What are the causes of hypomagnesemia?

The causes of magnesium depletion and hypomagnesemia are decreased gastrointestinal (GI) absorption and increased renal loss. Decreased GI absorption is frequently due to diarrhea, malabsorption, and inadequate dietary intake. Common causes of excessive urinary loss are diuresis due to alcohol, glycosuria, and loop diuretics. Medical conditions putting persons at high risk for hypomagnesemia are alcoholism, congestiveheart failure, diabetes, chronic diarrhea, hypokalemia, hypocalcemia, and malnutrition (strength of recommendation: C, based on expert opinion, physiology, and case series). Evidence suggests that magnesium deficiency is both more common and more clinically significant than generally appreciated

What happy physicians have in common: A qualitative study of workplace perceptions of physicians with low burnout scores

Introduction: Burnout is a phenomenon in the medical field that adversely affects patient care, physician retention, and physician well-being. The preponderance of burnout research has primarily focused on exploring what parts of medical practice and individual characteristics contribute to burnout. Our research aims to add to the growing body of evidence exploring what physicians who love their work have in common. Methods: Physician participants in this qualitative study were recruited through their local medical society from those who indicated a willingness to share tips for joy in practice. Potential participants were then screened for low probability of burnout using a validated single-item burnout inventory. Nine primarily mid- to late-career physicians engaged in semi-structured interviews and thematic analysis was used to analyze data. Of the interviewed physicians, five were practicing in the primary care specialties of family or internal medicine and four in specialties outside of primary care. Results: Six major themes arose from the nine interviews and included variety in work, a sense of empowerment, connection with patients, visible impact of one?s work, feelings of community with coworkers and colleagues, and experiencing a sense of calling. Conclusion: While further research is needed to demonstrate the transferability of the themes from these interviews, an asset-rooted approach to physician wellness is a direction for research and intervention that deserves further attention. Focusing only on alleviating the factors that contribute to burnout is a worthy goal, but ignores the necessity of designing training systems and workplaces that are built to foster the elements of medicine that bring joy and fulfillment to practice

Cracking the Nut on LCME Standard 8.7: Innovations to Ensure Comparability Across Geographically Distributed Campuses

Problem: A large state university in the southeastern United States and state Area Health Education Centers (AHEC) collaborated to establish branch campuses to increase clinical capacity for medical student education. Prior to formally becoming branch campuses, two AHEC sites had established innovative curricular structures different than the central campus. These sites worked with the central campus as clinical training sites. Upon becoming formal campuses, their unique clinical experiences were maintained. A third campus established a curricular structure identical to the central campus. Little exists in the literature regarding strategies that ensure comparability yet allow campuses to remain unique and innovative. Intervention: We implemented a balanced matrix organizational structure, well-defined communication plan, and newly developed tool to track comparability. A balanced matrix organization model framed the campus relationships. Adopting this model led to identifying reporting structures, developing multidirectional communication strategies, and the Campus Comparability Tool. Context: The UNC School of Medicine central campus is in Chapel Hill. All 192 students complete basic science course work on central campus. For required clinical rotations, approximately 140 students are assigned to the central campus, which includes rotations in Raleigh or Greensboro. The remaining students are assigned to Asheville (25–30), Charlotte (25–30), or Wilmington (5–7). Chapel Hill and Wilmington follow identical rotation structures, 16 weeks each of (a) combined surgery and adult inpatient experiences; (b) combined obstetrics/gynecology, psychiatry, and inpatient pediatrics; and (c) longitudinal clinical experiences in adult and pediatric medicine. Asheville offers an 8-month longitudinal integrated outpatient experience with discreet inpatient experiences in surgery and adult care. Charlotte offers a 6-month longitudinal integrated experiences and 6 months of block inpatient experiences. Aside from Charlotte and Raleigh, the other sites are urban but surrounded by rural counties. Chapel Hill is 221 miles from Asheville, 141 from Charlotte, and 156 from Wilmington. Outcome: Using the balanced matrix organization, various reporting structures and lines of communication ensured the educational objectives for students were clear on all campuses. The communication strategies facilitated developing consistent evaluation metrics across sites to compare educational experiences. Lessons Learned: The complexities of different healthcare systems becoming regional campuses require deliberate planning and understanding the culture of those sites. Recognizing how size and location of the organization affects communication, the central campus took the lead centralizing functions when appropriate. Adopting uniform educational technology has played an essential role in evaluating the comparability of core educational content on campuses delivering content in very distinct ways