Implementation of a point-of-care ultrasound skills practicum for hospitalists

Introduction Point-of-care ultrasound is recognized as a safe and valuable diagnostic tool for patient evaluation. Hospitalists are prime candidates for advancing the point-of-care ultrasound field given their crucial role in inpatient medicine. Despite this, there is a notable lack of evidence-based ultrasound training for hospitalists. Most research focuses on diagnostic accuracy rather than the training required to achieve it. This study aims to improve hospitalists' point-of-care ultrasound knowledge and skills through a hands-on skills practicum. Methods Four skill practicums were conducted with pre-course, post-course, and six-month evaluations and knowledge assessments. Results The mean pre- vs. post-course knowledge assessment scores significantly improved, 41.7% vs. 75.9% (SD 16.1% and 12.7%, respectively, p < 0.0001). The mean ultrasound skills confidence ratings on a 10-point Likert scale significantly increased post-course (2.60 ± 1.66 vs. 6.33 ± 1.63, p < 0.0001), but decreased at six months (6.33 ± 1.63 vs. 4.10 ± 2.22, p < 0.0001). The greatest limitations to usage pre-course and at six months were knowledge/skills and lack of machine access. While knowledge/skills decreased from pre-course (82.0%) as compared to six-months (64.3%), lack of machine access increased from pre-course (15.8%) to six-months (28.6%) (p = 0.28). Conclusion Hospitalists agree that point-of-care ultrasound has utility in the diagnostic and therapeutic management of patients, though the lack of training is a significant limitation. Our study demonstrated that a brief skills practicum significantly improves hospitalists’ confidence and knowledge regarding ultrasound image acquisition and interpretation in the short term. Long-term confidence and usage wanes, which appears to be due to the lack of machine access

Twelve Tips for Just in Time Teaching of Communication Skills for Difficult Conversations in the Clinical Setting

The ability to communicate well with patients and other members of the healthcare team is a vital skill for physicians to have, but one that is often not emphasized in medical education. Learners of all levels can obtain and develop good communication skills regardless of their natural ability in this area, and the clinical setting represents an underutilized resource to accomplish this task. With this in mind, we have reviewed the growing body of literature on the subject and organized our findings into twelve tips to help educators capitalize on these missed opportunities. While our emphasis is helping learners with difficult discussions, these tips can be easily adapted to any other clinical encounter requiring clear communication. Teaching effective communication skills in the clinical setting requires some extra time, but the steps outlined should not take more than a few minutes to complete. Taking the time to develop these skills in our learners will make a significant difference not only their lives but also their patients and their families

Atypical use of audience response system provides opportunity to formatively assess faculty teaching and improve learning outcomes

In response to curricular reform, a particularly effective new approach was developed for a course offered at all nine IUSM centers. Participants will learn about interdisciplinary planning, implementation of a "Grand Rounds" approach, novel use of audience response system for retrieval practice and formative assessment of teaching methods, and how Bloom scale ratings relate to student engagement and focus

Limitation of Life-Sustaining Care in the Critically Ill: A Systematic Review of the Literature

When life-sustaining treatments (LST) are no longer effective or consistent with patient preferences, limitations may be set so that LSTs are withdrawn or withheld from the patient. Many studies have examined the frequency of limitations of LST in intensive care unit (ICU) settings in the past 30 years. This systematic review describes variation and patient characteristics associated with limitations of LST in critically ill patients in all types of ICUs in the United States. A comprehensive search of the literature was performed by a medical librarian between December 2014 and April 2017. A total of 1,882 unique titles and abstracts were reviewed, 113 were selected for article review, and 36 studies were fully reviewed. Patient factors associated with an increased likelihood of limiting LST included white race, older age, female sex, poor preadmission functional status, multiple comorbidities, and worse illness severity score. Based on several large, multicenter studies, there was a trend toward a higher frequency of limitation of LST over time. However, there is large variability between ICUs in the proportion of patients with limitations and on the proportion of deaths preceded by a limitation. Increases in the frequency of limitations of LST over time suggests changing attitudes about aggressive end-of-life-care. Limitations are more common for patients with worse premorbid health and greater ICU illness severity. While some differences in the frequency of limitations of LST may be explained by personal factors such as race, there is unexplained wide variability between units

Bridging the gap for future clinician‐educators

Background In contrast to the training required in the UK, opportunities for medical education training in the USA are limited. Resident‐as‐teacher programmes are typically insufficient to prepare trainees to be successful clinician‐educators, but few pursue formal education degrees. We sought to assess the need for, and feasibility of, a training pathway for subspecialty fellows in a large Department of Medicine that would prepare our trainees to become effective educators. Methods Quantitative and qualitative methods were used. Previous fellowship applicants and current programme directors were surveyed to determine the potential benefits of the programme. A pilot programme was conducted with fellows interested in education to determine the feasibility of the programme. Pilot participants were interviewed regarding the benefits that they gained from the pilot and the logistical challenges that they experienced. In contrast to the training required in the UK, opportunities for medical education training in the USA are limited Results Five highly ranked fellows would have scored our programmes higher if we offered this training pathway. Pilot participants and fellowship programme directors agreed that there is a compelling need for such a training pathway. A number of themes arose from the interviews that enabled us to build the framework for a strong programme. Discussion Our findings suggest that a clinician‐educator training pathway that draws from multiple subspecialties has the potential to improve recruitment, provide needed career counselling and skills development to trainees, and to build a community of educators that will benefit the institution. Important insights from pilot participant interviews will inform the programme design, in order to keep trainees engaged and overcome logistical challenges

Learning in the Time of COVID-19: Key Lessons From the Pandemic for Medical Trainees

The COVID-19 pandemic has changed the face of education for undergraduate and graduate medical trainees. Lectures, clinical clerkships, and testing have all been impacted significantly because of patient care needs and concern for the health and safety of trainees. While traditional teaching strategies have been upended, the challenges posed by the pandemic have also created unique opportunities for trainees. In this article, the authors summarize lessons trainees can learn from the ongoing pandemic in the following areas: public health, disaster preparedness, and resource allocation; reinventing professional and personal roles to meet the needs of the health care system; flexibility in navigating testing, licensure, and certification; appraising scientific evidence quickly and accurately; balancing a physician’s call to duty with fear for personal safety; combating moral injury; interprofessional collaboration; and advocating for oneself and colleagues. Focusing on these lessons can help educators steer their efforts to better prepare future physicians for unforeseen challenges that may come up in their personal and professional lives as well as in society as a whole

FOXO3 determines the accumulation of α-synuclein and controls the fate of dopaminergic neurons in the substantia nigra

Parkinson's disease (PD) is characterized by the selective degeneration of neuronal populations presumably due to pathogenic interactions between aging and predisposing factors such as increased levels of α-synuclein. Here, we genetically modulate the activity of the transcription factor Forkhead box protein O3 (FOXO3) in adult nigral dopaminergic neurons using viral vectors and explore how this determinant of longevity impacts on neuronal fate in normal and diseased conditions. We find that dopaminergic neurons are particularly vulnerable to changes in FOXO3 activity in the substantia nigra. While constitutive activation has proapoptotic effects leading to neuronal loss, inhibition of FOXO-mediated transcription by a dominant-negative competitor causes oxidative damage and is detrimental at high vector dose. To address the role of FOXO3 in PD, we modulate its activity in dopaminergic neurons overexpressing human α-synuclein. In this pathogenic condition, we find that FOXO inhibition has protective effects, suggesting that this transcription factor ultimately contributes to neuronal cell death. Nevertheless, mild FOXO3 activity also protects nigral neurons against the accumulation of human α-synuclein, albeit to a lesser extent. FOXO3 reduces the amount of α-synuclein present in the soluble protein fraction and promotes the coalescence of dense proteinase K-resistant aggregates, with an accumulation of autophagic vacuoles containing lipofuscin. Consistent with these in vivo observations, we find that FOXO3 controls autophagic flux in neuronal cells. Altogether, these results point to FOXO3 as an important determinant of neuronal survival in the substantia nigra, which may oppose α-synuclein accumulation and proteotoxicit

COVID-19 Infection versus Influenza (Flu) and Other Respiratory Illnesses

This article is made available for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.SARS-CoV-2 is the virus that causes the COVID-19 infection. You can be ill with more than one virus at the same time. As the SARS-CoV-2 virus pandemic continues, influenza and other respiratory infections will also emerge in the community. Respiratory infections may present with similar symptoms and all can spread from person to person. It is hard to tell which virus or bacteria is causing a person’s illness based on symptoms alone. At times testing is needed to see which virus(es) or bacteria are present. These tests usually involve getting a nose and/or throat swab sample, as most of these viruses are present in large amounts in the back of the nose and throat. There is still a lot to learn about the COVID-19 infection and research is ongoing