The association of medical student debt on choice of primary care specialty and rural practice location.

A shortage of primary care physicians (PCP) is present nationally and within Kentucky. The shortage is expected to worsen, unless a dramatic increase occurs in the generation of additional primary care clinicians. Geographical maldistributions of PCP also exist. Whereas 20% of the US population resides in rural areas, only 10% of physicians practice in these areas. This study explores factors that influence medical students’ decisions to select primary care residency training programs, and to practice in rural areas. Specifically, the levels of debt among 1391 graduates from University of Louisville School of Medicine (ULSOM) during 2001-2010 were examined in association with their selection of categories of residency training programs. Similarly, levels of debt among 1180 ULSOM graduates during 2001-2008 were examined in association with rural practice locations. Statistical methods included evaluations of receiver-operating curves (ROC) and multiple logistic regression analyses. The ROC analyses showed no association was present for any level of debt with either selection of primary care residency programs or rural practice sites. Multiple logistic regression analyses showed a statistically significant, positive association was present between the two extreme quintiles of medical students’ debt, whereby medical students in the lower quintile of debt were more likely select a primary care residency, compared to those students within the highest quintile. No statistically significant association was found for students’ debt with rural practice location. Multiple policy options to increase the primary care workforce were examined, including raising physicians’ reimbursements, shortening time for medical training, and altering how medical schools finance medical education. Policy makers may also consider the affinity model, whereby increasing medical school admissions among applicants from rural areas may result in greater numbers of PCP that are more likely to return to practice in rural areas. Similarly, programs to better support rural pipeline programs may be considered. Other policy solutions may include allowing nurse practitioners and other clinical personnel to work at the full scope of their training as well as a fuller utilization of health information technology. Addressing population health through the Triple Aim may provide novel solutions

A closer look into empathy among medical students: The career eulogy as a lens

Background Empathy is widely considered to be key to being an effective physician. The measurement of empathy is important to those designing medical education. The majority of the literature on empathy is based on survey scales that ask the learner to express their degree of agreement with a series of statements. We have previously studied and published an entirely projective measure that we term a career eulogy. Methods We had 65 students based at a regional rural medical school campus complete measures of a career eulogy (CE) and the Jefferson Scale of Empathy (JSE) over their four years in medical school. We then calculated weighted correlations between these two instruments. We also asked students to rank 10 factors that they thought affected student responses about empathy. Results We found a significant moderate correlation of JSE score with mentions of compassion on the CE (r = 0.414, p= 0.001). We also found that women scored higher on both instruments. The only factor showing consensus among students was that the general outlook on life was the most likely factor explaining student empathy responses. Conclusions Mentions in the compassion category on the CE appear to be measuring a concept very similar to empathy on the JSE. Students expressed that factors affecting their responses about empathy are very individual and that only interventions to change the general outlook on life may affect these measures of empathy. Having used the CE for the last five years, we find it to be a brief, very useful exercise both for measurement of empathy and as a group facilitation method in our professional identity curriculum. We welcome others to use our CE instrument in larger and more diverse groups to determine its true value in both measuring empathy and facilitating group process

Rural Medical Student Opinions About Rural Practice: Does Choice of College Make a Difference?

Purpose While many programs assume medical students who attended rural colleges are more likely to practice in smaller towns later, there are few studies to support this assumption. This study examines aspects of medical students’ opinions about rural living and rural practice based on where they attended college. Method Students with rural upbringing were identified and administered a previously published rural health opinion survey. The opinion survey was administered across three academic years, from 2015 to 2017, and included a total of three scales and nine subscales for analysis. Factor analysis was used to identify the nine subscales. Results Respondents who attended small town colleges tended to have much stronger opinions about the positive aspects of small town living. Small town college attendees also had stronger positive opinions regarding rural practice than their larger college counterparts. Discussion These preliminary data indicate considering a medical school applicants’ choice of college may provide insight into their opinions about future rural practice. Additional research is needed to collect a larger dataset to examine the association of college choice with opinions about rural practice

Do medical residents with rural upbringing show less decline in empathy during training? A report from a rural family medicine residency

Abstract Purpose Our focus in this study was to determine if demographic variables, including specifically rural upbringing, showed any association with a measure of empathy among family medicine residents at a rural site. Methods We surveyed 40 residents annually using the Jefferson Scale of Empathy (JSE) from 2016 to 2020 and compared scores between residents with rural vs urban hometowns. The response rate was 98/99 (99%) of completed survey opportunities. Findings There was no significant difference in JSE scores of rural vs urban residents at baseline, and both groups showed a decline after the PG-1 year. However, the rural-raised residents showed a significantly different rebound after the PG-2 and PG-3 year, with the urban-raised residents actually showing a slight continuing decline (p=.023 and p=.033). Conclusion These preliminary findings among family medicine residents at a rural site suggest that rural background residents might regain empathy better than urban background residents during the course of their training. Further study should validate our findings and address possible explanations, including the importance of cultural concordance with the patient population served. This and other hypotheses will be explored in further studies with focus groups and other contemporaneous measures

W/SiC x-ray multilayers optimized for use above 100 keV

We have developed a new depth-graded multilayer system comprising W and SiC layers, suitable for use as hard x-ray reflective coatings operating in the energy range 100-200 keV. Grazing-incidence x-ray reflectance at E = 8 keV was used to characterize the interface widths, as well as the temporal and thermal stability in both periodic and depth-graded W/SiC structures, whereas synchrotron radiation was used to measure the hard x-ray reflectance of a depth-graded multilayer designed specifically for use in the range E ~150-170 keV. We have modeled the hard x-ray reflectance using newly derived optical constants, which we determined from reflectance versus incidence angle measurements also made using synchrotron radiation, in the range E = 120-180 keV. We describe our experimental investigation in detail, compare the new W/SiC multilayers with both W/Si and W/B4C films that have been studied previously, and discuss the significance of these results with regard to the eventual development of a hard x-ray nuclear line telescope

Assessing Medical Students’, Residents’, and the Public's Perceptions of the Uses of Personal Digital Assistants

Although medical schools are encouraging the use of personal digital assistants (PDAs), there have been few investigations of attitudes toward their use by students or residents and only one investigation of the public's attitude toward their use by physicians. In 2006, the University of Louisville School of Medicine surveyed 121 third- and fourth-year medical students, 53 residents, and 51 members of the non-medical public about their attitudes toward PDAs. Students were using either the Palm i705 or the Dell Axim X50v; residents were using devices they selected themselves (referred to in the study generically as PDAs). Three survey instruments were designed to investigate attitudes of (a) third- and fourth-year medical students on clinical rotations, (b) Internal Medicine and Pediatrics residents, and (c) volunteer members of the public found in the waiting rooms of three university practice clinics. Both residents and medical students found their devices useful, with more residents (46.8%) than students (16.2%) (p < 0.001) rating PDAs “very useful.” While students and residents generally agreed that PDAs improved the quality of their learning, residents’ responses were significantly higher (p < 0.05) than students’. Residents also responded more positively than students that PDAs made them more effective as clinicians. Although members of the public were generally supportive of PDA use, they appeared to have some misconceptions about how and why physicians were using them. The next phase of research will be to refine the research questions and survey instruments in collaboration with another medical school

On the Geometric Interpretation of the Nonnegative Rank

The nonnegative rank of a nonnegative matrix is the minimum number of nonnegative rank-one factors needed to reconstruct it exactly. The problem of determining this rank and computing the corresponding nonnegative factors is difficult; however it has many potential applications, e.g., in data mining, graph theory and computational geometry. In particular, it can be used to characterize the minimal size of any extended reformulation of a given combinatorial optimization program. In this paper, we introduce and study a related quantity, called the restricted nonnegative rank. We show that computing this quantity is equivalent to a problem in polyhedral combinatorics, and fully characterize its computational complexity. This in turn sheds new light on the nonnegative rank problem, and in particular allows us to provide new improved lower bounds based on its geometric interpretation. We apply these results to slack matrices and linear Euclidean distance matrices and obtain counter-examples to two conjectures of Beasly and Laffey, namely we show that the nonnegative rank of linear Euclidean distance matrices is not necessarily equal to their dimension, and that the rank of a matrix is not always greater than the nonnegative rank of its square

Rural Medical Student Opinions About Rural Practice: Does Choice of College Make a Difference?

Purpose While many programs assume medical students who attended rural colleges are more likely to practice in smaller towns later, there are few studies to support this assumption. This study examines aspects of medical students’ opinions about rural living and rural practice based on where they attended college. Method Students with rural upbringing were identified and administered a previously published rural health opinion survey. The opinion survey was administered across three academic years, from 2015 to 2017, and included a total of three scales and nine subscales for analysis. Factor analysis was used to identify the nine subscales. Results Respondents who attended small town colleges tended to have much stronger opinions about the positive aspects of small town living. Small town college attendees also had stronger positive opinions regarding rural practice than their larger college counterparts. Discussion These preliminary data indicate considering a medical school applicants’ choice of college may provide insight into their opinions about future rural practice. Additional research is needed to collect a larger dataset to examine the association of college choice with opinions about rural practice

Desert plant bacteria reveal host influence and beneficial plant growth properties

© 2018 Eida et al.This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Deserts, such as those found in Saudi Arabia, are one of the most hostile places for plant growth. However, desert plants are able to impact their surrounding microbial community and select beneficial microbes that promote their growth under these extreme conditions. In this study, we examined the soil, rhizosphere and endosphere bacterial communities of four native desert plants Tribulus terrestris, Zygophyllum simplex, Panicum turgidum and Euphorbia granulata from the Southwest (Jizan region), two of which were also found in the Midwest (Al Wahbah area) of Saudi Arabia. While the rhizosphere bacterial community mostly resembled that of the highly different surrounding soils, the endosphere composition was strongly correlated with its host plant phylogeny. In order to assess whether any of the native bacterial endophytes might have a role in plant growth under extreme conditions, we analyzed the properties of 116 cultured bacterial isolates that represent members of the phyla Proteobacteria, Bacteroidetes, Actinobacteria and Firmicutes. Our analysis shows that different strains have highly different biochemical properties with respect to nutrient acquisition, hormone production and growth under stress conditions. More importantly, eleven of the isolated strains could confer salinity stress tolerance to the experimental model plant Arabidopsis thaliana suggesting some of these plant-associated bacteria might be useful for improving crop desert agriculture