Gazing in the Mirror: Reflecting on Student Perspectives in Work-Integrated Learning in Healthcare Education

Abstract: Student engagement is typically woven into the curriculum of healthcare education through hands-on experiences, lectures, discussions, active learning, and lab components. This engagement is critical to developing student confidence, efficacy, and esteem in important skills that will serve them as they enter their profession. In our doctoral program, we are allowed additional engagement opportunities, including belonging to a research project with professionals. Upon reflection, our experience on an interprofessional research team has helped to translate our classroom knowledge to research and professional practice skills. Plain-Language Summary: This paper is a reflection on the value of adding work skills beyond common fieldwork placements. We recommend schools give students an opportunity to try research skills as part of a working team

Transitions into GME Program Leadership Roles in Neonatal-Perinatal Medicine: Opportunities for Improvement

Introduction: Graduate Medical Education (GME) leadership can be a rewarding and valuable career path. Strong, skilled leadership is critical to the success of any training program. Despite this, there are few requirements and minimal guidance to prepare for GME leadership roles. Aims: Identify pathways into Neonatal-Perinatal Medicine (NPM) GME leadership roles and describe the needs of incoming program leaders. Methods: The Organization of Neonatal-Perinatal Training Program Directors (ONTPD) distributed an annual anonymous survey to all NPM programs in September 2024. Quantitative questions utilized descriptive statistics. For free text responses, thematic qualitative analysis was utilized to summarize the findings. Coding discrepancies were reconciled amongst the 3 independent reviewers. Results: Leadership from 87 out of 105 (83%) of NPM programs responded. The majority of respondents were the program director (PD) 88%, with 65% of PDs having previously served as an Associate PD (APD), with a median of 2 years in the APD role (Table 1). Of program leaders, only half (55%) planned to have a career in GME, with a wide variety of situations leading to the leadership role (Figure 1). Leaders first joined GME leadership a median of 4 years after completing fellowship. Most program leaders had support for transitioning into the role (91%) including: mentoring from other PD/APDs (44%), meetings to review program tasks and timelines (43%), program coordinator assisted in preparing (41%), and previous program leader stayed in another program role (40%). Figure 2 showcases program leadership’s overall satisfaction or dissatisfaction with important elements of the transition. Thematic analysis identified 6 major themes as most helpful in preparing for a role in fellowship program leadership: mentorship, resources, support, experience, planned transition, and national conferences. Local mentorship, resources, and outgoing program director support were most commonly described and national resources and mentorship through ONTPD were frequently cited. Conclusion: NPM program leaders need mentorship, resources, and support both locally and nationally. We identified areas of opportunity to optimize planned transitions for new leaders. We encourage division leaders to define roles, provide appropriate protected time for leadership in GME, and allocate divisional support and resources. These results reiterate the importance of national collaboration as a tool for new and successful GME leaders

Universal Adolescent Depression Screening and Implications for Identification of Adolescent Depression and Mental Health Referrals

Background: Throughout the United States, mental health concerns have been steadily increasing, which has created a significant impact for caregivers, overburdened healthcare facilities, and patients. In fact, a large number of those experiencing mental health issues are unidentified and thus more likely to experience mental health crises, suicidal ideation, or suicide attempts. Rural adolescents are significantly more vulnerable than their urban counterparts related to disparities in both mental health services and preventative screening. Coordination with a critical access hospital (CAH) emergency department revealed that there was no universal adolescent depression screening in place, and patients were potentially going undiagnosed and untreated. Objectives: Objectives of this quality improvement project included increasing staff knowledge and competence with administration of the PHQ-2/PHQ-9 through an educational in-service, providing universal adolescent depression screening in a CAH ED through administration of the PHQ-2/PHQ-9 to all presenting patients ages 12-18, and using depression screening results to increase the provision of mental health referrals in this setting. Methods: This quality improvement project was a prospective cohort study design, which was initiated by a rural CAH in the ED setting. Retrospective chart review pre- and post- project implementation involving three months prior to implementation and three months after implementation was conducted. Additionally, staff education related to depression screening was provided prior to project implementation and its effectiveness was measured through pre- and post- test result comparisons. Universal depression screening using PHQ-2/PHQ-9 tools was then completed on patients presenting to the CAH who were within the designated 12-18 year old age range. Results: There were 24 staff members that completed the educational training along with pre- and post- tests. Pre-test scores demonstrated a mean of 71.92 (SD=10.50), and post-test scores had an increased mean of 82.88 (SD=4.76). A paired t-test showed that the mean difference between pre- and post- test scores was -10.96 (CI: -15.22 to -6.70) with a significant t-value of -5.319 (p Conclusion: Universal adolescent depression screening has the potential to increase identification and treatment rates as well as providing the opportunity for mental health referrals. Early intervention has been shown to prevent financially and emotionally costly mental health crises, and universal screening can aid in the identification that leads to early intervention. Although this study was limited by small sample sizes, staff knowledge and adolescent screening rates increased after education and project implementation. This demonstrated that further studies with larger sample sizes and more diverse settings are needed to demonstrate full practice implications

Pearls for Surgical Dermatology: Common Sense Solutions for Common Problems

Introduction: Efficiency and precision in surgical dermatology are crucial for optimizing patient outcomes and procedural success. This study presents a collection of practical surgical pearls designed to address common challenges encountered in dermatologic surgery. By implementing these streamlined techniques, practitioners can improve hemostasis, enhance visualization, and reduce surgical tension while maintaining favorable cosmetic results. Methods & Key Techniques: Several surgical pearls were compiled based on clinical experience and literature review. Key strategies include: Forceps-Assisted Cautery for Hemostasis: A technique that enhances efficiency by directing electrical current through forceps to neutralize bleeding vessels without additional clamps or sutures. Nasal Ala Hemostasis with Q-Tip Support: Utilizing a cotton-tipped applicator within the nares to provide back pressure and improve bleeding control. Plicating Stitch for Linear Closure: A subcutaneous suture placed before wedge removal to minimize scar length and maintain aesthetic outcomes. Towel Clamp & High-Tensile Sutures for Scalp Flaps: Methods to facilitate tension-free closure and expedite wound approximation. Q-Tip-Assisted Punch Biopsy Hemostasis: A simple technique for maintaining hemostasis while preparing sutures. Tragus Displacement for Conchal Bowl Procedures: A method using a rake retractor to improve surgical access and visualization. Conclusion: These surgical pearls offer low-cost, high-impact modifications that can be seamlessly integrated into dermatologic surgery to enhance efficiency and patient outcomes. By incorporating these techniques, clinicians can reduce procedural complexity, improve hemostasis, and optimize cosmetic results while maintaining patient comfort.https://digitalcommons.unmc.edu/emet_posters/1041/thumbnail.jp

Culturally Tailored Interventions Enhance Diabetes Awareness and Management within the Karen Community

https://digitalcommons.unmc.edu/com_fam_pres/1017/thumbnail.jp

Multilevel Considerations for Youth Attention-Deficit/Hyperactivity Disorder Prognosis and Management: Examining the Relationship between Health Care Factors and Familial Factors in Families of Children and Adolescents with ADHD

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder impacting up to 10% of U.S. youth, and is associated with several negative social, health, and academic or occupational outcomes. Risk and prognostic factors for ADHD are multifactorial, and the management of youth ADHD is multimodal. Familial environments are one prognostic factor for ADHD, with family resilience being positively associated with youth ADHD prognosis. Researchers exploring multilevel interventions for the management of youth ADHD have proposed health care systems as a setting for interventions targeting family resilience, however little research examines the relationship between health care system factors and family factors in families of children and adolescents with ADHD. The studies in this dissertation examine the relationship between three health care system factors, including family-centered care, care coordination, and parental emotional support from a health care provider, and family resilience, using the Family Resilience and Connection Index (FRCI) as an outcome measure. Outcomes demonstrate a statistically significant relationship between family-centered care and FRCI, as well as care coordination and FRCI. There was not a statistically significant relationship between parental emotional support from a health care provider and FRCI. As models of care for youth with ADHD, such as the Medical Home Model, include multiple health care system factors, future research should examine the comparative and/or cumulative impacts these health care system factors have on family resilience to better inform health care system practices in the management of children and adolescents with ADHD

App Assisted Depression Self-Management in Integrated Primary Care: A Pilot Study Exploring Patient and Provider Experiences

The integrated primary care (IPC) setting is currently the de facto institution for accessing mental healthcare among underserved populations. However, many barriers exist for these populations when seeking regular and adequate mental healthcare, including provider availability and transportation challenges. This study piloted the incorporation of mindLAMP, a mHealth app, into IPC treatment to offer a low-resource intervention designed to improve and expand access to mental healthcare for underserved patients between face-to-face visits. This study gathered data from a sample of both behavioral health providers and patients (N = 6) in IPC settings to pilot the use of the mindLAMP app among traditionally underserved patients with depression. The Patient Activation Measure and Patient Health Questionnaire were used to assess patient outcomes in addition to conducting a directed content analysis on qualitative data obtained with interviews of both patients and providers. Results from the mixed methods study design indicate that implementing this digital intervention in the IPC setting is feasible and positively experienced by both patients and providers. Perceived positive outcomes were reported by both patients and providers after incorporating the mHealth app into their mental healthcare. However, both patients and providers discussed barriers to mHealth app use that need to be addressed in order to accommodate more widespread use. Further, constraints and barriers at the provider, patient, and healthcare system levels were discussed and need to be examined further to increase the implementation of this multilevel digital intervention

An Innovative Approach to Operating Room Simulation with Dental Hygiene Student Preparedness and Awareness: An iEXCEL Interprofessional Pilot Project

During previous student rotations in the operating room, senior dental hygiene students exhibited a lack of understanding and preparedness, resulting in significant anxiety and limited experiential learning. This project aims to create a simulated interprofessional learning environment where dental hygiene students can experience a dental surgical case scenario in a simulated operating room. Senior dental hygiene (DH) students participated in pre- and post-survey assessments using REDCap, focusing on student preparedness and enhanced awareness of the operating room through simulation. A convergent mixed methods design was employed, collecting quantitative and qualitative data in parallel, analyzing them separately, and then merging the results. Likert scale questions were used to evaluate the impact of the operating room simulation on student preparedness at the UNMC Davis Global Center. The findings revealed a statistically significant association between students\u27 reliance on past experiences and positive changes in empathy and anxiety levels. Thematic analysis was performed to gather specific student feedback. The project showcased the effectiveness of experiential learning in improving student preparedness for clinical practice. These findings will be instrumental in developing simulation opportunities that promote effective experiential learning

The Peptidyl Arginine Deiminase Inhibitor BB-CLA Decreases the Inflammatory and Fibrotic Responses in Macrophages and Rheumatoid Arthritis Synovial Fibroblasts Exposed to Fibrinogen Modified with Malondialdehyde-Acetaldehyde Adduct and Citrulline

Background. Peptide citrullination and adduction with malondialdehyde-acetaldehyde adduct (MAA) are involved in the pathogenesis of rheumatoid arthritis (RA). Anti-cyclic citrullinated peptide antibodies are \u3e90% specific for the diagnosis of RA, and MAA co-localizes with citrullinated proteins in RA synovial fluid. In addition, macrophages demonstrate increased expression of peptidyl arginine deiminase-2 (PAD2), an isozyme of PAD, in response to these MAA-adducted proteins. PAD catalyzes protein citrullination and may mediate the immunogenic transformation of synovial proteins and subsequent auto-antibody formation in RA. Here, we determine whether inhibition of PAD effects inflammatory and fibrotic markers in macrophages and RA human fibroblast-like synoviocytes (HFLS-RA) in response to stimulation with MAA and citrulline (CIT)-modified fibrinogen (FIB). Methods. U-937 cells were differentiated into activated macrophages and subsequently stimulated with unmodified FIB, FIB-MAA, FIB-CIT, or FIB-MAA-CIT in the presence (treatment group) and absence (control group) of BB-CLA for 48 hours. Supernatants collected from the media were assessed by ELISA for interleukin-1b (IL-1b), interleukin-6 (IL-6), interleukin-8 (IL-8), and monocyte chemoattractant protein-1 (MCP-1). HFLS from RA patients were stimulated with treatment and control supernatants from the macrophage cultures and assessed via immunofluorescent staining for the fibrotic markers vimentin and type II collagen. Results. The effect of PAD inhibition on inflammatory cytokine levels (Figure 1) was pronounced with FIB-CIT and FIB-MAA-CIT stimulations and mild with FIB and FIB-MAA stimulations. If fold decrease could not be calculated due to cytokine levels reaching 0, it is denoted as *0. Macrophages stimulated with FIB, FIB-MAA, FIB-CIT, and FIB-MAA-CIT, respectively, showed decreases in IL-1b (*0, *0, 4-fold, 6-fold, respectively), IL-6 (*0, *0, *0, 3-fold), IL-8 (*0, 1.6-fold, 8-fold, 14-fold), and MCP-1 (1.3-fold, 2-fold, 15-fold, 17-fold). In the absence of PAD inhibition, control group cytokine levels generally followed the trend of FIB-MAA-CIT \u3e FIB-CIT \u3e FIB-MAA \u3e FIB. A similar pattern of cellular response was observed (Figure 2) in HFLS-RA cells stimulated with macrophage supernatants from the treatment group, where vimentin (1.3-fold for FIB, 2-fold for FIB-MAA, 2-fold for FIB-CIT, 4-fold for FIB-MAA-CIT) and type II collagen (9-fold, 11-fold, 18-fold, 21-fold) expression were diminished compared with the control group. In the absence of PAD inhibition, mean pixel density levels followed FIB-MAA-CIT \u3e FIB-CIT \u3e FIB-MAA \u3e FIB for both anti-vimentin and anti-type II collagen staining. Conclusions. This study provides insight into the degree to which inflammatory and fibrotic responses from macrophages and HFLS to MAA and CIT modified fibrinogen may be PAD-mediated. MAA and CIT modification of fibrinogen increased inflammatory cytokines from macrophages and fibrotic proteins from HFLS-RA. BB-CLA markedly diminishes these responses. These observations further the understanding of the roles of MAA and CIT modified antigen in the joint synovium of RA patients, and the therapeutic use of PAD inhibitors in RA treatment.https://digitalcommons.unmc.edu/emet_posters/1038/thumbnail.jp