Development of a clinical teaching evaluation and feedback tool for faculty

Copyright © 2019 by The American Society for Pharmacology and Experimental Therapeutics. Sigma-2 receptors, recently identified as TMEM97, have been implicated in cancer and neurodegenerative disease. Structurally distinct sigma-2 receptor ligands induce cell death in tumor cells, linking sigma-2 receptors to apoptotic pathways. Recently, we reported that sigma-2 receptors can also stimulate glycolytic hallmarks, effects consistent with a prosurvival function and upregulation in cancer cells. Both apoptotic and metabolically stimulative effects were observed with compounds related to the canonical sigma-2 antagonist SN79. Here we investigate a series of 6-substituted SN79 analogs to assess the structural determinants governing these divergent effects. Substitutions on the benzoxazolone ring of the core SN79 structure resulted in high-affinity sigma-2 receptor ligands (Ki 5 0.56–17.9 nM), with replacement of the heterocyclic oxygen by N-methyl (producing N-methylbenzimidazolones) generally decreasing sigma-1 affinity and a sulfur substitution (producing benzothiazolones) imparting high affinity at both subtypes, lowering subtype selectivity. Substitution at the 6-position with COCH3, NO2, NH2, or F resulted in ligands that were not cytotoxic. Five of these ligands induced an increase in metabolic activity, as measured by increased reduction of MTT (3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetra-zolium bromide) in human SK-N-SH neuroblastoma cells, further supporting a role for sigma-2 receptors in metabolism. Substitution with 6-isothiocyanate resulted in ligands that were sigma-2 selective and that irreversibly bound to the sigma-2 receptor, but not to the sigma-1 receptor. These ligands induced cell death upon both acute and continuous treatment (EC50 5 7.6–32.8 mM), suggesting that irreversible receptor binding plays a role in cytotoxicity. These ligands will be useful for further study of these divergent roles of sigma-2 receptors

Ideas to Action: Using Curriculum Design to Develop a “Roadmap to Wellness” Curriculum

Introduction: Physician burnout, well-being, and professional fulfillment are deeply intertwined topics that are increasingly recognized as affecting the lives of physicians, health care workers, and patients alike. The Accreditation Council for Graduate Medical Education (ACGME) mandates that all residencies address wellness within the context of residency training without providing much guidance on how to do so. Emergency Medicine organizations such as the American College of Emergency Physicians, the American Academy of Emergency Physicians, the Society for Academic Emergency Medicine, and the Council of Residency Directors of Emergency Medicine (CORD) suggest that one method to address wellness is in the form of a curriculum. Successfully developing or modifying a curriculum to work for individual residency programs can be a difficult task. Methods: The CORD Resilience Committee Wellness Curriculum Subcommittee comprised of experts in physician wellness and medical education started by conducted literature searches on terms related to burnout and wellness and searching the internet for documented wellness curricula, models and resources. Using this information and a standard curriculum development process, they created a roadmap for developing (or modifying), initiating, and evaluating a wellness curriculum. Conclusion: Wellness curricula are not a one-size-fits-all situation. Using the checklist and guidelines in this white paper, readers can individualize existing wellness curricula to help foster physician well-being

Implementing Health Sciences After-School Programming for Mississippi High School Students: the Impact of Social Determinants of Health

Corresponding author (Pharmacy Administration): Saara Nasruddin, [email protected]://egrove.olemiss.edu/pharm_annual_posters_2022/1013/thumbnail.jp

Inspiring Minds, Exploring Science with Project SCORE Curriculum

Corresponding author (Pharmacy Administration): Tess Johnson, [email protected]://egrove.olemiss.edu/pharm_annual_posters_2022/1009/thumbnail.jp

Health Matters: Student-Developed Research Questions by Project SCORE Students

Corresponding author (Health, Exercise Science, and Recreation Management): Melissa Presley, [email protected]://egrove.olemiss.edu/pharm_annual_posters_2022/1015/thumbnail.jp

Training in the Management of Psychobehavioral Conditions: A Needs Assessment Survey of Emergency Medicine Residents

ObjectiveMental health–related ED visits are increasing. Despite this trend, most emergency medicine (EM) residency programs devote little time to psychiatry education. This study aimed to identify EM residents’ perceptions of training needs in emergency psychiatry and self‐confidence in managing patients with psychobehavioral conditions.MethodsA needs assessment survey was distributed to residents at 15 Accreditation Council for Graduate Medical Education–accredited EM programs spanning the U.S. Survey items addressed amount and type of training in psychiatry during residency, perceived training needs in psychiatry, and self‐confidence performing various clinical skills related to emergency psychiatric care. Residents used a 5‐point scale (1 = nothing; 5 = very large amount) to rate their learning needs in a variety of topic areas related to behavioral emergencies (e.g., medically clearing patients, substance use disorders). Using a scale from 0 to 100, residents rated their confidence in their ability to independently perform various clinical skills related to emergency psychiatric care (e.g., differentiating a psychiatric presentation from delirium).ResultsOf the 632 residents invited to participate, 396 (63%) responded. Twelve percent of respondents reported completing a psychiatry rotation during EM residency. One of the 15 participating programs had a required psychiatry rotation. Residents reported that their program used lectures (56%) and/or supervised training in the ED (35%) to teach residents about psychiatric emergencies. Most residents reported minimal involvement in the treatment of patients with psychiatric concerns. The majority of residents (59%) believed that their program should offer more education on managing psychiatric emergencies. Only 14% of residents felt “quite” or “extremely” prepared to treat psychiatric patients. Overall, residents reported the lowest levels of confidence and highest need for more training related to counseling suicidal patients and treating psychiatric issues in special populations (e.g., pregnant women, elderly, and children).ConclusionsMost EM residents desire more training in managing psychiatric emergencies than is currently provided.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/152005/1/aet210377-sup-0001-DataSupplementS1.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/152005/2/aet210377.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/152005/3/aet210377_am.pd

Perception of Physician Empathy Varies With Educational Level and Gender of Patients Undergoing Low-Yield Computerized Tomographic Imaging

Objective: Lack of empathic communication between providers and patients may contribute to low value diagnostic testing in emergency care. Accordingly, we measured the perception of physician empathy and trust in patients undergoing low-value computed tomography (CT) in the emergency department (ED). Methods: Multicenter study of ED patients undergoing CT scanning, acknowledged by ordering physicians as unlikely to show an emergent condition. Near the end of their visit, patients completed the Jefferson Scale of Patient Perception of Physician Empathy (JSPPPE), Trust in Physicians Survey (TIPS), and the Group Based Medical Mistrust Scale (GBMMS). We stratified results by patient demographics including gender, race, and education. Results: We enrolled 305 participants across 9 sites with diverse geographic, racial, and ethnic representation. The median scores (interquartile ranges) for the JSPPPE, TIPS, and GBMMS for all patients were 29 (24-33.5), 55 (47-62), and 18 (12-29). Compared with white patients, nonwhite patients had similar JSPPPE and TIPS scores but had higher (worse) GBMMS scores. Females had significantly lower JSPPPE and TIPS scores than males, and scores were lower (worse) in females with college degrees. Patients in the lowest tier of educational status had the highest (better) JSPPPE and TIPS scores. Scores were invariant with physician characteristics. Conclusion: Among patients undergoing low-value CT scanning in the ED, the degree of patient perception of physician empathy and trust varied based on the patients’ level of education and gender. Given this variation, an intervention to increase patient perception of physician empathy should contain individualized strategies to address these subgroups, rather than a one-size-fits-all approach

Development of a Clinical Teaching Evaluation and Feedback Tool for Faculty

Introduction: Formative evaluations of clinical teaching for emergency medicine (EM) faculty are limited. The goal of this study was to develop a behaviorally-based tool for evaluating and providing feedback to EM faculty based on their clinical teaching skills during a shift.  Methods: We used a three-phase structured development process. Phase 1 used the nominal group technique with a group of faculty first and then with residents to generate potential evaluation items. Phase 2 included separate focus groups and used a modified Delphi technique with faculty and residents, as well as a group of experts to evaluate the items generated in Phase 1. Following this, residents classified the items into novice, intermediate, and advanced educator skills. Once items were determined for inclusion and subsequently ranked they were built into the tool by the investigators (Phase 3).  Results: The final instrument, the “Faculty Shift Card,” is a behaviorally-anchored evaluation and feedback tool used to facilitate feedback to EM faculty about their teaching skills during a shift. The tool has four domains: teaching clinical decision-making; teaching interpersonal skills; teaching procedural skills; and general teaching strategies. Each domain contains novice, intermediate, and advanced sections with 2-5 concrete examples for each level of performance.  Conclusion: This structured process resulted in a well-grounded and systematically developed evaluation tool for EM faculty that can provide real-time actionable feedback to faculty and support improved clinical teaching

Mentoring during Medical School and Match Outcome among Emergency Medicine Residents

Introduction: Few studies have documented the value of mentoring for medical students, and research has been limited to more subjective (e.g., job satisfaction, perceived career preparation) rather than objective outcomes. This study examined whether having a mentor is associated with match outcome (where a student matched based on their rank order list [ROL]).Methods: We sent a survey link to all emergency medicine (EM) program coordinators to distribute to their residents. EM residents were surveyed about whether they had a mentor during medical school. Match outcome was assessed by asking residents where they matched on their ROL (e.g., first choice, fifth choice). They were also asked about rank in medical school, type of degree (MD vs. DO), and performance on standardized tests. Residents who indicated having a mentor completed the Mentorship Effectiveness Scale (MES), which evaluates behavioral characteristics of the mentor and yields a total score. We assessed correlations among these variables using Pearson’s correlation coefficient. Post-hoc analysis using independent sample t-test was conducted to compare differences in the MES score between those who matched to their first or second choice vs. third or higher choice.Results: Participants were a convenience sample of 297 EM residents. Of those, 199 (67%) reported having a mentor during medical school. Contrary to our hypothesis, there was no significant correlation between having a mentor and match outcome (r=0.06, p=0.29). Match outcome was associated with class rank (r=0.13, p=0.03), satisfaction with match outcome (r= -0.37, p<0.001), and type of degree (r=0.12, p=0.04). Among those with mentors, a t-test revealed that the MES score was significantly higher among those who matched to their first or second choice (M=51.31, SD=10.13) compared to those who matched to their third or higher choice (M=43.59, SD=17.12), t(194)=3.65, p<0.001, d=0.55.Conclusion: Simply having a mentor during medical school does not impact match outcome, but having an effective mentor is associated with a more favorable match outcome among medical students applying to EM programs