUSIONS: Despite the increasing use of the Hybrid procedure, overall mortality for the entire cohort has plateaued. After adjustment for risk factors, use of the Hybrid procedure was significantly and positively associated with mortality compared to the Norwood procedure.

SARS-CoV-2 variant of concern fitness and adaptation in primary human airway epithelia.

The severe acute respiratory syndrome coronavirus 2 pandemic is characterized by the emergence of novel variants of concern (VOCs) that replace ancestral strains. Here, we dissect the complex selective pressures by evaluating variant fitness and adaptation in human respiratory tissues. We evaluate viral properties and host responses to reconstruct forces behind D614G through Omicron (BA.1) emergence. We observe differential replication in airway epithelia, differences in cellular tropism, and virus-induced cytotoxicity. D614G accumulates the most mutations after infection, supporting zoonosis and adaptation to the human airway. We perform head-to-head competitions and observe the highest fitness for Gamma and Delta. Under these conditions, RNA recombination favors variants encoding the B.1.617.1 lineage 3' end. Based on viral growth kinetics, Alpha, Gamma, and Delta exhibit increased fitness compared to D614G. In contrast, the global success of Omicron likely derives from increased transmission and antigenic variation. Our data provide molecular evidence to support epidemiological observations of VOC emergence.

Storylines of family medicine XII: family medicine and the healthcare system.

Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine, as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In 'XII: Family medicine and the future of the healthcare system', authors address the following themes: 'Leadership in family medicine', 'Becoming an academic family physician', 'Advocare-our call to act', 'The paradox of primary care and three simple rules', 'The quadruple aim-melding the patient and the health system', 'Fit-for-purpose medical workforce', 'Universal healthcare-coverage for all', 'The futures of family medicine' and 'The 100th essay.' May readers of these essays feel empowered to be part of family medicine's exciting future.

Building an Equity-Centered Ecosystem: University of Utah Health as a Microcosm.

Academic medicine, and medicine in general, are less diverse than the general patient population. Family Medicine, while still lagging behind the general population, has the most diversity in leadership and in the specialty in general, and continues to lead in this effort, with 16.7% of chairs identifying as underrepresented in medicine. Historical and current systematic marginalization of Black or African American, Latina/e/o/x, Hispanic or of Spanish Origin (LHS), American Indian/Alaska Native, Native Hawaiian/Pacific Islander, and Southeast Asian individuals has created severe underrepresentation within health sciences professions. Over the last 30 years, the percentage of faculty from these groups has increased from 7 to 9% in allopathic academic medicine, with similar increases in Osteopathic Medicine, Dentistry, and Pharmacy, but all lag behind age-adjusted population means. Traditionally, diversity efforts have focused on increasing pathway programs to address this widening disparity. While pathway programs are a good start, they are only a portion of what is needed to create lasting change in the diversity of the medical profession as well as the career trajectory and success of underrepresented in medicine (URiM) health professionals toward self-actualization and positions of leadership. This article elucidates all parts of an ecosystem necessary to ensure that equity, diversity, and inclusion outcomes can improve.

Novel nitric oxide donors are coronary vasodilators that also bind to the papain-like protease of SARS-CoV-2.

Several investigational nitric oxide donors were originally created to correct vascular endothelial dysfunction in cardiovascular diseases. These 48 compounds contain an urea-like moiety attached to the well-known NO donors isosorbide 2- and 5-mononitrate. CR-0305 and CR-0202 were synthesized and found to be nontoxic in the cell lines HMEC-1, A549/hACE2 and VeroE6. CR-0305 induced vasodilation in human coronary arteries ex vivo. Since NO can also have antiviral properties, a study of drug-protein interactions with SARS-CoV-2 was undertaken using in silico modeling. CR-0305 experimentally outperformed the other compounds, including CR-0202, in binding the catalytic site of SARS-CoV-2 papain-like protease (PLpro). PLpro is a primary target for therapeutic inhibition of SARS-CoV-2 as it mediates viral replication and modulates host innate immune responses. CR-0305 is predicted to sit firmly in the PLpro catalytic pocket as confirmed by molecular dynamics simulations, wherein stability of binding to the catalytic site of PLpro induces a conformational change in the BL2 loop to a more closed conformation as observed previously with GRL0617. Surface plasmon resonance was performed with CR-0305 and CR-0202 to characterize binding affinity to purified SARS-CoV-2 PLpro protein. CR-0305 and CR-0202 also inhibited SARS-CoV-2 infection compared to vehicle as measured by virus N protein staining with a specific antibody in A549-ACE2 and VeroE6 cells at 20 µM. CR-0305 is a coronary vasodilator that appears to bind to the catalytic site of the PLpro of SARS-CoV-2 while targeting delivery of antiviral NO to cells infected by SARS-CoV-2, suggesting multiple indications for future development.

Minority Tax on Medical Students: A Review of the Literature and Mitigation Recommendations.

BACKGROUND AND OBJECTIVES: Accreditation standards for MD- and DO-granting institutions require medical schools to recruit a diverse student body and educate students about diverse groups of patients. The minority tax is a summary of responsibilities assigned to racial and ethnic underrepresented faculty to achieve diversity, equity, and inclusion in medical institutions in addition to their typical academic workload. This article provides a narrative review of medical students' experiences of the minority tax and recommendations on how medical educators can support an equitable learning environment by eliminating the minority tax. METHODS: We searched the PubMed, Web of Science, and Scopus databases, Google Scholar, and medical society websites, blogs, and fora for terms, including minority tax, medical students, and undergraduate medical education. We included publications if they discussed the underrepresented in medicine medical students' experiences of the minority tax. RESULTS: Our search yielded six peer-reviewed original research articles and six publications of commentaries, opinion pieces, or news pieces. Students who were underrepresented in medicine reported spending more hours on diversity efforts compared with students who were not underrepresented; moreover, students reported that they had to sacrifice academic excellence in order to fulfill these additional diversity duties. CONCLUSIONS: The minority tax among medical students constitutes an unequitable and unjust barrier to career advancement, and it likely represents an early cause of attrition in the pipeline of underrepresented in medicine academic faculty. Medical educators can enact specific recommendations to eliminate or mitigate the minority tax experience for medical students.

Gearing Up: Accelerating Your CV to Promotion and Tenure.

The curriculum vitae (CV) is an important document for a faculty member and is one of the first documents reviewed by peers or evaluators when a faculty member is being considered for promotion. It catalogs the training history, accomplishments, awards, and productivity of a faculty member over time. Prior work has demonstrated how the CV should be organized and what content should be included. However, no contributions to the literature have discussed how reviewers and other academic leaders view CVs, how to structure CV entries to promote career advancement, and how CVs can become useful or limiting for faculty, regardless of whether a faculty member is actively going through the promotion process. We discuss how the CV can be seen by evaluators and concerns that can cause the CV to decelerate. We then make recommendations on how the CV can accelerate a faculty member toward academic career advancement and promotion.

Writing for Personal and Professional Wellness.

Writing is a part of every academic career in medicine, yet many busy clinicians have difficulty finding time to write and may see it as extra work during their time off. This professional development perspective offers a reframing of writing, not as extra work, but as a wellness activity. The National Academy of Medicine's (NAM) National Plan for Health Workforce Well-being identified seven priority areas where action should be taken to increase wellness in the workforce. Professional writing can "support mental health and reduce stigma" (an explicit NAM priority area) by allowing workers to express gratitude, practice reflection, and write without a deadline. Writing also addresses the NAM priority area of "create and sustain positive work and learning environments and culture" by giving opportunities to support your colleagues, invest in your team, celebrate success, find satisfaction in the sciences, and seek and find healing. By intentionally writing to process emotion and manage work stress, we shift the paradigm for busy clinicians to improve their well-being while simultaneously contributing to academic success.

Underrepresented in medicine (URiM) faculty development: Trends in biomedical database publication.

BACKGROUND: Biomedical databases create an educational platform that allows institutions to share innovations and research discoveries. Identifying literature in biomedical databases that inform the faculty development experiences of faculty underrepresented in medicine (URiM) can help institutions identify resources to promote career advancement for this group. The authors sought to determine biomedical database trends in publications related to faculty development experiences of URiM faculty over the last twenty years. METHODS: An electronic search for literature published between January 2003 to Dec 2022 was conducted in the databases CINAHL, PubMed, Scopus, and PsycInfo using keywords underrepresented minority, faculty development, career development, professional development, academic medicine, and workforce in the title, abstract, or body of the manuscript. Growth rates were calculated for each database. The statistical significance difference in median numbers of publication per database was evaluated using Krusksal Wallis and Dunn's test post hoc. RESULTS: Search results found 1516 publications over the twenty-year period. Scopus published the most literature with 1,372 publications with a mean number of 68.6 per year (SD 83.47). Both Scopus and PubMed had increased growth rates at 41% and 25%, respectively. There were statistically significant differences in median publication numbers between Scopus, CINAHL, and PsycInfo (p < 0.001) but not PubMed (p 0.062). CONCLUSION: Trends in publications related to URiM faculty development have increased over the last twenty years, most noted in the Scopus and PubMed biomedical databases.

Consistent Visual Analysis of Multielement Data: A Preliminary Evaluation.

Experimenters provided 33 graphical displays of hypothetical data depicted in a multielement experimental design to editorial board members of prominent, applied, behavior-analytic journals via an online survey. For each display, participants indicated (a) the presence or absence of experimental control and (b) the degree of experimental control (rated on a 1-100 scale). Each depiction varied systematically in (a) the number of data paths, (b) the number of data paths elevated above the control, (c) the mean difference between affected data paths and control conditions, and (d) the degree of variability within conditions. Correspondence among experts' ratings of experimental control was high across all presented graphical displays, supporting the reliability of visual analysis as an evaluative tool for these designs.

Structure and Funding of Clinical Informatics Fellowships: A National Survey of Program Directors.

BACKGROUND: In 2011, the American Board of Medical Specialties established clinical informatics (CI) as a subspecialty in medicine, jointly administered by the American Board of Pathology and the American Board of Preventive Medicine. Subsequently, many institutions created CI fellowship training programs to meet the growing need for informaticists. Although many programs share similar features, there is considerable variation in program funding and administrative structures. OBJECTIVES: The aim of our study was to characterize CI fellowship program features, including governance structures, funding sources, and expenses. METHODS: We created a cross-sectional online REDCap survey with 44 items requesting information on program administration, fellows, administrative support, funding sources, and expenses. We surveyed program directors of programs accredited by the Accreditation Council for Graduate Medical Education between 2014 and 2021. RESULTS: We invited 54 program directors, of which 41 (76%) completed the survey. The average administrative support received was $27,732/year. Most programs (85.4%) were accredited to have two or more fellows per year. Programs were administratively housed under six departments: Internal Medicine (17; 41.5%), Pediatrics (7; 17.1%), Pathology (6; 14.6%), Family Medicine (6; 14.6%), Emergency Medicine (4; 9.8%), and Anesthesiology (1; 2.4%). Funding sources for CI fellowship program directors included: hospital or health systems (28.3%), clinical departments (28.3%), graduate medical education office (13.2%), biomedical informatics department (9.4%), hospital information technology (9.4%), research and grants (7.5%), and other sources (3.8%) that included philanthropy and external entities. CONCLUSION: CI fellowships have been established in leading academic and community health care systems across the country. Due to their unique training requirements, these programs require significant resources for education, administration, and recruitment. There continues to be considerable heterogeneity in funding models between programs. Our survey findings reinforce the need for reformed federal funding models for informatics practice and training.

Preparing Community Health Workers to Empower Latino(a)s With Diabetes: A Real-World Implementation Study.

PURPOSE: The purpose of the study was to evaluate the delivery of diabetes self-management education (DSME) to Latino(a) adults by community health workers (CHWs). METHODS: Investigators developed an evidence-based, bilingual (Spanish/English) diabetes education curriculum and trained 10 CHWs on its content. CHWs then implemented the curriculum in 6-month diabetes group visit programs for low-income Latino(a)s with type 2 diabetes in nonacademic 501(c)3 community clinics. Investigators evaluated efficacy of the training through successful implementation, measured by participant group visit acceptance and attendance. RESULTS: Participants (n = 70) reported high levels of program satisfaction (3.8/4.0), improvement in quality of life (9.7/10), meeting of individual needs (3.8/4.0), and acceptability (9.7/10.0). Content analyses revealed that 87.1% of participants would not change the program or wanted to extend it. Participant attendance was 81.6%. CONCLUSIONS: Investigators demonstrated the ability to develop a training that nonmedical personnel (CHWs) successfully implemented in a real-world study. This study provides a curricular framework for CHW-led education that may serve as a template to extend to other diseases and populations.

Trends Among Women in Academic Medicine Faculty Ranks.

Introduction: Similar proportions of women and men have entered medical school since 2003. However, career advancement and promotion for women continues to be fraught with disparities and inequalities. Building on current literature, this study explores the rates of change of female faculty in faculty ranks over the last 10 years to gain a more comprehensive view of the faculty trends of women in academic medicine. Methods: Using the Faculty Administrative Management Online User System database, counts by gender and faculty rank at each Association of American Medical Colleges (AAMC) academic medical school were obtained. Statistical analysis was done using generalized estimating equations modeling to assess rates of change for each gender from 2012 to 2021. Results: Higher proportions of female faculty are concentrated at the Instructor and Assistant Professor level and lower proportions at the Associate Professor and Professor rank compared to male faculty. Over the study period, female faculty showed increased rate change compared to male faculty of 1.007 (95% confidence interval [CI]: 1.002-1.012) for Associate Professor rank and 1.012 (95% CI: 1.007-1.016) for Professor rank. At the Instructor and Assistant Professor levels, female faculty decreased at a relative rate of 0.980 (95% CI: 0.969-0.990) and 0.995 (95% CI: 0.992-0.997) each year, respectively. Conclusion: Female faculty continue to be concentrated at the junior faculty rank. Rate changes at the senior faculty rank for female faculty have slightly improved over the last 10 years compared to male faculty. However, this improvement is minimal, and work is still needed to achieve true gender equity in academic medicine.

Failure to Participate in Sports: An Evaluation of Preparticipation Physicals in a Local School District.

PURPOSE: To determine the incidence of the documentation of athlete failure of preparticipation sports physicals. METHODS: This was a retrospective observational study that involved review of preparticipation examination physical form documentation from multiple clinicians for all student athletes who participated in athletics during the 2018 to 2019 academic year at Galveston Independent School District (GISD). We collected the reasons for failure to pass the preparticipation physical examination. RESULTS: Of the approximately 800 student athlete forms reviewed, 183 forms indicated individual athletes failed the visual acuity or cardiovascular portions of the preparticipation physical examination. DISCUSSION: Athlete failures of the preparticipation physical examination may cause delays in sports participation, and time and monetary costs to students and their parents. Inconsistences in guidelines used to clear athletes as well as variation in form completion impacts whether athletes reportedly failed or passed the examination. Mass participation screening becomes a safety net for communities for athletes who may not have primary care providers to encourage follow-up with a regular clinician for previously undiagnosed medical issues and standardizing guideline use and form completion across clinicians who do these exams may improve numbers of athletes who are cleared to play sports. CONCLUSION: Focusing on preventable and addressable preparticipation examination failures may help clinicians who perform these exams, while also establishing a safety net for previously undiagnosed medical conditions. Instituting yearly vision checks, addressing cardiovascular issues, and encouraging yearly follow-up with primary care clinicians can more readily address physical and mental health issues and will provide more comprehensive care to student athletes.

Retrograde intramedullary nailing of the femur: identifying the true anatomic axis for the ideal start point.

PURPOSE: Retrograde femoral intramedullary nailing (IMN) is commonly used to treat distal femur fractures. There is variability in the literature regarding the ideal starting point for retrograde femoral IMN in the coronal plane. The objective of this study was to identify the ideal starting point, based on radiographs, relative to the intercondylar notch in the placement of a retrograde femoral IMN. METHODS: A consecutive series of 48 patients with anteroposterior long-leg radiographs prior to elective knee arthroplasty from 2017 to 2021 were used to determine the femoral anatomic axis. The anatomic center of the isthmus was identified and marked. Another point 3 cm distal from the isthmus was marked in the center of the femoral canal. A line was drawn connecting the points and extended longitudinally through the distal femur. The distance from the center of the intercondylar notch to the point where the anatomic axis of the femur intersected the distal femur was measured. RESULTS: On radiographic review, the distance from the intercondylar notch to where the femoral anatomic axis intersects the distal femur was normally distributed with an average distance of 4.1 mm (SD, 1.7 mm) medial to the intercondylar notch. CONCLUSION: The ideal start point, based on radiographs, for retrograde femoral intramedullary nailing is approximately 4.1 mm medial to the intercondylar notch. Medialization of the starting point for retrograde intramedullary nailing in the coronal plane aligns with the anatomic axis. These results support the integration of templating into preoperative planning prior to retrograde IMN of the femur, with the knowledge that, on average, the ideal start point will be slightly medial. Further investigation via anatomic studies is required to determine whether a medial start point is safe and efficacious in patients with distal femur fractures treated with retrograde IMNs.