Lean Health Care Internships: A Novel Systems-Based Practice Education Program for Undergraduate Medical Students.

PROBLEM: Given the United States' urgency for systemic-level improvements to care, advancing systems-based practice (SBP) competency among future physicians is crucial. However, SBP education is inadequate, lacks a unifying framework and faculty confidence in its teaching, and is taught late in the medical education journey. APPROACH: The Oklahoma State University Center for Health Systems Innovation (CHSI) created an SBP program relying on Lean Health Care for a framework and targeted medical students before their second year began. Lean curricula were developed (lecture and simulation) and a partnership with a hospital was secured for work-based practice. The CHSI developed a skills assessment tool for preliminary evaluation of the program. In June 2022, 9 undergraduate medical students responded to a Lean Health Care Internship (LHCI) presentation. OUTCOMES: Student SBP skills increased after training and again after work-based practice. All 9 students reported that their conceptualization of problems in health care changed "extraordinarily," and they were "extraordinarily" confident in their ability to approach another health care problem by applying the Lean method. The LHCI fostered an awareness of physicians as interdependent systems citizens, a key goal of SBP competency. After the internship concluded, the Lean team recommendations generated a resident-led quality assurance performance improvement initiative for bed throughput. NEXT STEPS: The LHCI was effective in engaging students and building SBP skills among undergraduate medical education students. The levels of student enthusiasm and skill acquisition exceeded the Lean trainers' expectations. The researchers will continue to measure LHCI's effect on students' rotation experiences to better evaluate the long-term benefit of introducing SBP concepts earlier in medical education. The program's success has spurred enthusiasm for continued collaboration with hospital and residency programs. Program administrators are exploring how to broaden access.

Exploration of nurses' pediatric pain management experiences in rural hospitals: A qualitative descriptive study.

BACKGROUND: Hospitalized children continue to experience inadequate pain management. Children in the rural hospital setting may be at risk due to unique challenges experienced by Registered Nurses (RNs) in this context. OBJECTIVES: To understand the experience of pain care from RNs who work in rural hospitals with inpatient pediatric patients. DESIGN: Qualitative description that used semi-structured interviews to explore RNs' inpatient pediatric pain care experiences. PARTICIPANTS: RNs who: 1) worked directly with pediatric in-patients; 2) spoke English; 3) and who worked in rural Northern Ontario. Hospital sites were selected based on population density, from one province in Canada. To reduce heterogeneity, only sites with dedicated pediatric beds were eligible (n = 9). METHODS: This qualitative descriptive study used semi-structured interviews over Skype and telephone. Data were analyzed using inductive content analysis. RESULTS: Ten participants were recruited from seven sites. Five main categories were identified, with one category that influenced all other categories. Rural RNs needed to practice as generalists as they care for many types of patients. Resource challenges included a lack of specialist expertise and educational opportunities. Pediatric pain was not perceived as a priority within their organizations. Most participants perceived there were no explicit standards for pain care. Moving forward the adoption of built in assessments in electronic documentation was suggested as a solution to standard pain care. CONCLUSIONS: Opportunity exists to improve pediatric pain management, however, without a systematic approach that considers the rural context, pain care for children will continue to be based on individual's beliefs and knowledge.

Congenital Tuberculosis Complicated by Hemophagocytic Lymphohistiocytosis.

We present the case of a male infant with congenital tuberculosis in a nonendemic setting complicated by hemophagocytic lymphohistiocytosis, who was treated successfully with antituberculous therapy and corticosteroids. We review the pediatric literature concerning the unusual association of these 2 rare conditions.

Do middle school students really have fixed images of elders?

OBJECTIVE: The purpose of this study was to determine whether combinations of characteristics, abstracted from drawings of elders made by middle school students, grouped together to form cohesive perceptions, or stereotypes, of human aging. METHODS: We abstracted 49 characteristics from drawings of elders made by 1,944 students at two middle schools in San Antonio, Texas, at the beginning of the 1998-1999 school year. Correlational and factor analyses were used to determine if there was an underlying structure or grouping to the characteristics. Logistic regression was used to determine the variables associated with the investigators' classification of the images as positive, neutral, or negative. RESULT: The standardized alpha coefficient for the 49 variables was low (alpha = 0.37). The Spearman rho correlations between the variables were also low, with 90.2% of the 1,176 comparisons being < 0.10. Exploratory factor analyses did not provide a useful grouping of characteristics drawn by the students, including analyses stratified by gender and restricted to the most common 34 characteristics. Among the 49 characteristics that emerged from the drawings, 11, 4, and 11 traits were directly associated with classifying the drawings as positive, neutral, or negative, respectively. DISCUSSION: These analyses indicate that middle school students have not formed strong images regarding aging: No clear cohesive stereotypes of elders emerged from the images drawn by these children. Absence of stereotypic views implies that middle school students may not have a built-in bias toward older people and age-associated changes. This suggests that young adolescents are at a point where instruction including gerontological content can be used to effectively teach about aging and health promotion.

Sentence completion to assess children's views about aging.

PURPOSE: Sentence completion exercises require students to give open-ended responses to prompts. The first purpose of this article is to describe the method of sentence completion to assess middle-school children's attitudes and beliefs about aging. The second purpose is to describe the patterns of characteristics that children associate with aging. DESIGN AND METHODS: Two middle schools in San Antonio, TX agreed to have their students participate in the sentence completion exercises at the beginning of the 1998-1999 school year. Teachers asked students to write responses to the following prompts: "Old is.," "You know you are old when.," "You know your parents are old when.," "When I am old, I.," and "Old people." We coded the responses for their characteristics and whether they were positive, negative, or neutral. RESULTS: Of the 2,476 students, 1,874 (75.6%) wrote responses to at least one prompt. Overall, we collected 3,700 responses and coded 9,438 characteristics (2.6 characteristics per response). The most common characteristics of aging were having wrinkles (21.1%), having gray hair or being bald (20.0%), and being less active (17.5%). Students had a much more positive view of their future (55.4%) compared with their view of aging elicited by the other prompts (range of 4.9-25.7% positive responses). Students infrequently associated old age with specific conditions; only 4.6% mentioned diseases, 6.0% mentioned being ill or taking medications, and 5.7% mentioned sensory problems. IMPLICATIONS: Middle-school students view their futures much more positively than the changes they observe in their parents and other elders. Students infrequently identified specific diseases or impairments as responsible for the changes they observe with aging. These observed responses provide a starting point for educators to develop and deliver gerontologically based materials that teach about healthful habits to maintain independence across a life span.