Practice Characteristics of Graduates of East Tennessee State University Quillen College of Medicine: Factors Related to Career Choices in Primary Care

The nation is facing a physician shortage, specifically in relation to primary care and in rural underserved areas. The most basic function of a medical school is to educate physicians to care for the national population. The purpose of this study was to examine the physician practicing characteristics of the graduates of East Tennessee State University Quillen College of Medicine including factors that influence graduates’ specialty choices and practice locations, especially those related to primary care. Secondary data for this study were collected from the college’s student database system and the American Medical Association Physician Masterfile. The study population included all living graduates with Doctor of Medicine (MD) degrees who graduated from 1998 through 2009 (n=678). Statistical procedures included Pearson Chi-square, logistic regression, independent t tests, ANOVA, and multiple linear regression. Data analyses revealed that the majority of graduates were between 24 and 29 years of age, male, white, non-Hispanic, and from metropolitan hometowns. Most had completed the generalist track and initially entered a primary care residency training program. The majority passed USMLE Step 1 and Step 2 on the first attempt. The USMLE Step 2-CK average was 212.50. The average cumulative GPA was 3.44. Graduates were nearly evenly divided between primary care and nonprimary care practice, with the majority practicing in metropolitan areas. Graduates who initially entered primary care residency training were more likely to practice primary care medicine than those who entered nonprimary care programs; however, fewer graduates were practicing primary care than had entered primary care residency training. Graduates who attended internal medicine residency training were less likely to be practicing primary care medicine than those who attended family medicine, pediatrics, or OB/GYN programs. Women and Rural Primary Care Track graduates were significantly more likely to practice primary care than were men and generalist track graduates, respectively. Nonprimary care physicians had significantly higher USMLE Step 2-CK scores than did primary care physicians (PCPs). PCPs practiced in more rural locales than non-PCPs. Family physician graduates tended to practice in more rural locales than OB/GYNs or pediatricians. Hometown location predicted practice location over and above medical school track

Gender Differences in Working Memory in Humans Tested on a Virtual Morris Water Maze.

A computerized virtual version of the Morris water maze (vMWM) was used to assess human gender differences in spatial working memory. In Experiment 1, the release point and platform location was changed on every other trial for 20 trials. Men had significantly reduced acquisition latencies and more accurate heading errors on the first daily trial compared to women. In Experiment 2, the release point and platform location was changed every fourth trial for 20 trials. Men had significantly shorter acquisition latencies and path lengths than women. Experiment 3 was identical to Experiment 2, except that environmental cues were changed throughout testing. Men had significantly shorter acquisition latencies and path lengths than did the women. These studies are the first to demonstrate significant gender differences in a spatial working memory version of the vMWM

Co-Creating A Social, Emotional, And Mental Health Well-Being Group For College Students With Disabilities And/Or Chronic Health Conditions And Are Registered With Disability Support Services

ABSTRACT Nearly one in four adults in the United States report living with a disability (Centers for Disease Control and Prevention, 2024). According to the National Center for Educational Statistics (2023), approximately 21 percent of undergraduate students and 11 percent of postbaccalaureate students report having a disability. Students with disabilities in college encounter considerable obstacles that can adversely affect their mental health, academic performance, and general well-being. These obstacles encompass social isolation, stigma, and insufficient personalized support services, resulting in increased levels of anxiety, depression, and dropout rates compared to students without disabilities. Despite the critical need, there is a gap in the availability of programs specifically designed to address the social-emotional-mental well-being of college students with disabilities. To address this gap, this dissertation sought to co-create a well-being program tailored to the unique needs of college students with disabilities and/or chronic health conditions. The aims of this research were: • Aim 1: To systematically identify the social, emotional, and mental well-being needs and preferred support strategies of college students with disabilities and/or chronic health conditions through participatory research approaches. We administered an anonymous survey to 132 undergraduate and graduate students and conducted qualitative interviews and focus groups with college students with disabilities and/or chronic health conditions to explore their experiences, challenges, and needs related to social-emotional-mental well-being. Initially, the university Disability Support Services (DSS) disseminated the survey to registered students. To increase participation, we administered the survey to 14 students who were taking an undergraduate honors seminar focused on disabilities, chronic health conditions, and social-emotional-mental well-being promotion, taught by the doctoral student’s dissertation chair and the doctoral student who served as Teaching Assistant (TA). This group of students became the core group of students to help co-create the program. The students initially helped to refine the survey to ensure that it was user-friendly and engaging for students to complete. • Aim 2: To co-design a social-emotional-mental well-being program for college students with disabilities and/or chronic health conditions. We utilized participatory design methods to engage college students with disabilities and/or chronic health conditions in the co-creation of the well-being program. This process involved iterative feedback and prototyping to refine the program components. Specifically, we conducted six focus group sessions with three different groups. One group became the core group of students who helped to co-create the program. The three groups included: 1. Core Group (n=14 students): students who were taking an undergraduate honors seminar focused on disabilities, chronic health conditions, and social-emotional-mental well-being promotion, taught by the doctoral student’s dissertation chair and the doctoral student who served as Teaching Assistant (TA) February 13, 2025: Students completed the initial draft of the survey and provided feedback on the survey construction, and then provided qualitative feedback on SwDC social-emotional-mental well-being needs and preferences for the program. February 20, 2025: Students completed the final version of the survey and shared their insights and reflections on what they thought should be in the program. March 6, 2025: Students further shared their thoughts on what students would like for the program to be and how it could be structured and implemented. March 18, 2025: Shared themes and drafted curriculum components, received feedback, and incorporated feedback for final components. 2. GROWTH Group: • Students and staff (n=5) who have a disability and/or chronic health condition and work together with the doctoral student and dissertation chair on co-creating and implementing GROWTH: Growing Resilience Out of Wellness and Thoughtful Habits, a social-emotional-mental well-being program for people living with mobility limitations. • 5 participants; 1 session • Note: one group member participated in two separate in-depth interviews to further explore ideas. 2. Student Engagement and Enrichment (SEE) Group: • Students who participate in the UAB Student Engagement and Enrichment Program at UAB and identify as having a disability and/or chronic health condition • 3 participants; 1 session We conducted thematic analyses to identify preferences, common themes, and develop program structure, components, and implementation strategies. This research addresses a critical gap in the mental health and well-being support services available to college students with disabilities and/or chronic health conditions. By involving students in the co-creation process, the resulting program is tailored to self-identified specific needs, which we hope will lead to improvements in coping strategies and social connectedness as well as reductions in depression and anxiety. This dissertation is innovative in its use of participatory research methods to co-create a well-being program directly with students with disabilities and chronic health conditions for students with disabilities and chronic health conditions

First insights into the phylogenetic diversity of Mycobacterium tuberculosis in Nepal

BACKGROUND: Tuberculosis (TB) is a major public health problem in Nepal. Strain variation in Mycobacterium tuberculosis may influence the outcome of TB infection and disease. To date, the phylogenetic diversity of M. tuberculosis in Nepal is unknown. METHODS AND FINDINGS: We analyzed 261 M. tuberculosis isolates recovered from pulmonary TB patients recruited between August 2009 and August 2010 in Nepal. M. tuberculosis lineages were determined by single nucleotide polymorphisms (SNP) typing and spoligotyping. Drug resistance was determined by sequencing the hot spot regions of the relevant target genes. Overall, 164 (62.8%) TB patients were new, and 97 (37.2%) were previously treated. Any drug resistance was detected in 50 (19.2%) isolates, and 16 (6.1%) were multidrug-resistant. The most frequent M. tuberculosis lineage was Lineage 3 (CAS/Delhi) with 106 isolates (40.6%), followed by Lineage 2 (East-Asian lineage, includes Beijing genotype) with 84 isolates (32.2%), Lineage 4 (Euro-American lineage) with 41 (15.7%) isolates, and Lineage 1 (Indo-Oceanic lineage) with 30 isolates (11.5%). Based on spoligotyping, we found 45 different spoligotyping patterns that were previously described. The Beijing (83 isolates, 31.8%) and CAS spoligotype (52, 19.9%) were the dominant spoligotypes. A total of 36 (13.8%) isolates could not be assigned to any known spoligotyping pattern. Lineage 2 was associated with female sex (adjusted odds ratio [aOR] 2.58, 95% confidence interval [95% CI] 1.42-4.67, p = 0.002), and any drug resistance (aOR 2.79; 95% CI 1.43-5.45; p = 0.002). We found no evidence for an association of Lineage 2 with age or BCG vaccination status. CONCLUSIONS: We found a large genetic diversity of M. tuberculosis in Nepal with representation of all four major lineages. Lineages 3 and 2 were dominating. Lineage 2 was associated with clinical characteristics. This study fills an important gap on the map of the M. tuberculosis genetic diversity in the Asian reg

Family Medicine Clerkship Students’ Experiences With Team-Based Care

Interprofessional team-based care has the potential to improve patient outcomes, improve access to care, decrease costs, and improve team satisfaction. In recent years, efforts to implement team-based care have grown with the adoption of the Patient-Centered Medical Home (PCMH) and an increasing focus on value-based payment models. To better prepare our learners for this future, we introduced a formal team-based care curriculum in our three family medicine residency programs and one pediatric program. In addition to curricula for residents, we developed a team-based care didactic for family medicine clerkship students, presented by an interprofessional team of faculty. This session will describe our curricular efforts, team-based didactic for students, and outcomes related to students’ experiences with and knowledge of team-based care

Does Structured Quality Improvement Training for Residents Increase QI in Practice?

East Tennessee State University implemented quality improvement (QI) training for second-year family medicine residents in 2009. Results in 2011 indicated training increased scores in QI skill assessments as well as self-efficacy in QI. With residents who completed the training now in practice, does the increase in knowledge and skill translate to increased QI in practice? A survey of graduates compares frequency of QI cycles and self-assessment of QI skills among graduating classes, those receiving QI training and those graduating before training began. Residents that completed the QI curriculum rated their training higher; however residents that did not receive training were more involved in QI in practice. We suggest that this is due to QI involvement increasing with practice. Results will guide curriculum improvements to strengthen future resident training

A New Model for Assessing Teaching Quality Improvement to Family Medicine Residents: Does It Work?

Objective: To develop and implement a formal didactics and experiential curriculum to train Family Medicine (FM) residents in Quality Improvement (QI) knowledge and skills. Method: 1) All FM faculty participated in seven workshops on QI theory and design. 2) All second year residents received a day-long workshop on knowledge and skills of QI and conducted QI projects for up to two years. Results: Knowledge and confidence scores significantly improved following training,

Cultivating Emerging Leaders: Understanding a Pastor\u27s Role

The purpose of this study is to understand the influence and impact a local church pastor can have in the development of emerging leaders. The researcher sought to understand a biblical model of the leader/follower relationship through examining the examples of Moses/Joshua, Elijah/Elisha, and Jesus/the disciples. These examples provided insight into the behaviors of established and emerging leaders and what roles each play in the developmental process. To further the study, a review of relevant literature pertaining to transformational leadership and follower-focused leadership models was completed. Servant leadership, situation leadership, and redemptive leadership were examined to understand the part an established leader plays in the development of emerging leaders. Additionally, an overview and incorporation of followership was included to understand the emerging leader’s responsibility in development. Finally, three developmental timelines were considered to explore how an emerging leader grows. A mixed-method grounded theory study was conducted using online surveys and interviews with established and emerging leaders. The study reviewed the experiences of pastoral leaders and resources helpful in the developmental process. The study resulted in the proposal of a framework for pastors to consider in the development of emerging leaders. Local pastors engaged in developing emerging leaders recognize four areas of development to nurture: spiritual development, personal development, leadership development, and ministry skill development. Growth in these areas should balance across the readiness of the emerging leader’s development. Focusing on these areas should happen in the context of a relationship. Established leaders must recognize their responsibility to initiate a relationship in conjunction with the Holy Spirit’s leading. At the same time, emerging leaders must acknowledge their role in shaping the path of development. The shared responsibility in development is defined and expanded in this project

Relationship of Patient Self-Administered COPD Assessment Test (CAT) to Physician Standard Assessment of COPD in a Family Medicine Residency Training Program

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality in the United States. COPD is of particular concern in certain sectors of the country, including Central Appalachia where our clinic is located. Assessing patients with COPD presents many challenges as symptoms range from those considered typical such as shortness of breath and sputum production to those less often identified like anxiety and social isolation. We conducted a pilot study comparing physician standard assessment of COPD to patient self-assessment using the COPD Assessment Test (CAT). The CAT is an eight-item questionnaire that measures the impact COPD has on an individual patient’s well-being and daily life. Based on our small sample size, physicians tend to underestimate the impact of COPD on a patient’s daily life. This discrepancy did not differ significantly by year of residency. Potential clinical impact of these findings include the need for more formalized and frequent patient self-assessment of disease burden as well as increased COPD assessment training within the residency curriculum

Focused Anticoagulation Service in Family Medicine Residencies

A report on the creation of a new program to improve family medicine residents\u27 understanding, and quality of care, of anticoagulation patients. Patients requiring anticoagulation therapy pose unique issues requiring a systematic approach to their care, balancing the potential benefit from therapy with possible adverse events. Here, we describe a model that helps to standardize both the care received by patients on anticoagulation therapy as well as the training of family medicine residents caring for those patients. A team-based model of care (family medicine residents, clinical pharmacists, and nurses) is used to achieve the goals of improved care and education. Clinical pharmacists are used in concert with family medicine residents and attendings to assess patients\u27 medication profiles and help direct patient care and resident learning. Both the idea itself and the formal structure are presented in a model for possible adaptation to other program