Screening for hepatocellular carcinoma in patients with hepatitis C virus infection

There is no evidence that it is beneficial to screen for hepatocellular carcinoma in symptomatic patients with HCV. (Strength of Recommendation [SOR]: C, based on a systematic review and case series studies.) Neither serum AFP measurement nor imaging is an ideal screening test. Patients can be screened for hepatocellular carcinoma using AFP measurement or ultrasonography; these tests have similar sensitivity and specificity. Computed tomography and magnetic resonance imaging offer increased screening sensitivity, but may be limited by cost and availability. (SOR: C, based on retrospective case series.) Combined testing with AFP measurement and ultrasonography improves sensitivity but decreases specificity

Aligning Medical Student Curriculum with Practice Quality Goals: Impacts on Quality Metrics and Practice Capacity for Students

The practice of medicine occurs primarily in the ambulatory environment where providers have many competing demands, including health record documentation and patient volume expectations. Subsequently, medical student education has not been a priority for providers, health systems, or community practices. Yet, accrediting and professional organizations, such as the Association of American Medical Colleges, American Academy of Family Physicians, Ambulatory Pediatric Association, Society of General Internal Medicine, and the Liaison Committee on Medical Education, recommend education in ambulatory settings

Students Adding Value: Improving Patient Care Measures While Learning Valuable Population Health Skills

Medical students are potential resources for ambulatory primary care practices if learning goals can align with clinical needs. The authors introduced a quality improvement (QI) curriculum in the ambulatory clinical rotation that matched student learning expectations with practice needs. In 2016-2017, 128 students were assigned to academic, university affiliated, community health, and private practices. Student project measures were matched with appropriate outcome measures on monthly practice dashboards. Binomial mixed effects models were used to model QI measures. For university collaborative practices with student involvement, the estimated odds of a patient being screened for breast cancer in March 2017 was approximately 2 times greater than in 2016. This odds ratio was 36.2% greater than the comparable odds ratio for collaborative practices without student involvement (95% confidence interval = 22.7% to 51.2% greater). When student curriculum and assignments align with practice needs, practice metrics improve and students contribute to improvements in real-world settings