Emanuel Olatunde Alaba Olanrewaju Odeku (1927-1974): First African Neurosurgeon Trained in the United States and Establisher of the National and West African Postgraduate Medical Colleges.

BACKGROUND: In this comprehensive historical account, the authors delve into the remarkable trajectory of Dr. Latunde E. Odeku, a pioneering figure in neurosurgery. METHODS: The inspiration for this project was ignited by the discovery of the original scientific and bibliographic materials of Latunde Odeku, a renowned Nigerian neurosurgeon and the first African neurosurgeon in history. Following a thorough review of the literature and information available on Dr. Odeku, we have compiled a comprehensive and detailed analysis of his life, work, and legacy. RESULTS: This paper begins by introducing his childhood and early education in Nigeria, highlights his journey through medical school and residency in the United States, and follows his career and role in establishing the first neurosurgical unit in West Africa. We celebrate the life and legacy of Latunde Odeku, a trailblazing neurosurgeon whose contribution has inspired generations of medical professionals in Africa and around the world. CONCLUSIONS: This article sheds light on the remarkable life and achievements of Dr. Odeku and his trailblazing work for generations of doctors and researchers.

For the People and the Profession.

In 1982 Dean Warren delivered the presidential address "Not for the Profession… For the People" in which he identified substandard surgical residency programs graduating residents who were unable to pass American Board of Surgery exams. Drs. Warren and Shires as members of the independent ACGME began to close the substandard programs in order to improve surgical care for average Americans i.e. "for the people". By 2003 these changes dramatically reduced the failure rate for the ABS exams and trained good surgeons who could operate independently however the residents were on duty for every other or every third night. In 2003 the ACGME mandated duty hour restrictions in order improve resident wellness and improve the training environment for the profession. However, work hour restrictions reduced the time surgical residents spent in the hospital environment primarily when residents had more autonomy and had exposure to emergency cases which degraded readiness for independent practice. Surgical educators in the 2 decades after the work hour restrictions have improved techniques of training so graduates could not only pass the board exams but also be prepared for independent practice. Surgical residency training has improved by both the changes implemented by the independent ACGME in 1981 and by the work hour restrictions mandated in 2003. Five recommendations are made to ensure that Dr Warren's culture of excellence in surgical training continues in an environment that enhances wellbeing of the trainee i.e. "For the People and the Profession".

Contemporary Issues in the Acquisition of Orthopaedic Surgical Skills During Residency: Competency-Based Medical Education and Simulation.

➤: Orthopaedic education should produce surgeons who are competent to function independently and can obtain and maintain board certification. ➤: Contemporary orthopaedic training programs exist within a fixed 5-year time frame, which may not be a perfect match for each trainee. ➤: Most modern orthopaedic residencies have not yet fully adopted objective, proficiency-based, surgical skill training methods despite nearly 2 decades of evidence supporting the use of this methodology. ➤: Competency-based medical education backed by surgical simulation rooted in proficiency-based progression has the potential to address surgical skill acquisition challenges in orthopaedic surgery.

Teaching medicine interns minimum geriatrics competencies within a "4 + 2" schedule.

The increased ambulatory training time in an "X + Y" (inpatient + ambulatory) residency schedule affords more opportunities to teach geriatrics principles of care. We describe our internal medicine (IM) residency program's experience in teaching the IM-family medicine (FM) minimum geriatrics competencies (MGC) during a longitudinal geriatrics rotation embedded within interns' yearlong "4 + 2" schedule. Interns spend 1 day of the ambulatory block in a geriatrics outpatient setting (Program of All-Inclusive Care for the Elderly, house calls, nursing home), during which geriatrics division faculty members give core didactic seminars. We revamped core seminars to address MGC related to medication management, cognitive health, complex chronic illnesses, end of life care, and ambulatory care. Three consecutive intern cohorts completed anonymous surveys pre- and postrotation, rating their confidence level in MGC addressed by the curriculum on a 5-point Likert scale. On postrotation surveys, they also rated the curriculum's contribution to geriatrics skills enhancement. Interns who completed both surveys (N = 22, 92%) reported statistically significant improved confidence ratings on all items, with the greatest point gains seen in performance of functional assessment (1.56), practice of optimal geriatric pharmacotherapy (1.78), and identification of older patients eligible for skilled (1.71) and unskilled home-based services (1.65). They rated geriatrics curricular components as being more helpful than other rotations and conferences in enhancing their geriatric skills. In conclusion, we developed a longitudinal geriatrics curriculum within the context of our "4 + 2" immersion schedule which other programs can easily adapt. Aligning curricular content with the MGC has resulted in interns' improved confidence in several important geriatrics skills.

Experience and Education in Residency Training: Capturing the Resident Experience by Mapping Clinical Data.

PROBLEM: Internal medicine training programs operate under the assumption that the 3-year residency training period is sufficient for trainees to achieve the depth and breadth of clinical experience necessary for independent practice; however, the medical conditions to which residents are exposed in clinical practice are not easily measured. As a result, residents' clinical educational experiences are poorly understood. APPROACH: A crosswalk tool (a repository of International Classification of Diseases [ICD]-10 codes linked to medical content areas) was developed to query routinely collected inpatient principal diagnosis codes and translate them into an educationally meaningful taxonomy. This tool provides a robust characterization of residents' inpatient clinical experiences. OUTCOMES: This pilot study has provided proof of principle that the crosswalk tool can effectively map 1 year of resident-attributed diagnosis codes to both the broad content category level (e.g., "cardiovascular disease") and to the more specific condition category level (e.g., "myocardial disease"). The authors uncovered content areas in their training program that are overrepresented and some that are underrepresented relative to material on the American Board of Internal Medicine (ABIM) Certification Exam. NEXT STEPS: The crosswalk tool introduced here translated residents' patient care activities into discrete, measurable educational content and enabled 1 internal medicine residency program to characterize residents' inpatient educational experience with a high degree of resolution. Leaders of other programs seeking to profile the clinical exposure of their trainees may adopt this strategy. Such clinical content mapping drives innovation in the experiential curriculum, enables comparison across practice sites, and lays the groundwork to test associations between individual clinical exposure and competency-based outcomes, which, in turn, will allow medical educators to draw conclusions regarding how clinical experience reflects clinical competency.

Local COVID-19 Epicenter in Detroit Metropolitan Area Causing Profound and Pervasive Reorganization of Clinical, Educational, Research, and Financial Programs of a Large Academic Gastroenterology Division with a GI Fellowship and Primary Medical School Affiliation.

AIM: To report revolutionary reorganization of academic gastroenterology division from COVID-19 pandemic surge at metropolitan Detroit epicenter from 0 infected patients on March 9, 2020, to > 300 infected patients in hospital census in April 2020 and > 200 infected patients in April 2021. SETTING: GI Division, William Beaumont Hospital, Royal Oak, has 36 GI clinical faculty; performs > 23,000 endoscopies annually; fully accredited GI fellowship since 1973; employs > 400 house staff annually since 1995; tertiary academic hospital; predominantly voluntary attendings; and primary teaching hospital, Oakland-University-Medical-School. METHODS: This was a prospective study. Expert opinion. Personal experience includes Hospital GI chief > 14 years until 2020; GI fellowship program director, several hospitals > 20 years; author of > 300 publications in peer-reviewed GI journals; committee-member, Food-and-Drug-Administration-GI-Advisory Committee > 5 years; and key hospital/medical school committee memberships. Computerized PubMed literature review was performed on hospital changes and pandemic. Study was exempted/approved by Hospital IRB, April 14, 2020. RESULTS: Division reorganized patient care to add clinical capacity and minimize risks to staff of contracting COVID-19 infection. Affiliated medical school changes included: changing "live" to virtual lectures; canceling medical student GI electives; exempting medical students from treating COVID-19-infected patients; and graduating medical students on time despite partly missing clinical electives. Division was reorganized by changing "live" GI lectures to virtual lectures; four GI fellows temporarily reassigned as medical attendings supervising COVID-19-infected patients; temporarily mandated intubation of COVID-19-infected patients for esophagogastroduodenoscopy; postponing elective GI endoscopies; and reducing average number of endoscopies from 100 to 4 per weekday during pandemic peak! GI clinic visits reduced by half (postponing non-urgent visits), and physical visits replaced by virtual visits. Economic pandemic impact included temporary, hospital deficit subsequently relieved by federal grants; hospital employee terminations/furloughs; and severe temporary decline in GI practitioner's income during surge. Hospital temporarily enhanced security and gradually ameliorated facemask shortage. GI program director contacted GI fellows twice weekly to ameliorate pandemic-induced stress. Divisional parties held virtually. GI fellowship applicants interviewed virtually. Graduate medical education changes included weekly committee meetings to monitor pandemic-induced changes; program managers working from home; canceling ACGME annual fellowship survey, changing ACGME physical to virtual site visits; and changing national conventions from physical to virtual. CONCLUSION: Reports profound and pervasive GI divisional changes to maximize clinical resources devoted to COVID-19-infected patients and minimize risks of transmitting infection.

The African American experience in reproductive medicine: provider, patient, and pipeline perspectives.

The goal of this Views and Reviews is to let colleagues and leaders well versed in the African American experience in reproductive medicine address the problems of racism affecting our trainees and patients and, more significantly, propose solutions. The areas in reproductive medicine that will be explored from the African American perspective include the pipeline of providers, health disparities, and access to infertility treatment.

Defining Successful Practice Within Health Systems Science Among Entering Residents: A Single-Institution Qualitative Study of Graduate Medical Education Faculty Observations.

PURPOSE: The American Medical Association's Accelerating Change in Medical Education consortium defined health systems science (HSS) as the study of how health care is delivered, how health care professionals work together to deliver that care, and how the health system can improve patient care and health care delivery. This framework is increasingly being incorporated into medical school curricula. Graduate medical education (GME) had previously elevated systems-based practice (SBP) as a core competency, but expectations are defined by specialty-specific milestones. The lack of a shared competency framework between undergraduate medical education (UME) and GME makes it challenging to ensure that entering residents are prepared to implement HSS/SBP concepts in the workplace. The authors explored GME faculty observations of residents exemplifying successful practice across HSS domains to inform targets for UME training and assessment. METHOD: Authors performed a single-institution qualitative study using transcribed phone interviews with eligible Vanderbilt residency program directors, associate program directors, and core faculty. Participants described observations of successful residents within each HSS domain. Two researchers independently coded, discussed, and reconciled deidentified transcripts using inductive-deductive approaches to identify themes. RESULTS: Seventeen faculty participated across specialties (17/39, 45%). Faculty responses emphasize precurricular experiences including professional degrees, work experience, extracurriculars, and medical school exposure. Importantly, successful residents exhibit foundational core workforce characteristics including growth mindset, curiosity, and a desire to learn about systems. GME faculty identified HSS domain-specific skills, noting distinctions among learning environments. Outcomes resulting from residents' application of HSS concepts include delivering high-quality, person-centered care and systems improvements. CONCLUSIONS: Descriptions of successful practice within HSS domains highlight preparatory experiences and core workforce characteristics and outline entry-level HSS behaviors. Conceptualized in a logic model framework, these findings describe key inputs, learning activities, outputs, and outcomes for systems-prepared entering residents bridging the UME-GME transition.

Educational value of surgical telementoring.

Educating surgeons is a time-consuming process. In addition to theoretical knowledge, the practical tasks of surgical procedures must be mastered. Translation of such knowledge from mentor to mentee may be efficiently done by surgical telementoring (ST). This is a review on surgical telementoring. Recent technological advances have made this tool in surgical education more available and applicable but future applications of ST have to be wisely guided by high-quality trials.

Team training and surgical crisis management.

Team training and crisis management derive their roots from fundamental learning theory and the culture of safety that burgeoned forth from the industrial revolution through the rise of nuclear energy and aviation. The integral nature of telemedicine to many simulation-based activities, whether to bridge distances out of convenience or necessity, continues to be a common theme moving into the next era of surgical safety as newer, more robust technologies become available.

Experiential Learning and Mentorship in Global Health Leadership Programs: Capturing Lessons from Across the Globe.

Objectives: The changing global landscape of disease and public health crises, such as the current COVID-19 pandemic, call for a new generation of global health leaders. As global health leadership programs evolve, many have incorporated experiential learning and mentoring (ELM) components into their structure. However, there has been incomplete consideration on how ELM activities are deployed, what challenges they face and how programs adapt to meet those challenges. This paper builds on the co-authors' experiences as trainees, trainers, organizers and evaluators of six global health leadership programs to reflect on lessons learned regarding ELM. We also consider ethics, technology, gender, age and framing that influence how ELM activities are developed and implemented. Findings: Despite the diverse origins and funding of these programs, all six are focused on training participants from low- and middle-income countries drawing on a diversity of professions. Each program uses mixed didactic approaches, practice-based placements, competency and skills-driven curricula, and mentorship via various modalities. Main metrics for success include development of trainee networks, acquisition of skills and formation of relationships; programs that included research training had specific research metrics as well. Common challenges the programs face include ensuring clarity of expectations of all participants and mentors; maintaining connection among trainees; meeting the needs of trainee cohorts with different skill sets and starting points; and ensuring trainee cohorts capture age, gender and other forms of diversity. Conclusions: ELM activities for global health leadership are proving even more critical now as the importance of effective individual leaders in responding to crises becomes evident. Future efforts for ELM in global health leadership should emphasize local adaptation and sustainability. Practice-based learning and established mentoring relationships provide the building blocks for competent leaders to navigate complex dynamics with the flexibility and conscientiousness needed to improve the health of global populations. Key Takeaways: Experiential learning and mentorship activities within global health leadership programs provide the hands-on practice and support that the next generation of global health leaders need to address the health challenges of our times.Six global health leadership programs with experiential learning and mentorship components are showcased to highlight differences and similarities in their approaches and capture a broad picture of achievements that can help inform future programs.Emphasis on inter-professional training, mixed-learning approaches and mentorship modalities were common across programs. Both individual capacity building and development of trainees' professional networks were seen as critical, reflecting the value of inter-personal connections for long-term leadership success.During program design, future programs should recognize the "frame" within which the program will be incorporated and intentionally address diversity-in all its forms-during recruitment as well as consider North-South ethics, leadership roles, hierarchies and transition plans.