Implementation of a Workplace-Based Assessment to Measure Performance of the Core Entrustable Professional Activities in the Pediatric Clerkship

Background: In 2013, the AAMC convened a panel of medical education experts to delineate the 13 Core Entrustable Professional Activities (Core EPAs) medical school graduates should be able to perform without direct supervision by day one of their residency. 1 Assessment of these EPAs requires direct observation to render entrustment decisions. 2 As part of our engagement in the AAMC Core EPA pilot,3 we created a workplace-based assessment (WBA) system to assist in measurement of student performance for the Core EPAs at the Virginia Commonwealth University School of Medicine. For the Pediatrics clerkship, we identified 6 Core EPAs to assess for all students during the 2018-2019 academic year: -Core EPA 1 (history and physical exam) -Core EPA 2 (prioritize a differential diagnosis) -Core EPA 3 (recommend and interpret common diagnostic and screening tests) -Core EPA 5 (document clinical encounter in patient record) -Core EPA 6 (provide an oral presentation of a clinical encounter) -Core EPA 9 (collaborate as a team member of an interprofessional team)

Family Centered Rounds Simulation and Medical Students\u27 Perceptions

Background: Studies show that family centered rounds (FCR) improve family satisfaction by involving the families in their children’s care. Medical students consistently find FCR beneficial to families but have differing attitudes regarding benefits to the medical team. Some concerns raised by the students include longer rounds, decreased bedside teaching, and lack of opportunities to improve FCR skills. We developed a FCR simulation to aid medical students in FCR presentation. Methods: On the first day of the clerkship, medical students presented a patient admission to two evaluators playing a parent and an attending physician. The patient admission note was emailed to the students prior to the simulation. Students were provided immediate feedback and asked to complete a survey. The survey asked if they thought FCR would benefit family, nurses, physicians, students, and efficiency of rounds. The students provided answers based on five point Likert scale. Finally, they completed a similar survey at the end of the clerkship. Results: The vast majority (95%) of the students had never participated in FCR prior to the simulation. The simulation made students more comfortable presenting in FCR (average score 4.5 on 5 point Likert Scale). There were no significant differences in positive attitudes towards FCR to families, nursing, physician, and medical education in the pre and post clerkship surveys. Most (67%) students’ perception towards FCR changed positively by the end of the clerkship. Discussion: Most of the medical students had never participated in FCR presentation prior to the start of the clerkship, and they found the simulation helpful in preparing for FCR. Although specific attitudes about the benefit of FCR to the family and medical team did not change likely due to ceiling effect, most of the students did have positive perception of FCR by the end of the clerkship

Quiet Please: The effects of sleep quality and quantity as a result of a QI project to minimize nighttime sleep interruptions

Quiet Please! The effects on sleep quality and quantity as a result of QI project to minimize nighttime interruptions INTRODUCTION: Sleep is a significant component of health that is often overlooked in hospitalized patients. We introduced a QI project in 2016 to minimize nighttime interruptions in clinically stable patients by performing “passive vitals” which eliminated temperature and blood pressure readings at 4am and allowed patients to sleep longer overnight. Despite this intervention, the effects on sleep quality and quantity are unknown. OBJECTIVE: The objective was to compare total sleep time, sleep interruptions, and sleep quality between patients eligible for passive vitals and those ineligible through survey data collected from July to November 2019. METHODS: Participants eligible and non-eligible for passive vitals self-reported the number of hours of sleep, number of nighttime awakenings, awakenings attributed to hospital staff, and elaborated on reasons for poor sleep. The survey also allowed previously hospitalized patients to compare the current stay to those in the past by assessing their quality of sleep and how tired they felt upon waking using a 5-point scale. Data was analyzed using Chi-square test. RESULTS: Forty-eight eligible and fifty-six non-eligible patients were surveyed. The total hours of sleep between groups was not statistically significant (p=0.11). There were no significant differences in the number of total sleep interruptions (p=0.95) and those by hospital staff (p =0.55). For patients who were previously hospitalized, there were no significant differences in sleep quality rating (p=0.10) and how tired they felt the next morning (p=0.78). Both groups cited similar reasons for poor sleep including care-related and illness symptom-related disruptions most commonly, followed by environmental-related complaints. DISCUSSION: The total hours of sleep, number of sleep interruptions, sleep quality, and rating of tiredness did not differ among the eligible and non-eligible groups. Many factors contributed to poor overall sleep which cannot be mitigated by passive vital signs in eligible patients at 4am. Other factors will need to be addressed

Virtual, Non-Clinical “Bootcamp” to prepare for the NBME Subject Matter (Shelf) Exam during the Pediatric Clerkship

Background: Medical education changed due to the COVID-19 pandemic. Educational sessions were offered virtually. There are published education innovations for pre-clinical curricula (1). However, providing virtual education during the clinical clerkship was a daunting challenge. In addition to the delay in patient care exposure, students’ performance in the NBME Subject Matter (Shelf) Exam scores have declined during the pandemic (2). VCU School of Medicine also needed to provide continued instructions to students whose clinical clerkships were delayed. Description of the Innovation: Due to the COVID-19 pandemic, the clinical start for the class of 2022 was delayed by 3 months. During the 3-month time, various non-clinical (virtual) educational curricula were offered. For the Pediatrics clerkship, we designed and implemented a two-week, virtual “bootcamp” for students to prepare for the NBME Subject Matter (Shelf) Exam. We offered didactic sessions (two 1-hour sessions per day), M4 Teaching Assistant (TA) study sessions (1-hour session per day), virtual office hours for students to connect with the M4 TAs and the clerkship director to ask questions, and self-study time. At the end of the two-week curriculum, students were given the option to take the exam at the end of the two weeks or take the exam at the end of the clinical clerkship. Results: We examined the Shelf Exam performance for the Class of 2021 (pre-COVID), Class of 2022 and 2023 (COVID affected) who were offered the two-week virtual, non-clinical bootcamp, and the class of 2024 (post-COVID). For the classes of 2021 and 2024, students had weekly didactic sessions (one half-day per week) and self-study time. All students were required to take the Shelf exam at the end of the clinical block. We specifically looked at the total number and percentage of students achieving an exemplary mark (indicated by Shelf exam score ≥ 80%). For the classes of 2022 and 2023 (COVID affected), we looked at the number of students achieving the exemplary mark who took the exam at the end of the two-week curriculum. Our hypothesis was that COVID-affected students would perform less well than their pre-COVID or post-COVID counterparts due to the fact that these students were preparing for the exam without the benefit of clinical education. For the class of 2024, the Shelf exam grades for the first 5 blocks (out of 7) are available for analysis. The percentage of students who achieved an exemplary designation was similar in all 4 years (class of 2021=56%, class of 2022=56%, class of 2023=64%, and class of 2024=46%). The mean Shelf exam scores from exemplary designations were also not statistically significant (class of 2021=84.57, class of 2022=85.11, p=0.324, class of 2023=85.23, p=0.224, and class of 2024=84.81, p=0.654). Conclusion: We were able to successfully develop and implement a two-week, virtual, non-clinical curriculum that prepared the students for the NBME Subject Matter Exam. When compared to the pre-COVID student cohort, there was no difference in the percentage of students who achieved an exemplary mark as well as the mean exam score. In fact, we were able to demonstrate this from two class cohorts (classes of 2022 and 2023). From our experience, we can surmise that the Shelf exam performance does not depend on clinical experience. Students who took the Shelf exam prior to starting the clinical clerkship were less stressed about studying for an exam and concentrated more on patient care. This approach to clinical education may be worth duplicating in other clerkships and in future years

Technetium and rhenium in volcanic soils by Icpms

Technetium-99 (99Tc) and rhenium (Re) were determined in volcanic tuff muck rock, from the potential repository at Yucca Mountain and in nuclear bomb cavity samples from the Nevada Test Site (NTS). These analyses were performed in order to test the feasibility of using high resolution inductively couple plasma mass spectrometry (HR-ICPMS) for the determination of 99Tc. Six 20 gram tuff samples were analyzed in duplicate for 99Tc and Re following separation using an anion exchange resin to remove potential interferences. Four nuclear bomb cavity samples were analyzed using one gram samples. A 99Tc method detection limit (MDL) of 33 pg/kg (parts per quadrillion (ppq)) was achieved, however the tuff samples analyses results were all less than this concentration. The average Re concentration of the six tuff samples was 23 ng/kg (ppt) with an average relative standard deviation (RSD) of 7.5%. The nuclear bomb cavity samples 99Tc analyses results ranged from 330 to 11,900 pg/kg (ppq)

Role Of Point Of Care Ultrasound In The Diagnosis Of Retinal Detachment In The Emergency Department.

Ocular complaints represent up to 3% of all emergency department (ED) visits. These presentations can result in permanent vision loss if not promptly diagnosed and treated. Recently, point of care ultrasound (POCUS) has been investigated for the evaluation of ocular pathology in the ED. Multiple studies have investigated the role that ultrasound may play in the early diagnosis of these patients. Ocular ultrasound can be used to visualize the structures of the eye and evaluate for pathology such as retinal detachment, vitreous hemorrhage and vitreous detachment. This comprehensive review aims to present current evidence for the efficacy and reliability of ED ocular ultrasound use in the detection of retinal detachment and additional ocular pathologies

Current and emerging therapies for the treatment of pancreatic cancer

Pancreatic adenocarcinoma carries a dismal prognosis and remains a significant cause of cancer morbidity and mortality. Most patients survive less than 1 year; chemotherapeutic options prolong life minimally. The best chance for long-term survival is complete resection, which offers a 3-year survival of only 15%. Most patients who do undergo resection will go on to die of their disease. Research in chemotherapy for metastatic disease has made only modest progress and the standard of care remains the purine analog gemcitabine. For resectable pancreatic cancer, presumed micrometastases provide the rationale for adjuvant chemotherapy and chemoradiation (CRT) to supplement surgical management. Numerous randomized control trials, none definitive, of adjuvant chemotherapy and CRT have been conducted and are summarized in this review, along with recent developments in how unresectable disease can be subcategorized according to the potential for eventual curative resection. This review will also emphasize palliative care and discuss some avenues of research that show early promise

PREMIS Requirement Statement Project Report

This is the report of the PRESTA Project, the objective of which was to develop a requirements specification for preservation metadata based on the PREMIS (PREservation Metadata: Implementation Strategies) final report, the Data Dictionary for Preservation Metadata

Tricuspid Annular Plane of Systolic Excursion for the Evaluation of Patients with Severe Sepsis and Septic Shock

Introduction: Sepsis is a systemic infection that can rapidly progress into multi organ failure and shock if left untreated. Previous studies have demonstrated the utility of point of care ultrasound (POCUS) in the evaluation of patients with sepsis. However, limited data exists on the evaluation of the tricuspid annular plane of systolic excursion (TAPSE) in patients with sepsis.Methods: We prospectively enrolled patients who presented to the emergency department (ED) with concern for severe sepsis or septic shock in a pilot study. In patients that screened positive, the treating physician then performed POCUS to measure the TAPSE value. We compared the intensive care unit (ICU) admission rate, hospital length of stay, and morbidity with their respective TAPSE values.Results: We enrolled 24 patients in the study. Eight patients had TAPSE values less than 16 millimeters (mm), two patients had TAPSE values between 16mm-20mm, and fourteen patients had TAPSE values greater than 20mm. There was no statistically significant association between TAPSE levels and ICU admission (p=0.16), or death (p=0.14). The difference of length of stay (LOS) was not statistically significant in case of hospital LOS (p= 0.72) or ICU LOS.Conclusion: Our pilot data did not demonstrate a correlation between severe sepsis or septic shock and TAPSE values. This may be due to several factors including patient comorbidities, strict definitions of sepsis and septic shock, as well as the absence of septic cardiomyopathy (SCM) in patients with sepsis and septic shock. Future large-scale studies are needed to determine if TAPSE can be beneficial in the ED evaluation of patients with concern for SCM

On The Nature of Variations in the Measured Star Formation Efficiency of Molecular Clouds

Measurements of the star formation efficiency (SFE) of giant molecular clouds (GMCs) in the Milky Way generally show a large scatter, which could be intrinsic or observational. We use magnetohydrodynamic simulations of GMCs (including feedback) to forward-model the relationship between the true GMC SFE and observational proxies. We show that individual GMCs trace broad ranges of observed SFE throughout collapse, star formation, and disruption. Low measured SFEs (<<1%) are "real" but correspond to early stages, the true "per-freefall" SFE where most stars actually form can be much larger. Very high (>>10%) values are often artificially enhanced by rapid gas dispersal. Simulations including stellar feedback reproduce observed GMC-scale SFEs, but simulations without feedback produce 20x larger SFEs. Radiative feedback dominates among mechanisms simulated. An anticorrelation of SFE with cloud mass is shown to be an observational artifact. We also explore individual dense "clumps" within GMCs and show that (with feedback) their bulk properties agree well with observations. Predicted SFEs within the dense clumps are ~2x larger than observed, possibly indicating physics other than feedback from massive (main sequence) stars is needed to regulate their collapse.Comment: Fixed typo in the arXiv abstrac