Genomic assessment of quarantine measures to prevent SARS-CoV-2 importation and transmission

Mitigation of SARS-CoV-2 transmission from international travel is a priority. We evaluated the effectiveness of travellers being required to quarantine for 14-days on return to England in Summer 2020. We identified 4,207 travel-related SARS-CoV-2 cases and their contacts, and identified 827 associated SARS-CoV-2 genomes. Overall, quarantine was associated with a lower rate of contacts, and the impact of quarantine was greatest in the 16–20 age-group. 186 SARS-CoV-2 genomes were sufficiently unique to identify travel-related clusters. Fewer genomically-linked cases were observed for index cases who returned from countries with quarantine requirement compared to countries with no quarantine requirement. This difference was explained by fewer importation events per identified genome for these cases, as opposed to fewer onward contacts per case. Overall, our study demonstrates that a 14-day quarantine period reduces, but does not completely eliminate, the onward transmission of imported cases, mainly by dissuading travel to countries with a quarantine requirement

Genomic epidemiology of SARS-CoV-2 in a UK university identifies dynamics of transmission

AbstractUnderstanding SARS-CoV-2 transmission in higher education settings is important to limit spread between students, and into at-risk populations. In this study, we sequenced 482 SARS-CoV-2 isolates from the University of Cambridge from 5 October to 6 December 2020. We perform a detailed phylogenetic comparison with 972 isolates from the surrounding community, complemented with epidemiological and contact tracing data, to determine transmission dynamics. We observe limited viral introductions into the university; the majority of student cases were linked to a single genetic cluster, likely following social gatherings at a venue outside the university. We identify considerable onward transmission associated with student accommodation and courses; this was effectively contained using local infection control measures and following a national lockdown. Transmission clusters were largely segregated within the university or the community. Our study highlights key determinants of SARS-CoV-2 transmission and effective interventions in a higher education setting that will inform public health policy during pandemics.</jats:p

Procedural skill maintenance: Perspectives and motivations of pediatric emergency medicine faculty

BackgroundPediatric emergency medicine (PEM) physicians receive training in critical procedures, but these procedures are rare in practice. The literature on maintenance of procedural skills focuses on ways to practice (e.g., via simulation) and pays little attention to motivation's role. Understanding what motivates PEM physicians to maintain procedural skills can inform the design of supportive policies and interventions. Our study explores how PEM physicians conceptualize maintenance of procedural skills, what motivates them to maintain procedural skills, and barriers to procedural skill maintenance.MethodsThis was a qualitative study of 12 PEM faculty guided by the self-determination theory (SDT) of motivation. SDT describes a typology that distinguishes extrinsic and intrinsic motivation, with intrinsic motivation based on autonomy, competence, and relatedness. Interviews were transcribed and coded using constant-comparative technique, and interviews continued until thematic sufficiency was achieved.ResultsParticipants had difficulty defining procedural skill maintenance by specific criteria and expressed ambivalence about external standards for competence, noting the need to account for individual and local practice factors. Three themes characterizing participants' motivation for procedural skills maintenance included: (1) desire to provide optimal patient care and fear of unsuccessful performance (competence), (2) procedural competence as part of the identity of a PEM physician who teaches and performs procedures (competence and relatedness), and (3) desire for accessibility and choice of options in maintaining procedural skills (autonomy). Participants identified lack of opportunities, time, and support as barriers to motivation and skills maintenance.ConclusionSDT concepts were integral to understanding faculty motivation, and this highlights the need for prioritizing faculty autonomy, competence, and relatedness in designing supports for procedural skill maintenance. Our findings regarding the difficulty in defining maintenance of skills emphasize the need for further discussion and study of this topic

How do internal medicine subspecialty societies support clinician-educator careers? A qualitative exploratory study

Abstract Background Internal Medicine (IM) subspecialty professional societies can provide valuable community, recognition, resources, and leadership opportunities that promote career success. Historically, this support focused on clinical and research dimensions of academic careers, but educational dimensions have gained more attention recently. This study explores how IM subspecialty professional societies support their clinician-educator members. Methods Using a qualitative study with two phases, the authors collected information from each IM subspecialty society’s website about support for medical education. Using information from the first phase, we developed an interview guide for subspecialty society leaders. We used inductive thematic analysis to analyze interview transcripts. Results Website analysis identified various mechanisms used by several IM subspecialty societies to promote medical education. These included websites focused on medical education, dedicated medical education poster/abstract sessions at annual meetings, and strategies to promote networking among clinician-educators. Interviews with eight subspecialty society leaders about the professional societies’ roles with respect to medical education yielded four main themes: [1] varying conceptions of “medical education” in relation to the society [2] strategies to advance medical education at the society level [3] barriers to recognizing medical education [4] benefits of clinician-educators to the societies. Integrating these themes, we describe recommended strategies for professional societies to better serve clinician-educators. Conclusions We explore how IM subspecialty societies attend to a growing constituency of clinician-educators, with increasing recognition and support of the career path but persistent barriers to its formalization. These conversations shed light on opportunities for professional subspecialty societies to better serve the needs of their clinician-educator members while also enabling these members to make positive contributions in return.http://deepblue.lib.umich.edu/bitstream/2027.42/173626/1/12909_2022_Article_3287.pd

How do pharmacists select antimicrobials? A model of pharmacists’ therapeutic reasoning processes

INTRODUCTIONClinicians engage in clinical reasoning, comprised of both diagnostic and therapeutic components, when caring for patients. While diagnostic reasoning has been extensively investigated, relatively few studies have examined how clinicians make treatment decisions. Recent work has explored how physicians engage in therapeutic reasoning while selecting antimicrobials. However, understanding pharmacists’ antimicrobial reasoning is equally important due to their role in ensuring appropriate antimicrobial use. Therefore, we aimed to further our understanding of antimicrobial reasoning in pharmacists and compare their reasoning processes to physicians.METHODSWith a postpositivist orientation and using a general qualitative approach, we conducted semi‐structured interviews with hospital‐based pharmacists specializing in infectious diseases or other hospital‐based specialties. Participants narrated their thought processes while selecting antimicrobials for three case vignettes. We analyzed transcripts iteratively using a code book from a prior study of antimicrobial reasoning in physicians as a sensitizing framework.RESULTSParticipants included 11 pharmacists (5 infectious diseases and 6 noninfectious diseases pharmacists). Overall, participants’ responses reflected a three‐step reasoning process: Naming the Syndrome, Delineating Pathogens, and Selecting the Antimicrobial. Patient‐, syndrome‐, and system‐based factors interacted with drug characteristics to influence the selection of specific antimicrobial regimens.CONCLUSIONWe identified a framework for pharmacists’ antimicrobial therapeutic reasoning similar to physicians’ reasoning, with some nuances that may be attributable to the pharmacists’ role in medication review and antimicrobial stewardship. Application of this framework has the potential to aid in teaching, improve multidisciplinary care, and provide a framework for interprofessional communication.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/172005/1/jac51580.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/172005/2/jac51580_am.pd

Improving clerkship preparedness: a hospital medicine elective for pre-clerkship students

Background: Medical students often struggle to apply their nascent clinical skills in clerkships. While transitional clerkships can orient students to new roles and logistics, students may benefit from developing clinical skills in inpatient environments earlier in their curriculum to improve readiness for clerkships. Intervention: Our four- to six-session elective provides pre-clerkship students with individualized learning in the inpatient setting with the aim of improving clerkship preparedness. Students work one-on-one with faculty who facilitate individualized learning through mentoring, deliberate practice, and directed feedback. Second-year medical students are placed on an attending-only, traditionally ‘non-teaching’ service in the hospital medicine division of a Veterans Affairs (VA) hospital for half-day sessions. Most students self-select into the elective following a class-wide advertisement. The elective also accepts students who are referred for remediation of their clinical skills. Outcome: In the elective’s first two years, 25 students participated and 47 students were waitlisted. We compared participant and waitlisted (non-participant) students’ self-efficacy in several clinical and professional domains during their first clerkship. Elective participants reported significantly higher clerkship preparedness compared to non-participants in the areas of physical exam, oral presentation, and formulation of assessments and plans. Conclusions: Students found the one-on-one feedback and personalized attention from attending physicians to be a particularly useful aspect of the course. This frequently cited benefit points to students’ perceived needs and the value they place on individualized feedback. Our innovation harnesses an untapped resource – the hospital medicine ‘non-teaching’ service – and serves as an attainable option for schools interested in enhancing early clinical skill-building for all students, including those recommended for remediation. Abbreviations: A&P: Assessment and plan; H&P: History and physical; ILP: Individual learning pla