Promotion Criteria for Medical Educators: Are We Climbing a Ladder with Invisible Rungs?

OBJECTIVE: In 2006 the Association of American Medical Colleges recommended standardization of documentation of the contributions of medical educators and guidelines for their academic promotion. The authors characterized current United States (US) medical school promotion guidelines for medical educators. METHODS: Authors collected publicly available data from medical school promotion websites from March through July 2022 after determining categories by traditional-set domains as well as peer-reviewed standards. Extracted data were analyzed using descriptive and inferential statistics, and frequencies were calculated for nominal and categorical data. RESULTS: Of 155 medical schools identified, promotion criteria were publicly available for 143 (92%) schools. Ninety-one (64%) schools identified a distinct educator track. Of those with a defined educator track, 44 (48%) schools consider workshops or other media when evaluating candidates for promotion, and only 52 (57%) of schools with a specified educational track require additional documentation of teaching or education as part of their promotion process. Notably, 34 (37%) of the 91 schools with an educator track specifically require an Educational Portfolio, compared to 27 (52%) of the 52 schools that do not have a specific educator track for promotion. CONCLUSION: This study describes the current lack of clarity and consistency of the promotion criteria for medical educators and indicates that the guidelines proposed by the Association of American Medical Colleges over 15 years ago have not been widely adopted. These data amplify previous calls for a more objective set of criteria for evaluating and recognizing the contributions of medical educators.

Simulation Modeling of Air and Droplet Temperatures in the Human Respiratory Tract for Inhaled Tobacco Products.

Respiratory tract dosimetry predictions for inhalation of tobacco product smoke and aerosols are sensitive to the values of the physicochemical properties of constituents that make up the puff. Physicochemical property values may change significantly with temperature, particularly in the oral cavity and upper airways of the lung, where the puff undergoes adjustments from high temperatures in the tobacco product to reach body temperature. The assumption of fixed property values may introduce uncertainties in the predicted doses in these and other airways of the lung. To obtain a bound for the uncertainties and improve dose predictions, we studied temperature evolution of the inhaled puff in the human respiratory tract during different puff inhalation events. Energy equations were developed for the transport of the puff in the respiratory tract and were solved to find air and droplet temperatures throughout the respiratory tract during two puffing scenarios: 1. direct inhalation of the puff into the lung with no pause in the oral cavity, and 2. puff withdrawal, mouth hold, and puff delivery to the lung via inhalation of dilution air. These puffing scenarios correspond to the majority of smoking scenarios. Model predictions showed that temperature effects were most significant during puff withdrawal. Otherwise, the puff reached thermal equilibrium with the body. Findings from this study will improve predictions of deposition and uptake of puff constituents, and therefore inform inhalation risk assessment from use of electronic nicotine delivery systems (ENDS) and combusted cigarettes.

A Novel Framework for Modeling Person-to-Person Transmission of Respiratory Diseases.

From the beginning of the COVID-19 pandemic, researchers assessed the impact of the disease in terms of loss of life, medical load, economic damage, and other key metrics of resiliency and consequence mitigation; these studies sought to parametrize the critical components of a disease transmission model and the resulting analyses were informative but often lacked critical parameters or a discussion of parameter sensitivities. Using SARS-CoV-2 as a case study, we present a robust modeling framework that considers disease transmissibility from the source through transport and dispersion and infectivity. The framework is designed to work across a range of particle sizes and estimate the generation rate, environmental fate, deposited dose, and infection, allowing for end-to-end analysis that can be transitioned to individual and population health models. In this paper, we perform sensitivity analysis on the model framework to demonstrate how it can be used to advance and prioritize research efforts by highlighting critical parameters for further analyses.

Clinical pharmacy faculty interventions in a pediatric intensive care unit: an eight-month review.

OBJECTIVES: The American Academy of Pediatrics and the Society of Critical Care Medicine have documented the importance of pharmacist involvement in pediatric care. Numerous studies have reported the impact of clinical pharmacy interventions in various adult care settings. However, in the pediatric critical care setting, the impact has not been well documented. The purpose of this study was to describe clinical pharmacy faculty interventions in a pediatric intensive care unit (PICU). METHODS: A pediatric clinical pharmacy faculty member performed and documented clinical interventions in a level I, 18-bed, tertiary care PICU. Information gathered included medication name, specific intervention performed, basic patient demographics, and length of stay from May to December 2009. RESULTS: During the study period, there were 893 interventions performed on 159 patients over 66 days of service. (Average of 5.5 interventions/patient, and 34 interventions/100 patient PICU days.) Dosing recommendations and pharmacokinetics were the most common type of intervention (28.8% and 21.4%, respectively). Antibiotics and sedatives/analgesia were the most common drug classes in which interventions were made (34.4% and 20.3%, respectively). Ninety-eight percent of all interventions were accepted by the medical staff. The estimated annual cost savings from these interventions was $119,700. CONCLUSIONS: The average number of interventions per patient in this study was higher than that reported in the literature to date. Dosing recommendations and pharmacokinetics were the most commonly recommended interventions documented. Although this study showed considerable cost savings by a pharmacy clinical faculty member, further study of economic benefits is needed.

The effect of facilitated peer support sessions on burnout and grief management among health care providers in pediatric intensive care units: a pilot study.

BACKGROUND: Children admitted to pediatric intensive care units (PICUs) face potentially life limiting conditions. The toll on heath care professionals caring for these children is significant and often overlooked. There is a potential need for increased staff support, and facilitated peer support sessions could be an effective management tool, but few studies specifically evaluate this multidisciplinary population. The purpose of this pilot study is to evaluate the current rates of grief and burnout among health care professionals in our PICU, and explore facilitated support sessions as a method of reducing grief perceptions and burnout among providers. METHODS: A convenience sample of approximately 50 interdisciplinary professionals was invited to participate. The Copenhagen Burnout Inventory (CBI) and Hogan Grief Reaction Checklist (HGRC) were administered before and after two interactive, facilitated peer support sessions in a pretest/posttest design. RESULTS: The results of pretest/posttest CBI and HGRC instruments did not indicate statistically significant changes. It is notable that the instruments indicated low levels of grief and burnout among participants pre-/post-implementation. CONCLUSIONS: While facilitated peer support did not reduce grief and burnout scores among our PICU interdisciplinary staff, many factors could have affected results, including small sample size, potentially different participants across sessions, timing of sessions, and the timing of administration of posttest instruments. Additionally, even though not statistically significant, the area of personal growth showed a trend toward improvement, indicating an area for further research.

Severe invasive community-associated methicillin-resistant Staphylococcus aureus infections in previously healthy children.

OBJECTIVE: An increase in community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections has been reported in the literature. Most severe, life-threatening infections were previously thought to be associated with chronically ill or frail patients. Our pediatric intensive care unit (PICU) has seen a recent dramatic increase in primary, severe invasive CA-MRSA infections in healthy children. DESIGN/SETTING: A retrospective chart review of all previously healthy patients admitted to our 19-bed combined medical-surgical PICU with a primary diagnosis of severe invasive, culture-proven CA-MRSA disease during the past 6 years. RESULTS: Eleven previously healthy patients were admitted to our PICU with severe, primary, invasive CA-MRSA infections from March 2006 through September 2007, in contrast to no patients meeting these criteria in the preceding 5 years. The mortality rate was 27%, compared with an overall PICU mortality rate during the study period of <7%. The mean PICU length of stay of these patients was 14.9 days, compared with an average PICU length of stay of 2.4 days. Despite initiation of treatment with vancomycin at admission to the PICU in all but one case, patients took a mean of 5.7 days to convert to negative blood cultures. Eight patients had bacteremia longer than 4 days. Six of the patients developed bilateral necrotizing pneumonia requiring prolonged mechanical ventilation. CONCLUSIONS: Severe CA-MRSA infections in healthy children are increasing at an alarming rate in our institution. This acute rise in incidence, coupled with an alarmingly high associated mortality rate, raises important questions about the initial empirical antibiotic therapy we use in caring for patients presenting with suspected life-threatening CA-MRSA disease. Vancomycin monotherapy may not be adequate treatment for severe CA-MRSA infections.

Acute exercise decreases airway inflammation, but not responsiveness, in an allergic asthma model.

Previous studies have suggested that the asthmatic responses of airway inflammation, remodeling, and hyperresponsiveness (AHR) are interrelated; in this study, we used exercise to examine the nature of this interrelationship. Mice were sensitized and challenged with ovalbumin (OVA); mice were then exercised via running on a motorized treadmill at a moderate intensity. Data indicate that, within the lungs of OVA-treated mice, exercise attenuated the production of inflammatory mediators, including chemokines KC, RANTES, and MCP-1 and IL-12p40/p80. Coordinately, OVA-treated and exercised mice displayed decreases in leukocyte infiltration, including eosinophils, as compared with sedentary controls. Results also show that a single bout of exercise significantly decreased phosphorylation of the NFkappaB p65 subunit, which regulates the gene expression of a wide variety of inflammatory mediators. In addition, OVA-treated and exercised mice exhibited decreases in the levels of Th2-derived cytokines IL-5 and IL-13 and the prostaglandin PGE(2), as compared with sedentary controls. In contrast, results show that a single bout of exercise had no effect on AHR in OVA-treated mice challenged with increasing doses of aerosolized methacholine (0-50 mg/ml) as compared with sedentary mice. Exercise also had no effect on epithelial cell hypertrophy, mucus production, or airway wall thickening in OVA-treated mice as compared with sedentary controls. These findings suggest that a single bout of aerobic exercise at a moderate intensity attenuates airway inflammation but not AHR or airway remodeling in OVA-treated mice. The implication of these findings for the interrelationship between airway inflammation, airway remodeling, and AHR is discussed.

Anaphylaxis and superior vena cava thrombus in a pediatric patient with acute lymphoblastic leukemia.

Pediatric patients with malignancies are at significant risk for complications from their underlying condition and medical therapy. Emergency medicine physicians must be quick to suspect life-threatening events, which can present insidiously. We describe a case of anaphylaxis and superior vena cava syndrome in an 18-year-old female patient after polyethylene glycol-conjugated asparaginase chemotherapy for acute lymphoblastic leukemia. Pertinent literature surrounding risk factors, diagnosis, and treatment is also reviewed.

Oral and nasal enteral tube placement errors and complications in a pediatric intensive care unit.

OBJECTIVE: To report five cases of errors in the placement of oral/nasal enteral tubes in a pediatric intensive care unit, and to review literature on placement techniques and complication rates. DESIGN: Case series and review of the literature. SETTING: A 19-bed pediatric intensive care unit in a tertiary care pediatric hospital. PATIENTS: A 14-yr-old male with respiratory distress following a near drowning, a 10-yr-old male with recurrent acute lymphocytic leukemia and Pneumocystis carinii pneumonia, a 16-yr-old female with complex congenital heart disease and respiratory failure, a 16-yr-old male with status asthmaticus, and a 2-yr-old male with congenital heart disease. INTERVENTIONS: None. MAIN RESULTS: Five cases of enteral tube placement errors occurred in our combined medical-surgical pediatric critical care unit within the past year. All five resulted in placement of the feeding tube in the respiratory tract, four occurred despite the presence of cuffed endotracheal tubes. Three of the five patients had subsequent worsening of their respiratory status. One developed a pneumothorax, one developed pulmonary hemorrhage, and one developed an increased oxygen requirement. CONCLUSIONS: Patients in the pediatric intensive care unit may have characteristics that place them at an increased risk for misplacement of oral or nasal enteral tubes into the respiratory tract. Placement of enteral tubes into the respiratory tract may cause serious morbidity and possibly mortality. Checking the placement of enteral tubes with traditional methods does not prevent misplacement in the respiratory tree, and new techniques should be considered.