Impact of a Longitudinal Medical Spanish Curriculum on Student Communication Skills.

PURPOSE: This study describes and examines the short- and longer-term impact of a required longitudinal medical Spanish curriculum on physician assistant student preparedness and ability to communicate with patients in Spanish during clinical rotations. METHODS: Fifty-eight preclinical students participated in an 80-hour curriculum delivered weekly over 3 semesters. Teaching followed a framework of second-language acquisition and included structured grammar and medical vocabulary practice with didactic, interactive, and group assignments. Vocabulary and grammar were assessed with quizzes. Oral proficiency was assessed by faculty with Spanish Objective Structured Clinical Examination (OSCE) stations at midpoint and end using the Interagency Language Roundtable (ILR), a 6-level scale (immediate outcome). Students self-rated proficiency and confidence and evaluated curriculum effectiveness for preparing them to care for Spanish-speaking patients (longer-term outcomes). RESULTS: All students passed the written and oral quizzes. Faculty-scored ILR verbal proficiency at the OSCEs increased by a mean level of 0.5 over 6 months. Student self-assessed proficiency improved on average by one level from baseline to 24 months later. Students rated highly curriculum effectiveness, preparedness to communicate in Spanish during clinical rotations, ability to judge when an interpreter was needed, and the importance of medical Spanish to future practice. CONCLUSIONS: A required integrated longitudinal medical Spanish curriculum was well received. Physician assistant students demonstrated short-term interval progression in Spanish proficiency, with improvements in both faculty and self-rating scores, and readiness to apply the skill to practice. They valued active learning associated with repeated practice with feedback, role playing, and interval assessments throughout the curriculum.

Cannabinoid hyperemesis syndrome: An unrecognized cause of nausea and vomiting.

Cannabis has long been used for medical and recreational purposes because of its antiemetic, analgesic, and mood effects. Ironically, chronic use of cannabis can result in paradoxical effects, including a condition known as cannabinoid hyperemesis syndrome. Patients with this syndrome often are seen in the ED with cyclic vomiting, nausea, and epigastric pain. Although the definitive treatment of cannabinoid hyperemesis syndrome is discontinuing the causative agent, medical management that includes rehydration is important to prevent complications. Common antiemetic medications are ineffective, but some studies have shown haloperidol and lorazepam to be effective in treating acute symptoms.

Evaluating Medical Spanish Proficiency: A Comparison of Physician Assistant Student Self-Assessment to Standardized Patient and Expert Faculty Member Ratings.

PURPOSE: Whether physician assistant (PA) students' self-assessment or standardized patient (SP) evaluations of students' medical Spanish proficiency accurately reflect their language proficiency is unclear. This study compares PA student and SP ratings with an expert faculty member's rating to determine whether student or SP ratings can be used to evaluate language proficiency. METHODS: Fifty-eight students participated in a single-station Spanish Objective Structured Clinical Examination (OSCE) at the midpoint of a medical Spanish curriculum. Using the Interagency Language Roundtable (ILR)-a 6-point, single-item language proficiency scale previously validated among physicians-PA students and SPs evaluated students' medical Spanish proficiency. Their scores were then compared with the scores derived by an expert faculty rater who had viewed a video of each student-SP encounter. The faculty's score was considered the gold standard. Correlation between scores was calculated using Spearman's rank correlation coefficient. RESULTS: Mean student scores were highest when rated by SPs (M = 3.8, SD = 0.9), followed by self (M = 3.0, SD = 0.9), and then faculty (M = 2.5, SD = 1.2). Spearman's rank correlation coefficient showed a strong positive correlation between students and the expert faculty rater (rs = 0.67, P < .001) and between SPs and the expert faculty rater (rs = 0.72, P < .001). The correlation was stronger for high- than for low-proficiency students. Students' self-rated scores showed significant improvement from baseline to the OSCE. CONCLUSIONS: PA students participating in a medical Spanish curriculum and SPs show good correlation with an expert faculty rater in assessing Spanish proficiency during an OSCE. Standardized patients demonstrate scoring leniency. The ILR has potential for tracking aggregate student progress and curriculum effectiveness. With training, student self-rating could be used for interval assessment of medical Spanish communication.

Impact of a Required Service-Learning Curriculum on Preclinical Students.

PURPOSE: The impact of brief service-learning curricula on physician assistant (PA) students is not well reported. This study explores student learning immediately and then one to 2 years after a preclinical service-learning experience through written reflections and a survey. METHODS: The 16-hour curriculum within a behavioral science course involved community immersion and engagement with underserved clients. Reflections written by students from 3 consecutive classes were coded for major themes, and theme frequency was assessed. We then administered a survey to explore the curricular impact after students completed their clinical clerkships. RESULTS: All students (132/132) completed the required curriculum. We identified 4 major themes from 132 reflections. The themes were (most to least frequent) self-discovery (54/132), patient focus (30/132), community resources (28/132), and patient-provider relationship (20/132). The primary attitude change (self-discovery) was student awareness of their own biases and recognition of the need for cultural humility when caring for underserved clients. In the postcurriculum survey (response 69/95), students recalled community resources as the most important learning, followed by self-discovery. Students viewed the curriculum positively and noted that the exposure increased their comfort with caring for underserved patients in their clerkships. CONCLUSIONS: Immersion in a community-based service-learning experience with underserved clients is associated with increased self-awareness and intent to change behavior. Students perceive the experience as important for future clerkships. Preclinical service-learning curricula prepare students to care for underserved patients.

Metacognition, Formative Assessment, and Student Perspective: Learning About Metacognition Through In-Class Comparison of Response Systems.

PURPOSE: Educators influence learning context through, among other things, triadic reciprocal causation-a behavioral model used in social cognitive theory. Eliciting responses from learners during instruction may contribute to learning by engaging their metacognition. In this study, metacognition was examined based on learners' experience with 2 different polling methods: student response systems (SRS), commonly known as "clickers," and a low-technology response system (LTRS), where students raise labeled signs, each with a different response. Scale item results are reported. METHODS: Scales measuring the influence of metacognition from polling methods were administered, following treatment (SRS) and comparison method (LTRS), to first-year physician assistant (PA) students (n = 54). Statistical tests of significance and effect size for each item were compared. RESULTS: Performance outcomes suggest that the SRS enhances learning experiences more than low-technology polling. Self-reported surveys indicate that self-monitoring, note-taking, and understanding during lectures are significantly improved with the use of clickers. Peer and social comparison items did not demonstrate significance collectively, but survey results indicate that candidates compared themselves to their peers significantly more with the LTRS than with the SRS. CONCLUSION: Findings support the practice of using an electronic SRS to poll PA students and enhance learning.

The role of SGLT2 inhibitors in managing type 2 diabetes.

The sodium glucose cotransporter 2 (SGLT2) inhibitors canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin represent a novel class of medications to manage type 2 diabetes through urinary excretion of glucose. These drugs block glucose reabsorption by the kidneys to increase glucosuria. These drugs provide hemoglobin A1C reduction, promote weight loss, and remain hypoglycemic-neutral when not used in combination with insulin or secretagogues. Canagliflozin and empagliflozin have shown cardiovascular benefit. The potential to reduce the risk of cardiovascular death in patients with type 2 diabetes, along with the benefit of weight reduction, makes these new agents useful tools for the primary care provider.

Out of air: Is going to high altitude safe for your patient?

As more people travel to high altitudes for recreation or work, more travelers with underlying medical conditions will need advice before traveling or treatment for altitude illness. This article focuses on the two main issues for travelers: whether travel to a high altitude will have a negative effect on their underlying medical condition and whether the medical condition increases the patient's risk of developing altitude illness. Although patients with severe pulmonary or cardiac conditions are most at risk in the hypoxic environment, other conditions such as diabetes and pregnancy warrant attention as well.

When less is more: validating a brief scale to rate interprofessional team competencies.

BACKGROUND: There is a need for validated and easy-to-apply behavior-based tools for assessing interprofessional team competencies in clinical settings. The seven-item observer-based Modified McMaster-Ottawa scale was developed for the Team Objective Structured Clinical Encounter (TOSCE) to assess individual and team performance in interprofessional patient encounters. OBJECTIVE: We aimed to improve scale usability for clinical settings by reducing item numbers while maintaining generalizability; and to explore the minimum number of observed cases required to achieve modest generalizability for giving feedback. DESIGN: We administered a two-station TOSCE in April 2016 to 63 students split into 16 newly-formed teams, each consisting of four professions. The stations were of similar difficulty. We trained sixteen faculty to rate two teams each. We examined individual and team performance scores using generalizability (G) theory and principal component analysis (PCA). RESULTS: The seven-item scale shows modest generalizability (.75) with individual scores. PCA revealed multicollinearity and singularity among scale items and we identified three potential items for removal. Reducing items for individual scores from seven to four (measuring Collaboration, Roles, Patient/Family-centeredness, and Conflict Management) changed scale generalizability from .75 to .73. Performance assessment with two cases is associated with reasonable generalizability (.73). Students in newly-formed interprofessional teams show a learning curve after one patient encounter. Team scores from a two-station TOSCE demonstrate low generalizability whether the scale consisted of four (.53) or seven items (.55). CONCLUSION: The four-item Modified McMaster-Ottawa scale for assessing individual performance in interprofessional teams retains the generalizability and validity of the seven-item scale. Observation of students in teams interacting with two different patients provides reasonably reliable ratings for giving feedback. The four-item scale has potential for assessing individual student skills and the impact of IPE curricula in clinical practice settings. ABBREVIATIONS: IPE: Interprofessional education; SP: Standardized patient; TOSCE: Team objective structured clinical encounter.

Exercise: A vitally important prescription.

Sedentary lifestyles and low physical activity have led to rising health concerns and increasing mortality risks. With the growing concern of the inactivity of adult Americans, it is important that physical activity be promoted to prevent disease and reduce health risks. This article reviews the benefits of physical activity and the steps that primary care providers should take to evaluate physical activity as the fifth vital sign in every patient encounter. The 5A's (assess, advise, agree, assist, and arrange) should be applied in order to implement an exercise prescription into the practice of medicine.

Osteosarcoma: Accurately diagnosing this bone-chilling disease.

Osteosarcoma is the most common primary bone malignancy in children and adolescents. Because the incidence of osteosarcoma is low and the disease occurs in physically active patients, it may be misdiagnosed as a more benign condition, thus leading to late diagnosis. This article describes the disease's most frequent presenting complaints and initial radiographic findings, as well as its risk factors and common misdiagnoses. Clinicians should consider osteosarcoma in young patients with persistent bone pain, especially pain with weight-bearing.

What and how do students learn in an interprofessional student-run clinic? An educational framework for team-based care.

BACKGROUND: The student-run clinic (SRC) has the potential to address interprofessional learning among health professions students. PURPOSE: To derive a framework for understanding student learning during team-based care provided in an interprofessional SRC serving underserved patients. METHODS: The authors recruited students for a focus group study by purposive sampling and snowballing. They constructed two sets of semi-structured questions for uniprofessional and multiprofessional groups. Sessions were audiotaped, and transcripts were independently coded and adjudicated. Major themes about learning content and processes were extracted. Grounded theory was followed after data synthesis and interpretation to establish a framework for interprofessional learning. RESULTS: Thirty-six students from four professions (medicine, physician assistant, occupational therapy, and pharmacy) participated in eight uniprofessional groups; 14 students participated in three multiprofessional groups (N = 50). Theme saturation was achieved. Six common themes about learning content from uniprofessional groups were role recognition, team-based care appreciation, patient experience, advocacy-/systems-based models, personal skills, and career choices. Occupational therapy students expressed self-advocacy, and medical students expressed humility and self-discovery. Synthesis of themes from all groups suggests a learning continuum that begins with the team huddle and continues with shared patient care and social interactions. Opportunity to observe and interact with other professions in action is key to the learning process. DISCUSSION: Interprofessional SRC participation promotes learning 'with, from, and about' each other. Participation challenges misconceptions and sensitizes students to patient experiences, health systems, advocacy, and social responsibility. Learning involves interprofessional interactions in the patient encounter, reinforced by formal and informal communications. Participation is associated with interest in serving the underserved and in primary care careers. The authors proposed a framework for interprofessional learning with implications for optimal learning environments to promote team-based care. Future research is suggested to identify core faculty functions and best settings to advance and enhance student preparation for future collaborative team practice.

Transfusion-free treatment strategies for acute anemia in critical care.

Acute anemia is a frequently encountered diagnosis in critically ill patients, and can be a challenge if blood products are not readily available or if patients refuse these products on the basis of their religious beliefs. This article discusses the goals of anemia management and summarizes several alternatives to blood transfusions that can be used to prevent and treat acute anemia.

Interprofessional education and practice guide No. 5: Interprofessional teaching for prequalification students in clinical settings.

The importance of interprofessional education in health professions training is increasingly recognised through new accreditation guidelines. Clinician teachers from different professions may find themselves being asked to teach or supervise learners from multiple health professions, focusing on interprofessional dynamics, interprofessional communication, role understanding, and the values and ethics of collaboration. Clinician teachers often feel prepared to teach learners from their own profession but may feel ill prepared to teach learners from other professions. In this guide, we draw upon the collective experience from two countries: an institution from the United States with experience in guiding faculty to teach in a student-run interprofessional clinic and an institution from Canada that offers interprofessional experiences to students in community and hospital settings. This guide offers teaching advice to clinician educators in all health professions who plan to or already teach in an interprofessional clinical setting. We anticipate that clinician teachers can learn to fully engage learners from different professions, precept effectively, recognise common pitfalls, increase their confidence, reflect, and become role models to deliver effective teaching in interprofessional settings.

Healing livers, saving lives: Hepatitis C screening in an era of cure.

Chronic hepatitis C affects more than 3 million people in the United States. In the past, drug therapy with interferon and ribavirin resulted in low overall cure rates and early discontinuation due to adverse reactions. The new direct-acting antivirals offer not only a shorter duration of treatment with fewer adverse reactions, but greatly improved overall cure rates as high as 96%. Updated national screening recommendations (including a one-time screening for patients born between 1945 and 1965), combined with timely referral and treatment, offer a prime opportunity for healthcare providers to improve public health outcomes and reduce healthcare costs.

New oral anticoagulants for patients with nonvalvular atrial fibrillation.

Four new oral anticoagulants have been approved for reducing stroke risk in patients with nonvalvular atrial fibrillation. Compared with warfarin, these agents offer a more predictable dose response with fewer food and drug interactions and no regular blood monitoring, although some of the drugs have an increased risk of major gastrointestinal bleeding. This article reviews the new drugs.

Fighting childhood obesity one game at a time.

Traditional video games contribute to a sedentary lifestyle. Active video games that include physical activity may help reduce childhood obesity and have found an unconventional niche in medical treatment and training. This article offers providers practical information on how to evaluate popular active video games and how to encourage patients to make them part of a more healthful lifestyle.