Socioeconomic Status and Mock Interview Performance among Prospective Medical School Applicants.

We aim to evaluate the association between family income and mock multiple mini interview (MMI) performance for prospective medical school applicants. Each applicant participated in a three-station mock MMI and were scored on four items, each on a sevenpoint scale. Of the 48 prospective applicants participating, 29 (60% survey response rate) completed the survey. Hispanic applicants were significantly more likely to have a family income of less than or equal to $20,000 versus more than $20,000 (p<.05). The adjusted analysis suggested mock MMI total score was significantly lower for prospective medical school applicants with family incomes of less than or equal to $20,000 versus more than $20,000 (ß coefficient 5.37, 95% CI 0.05-10.69, p = .048). The mock MMI performance of prospective applicants with lower family incomes indicates the need for further interview skill preparation or new interview scoring protocols.

Implementation and Outcomes of a Community Assessment Service-Learning Activity Within Academic Learning Communities.

A community needs assessment and engagement activity was implemented in 2013 in the core preclinical curriculum as part of the doctoring course within Academic Communities at UC San Diego School of Medicine. This required educational experience included curricular learning objectives as well as goals to strengthen community service within academic communities. This activity was implemented and sustained within the academic communities with each community serving a different community of San Diego. Survey data from preclinical students from 2014 to 2017 consistently reported that the community assessment activity helped sustain or develop a service project in the academic community (67.1%-79.6% strongly agree or agree) and increased students' knowledge of the needs in the assigned San Diego community (76.3%-80.6% strongly agree or agree). Students felt that the community assessment and engagement activity was a valuable learning experience (62.5%-77.8% strongly agree or agree). As a result of this educational intervention, 14 projects were implemented in the community. A subset of particularly interested and motivated medical students then took on leadership roles in these projects. Student-led scholarly assessment of the impact of some of these interventions resulted in 2 peer-reviewed publications thus far and 9 national presentations at the time of this publication. These assessments demonstrate not only educational impact, but health-system-level changes and meaningful change in patient outcomes.

Perioperative Risk Factors Associated With Morbidity and Mortality Following Pediatric Inpatient Sinus Surgery.

OBJECTIVES:: Pediatric sinus surgery is indicated for a wide range of sinonasal and skull base pathologies, but it is most commonly performed for recalcitrant chronic rhinosinusitis or complicated acute sinusitis. The authors aim to report medical risk factors of morbidity and mortality following inpatient sinus surgery in the pediatric population. METHODS:: Using data from the Kids' Inpatient Database from 2003 to 2012, patients with International Classification of Diseases, Ninth Revision, procedure codes for primary sinus surgery were identified. Mixed-effect multivariable logistic regression was used to identify risk factors of inpatient postoperative morbidity and mortality. RESULTS:: The final sample included a weighted estimate of 4965 pediatric patients. The rates of inpatient morbidity and mortality were 6% and 1%, respectively. Respiratory complications (2.5%) were the most prevalent postoperative adverse events. The most prevalent comorbidities were chronic sinusitis (59.8%), acute sinusitis (27.8%), and cystic fibrosis (26.4%). Compared with patients who did not experience any morbidity, patients with inpatient morbidity had higher rates of pneumonia, mycoses, and nasal or paranasal benign neoplasm ( P < .05). The odds of inpatient morbidity and mortality were highest for patients with leukemia (odds ratio, 2.74; 95% confidence interval, 1.59-4.72; P < .001) and mycoses (odds ratio, 15.84; 95% confidence interval, 6.45-38.89; P < .001), respectively. CONCLUSIONS:: This study is the first to report the national comorbidity burden and risk factors for postoperative adverse events following inpatient sinus surgery. Knowledge of the comorbidities and independent factors associated with morbidity and mortality will help in directing preoperative optimization and counseling. LEVEL OF EVIDENCE:: 2c.

University of California San Diego's Program in Medical Education-Health Equity (PRIME-HEq): Training Future Physicians to Care for Underserved Communities.

The Program in Medicine-Health Equity (PRIME-HEq) at the University of California, San Diego prepares physicians to clinically serve and publicly advocate for underserved communities. In this article we share some of PRIME-HEq's defining features, such as our admissions process, student-directed service-focused elective courses, active community engagement, and multi-disciplinary Master's training.

Are disadvantaged and underrepresented minority applicants more likely to apply to the program in medical education-health equity?

PURPOSE: To determine whether underrepresented minority (URM) students and students from disadvantaged backgrounds were more likely to apply to a combined MD-master's degree program designed to train physician leaders in providing care to underserved communities. METHOD: University of California, San Diego (UCSD), School of Medicine applications from the 2008-2010 incoming classes were analyzed. American Medical College Application Service and UCSD secondary application data were used to build a logistic regression model to determine which characteristics were most associated with applying to the MD-master's degree Program in Medical Education-Health Equity (PRIME-HEq). RESULTS: Of the total UCSD applications reviewed from disadvantaged students, 61.5% also applied to PRIME-HEq (319/519) compared with 23.5% of nondisadvantaged students (917/3,895, χ = 326.665, P < .001). Of URM student applications, 55.6% also applied to PRIME-HEq (358/644) compared with 23.3% of non-URM students (878/3,770, χ = 284.654, P < .001). Results of a backward stepwise logistic regression analysis showed that disadvantagedstatus was the greatest predictor of applying to PRIME-HEq (odds ratio = 3.15; 95%confidence interval = 2.50-3.966; P< .001). CONCLUSIONS: URM students and students from disadvantaged backgrounds were more likely to be interested in a curriculum designed to train them to work with underserved communities. These results suggest that PRIME-HEq, or similarly focused programs, may influence URM and disadvantaged students' application decisions.

Culture clash: a missed opportunity.

CASE: Erasto is a term infant born by vaginal delivery to a gravida 7 para 7 Somalia woman with full prenatal care in the United States. His mother had gestational diabetes. The delivery was complicated by respiratory distress and an urgent admission to the neonatal intensive care unit for further evaluation for possible pulmonary disease and a congenital heart condition. A female pediatric intern was assigned to update Erasto's mother on the baby's status and to obtain consent for an intravascular line placement. When she entered the room to talk to the mother, multiple family members spanning at 3 generations were with the baby's mother. They were all women with the exception of Erasto's father who was apprised of the baby's clinical status by the male neonatal physician several minutes earlier. Through a telephone translator, the intern explained to Erasto's mother that her baby may have heart and lung problems that may be related to her gestational diabetes. At this point, many family members spoke simultaneously and excitedly. Some accused the intern of keeping the baby in the neonatal intensive care unit "to make more money," and others said they would sue her "if anything happened to Erasto." The mother denied that she had gestational diabetes, and claimed that because she "believed in God...nothing is wrong with my baby." The intern was not prepared for this response and asked herself, "What went wrong?"

Culture clash: a missed opportunity.

CASE: Erasto is a term infant born by vaginal delivery to a gravida 7 para 7 Somalia woman with full prenatal care in the United States. His mother had gestational diabetes. The delivery was complicated by respiratory distress and an urgent admission to the neonatal intensive care unit for further evaluation for possible pulmonary disease and a congenital heart condition. A female pediatric intern was assigned to update Erasto's mother on the baby's status and to obtain consent for an intravascular line placement. When she entered the room to talk to the mother, multiple family members spanning at 3 generations were with the baby's mother. They were all women with the exception of Erasto's father who was apprised of the baby's clinical status by the male neonatal physician several minutes earlier. Through a telephone translator, the intern explained to Erasto's mother that her baby may have heart and lung problems that may be related to her gestational diabetes. At this point, many family members spoke simultaneously and excitedly. Some accused the intern of keeping the baby in the neonatal intensive care unit "to make more money," and others said they would sue her "if anything happened to Erasto." The mother denied that she had gestational diabetes, and claimed that because she "believed in God...nothing is wrong with my baby." The intern was not prepared for this response and asked herself, "What went wrong?"