Curriculum Enrichment Across the Medical Education Continuum Using e-Delphi and the Community Priority Index.

OBJECTIVE: To describe the use of the e-Delphi combined with the Community Priority Index (CPI) to support medical curriculum enrichment. METHODS: This mixed-methods study was conducted from December 2017 to May 2018 at Baylor College of Medicine in Houston, Texas. First, a nominal group identified a topical list. Second, to refine the curriculum content and achieve consensus, an e-Delphi was implemented with healthcare experts regarding the following target cohorts (N = 40): transformed postbaccalaureate premedical scholar students, medical students, clinical fellows, and junior faculty. Third, the CPI incorporated multicriteria decision making and calculation of standardized prioritization scores (range 0-1) with bootstrap 95% confidence intervals (CIs). RESULTS: Among transformed postbaccalaureate premedical scholar students, medical students, and clinical fellows, the e-Delphi-CPI system's highest ranked topic was in the domain of leadership skills and competence for transformed postbaccalaureate premedical scholar students (CPI 0.87, 95% CI 0.58-0.94), medical students (CPI 0.85, 95% CI 0.36-0.91), and clinical fellows (CPI 0.86, 95% CI 0.32-0.92), respectively. For junior faculty, the highest ranked topic was introductory research methods (CPI 0.90, 95% CI 0.65-1.00). In each cohort, the top three ranked topics also contained leadership skills and competence and introductory research methods. The system ranked practical issues in health disparity as the third most valued domain among transformed postbaccalaureate premedical scholar students. CONCLUSIONS: The integrated e-Delphi-CPI system identified the highest ranked options across all of the domains and established comparability across cohorts. We recommend the e-Delphi-CPI system to advance medical curriculum enrichment processes.

Advancing Holistic Review for Faculty Recruitment and Advancement.

PROBLEM: The challenges to developing a physician and scientific workforce that both reflects and provides quality care for the complex and richly diverse population of the United States are considerable. APPROACH: One medical school (Baylor College of Medicine) sought to adapt the Holistic Review in Admissions process developed by the Association of American Medical Colleges and apply it to faculty. In the fall of 2016, academic leaders received on-site training and completed several workshop exercises. The goal was for the leaders to build consensus around a holistic review framework for hiring and advancing faculty that is based on the institution's mission, vision, and values. OUTCOMES: This training occurred during Baylor's ongoing strategic planning and helped inform improvements in the faculty recruitment and hiring process, in the guidelines for faculty appointment and promotion, and in the pilot of an administrative leadership candidate rating tool, the "experiences-attributes-academic metrics model." The model that developed from the pilot translates the holistic review concept into a tool for identifying, hiring, and promoting faculty members and administrative leaders that is aligned to the values of Baylor. The utility of this framework lies in the clear delineation of metrics and qualifications along with the prioritization of attributes and experiences. NEXT STEPS: This innovation is being piloted and evaluated to determine its effect on advancing the institutional mission of Baylor.

Micro-ribonucleic acid-155 is a direct target of Meis1, but not a driver in acute myeloid leukemia.

Micro-ribonucleic acid-155 (miR-155) is one of the first described oncogenic miRNAs. Although multiple direct targets of miR-155 have been identified, it is not clear how it contributes to the pathogenesis of acute myeloid leukemia. We found miR-155 to be a direct target of Meis1 in murine Hoxa9/Meis1 induced acute myeloid leukemia. The additional overexpression of miR-155 accelerated the formation of acute myeloid leukemia in Hoxa9 as well as in Hoxa9/Meis1 cells in vivo However, in the absence or following the removal of miR-155, leukemia onset and progression were unaffected. Although miR-155 accelerated growth and homing in addition to impairing differentiation, our data underscore the pathophysiological relevance of miR-155 as an accelerator rather than a driver of leukemogenesis. This further highlights the complexity of the oncogenic program of Meis1 to compensate for the loss of a potent oncogene such as miR-155. These findings are highly relevant to current and developing approaches for targeting miR-155 in acute myeloid leukemia.

Improving HIV/AIDS Knowledge Management Using EHRs.

BACKGROUND: A primary goal for the development of EHRs and EHR-related technologies should be to facilitate greater knowledge management for improving individual and community health outcomes associated with HIV / AIDS. Most of the current developments of EHR have focused on providing data for research, patient care and prioritization of healthcare provider resources in other areas. More attention should be paid to using information from EHRs to assist local, state, national, and international entities engaged in HIV / AIDS care, research and prevention strategies. Unfortunately the technology and standards for HIV-specific reporting modules are still being developed. METHODS: A literature search and review supplemented by the author's own experiences with electronic health records and HIV / AIDS prevention strategies will be used. This data was used to identify both opportunities and challenges for improving public health informatics primarily through the use of latest innovations in EHRs. Qualitative analysis and suggestions are offered for how EHRs can support knowledge management and prevention strategies associated with HIV infection. RESULTS: EHR information, including demographics, medical history, medication and allergies, immunization status, and other vital statistics can help public health practitioners to more quickly identify at-risk populations or environments; allocate scarce resources in the most efficient way; share information about successful, evidenced-based prevention strategies; and increase longevity and quality of life. CONCLUSION: Local, state, and federal entities need to work more collaboratively with NGOs, community-based organizations, and the private sector to eliminate barriers to implementation including cost, interoperability, accessibility, and information security.