Introduction to Disability and Antiableist Health Care: A Pilot, Student-Led Module for Preclinical Medical Students.

ABSTRACT: Physical medicine and rehabilitation physicians often care for disabled patients, who comprise America's largest marginalized population. Despite medical students' and physicians' discomfort with caring for disabled patients and the pervasiveness of ableism in health care, medical education lacks disability-focused education. Kern's approach to curriculum development and disability community input were used to design a three-part, elective curriculum for first-year medical students. Part one introduced disability models and language. Part two described how to perform a comprehensive history and physical examination for a disabled patient using ADEPT-CARE. Part three provided an overview of disability history and the disability rights movement. The curriculum's goal was to improve students' attitudes regarding disability health and self-perceived knowledge and confidence in caring for patients with disabilities. The curriculum was evaluated through presurvey and postsurvey. Students favorably reviewed the curriculum. One hundred percent of students ( n = 21) agreed or strongly agreed that the curriculum improved their knowledge of disability health, increased their perceived confidence in caring for patients with disabilities, and enhanced their medical education. There were no statistically significant differences in students' attitudes toward patients with disabilities after curriculum completion. Our asynchronous module provides one potential curriculum for increasing preclinical medical students' self-perceived knowledge of disability health.

ADEPT-CARE: A pilot, student-led initiative to improve care for persons with disabilities via a novel teaching tool.

BACKGROUND: Over one-quarter of United States adults live with a disability. Despite persistent ableism, defined as discrimination and prejudice against people with disabilities, in healthcare, disability-focused training remains largely absent from medical education. OBJECTIVE: The aim of this study was to pilot and evaluate a novel teaching mnemonic (ADEPT-CARE) for performing a comprehensive history and physical exam for disabled patients. METHODS: In Spring 2022, first-year medical students at a suburban Mid-Atlantic institution could electively participate in a learning module that included ADEPT-CARE. Surveys were administered to students before and following exposure to the ADEPT-CARE protocol. RESULTS: Of 142 eligible students, 33 and 21 completed the pre- and post-surveys, respectively. The ADEPT-CARE protocol made sense to 95.2% of students. All (100%) students reported that they will use the ADEPT-CARE protocol in the assessment of patients with disabilities. Students were more likely to agree or strongly agree that they had a consistent approach or strategy in mind when assessing a patient with a disability after exposure to ADEPT-CARE (85.7% vs. 39.4%, respectively, p = 0.002). There was no statistically significant difference in students' perceived confidence in their ability to assess a patient with a disability after curriculum completion compared to before (85.7% vs. 81.8%, respectively, p = 1.0). CONCLUSIONS: The ADEPT-CARE protocol has the potential to be an effective teaching tool by providing a framework to equitably care for disabled patients. Future research should assess whether students' self-reported increased confidence and intention to utilize ADEPT-CARE translates into the clinical setting.

Caecal volvulus in a foramen of Winslow hernia.

Caecal herniation through the foramen of Winslow is an uncommon presentation of internal hernia with an estimated overall incidence of 0.02%. Even rarer still is a caecal volvulus strangulated in the lesser sac, a surgical emergency seldom described in the literature. A woman in her 70s presented with a 1-day history of acute-onset right upper quadrant and epigastric pain associated with nausea and vomiting. Prompt CT imaging revealed caecal volvulus within a foramen of Winslow hernia. The diagnosis was confirmed by laparotomy. A right hemicolectomy was performed and the foraminal defect was closed. We identified eight case reports of this rare entity published within the last 30 years. Our patient was managed in a similar manner and recovered without complication, providing further guidance for the operative management of caecal volvulus in the foramen of Winslow.

Evaluation of a Required Vertical Point-of-Care Ultrasound Curriculum for Undergraduate Medical Students.

Introduction Point-of-care ultrasound training beginning in undergraduate medical education reinforces anatomy and physical examination skills and enhances clinical care. Implementation in an overcrowded curriculum requires strategic planning to overcome barriers including lack of faculty and equipment. Using Kern's six-step model as a framework, our study question was whether a longitudinal point-of-care ultrasound curriculum threaded through four years of medical school and using a novel combination of evidence-based strategies was feasible, acceptable, and resulted in students achieving ultrasound competencies by graduation. Materials and methods From 2016 to 2020, a required, vertical point-of-care ultrasound curriculum was created across all four undergraduate medical education class years, spearheaded by a single ultrasound fellowship-trained emergency physician with support from two basic anatomy faculty. We utilized strategies including handheld ultrasound devices, near-peer teaching, flipped classroom with virtual learning modules, staggered station rotations, and gamification to optimize student-instructor ratios and faculty time. Surveys and timed objective structured clinical assessments evaluated the curriculum. Results Students from the class of 2022 (n=99, 100% of class) participated in all curricular elements. Senior students answered more survey knowledge questions correctly when compared to pretest questions answered by first- and second-year students. Among 84 students who completed the survey, 75 (89%) rated their ultrasound curriculum as superior or above average. Objective structured clinical examination scores recorded for 53 students (54% of the class) demonstrated students correctly identified a median of 11-18 structures (interquartile range: 9.5-13) using point-of-care ultrasound. Conclusion Evidence-based strategies allowed faculty to develop a four-year required ultrasound curriculum that was highly acceptable by students and improved their knowledge and skills at graduation. At low cost and with few faculty, this program has been sustained for over six years.

Cultural pluralism and prejudice reduction.

Predictions derived from models of cultural pluralism and cultural assimilation were tested. Previous research has shown that highlighting differences between ethnic groups, in conjunction with self-focus, can reduce prejudice. The presented research tested the following questions: (a) does highlighting differences function to reduce prejudice between groups that are dissimilar to each other as well as between those that are highly similar, (b) is prejudice reduction due to distinctiveness a function of the lessened ingroup positivity or lessened outgroup negativity, (c) does making distinctiveness salient reduce prejudice toward only the distinctive outgroups or to outgroups more generically, and (d) does the manipulation equally impact African American, Mexican American, Mexican National, and White American participants? Results demonstrated that highlighting differences while simultaneously focusing on the self reduces prejudice, although similarity mediates the relationship with those who are perceived as more different. Distinctiveness also reduced outgroup negativity and generalized to other outgroups. Finally, the manipulation reduced prejudice only for White Americans, Mexican Americans, and Mexican Nationals.

Reducing online identity disclosure using warnings.

In an experimental design, we tested whether written warnings can reduce the amount of identity information exposure online. A psychological attack on information privacy that has been shown to be effective in previous research was launched. This attack took advantage of the fact that people respond to certain types of requests in a relatively automatic, or mindless, fashion. The experiment manipulated the word that was used in the alert header: "warning", "caution", or "hazard". All warnings proved to be effective in reducing disclosure, but "hazard" proved to be most effective. Also warnings were more effective in reducing disclosure of driver's license numbers than email addresses. The discussion (a) provides tentative conclusions why these patterns were obtained, (b) suggests how to design warnings in cyber-environments, and (c) addresses future possibilities for research on this topic.

Fate of Small Populations of Listeria monocytogenes on Poultry Processed Using Moist Heat.

The survival of small populations of Listeria monocytogenes on poultry processed using a moist heating method was determined. Various inoculum concentrations (3.2 × 102, 4.8 × 103, and 4.7 × 104) were applied to chicken breasts which were cooked to an internal endpoint temperature of 73.9°C (165°F). After cooking, portions were either vacuum-packaged or wrapped in an oxygen permeable film and stored for up to 4 wk at 4°C or up to 10 d at 10°C. Some Listeria survived the cooking process regardless of the inoculum levels. Significant increases (p<0.05) in the L. monocytogenes population occurred for each inoculum concentration at both storage temperatures within the first sampling period (week 1 for 4°C and day 3 for 10°C). Samples stored at both temperatures were able to re-establish themselves to population levels at or above the initial inoculum. No differences were noted due to packaging.

Survival of Large Populations of Listeria monocytogenes on Chicken Breasts Processed Using Moist Heat.

The ability of Listeria monocytogenes to survive and proliferate on chicken processed using a moist heating method was investigated. Chicken breasts were inoculated with 106-107 microorganisms/g, cooked to one of five different cooking temperatures, then either vacuum packaged or wrapped in an oxygen permeable film and stored at 4°C for up to 4 weeks or at 10°C for up to 10 d. Lethality was directly related to the cooking temperatures employed in this study, however survivors were encountered at each of the heat treatments employed. By the fourth week of storage at 4°C, the L. monocytogenes population in all of the samples, except those cooked to 82.2°C increased significantly. In contrast, within the first week of storage at 4°C the population increased in only three samples (73.9°C film overwrap, 65.6°C and 71.1°C vacuum packaged). Storage at 10°C allowed microbial populations in 6 of the 10 treatments to significantly increase within 3 d, with the remaining 4 significantly increasing within 10 d. Differences in packaging influenced the growth rate of L. monocytogenes at both storage temperatures.