Case Report: Uncommon cause of limp in the 21st century

Scurvy results from a deficiency of ascorbic acid. This disease first appeared in children during the 19th century with the emergence of new dietary habits; in particular, heating milk that leads to a loss of ascorbic acid. Even though scurvy has become a rare condition in western countries, many cases are still reported in pediatric patients, especially in those who lack proper nutrition due to neurological or psychiatric illnesses. Symptoms include bleeding and swollen gums, loosening of teeth, bone abnormalities, arthralgia, delayed wound healing, anemia, petechiae, and purpura. Bone lesions are mainly irregularities of long bones metaphyses. We report the case of a five-year-old boy who presented with arthralgia and limb deformation (genu valgum). The patient was investigated for vitamin deficiencies to exclude rickets. The radiologic investigations revealed metaphyseal signs compatible with scurvy. During the hospitalization, the patient was observed to have abnormal eating patterns and the scurvy was attributed to malnutrition. Although the occurrence of scurvy is rare, it remains essential to detect this disease in children at risk of developing vitamin deficiencies. Without targeted treatment, the complications of scurvy can be serious and potentially fatal

Exploration of Validity Evidence for the P MEX in a Residency Admissions Process

The residency admissions process is a high-stakes assessment system with the purpose of identifying applicants who best meet standards of the residency program and the medical specialty. With the growing importance of professionalism in medical education, it is imperative to develop professionalism assessments that demonstrate robust validity evidence. The Professionalism Mini-Evaluation Exercise (P-MEX) is an assessment that has demonstrated validity evidence in the authentic clinical setting. This dissertation examines validity evidence for the P-MEX, a focused and standardized assessment of professionalism, in a simulated patient setting. Ginsburg’s professionalism framework and Messick’s unified validity framework were used to frame this study. This study examines the internal structure and relations to other variables validity evidence for the P-MEX using longitudinal data from eight cohorts of pediatric applicants from admission to the end of the first year of post-graduate training. Results indicate that the P-MEX demonstrates moderate reliability and predicts professionalism performance at the end of the first year of training. The P-MEX also demonstrates a four-factor model of: doctor-patient relationship skills, interprofessional skills, professional demeanor, and reflective skills. Identifying the factorial structure of the P-MEX allows for the provision of diagnostic and actionable professionalism feedback. Validity evidence supports the use of P-MEX scores as part of the admissions process to assess professionalism, as part of the admissions process. Educators may wish to integrate the P-MEX assessment into their professionalism curricula

Validity and Feasibility Evidence for the Professionalism Mini-­Evaluation Exercise in Resident Admissions

Purpose: To provide validity and feasibility evidence for use of the Professionalism Mini-Evaluation Exercise (P-MEX) in a pediatric residency admissions process. Method: In 2012 and 2013, the OSCE-based P-MEX was administered to applicants invited for an interview at the University of Geneva Pediatrics Residency Program. Validity evidence was gathered for content (item analysis and qualitative feedback); response process (inter-rater reliability with intraclass correlation); internal structure (Generalizability); relationship to other variables (correlations); and consequences (logistic regression to predict admission). Kane’s formula was used to create composite scores using P-MEX, structured letter of reference (SLR), and structured interview (SI) scores. Differences in the applicant rank list based on composite score versus faculty global ratings were analyzed using Wilcoxon signed-rank test. Results: Seventy applicants were assessed. Moderate associations were found between pairwise correlations of P-MEX scores and SLR (r=0.25, P = .036), SI (r=0.34, P = .004), and global ratings (r=0.48, P < .001). P-MEX inter-rater reliability was moderately low (ICC=0.36). Reliability of the P-MEX was moderate (G-coefficient=0.45). Including P-MEX scores increased composite reliability from 0.51 to 0.74. P-MEX scores had the greatest correlation with acceptance (r=0.56, P < .001), were the strongest predictor of acceptance (OR=4.37, P < .001), and increased pseudo R-squared by 0.20 points. Rank lists of applicants using composite score versus global rating differed significantly (z=5.41, P < .001)

Towards equitable learning environments for medical education : bias and the intersection of social identities

Context: Medical educators are increasingly paying attention to how bias creates inequities that affect learners across the medical education continuum. Such bias arises from learners' social identities. However, studies examining bias and social identities in medical education tend to focus on one identity at a time, even though multiple identities often interact to shape individuals' experiences. Methods: This article examines prior studies on bias and social identity in medical education, focusing on three social identities that commonly elicit bias: race, gender and profession. By applying the lens of intersectionality, we aimed to generate new insights into intergroup relations and identify strategies that may be employed to mitigate bias and inequities across all social identities. Results: Although different social identities can be more or less salient at different stages of medical training, they intersect and impact learners' experiences. Bias towards racial and gender identities affect learners' ability to reach different stages of medical education and influence the specialties they train in. Bias also makes it difficult for learners to develop their professional identities as they are not perceived as legitimate members of their professional groups, which influences interprofessional relations. To mitigate bias across all identities, three main sets of strategies can be adopted. These strategies include equipping individuals with skills to reflect upon their own and others' social identities; fostering in-group cohesion in ways that recognise intersecting social identities and challenges stereotypes through mentorship; and addressing intergroup boundaries through promotion of allyship, team reflexivity and conflict management. Conclusions: Examining how different social identities intersect and lead to bias and inequities in medical education provides insights into ways to address these problems. This article proposes a vision for how existing strategies to mitigate bias towards different social identities may be combined to embrace intersectionality and develop equitable learning environments for all.</p

Development and validity evidence for the intraprofessional conflict exercise: An assessment tool to support collaboration.

BackgroundEffective collaboration is the foundation for delivering safe, high quality patient care. Health sciences curricula often include interprofessional collaboration training but may neglect conflicts that occur within a profession (intraprofessional). We describe the development of and validity evidence for an assessment of intraprofessional conflict management.Methods and findingsWe designed a 22-item assessment, the Intraprofessional Conflict Exercise, to evaluate skills in managing intraprofessional conflicts based on a literature review of conflict management. Using Messick's validity framework, we collected evidence for content, response process, and internal structure during a simulated intraprofessional conflict from 2018 to 2019. We performed descriptive statistics, inter-rater reliability, Cronbach's alpha, generalizability theory, and factor analysis to gather validity evidence. Two trained faculty examiners rated 82 trainees resulting in 164 observations. Inter-rater reliability was fair, weighted kappa of 0.33 (SE = 0.03). Cronbach's alpha was 0.87. The generalizability study showed differentiation among trainees (19.7% person variance) and was highly reliable, G-coefficient 0.88, Phi-coefficient 0.88. The decision study predicted that using one rater would have high reliability, G-coefficient 0.80. Exploratory factor analysis demonstrated three factors: communication skills, recognition of limits, and demonstration of respect for others. Based on qualitative observations, we found all items to be applicable, highly relevant, and helpful in identifying how trainees managed intraprofessional conflict.ConclusionsThe Intraprofessional Conflict Exercise provides a useful and reliable way to evaluate intraprofessional conflict management skills. It provides meaningful and actionable feedback to trainees and may help health educators in preparing trainees to manage intraprofessional conflict

Thirteen-year mortality and morbidity in preterm infants in Switzerland

To report the population-based, gestational age (GA)-stratified mortality and morbidity for very preterm infants over 13 years in Switzerland

Exploring Medical Career Choice to Better Inform Swiss Physician Workforce Planning: Protocol for a National Cohort Study

BackgroundA medical student’s career choice directly influences the physician workforce shortage and the misdistribution of resources. First, individual and contextual factors related to career choice have been evaluated separately, but their interaction over time is unclear. Second, actual career choice, reasons for this choice, and the influence of national political strategies are currently unknown in Switzerland. ObjectiveThe overall objective of this study is to better understand the process of Swiss medical students’ career choice and to predict this choice. Our specific aims will be to examine the predominately static (ie, sociodemographic and personality traits) and predominately dynamic (ie, learning context perceptions, anxiety state, motivation, and motives for career choice) variables that predict the career choice of Swiss medical school students, as well as their interaction, and to examine the evolution of Swiss medical students’ career choice and their ultimate career path, including an international comparison with French medical students. MethodsThe Swiss Medical Career Choice study is a national, multi-institution, and longitudinal study in which all medical students at all medical schools in Switzerland are eligible to participate. Data will be collected over 4 years for 4 cohorts of medical students using questionnaires in years 4 and 6. We will perform a follow-up during postgraduate training year 2 for medical graduates between 2018 and 2022. We will compare the different Swiss medical schools and a French medical school (the University of Strasbourg Faculty of Medicine). We will also examine the effect of new medical master’s programs in terms of career choice and location of practice. For aim 2, in collaboration with the Swiss Institute for Medical Education, we will implement a national career choice tracking system and identify the final career choice of 2 cohorts of medical students who graduated from 4 Swiss medical schools from 2010 to 2012. We will also develop a model to predict their final career choice. Data analysis will be conducted using inferential statistics, and machine learning approaches will be used to refine the predictive model. ResultsThis study was funded by the Swiss National Science Foundation in January 2023. Recruitment began in May 2023. Data analysis will begin after the completion of the first cohort data collection. ConclusionsOur research will inform national stakeholders and medical schools on the prediction of students’ future career choice and on key aspects of physician workforce planning. We will identify targeted actions that may be implemented during medical school and may ultimately influence career choice and encourage the correct number of physicians in the right specialties to fulfill the needs of currently underserved regions. International Registered Report Identifier (IRRID)DERR1-10.2196/5313

Consensus Report by the Pediatric Acute Lung Injury and Sepsis Investigators and Pediatric Blood and Marrow Transplantation Consortium Joint Working Committees on Supportive Care Guidelines for Management of Veno-Occlusive Disease in Children and Adolescents, Part 3: Focus on Cardiorespiratory Dysfunction, Infections, Liver Dysfunction, and Delirium

Some patients with veno-occlusive disease (VOD) have multiorgan dysfunction, and multiple teams are involved in their daily care in the pediatric intensive care unit. Cardiorespiratory dysfunction is critical in these patients, requiring immediate action. The decision of whether to use a noninvasive or an invasive ventilation strategy may be difficult in the setting of mucositis or other comorbidities in patients with VOD. Similarly, monitoring of organ functions may be very challenging in these patients, who may have fulminant hepatic failure with or without hepatic encephalopathy complicated by delirium and/or infections. In this final guideline of our series on supportive care in patients with VOD, we address some of these questions and provide evidence-based recommendations on behalf of the Pediatric Acute Lung Injury and Sepsis Investigators and Pediatric Blood and Marrow Transplantation Consortium Joint Working Committees