Impact of a Resident-Driven Research Club on Scholarly Activity in an Academic Internal Medicine Residency Program During the COVID-19 Pandemic.

OBJECTIVES: Traditional journal clubs have been shown to be insufficient in improving residents' scholarly productivity, often due to the inability to sustain residents' interest and participation. Additionally, the 2019 novel coronavirus (COVID-19) pandemic restrictions caused a decline in academic scholarly productivity across residency programs. We evaluated the impact of a resident-led research club called 'journal café' on residents' scholarly productivity by comparing scholarly output between the journal café members and non-members during the COVID-19 pandemic. METHODS: The journal café was established in the 2012/2013 academic year by internal medicine residents of a university residency program in Atlanta, Georgia, to foster self-directed collaboration among residents based on shared interests in academic research. The journal café runs independently of the residency program's journal club. We categorized IM residents at our institution into journal café members and non-members and collected data on their research productivity during residency training and the COVID-19 pandemic. The survey was conducted between April and June 2021 and analyzed data presented using frequencies, tables, and appropriate charts. RESULTS: Sixty-eight residents (29 journal café members and 39 non-members) completed the survey (response rate of 85%). A significantly higher number of journal café members reported having five or more research publications (55.1% vs 7.1%, P < .001) and scientific presentations (48.3% vs 2.6%, P < .001) compared with non-members. Additionally, more journal café members published COVID-19-related research in peer-reviewed journals compared with non-members (68% vs 32%, n = 19). Finally, most of the residents cited the opportunity of a platform to share and brainstorm on research ideas as the reason for joining the journal café. CONCLUSION: We found an association between journal café participation and increased scholarly activity, particularly during the COVID-19 pandemic. Independent resident-led research clubs supported by the residency program may complement the traditional journal clubs and enhance residents' participation in research.

An Educational Intervention to Enhance Palliative Care Training at HBCUs.

CONTEXT: Primary palliative care training is important for clinicians at Historically Black Colleges and Universities (HBCUs) given the decreased access to specialty palliative care among Black patients and patients' preferences for race concordant care. OBJECTIVES: To describe the impact of a palliative care educational intervention at two HBCUs. METHODS: We administered a palliative care educational intervention in family and internal medicine residency programs at Morehouse School of Medicine and Howard University College of Medicine. Pre- and post-intervention surveys were sent to residents assessing attitudes toward their palliative care education and their perceived competency in specific palliative care domains. The results were analyzed using Chi-squared analysis. RESULTS: A total of 105 of 191 (response rate 55%) residents completed pre-intervention surveys and 101 of 240 (42%) completed post-intervention surveys. Prior to the intervention, 50% of residents rated their overall preparedness in palliative care as a 7 or above (0-10 Likert scale); 78% (P < .01) of respondents reported ≥7/10 after the educational intervention. While post-intervention residents did not feel better prepared to treat symptoms, a higher percentage reported feeling well prepared to deliver bad news (41% post-intervention vs. 23% pre-intervention) and conduct a family meeting (44% post-intervention vs. 27% pre-intervention) (P < .05). Pre-intervention, 14% of residents felt their overall palliative care education was very good or excellent, while post-intervention ratings increased to 30% (P < .01). CONCLUSION: Residents' confidence in their preparedness to provide palliative care, particularly in their communication skills increased after an intervention at two HBCUs.

Saved by the PEEP: Resolution of Complete Unilateral Lung Collapse Secondary to Mucus Plugging With Ventilator Technique.

Bronchoscopy can be used to resolve respiratory failure caused by tenacious mucus plugs. However, emergent bronchoscopy to resolve mucus plugging is not always available in small rural hospitals around the country. We present a case in which increasing the positive end-expiratory pressure settings on the ventilator resulted in immediate improvement in patient oxygenation and imaging findings during a respiratory emergency caused by mucus plugging.

Palliative Care Attitudes and Experiences among Resident Physicians at Historically Black Colleges and Universities.

CONTEXT: Seriously ill Black patients receive lower quality palliative care than White patients. Equitable access requires palliative care skills training for all physicians. Historically Black Colleges and Universities (HBCUs) play a key role in educating Black physicians and have less access to palliative care resources. OBJECTIVE: To investigate palliative care attitudes and experiences among primary care residents at HBCUs. METHODS: Internal Medicine and Family Medicine residents at two HBCUs completed an online survey assessing attitudes towards palliative care and teaching and clinical experiences in palliative care. We performed a descriptive analysis of survey items. RESULTS: Among 91 residents who completed the survey (response rate 48%), 65% were women and 68% Black. Most (96%) said that learning about palliative care was moderately/very important to their career; however, two-thirds of respondents considered care for dying patients to be depressing and half reported receiving negative messages about palliative care from other physicians. Residents reported receiving less teaching about providing palliative care (5.4 ± 2.3 on 10-point scale) than about managing sepsis (8.3 ± 1.8; P < 0.05). Fewer residents rated their palliative care education as "Excellent" or "Very Good" compared to their overall education (13% vs 70%; P < 0.05). CONCLUSION: In the first survey exploring palliative care education at HBCUs, residents viewed palliative care as important but described the quality of their palliative care education as poor. This study highlights opportunities for improving palliative care education at HBCUs as a step toward addressing disparities in serious illness care.

Lack of Exposure to Palliative Care Training for Black Residents: A Study of Schools With Highest and Lowest Percentages of Black Enrollment.

CONTEXT: The palliative medicine workforce lacks racial diversity with <5% of specialty Hospice and Palliative Medicine (HPM) fellows identifying as black. Little is known about black trainees' exposure to palliative care during their medical education. OBJECTIVES: To describe palliative care training for black students during medical school, residency, and fellowship training. METHODS: We conducted a cross-sectional descriptive study using Internet searches and phone communication in September 2019. We evaluated 24 medical schools in three predetermined categories: historically black colleges and universities (HBCUs; N = 4) and non-under-represented minority-serving institutions with the highest (N = 10) and lowest (N = 10) percentages of black medical students. Training opportunities were determined based on the presence of a course, clerkship, or rotation in the medical school and residency curricula, a specialty HPM fellowship program, and specialty palliative care consult service at affiliated teaching hospitals. RESULTS: None of the four HBCUs with a medical school offered a palliative care course or clerkship, rotation during residency, or specialty HPM fellowship program. Three of four HBCUs were affiliated with a hospital that had a palliative care consult service. Institutions with the highest black enrollment were less likely to offer palliative care rotations during internal medicine (P = 0.046) or family medicine (P = 0.019) residency training than those with the lowest black enrollment. CONCLUSION: Residents at schools with the highest black medical student enrollment lack access to palliative care training opportunities. Efforts to reduce health disparities and underrepresentation in palliative care must begin with providing palliative-focused training to physicians from under-represented minority backgrounds.

The impact of health literacy on self-monitoring of blood glucose in patients with diabetes receiving care in an inner-city hospital.

BACKGROUND: Self-monitoring of blood glucose (SMBG) is considered to be 1 of the cornerstones of diabetes self-management. It is unclear whether inadequate health literacy affects SMBG. OBJECTIVE: The objective of this study was to examine the relationship between health literacy and SMBG. METHODS: This was a cross-sectional survey of 189 patients with diabetes, aged 18 to 65 years, receiving care in a large urban, public health care setting. We measured health literacy using the shortened version of the Test of Functional Health Literacy in Adults. The diabetes care profile was used to determine the use of self-monitoring of blood glucose. RESULTS: Most (60.9%) of the survey participants were assessed as functionally health literate. The majority (90.9%) of the study participants reported testing their blood sugar at least once daily. Although adequate health literacy was associated with recording of blood sugar testing (p = .049), we found no statistically significant relationship between health literacy and the frequency of SMBG. Persons self-reporting having diabetes for more than 10 years were less likely to self-monitor blood glucose (odds ratio, 0.33; 95% CI, 0.11-0.99). CONCLUSIONS: SMBG frequency is not independently associated with health literacy, but SMBG result recording is noted among patients with inadequate literacy.

Evaluation of telemetry utilization, policy, and outcomes in an inner-city academic medical center.

OBJECTIVE: To evaluate the appropriateness and intermediate outcomes of telemetry admissions. METHODS: We abstracted demographic and clinical data from records of all new telemetry admissions during a 2-month period. To determine appropriateness, 2 authors classified patients using the American College of Cardiology (ACC) guidelines and our telemetry policy. Other utilization and outcome measures were assessed. Agreement between both guidelines was computed (kappa coefficient). Categorical group covariates were compared using chi2 test. Variations in telemetry length of stay (LOS) were compared using Mann-Whitney and Kruskal-Wallis tests. LOS predictors were ascertained by multiple regression analysis. RESULTS: Of the 120 patients, appropriate admission was 81.6% (ACC criteria) and 83% by our criteria. Guidelines interrater reliability was .89 (kappa). Telemetry events incidence was 33.3%, with 5.8% major and 27.5% minor. LOS was longer among major than minor events group(7.8 vs. 3.4 days, p = .01). Type of telemetry event was a predictor of LOS (p = .0001). The occurrence of a major telemetry event was associated with cardiology consultation (p = .03). CONCLUSIONS: Appropriate telemetry admission was observed in more than 80% of cases. Our telemetry policy had very good agreement with standard guideline. However, the low rate of major telemetry events in all patient groups suggests current guidelines might have considerable limitations.

Learning Styles of Internal Medicine Residents and Association With the In-Training Examination Performance.

INTRODUCTION: Assessment of how medical residents learn and the impact on standardized test performance is important for effective training. Kolb's learning study inventory categorizes learning into accommodating, assimilating, converging and diverging based on the four stages of learning: active experimentation, abstract conceptualization, concrete experience and reflective observation. The American College of Physicians (ACP) Internal Medicine In-Training Examination (IM-ITE) has been shown to positively correlate with successful performance on clinical assessments and board certification. We sought to evaluate the association between the individual learning styles of IM residents and performance on the ACP IM-ITE. METHODS: The Kolb LSI questionnaire was administered to IM residents during the 2016/2017 academic year. Logistic regression was used to analyze the association between residents preferred learning styles and performance on the ACP IM - ITE. RESULTS: 53 residents in the IM Residency Program of Morehouse School of Medicine completed the questionnaire. The predominant learning style was assimilating (49%), followed by converging (26%). There was no significant difference between the learning styles of residents when compared across gender, age, race, and PGY levels. Residents with a diverging learning style had the highest mean IM-ITE percentage score followed by assimilating and converging respectively (P = 0.14) CONCLUSIONS: The predominant learning styles among our IM residents are assimilating and converging, which is consistent with previous studies. Residents with a diverging style of learning appeared to perform better on the IM-ITE. We suggest that future studies should evaluate the feasibility of integrating brainstorming and group work sessions into the IM residency teaching curriculum and the impact on academic performance.

The preferred learning style among residents and faculty members of an internal medicine residency program.

OBJECTIVE: To determine the preferred learning style, as defined by David Kolb, and predictors of the different learning styles among residents and faculty members at an internal medicine residency program. DESIGN/SETTING: A cross sectional study of internal medicine residents and faculty members at Morehouse School of Medicine was performed using the Kolb Learning Style Inventory (LSI) version 3.1. MEASUREMENTS: The Kolb LSI is a questionnaire of 12 sentences, each with four phrases for sentence completion that are to be ranked according to how they apply to the subject. RESULTS: Forty-two out of 59 questionnaires that were given out to residents and attending physicians were properly completed and returned. Assimilating style was the predominant learning style among residents (42%) and attending physicians (55%). There was no significant association between age, gender or medical education status, and learning styles. CONCLUSIONS: The understanding of residents' learning styles may facilitate instructional rapport between residents and attending physicians, thereby improving residents' academic performance.

Candida dubliniensis abscess: A clinical case and a review of the literature.

Candida dubliniensis infections are rare in the absence of prolonged immunocompromised status or intravenous drug abuse. We present a case of a C. dubliniensis soft tissue abscess in a patient with uncontrolled diabetes as his only immunocompromising risk factor, treated with surgical drainage and medical management.

Is telemetry overused? Is it as helpful as thought?

Cardiac telemetry is widely used in hospitals, but it is expensive and labor-intensive. Therefore, it should be used only in those most likely to benefit. The authors review the available evidence and offer their recommendations.