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Swartz TH, Aberg JA. Preserving the Future of Infectious Diseases: Why We Must Address the Decline in Compensation for Clinicians and Researchers. Clin Infect Dis 2023; 77:1387-1394. [PMID: 37436703 DOI: 10.1093/cid/ciad416] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/01/2023] [Accepted: 07/10/2023] [Indexed: 07/13/2023] Open
Abstract
Infectious diseases (ID) physicians play a pivotal role in patient care and public health, yet concerns are mounting about their under-compensation compared with other medical specialties. This trend sees ID physicians, including new graduates, receiving lower remuneration than their general and hospital medicine peers, despite their significant contributions. The persistent disparity in compensation has been identified as a key factor behind the declining interest in the ID specialty among medical students and residents, potentially threatening patient care quality, research advancement, and diversity within the ID workforce. This viewpoint underscores the urgent need for the ID community to rally behind the Infectious Diseases Society of America in advocating for fair compensation for ID physicians and researchers. While focusing on wellness and work-life balance is vital, it is critical to address compensation, a significant source of distress for physicians. Failure to confront the issue of under-compensation promptly may jeopardize the future growth and sustainability of the ID specialty.
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Affiliation(s)
- Talia H Swartz
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Judith A Aberg
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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2
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Goel D, Tin MT, Hariprasad KC, Garg DS, Besic A, Dillon TA, Masson ZR, Goralsky LA, Goralsky JA, Barron MK, Saji JA, Hobson WL, Jones TW. Deeper Pathways for Recruitment Efforts: Identifying Opportunities for Undergraduate and Medical Student Involvement in Infectious Diseases. Open Forum Infect Dis 2023; 10:ofad439. [PMID: 37779598 PMCID: PMC10538255 DOI: 10.1093/ofid/ofad439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/21/2023] [Indexed: 10/03/2023] Open
Abstract
Background Only 74% of infectious diseases (ID) training positions were filled in the 2022 fellowship match, indicating a need to find increasingly novel and creative solutions for ID recruitment and outreach. Methods The websites of 2321 universities and 181 medical schools across the United States were manually searched for the presence of undergraduate clubs and interest groups, respectively, for multiple medical specialties and subspecialties, including ID. Geographic data were used to compare the proximity of ID fellowships to undergraduate institutions. Results ID student groups were extremely rare among the categories studied throughout undergraduate institutions (6 out of 2048, or 0.29%). Only 58 of 163 (35.6%) medical schools nationwide included an ID student group. Geographic comparison found that every adult ID fellowship is in the same county and/or city as at least 1 undergraduate institution and 28.5% of adult ID fellowships are in the same zip code as at least 1 undergraduate institution. Conclusions The relative paucity of ID student interest groups presents an opportunity for the ID community to begin outreach and recruitment at the undergraduate and medical student levels, specifically through student groups.
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Affiliation(s)
- Divyam Goel
- College of Science, University of Utah, Salt Lake City, Utah, USA
| | - Michelle T Tin
- College of Science, University of Utah, Salt Lake City, Utah, USA
| | - Krishna C Hariprasad
- College of Natural Sciences, Department of Molecular Biosciences, University of Texas at Austin, Austin, Texas, USA
| | - Diya S Garg
- College of Science, University of Utah, Salt Lake City, Utah, USA
| | - Arnel Besic
- College of Science, University of Utah, Salt Lake City, Utah, USA
| | - Tilly A Dillon
- College of Science, University of Utah, Salt Lake City, Utah, USA
| | - Zoe R Masson
- College of Science, University of Utah, Salt Lake City, Utah, USA
| | - Lauren A Goralsky
- Columbia College, Department of Biological Sciences, Columbia University, New York, New York, USA
| | - Julia A Goralsky
- Columbia College, Department of Biological Sciences, Columbia University, New York, New York, USA
| | - Molly K Barron
- College of Science and Technology, Temple University, Philadelphia, Pennsylvania, USA
| | - Jasmine A Saji
- Armour College of Engineering, Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, Illinois, USA
| | - Wendy L Hobson
- Department of Pediatrics, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, Utah, USA
| | - Trahern W Jones
- Department of Pediatrics, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, Utah, USA
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Grundy B, Houpt E. Complexity of Infectious Diseases Compared With Other Medical Subspecialties. Open Forum Infect Dis 2023; 10:ofad463. [PMID: 37771851 PMCID: PMC10533204 DOI: 10.1093/ofid/ofad463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/06/2023] [Indexed: 09/30/2023] Open
Abstract
We aimed to highlight the complexity of the field of clinical infectious diseases compared with other medical specialties. Using available metrics, the body of knowledge within clinical infectious diseases is comparatively large and complex. This increasing complexity is underappreciated by current physician compensation schemes, needs to be carefully managed to educate future physicians, and may serve as a barrier to recruitment into the field.
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Affiliation(s)
- Brian Grundy
- Division of Infectious Diseases, University of Colorado, Aurora, Colorado, USA
| | - Eric Houpt
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
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4
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Walker J, Heudebert JP, Patel M, Cleveland JD, Westfall AO, Dempsey DM, Guzman A, Zinski A, Agarwal M, Long D, Willig J, Lee R. Leveraging Technology and Gamification to Engage Learners in a Microbiology Curriculum in Undergraduate Medical Education. MEDICAL SCIENCE EDUCATOR 2022; 32:649-655. [PMID: 35531347 PMCID: PMC9066992 DOI: 10.1007/s40670-022-01552-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Microbiology is a critical and expansive topic that many medical schools' curriculum must teach in a constrained time frame. We implemented a microbiology question bank smart phone app enhanced with game elements and clinical pearls during a microbiology course for first-year medical students. We hypothesized that these enhancements and clinical pearls would engage the students meaningfully and increase their knowledge base. METHODS Though use was optional, students' game play was recorded through the app, which was compared to test grades retrospectively. A player efficiency rating (PER) was calculated as a function of question response, accuracy, and engagement. Students were separated into tertiles of PER and median exam grades were compared using a non-parametric Kruskal-Wallis (KW) test. An anonymous satisfaction and usability feedback survey was also administered. RESULTS One hundred eighty-one of the 189 students (96%) answered at least one question, and 165 (87%) completed all 56 questions. The average PER was 84.75. We received feedback surveys from 61 (34%) students in the course, with positive responses regarding the perceived impact on learning microbiology. The KW test found a positive correlation for median exam scores of the player groups when divided into tertiles by PER (p = 0.0002). CONCLUSIONS We leveraged gamification and clinical pearls to design a supplemental microbiology question bank. We found high engagement overall and higher class exam scores associated with greater use of the question bank.
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Affiliation(s)
- Jeremey Walker
- Department of Medicine, School of Medicine (UAB), University of Alabama, THT 229, 1900 University Blvd, AB 35294-0006 Birmingham, USA
| | | | - Mukesh Patel
- Department of Medicine, School of Medicine (UAB), University of Alabama, THT 229, 1900 University Blvd, AB 35294-0006 Birmingham, USA
- Birmingham Veterans Affairs Medical Center, Birmingham, USA
| | - John D. Cleveland
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, USA
| | - Andrew O. Westfall
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, USA
| | - Donald M. Dempsey
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, USA
| | - Alfredo Guzman
- Department of Medicine, School of Medicine (UAB), University of Alabama, THT 229, 1900 University Blvd, AB 35294-0006 Birmingham, USA
| | - Anne Zinski
- Department of Medical Education, University of Alabama School of Medicine, Birmingham, USA
| | - Monica Agarwal
- Department of Medicine, School of Medicine (UAB), University of Alabama, THT 229, 1900 University Blvd, AB 35294-0006 Birmingham, USA
| | - Dustin Long
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, USA
| | - James Willig
- Department of Medicine, School of Medicine (UAB), University of Alabama, THT 229, 1900 University Blvd, AB 35294-0006 Birmingham, USA
| | - Rachael Lee
- Department of Medicine, School of Medicine (UAB), University of Alabama, THT 229, 1900 University Blvd, AB 35294-0006 Birmingham, USA
- Birmingham Veterans Affairs Medical Center, Birmingham, USA
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5
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Marcelin JR, Brosnihan P, Swindells S, Fadul N, Bares SH. The Value of a Longitudinal HIV Track for Medical Students: Ten-Year Program Evaluation. Open Forum Infect Dis 2022; 9:ofac184. [PMID: 35794937 PMCID: PMC9251603 DOI: 10.1093/ofid/ofac184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 04/07/2022] [Indexed: 11/15/2022] Open
Abstract
We surveyed graduates of a longitudinal medical school human immunodeficiency virus curriculum to evaluate its impact. Respondents felt comfortable caring for people with human immunodeficiency virus (PWH) and found value from the curriculum regardless of ultimate career path. Programs like this contribute to the development of culturally sensitive clinicians comfortable caring for PWH.
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Affiliation(s)
- Jasmine R Marcelin
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA
| | - Paul Brosnihan
- Department of Surgery, Harbor-University of California Los Angeles Medical Center, Los Angeles, CA, USA
| | - Susan Swindells
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA
| | - Nada Fadul
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA
| | - Sara H. Bares
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA
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Kufel WD, Mastro KA, Steele JM, Wang D, Riddell SW, Paolino KM, Thomas SJ. Impact of a pharmacist-facilitated, evidence-based bundle initiative on Staphylococcus aureus bacteremia management. Diagn Microbiol Infect Dis 2021; 101:115535. [PMID: 34634714 DOI: 10.1016/j.diagmicrobio.2021.115535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/22/2021] [Accepted: 08/29/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate a pharmacist-facilitated evidence-based bundle (EBB) initiative with infectious disease consultation (IDC) for Staphylococcus aureus bacteremia (SAB). METHODS This was a before-and-after quasi-experimental study of adult patients with SAB before and after the pharmacist-facilitated EBB initiative, which included IDC, timely definitive antibiotics, source control, echocardiography, and repeat blood cultures. RESULTS Ninety and 111 patients were included in pre- and post-intervention cohorts, respectively. We observed significant increases in adherence to all 5 (4.4% vs 68.5%, P < 0.001) and 4 (10.0% vs 76.6%, P < 0.001) EBB elements. Time to definitive antibiotics (48 vs 16 hours, P < 0.001), time to IDC (43.5 vs 32 hours, P < 0.001), SAB duration (95 vs 66 hours, P = 0.009), persistent SAB (18.9% vs 9.0%, P = 0.041), and length of stay (14 vs 13 days, P = 0.027) also improved. No statistically significant differences for SAB-related readmission or all-cause mortality were observed. CONCLUSIONS Our pharmacist-facilitated SAB initiative was associated with improved EBB adherence and clinical outcomes.
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Affiliation(s)
- Wesley D Kufel
- Binghamton University School of Pharmacy and Pharmaceutical Sciences, Binghamton, NY, USA; State University of New York Upstate Medical University, Syracuse, NY, USA; State University of New York Upstate University Hospital, Syracuse, NY, USA.
| | - Keri A Mastro
- Binghamton University School of Pharmacy and Pharmaceutical Sciences, Binghamton, NY, USA; State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Jeffrey M Steele
- State University of New York Upstate Medical University, Syracuse, NY, USA; State University of New York Upstate University Hospital, Syracuse, NY, USA
| | - Dongliang Wang
- State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Scott W Riddell
- State University of New York Upstate Medical University, Syracuse, NY, USA; State University of New York Upstate University Hospital, Syracuse, NY, USA
| | - Kristopher M Paolino
- State University of New York Upstate Medical University, Syracuse, NY, USA; State University of New York Upstate University Hospital, Syracuse, NY, USA
| | - Stephen J Thomas
- State University of New York Upstate Medical University, Syracuse, NY, USA; State University of New York Upstate University Hospital, Syracuse, NY, USA
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Advanced practice providers in the infectious disease workforce: A nationwide utilization survey. JOURNAL OF INTERPROFESSIONAL EDUCATION & PRACTICE 2021; 24:100448. [PMID: 36567810 PMCID: PMC9765300 DOI: 10.1016/j.xjep.2021.100448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 06/01/2021] [Indexed: 12/27/2022]
Abstract
Background Shortages of infectious disease (ID) physicians is an identified workforce problem. The COVID-19 pandemic has exacerbated this care gap, leaving many communities without access to an ID physician. More advanced practice providers (APPs), specifically nurse practitioners and physician assistants, work as healthcare extenders, yet are not well described in ID. Purpose Evaluate collaboration between ID physicians and APPs, and potential barriers to utilization of APPs. Methods Anonymous and voluntary surveys; one for physicians, another for APPs. We collected experience, practice setting, familiarity regarding APPs in ID, use of APPs, and perceived barriers/concerns for utilization of APPs. Discussion Nationwide, 218 ID physicians and 93 APPs in ID responded. 71% (155) of ID physicians use APPs. Of APPs, 53% (49) had > 5 years ID experience. Responses highlighted opportunities for dedicated ID education, collaboration, and clarification of practice scope. Conclusion APPs are an experienced group who provide ID care, working alongside physicians to meet ID workforce needs.
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Cervantes J, Hong BY. The Impact of Experiential Learning in Host-Pathogen Research on Medical Students' Interests and Attitudes towards Microbiology and Immunology. JOURNAL OF MICROBIOLOGY & BIOLOGY EDUCATION 2021; 22:e00101-21. [PMID: 34594433 PMCID: PMC8439612 DOI: 10.1128/jmbe.00101-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/09/2021] [Indexed: 06/13/2023]
Abstract
There is a shortage of residents in the infectious diseases (IDs) specialty due to a lack of interest in this field. If the choice of an ID subspecialty is linked to medical school experiences, then how we teach microbiology and immunology could be a factor in the declining interest in the field. We sought to determine whether experiential learning activities on host-pathogen research might improve students' interests and attitudes toward medical microbiology and immunology. Experiential learning of medical students undertaking research project on microbiology/immunology leads to subjective attitude changes (i.e., increased science motivation, confidence, and knowledge) and the development of a new social niche. It also lets students learn new scientific techniques and use novel technological devices, which have an impact in the experiential learning of basic sciences such as microbiology and immunology. The results of this study support the idea of a beneficial effect of experiential learning, which may rekindle interest of medical students in the field of infectious diseases.
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Affiliation(s)
- Jorge Cervantes
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Bo-Young Hong
- Jackson Laboratory for Genomic Medicine, Farmington, Connecticut, USA
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Marshall AA, Wooten DA. An HIV Primary Care Rotation Improved HIV and STI Knowledge, Enhanced Sexual History-Taking Skills, and Increased Interest in a Career in Infectious Diseases Among Medical Students and Residents. Open Forum Infect Dis 2021; 8:ofab207. [PMID: 34104668 PMCID: PMC8180249 DOI: 10.1093/ofid/ofab207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/20/2021] [Indexed: 11/25/2022] Open
Abstract
Rotations in HIV primary care clinics have the potential to teach trainees core competencies and influence their career pathway. We found that fund of knowledge, confidence in obtaining a sexual history, and interest in an Infectious Diseases career all increased following an HIV clinic rotation.
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Affiliation(s)
- Austin A Marshall
- School of Medicine, University of California, San Diego, San Diego, California, USA
| | - Darcy A Wooten
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, San Diego, California, USA
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Antibiotic stewardship teams and Clostridioides difficile practices in United States hospitals: A national survey in The Joint Commission antibiotic stewardship standard era. Infect Control Hosp Epidemiol 2021; 41:143-148. [PMID: 31806059 DOI: 10.1017/ice.2019.313] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Clostridioides difficile infection (CDI) can be prevented through infection prevention practices and antibiotic stewardship. Diagnostic stewardship (ie, strategies to improve use of microbiological testing) can also improve antibiotic use. However, little is known about the use of such practices in US hospitals, especially after multidisciplinary stewardship programs became a requirement for US hospital accreditation in 2017. Thus, we surveyed US hospitals to assess antibiotic stewardship program composition, practices related to CDI, and diagnostic stewardship. METHODS Surveys were mailed to infection preventionists at 900 randomly sampled US hospitals between May and October 2017. Hospitals were surveyed on antibiotic stewardship programs; CDI prevention, treatment, and testing practices; and diagnostic stewardship strategies. Responses were compared by hospital bed size using weighted logistic regression. RESULTS Overall, 528 surveys were completed (59% response rate). Almost all (95%) responding hospitals had an antibiotic stewardship program. Smaller hospitals were less likely to have stewardship team members with infectious diseases (ID) training, and only 41% of hospitals met The Joint Commission accreditation standards for multidisciplinary teams. Guideline-recommended CDI prevention practices were common. Smaller hospitals were less likely to use high-tech disinfection devices, fecal microbiota transplantation, or diagnostic stewardship strategies. CONCLUSIONS Following changes in accreditation standards, nearly all US hospitals now have an antibiotic stewardship program. However, many hospitals, especially smaller hospitals, appear to struggle with access to ID expertise and with deploying diagnostic stewardship strategies. CDI prevention could be enhanced through diagnostic stewardship and by emphasizing the role of non-ID-trained pharmacists and clinicians in antibiotic stewardship.
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Abstract
The infectious diseases (ID) specialty continues to be in crisis due to a lack of interest by residents in the recruitment pool. It is possible that enhancing and innovating how microbiology is taught in medical school could increase the interest in ID. We need to improve teaching of preclinical medical microbiology and immunology by incorporating advancements in education and learning technologies to reignite the interest in the field. The shortage of ID specialists has important implications in our fight against ID threats such as the current COVID-19 global pandemic. In order to address this problem, we need to perform extensive research to identify the issues that medical learners and trainees are facing as they progress through their medical education towards the ID specialty.
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Affiliation(s)
- Jorge Cervantes
- Department of Medical Education, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center at El Paso, El Paso, TX USA
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12
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Steward WT, Koester KA, Guzé MA, Kirby VB, Fuller SM, Moran ME, Botta EW, Gaffney S, Heath CD, Bromer S, Shade SB. Practice transformations to optimize the delivery of HIV primary care in community healthcare settings in the United States: A program implementation study. PLoS Med 2020; 17:e1003079. [PMID: 32214312 PMCID: PMC7098549 DOI: 10.1371/journal.pmed.1003079] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 02/20/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The United States HIV care workforce is shrinking, which could complicate service delivery to people living with HIV (PLWH). In this study, we examined the impact of practice transformations, defined as efficiencies in structures and delivery of care, on demonstration project sites within the Workforce Capacity Building Initiative, a Health Resources and Services Administration (HRSA) Ryan White HIV/AIDS Program Special Projects of National Significance (SPNS). METHODS AND FINDINGS Data were collected at 14 demonstration project sites in 7 states and the District of Columbia. Organizational assessments were completed at sites once before and 4 times after implementation. They captured 3 transformation approaches: maximizing the HIV care workforce (efforts to increase the number of existing healthcare workforce members involved in the care of PLWH), share-the-care (team-based care giving more responsibility to midlevel providers and staff), and enhancing client engagement in primary HIV care to reduce emergency and inpatient care (e.g., care coordination). We also obtained Ryan White HIV/AIDS Program Services Reports (RSRs) from sites for calendar years (CYs) 2014-2016, corresponding to before, during, and after transformation. The RSR include data on client retention in HIV care, prescription of antiretroviral therapy (ART), and viral suppression. We used generalized estimating equation (GEE) models to analyze changes among sites implementing each practice transformation approach. The demonstration projects had a mean of 18.5 prescribing providers (SD = 23.5). They reported data on more than 13,500 clients per year (mean = 969/site, SD = 1,351). Demographic characteristics remained similar over time. In 2014, a majority of clients were male (71% versus 28% female and 0.2% transgender), with a mean age of 47 (interquartile range [IQR] 37-54). Racial/ethnic characteristics (48% African American, 31% Hispanic/Latino, 14% white) and HIV risk varied (31% men who have sex with men; 31% heterosexual men and women; 7% injection drug use). A substantial minority was on Medicaid (41%). Across sites, there was significant uptake in practices consistent with maximizing the HIV care workforce (18% increase, p < 0.001), share-the-care (25% increase, p < 0.001), and facilitating patient engagement in HIV primary care (13% increase, p < 0.001). There were also significant improvements over time in retention in HIV care (adjusted odds ratio [aOR] = 1.03; 95% confidence interval [CI] 1.02-1.04; p < 0.001), ART prescription levels (aOR = 1.01; 95% CI 1.00-1.01; p < 0.001), and viral suppression (aOR = 1.03; 95% CI 1.02-1.04; p < 0.001). All outcomes improved at sites that implemented transformations to maximize the HIV care workforce or improve client engagement. At sites that implemented share-the-care practices, only retention in care and viral suppression outcomes improved. Study limitations included use of demonstration project sites funded by the Ryan White HIV/AIDS Program (RWHAP), which tend to have better HIV outcomes than other US clinics; varying practice transformation designs; lack of a true control condition; and a potential Hawthorne effect because site teams were aware of the evaluation. CONCLUSIONS In this study, we found that practice transformations are a potential strategy for addressing anticipated workforce challenges among those providing care to PLWH. They hold the promise of optimizing the use of personnel and ensuring the delivery of care to all in need while potentially enhancing HIV care continuum outcomes.
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Affiliation(s)
- Wayne T. Steward
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco (UCSF), San Francisco, California, United States of America
- * E-mail:
| | - Kimberly A. Koester
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco (UCSF), San Francisco, California, United States of America
| | - Mary A. Guzé
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco (UCSF), San Francisco, California, United States of America
| | - Valerie B. Kirby
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco (UCSF), San Francisco, California, United States of America
| | - Shannon M. Fuller
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco (UCSF), San Francisco, California, United States of America
| | - Mary E. Moran
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco (UCSF), San Francisco, California, United States of America
| | - Emma Wilde Botta
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco (UCSF), San Francisco, California, United States of America
| | - Stuart Gaffney
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco (UCSF), San Francisco, California, United States of America
| | - Corliss D. Heath
- U.S. Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA), HIV/AIDS Bureau, Rockville, Maryland, United States of America
| | - Steven Bromer
- Department of Family and Community Medicine, University of California San Francisco (UCSF), San Francisco, California, United States of America
| | - Starley B. Shade
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco (UCSF), San Francisco, California, United States of America
- Institute for Global Health Sciences, University of California San Francisco (UCSF), San Francisco, California, United States of America
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Ryan KL, Jakeman B, Conklin J, Pineda LJ, Deming P, Mercier RC. Treatment of patients with HIV or hepatitis C by pharmacist clinicians in a patient-centered medical home. Am J Health Syst Pharm 2020; 76:821-828. [PMID: 31053839 DOI: 10.1093/ajhp/zxz059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
PURPOSE This report describes an innovative pharmacy practice model assisting in the care of patients living with or at risk of acquiring human immunodeficiency virus (HIV) and/or hepatitis C virus (HCV). SUMMARY In the state of New Mexico, pharmacists can obtain prescribing privileges through a Pharmacist Clinician (PhC) license. The license allows PhCs to assess patients, order laboratory/diagnostic tests, prescribe medication, and bill select insurances. PhCs have developed a practice model for patients living with or at risk of HIV and/or HCV at a Level 3 National Committee for Quality Assurance Patient-Centered Medical Home in Albuquerque, New Mexico. In 2015, 5 PhCs, employed part time, were involved with 8 different clinics: (1) HIV Adherence and Complex Care, (2) HIV Transitions of Care, (3) HCV Mono- and Co-Infection, (4) HIV Pre-Exposure Prophylaxis (PrEP), (5) HIV Primary Care and Cardiovascular Risk Reduction, (6) Young Adult Clinic, (7) Perinatal HIV, and (8) Pediatric HIV. In 2015, PhCs at the clinic billed for 774 direct patient encounters. CONCLUSION Pharmacists with the PhC license are able to provide high-quality medical care to patients living with or at risk of HIV and/or HCV infections within an interprofessional medical home model.
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Affiliation(s)
- Keenan L Ryan
- Department of Pharmacy, University of New Mexico Hospitals, Albuquerque, NM
| | - Bernadette Jakeman
- Department of Pharmaceutical Practice and Administrative Sciences, University of New Mexico College of Pharmacy, Albuquerque, NM
| | - Jessica Conklin
- Department of Pharmaceutical Practice and Administrative Sciences, University of New Mexico College, Albuquerque, NM
| | - Larry J Pineda
- Covenant Health System, Department of Quality Management, Lubbock, TX
| | - Paulina Deming
- University of New Mexico College of Pharmacy, Department of Pharmaceutical Practice and Administrative Sciences, Albuquerque, NM
| | - Renee-Claude Mercier
- University of New Mexico College of Pharmacy, Department of Pharmaceutical Practice and Administrative Sciences, Albuquerque, NM
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Burnham JP, Fritz SA, Yaeger LH, Colditz GA. Telemedicine Infectious Diseases Consultations and Clinical Outcomes: A Systematic Review. Open Forum Infect Dis 2019; 6:ofz517. [PMID: 31879674 PMCID: PMC6925389 DOI: 10.1093/ofid/ofz517] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 12/04/2019] [Indexed: 12/20/2022] Open
Abstract
Background Telemedicine use is increasing in many specialties, but its impact on clinical outcomes in infectious diseases has not been systematically reviewed. We reviewed the current evidence for clinical effectiveness of telemedicine infectious diseases consultations, including outcomes of mortality, hospital readmission, antimicrobial use, cost, length of stay, adherence, and patient satisfaction. Methods We queried Ovid MEDLINE 1946-, Embase.com 1947-, Scopus 1823-, Cochrane Database of Systematic Reviews (CDSR), Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov 1997- through August 5, 2019, for studies looking at clinical outcomes of infectious diseases in the setting of telemedicine use. We did not restrict by language or year of publication. Clinical outcomes searched included 30-day all-cause mortality, 30-day readmissions, patient compliance/adherence, patient satisfaction, cost or cost-effectiveness, length of hospital stay, antimicrobial use, and antimicrobial stewardship. Bias was assessed using standard methodologies. PROSPERO CRD42018105225. Results From a search pool of 1154 studies, only 18 involved telemedicine infectious diseases consultation and our selected clinical outcomes. The outcomes tracked were heterogeneous, precluding meta-analysis, and the majority of studies were of poor quality. Overall, clinical outcomes with telemedicine infectious diseases consultation seem comparable to in-person infectious diseases consultation. Conclusions Although in widespread use, the clinical effectiveness of telemedicine infectious diseases consultations has yet to be sufficiently studied. Further studies, or publication of previously collected and available data, are warranted to verify the cost-effectiveness of this widespread practice. Systematic review registration PROSPERO CRD42018105225.
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Affiliation(s)
- Jason P Burnham
- Division of Infectious Diseases Washington University School of Medicine, St. Louis, Missouri, USA
| | - Stephanie A Fritz
- Department of Pediatrics, Washington University in St. Louis, Missouri, USA
| | - Lauren H Yaeger
- Bernard Becker Medical Library, Washington University in St. Louis, Missouri, USA
| | - Graham A Colditz
- Division of Public Health Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
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Barsoumian AE, Hartzell JD, Bonura EM, Ressner RA, Whitman TJ, Yun HC. Factors Influencing Selection of Infectious Diseases Training for Military Internal Medicine Residents. Clin Infect Dis 2019; 67:1582-1587. [PMID: 29912315 DOI: 10.1093/cid/ciy322] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 04/12/2018] [Indexed: 11/14/2022] Open
Abstract
Background Applications to infectious diseases fellowships have declined nationally; however, the military has not experienced this trend. In the past 6 years, 3 US military programs had 58 applicants for 52 positions. This study examines military resident perceptions to identify potential differences in factors influencing career choice, compared with published data from a nationwide cohort. Methods An existing survey tool was adapted to include questions unique to the training and practice of military medicine. Program directors from 11 military internal medicine residencies were asked to distribute survey links to their graduating residents from December 2016 to January 2017. Data were categorized by ID interest. Result The response rate was 51% (n = 68). Of respondents, 7% were ID applicants, 40% considered ID but reconsidered, and 53% were uninterested. Of those who considered ID, 73% changed their mind in their second and third postgraduate years and cited salary (22%), lack of procedures (18%), and training length (18%) as primary deterrents to choosing ID. Active learning styles were used more frequently by ID applicants to learn ID concepts than by those who considered or were uninterested in ID (P = .02). Conclusions Despite differences in the context of training and practice among military trainees compared with civilian colleagues, residents cited similar factors affecting career choice. Interest in global health was higher in this cohort. Salary continues to be identified as a deterrent to choosing ID. Differences between military and civilian residents' desire to pursue ID fellowship are likely explained by additional unmeasured factors deserving further study.
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Affiliation(s)
- Alice E Barsoumian
- Infectious Disease Service, Department of Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, TX
| | - Joshua D Hartzell
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Erin M Bonura
- Division of Infectious Diseases, Oregon Health & Science University, Portland, MD
| | - Roseanne A Ressner
- Department of Infectious Diseases, Walter Reed National Military Medical Center, Bethesda, MD
| | - Timothy J Whitman
- Department of Infectious Diseases, Walter Reed National Military Medical Center, Bethesda, MD
| | - Heather C Yun
- Infectious Disease Service, Department of Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, TX
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16
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17
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Burnham JP, Fritz SA, Yaeger LH, Colditz GA. Telemedicine infectious diseases consultations and clinical outcomes: a systematic review and meta-analysis protocol. Syst Rev 2019; 8:135. [PMID: 31174594 PMCID: PMC6554925 DOI: 10.1186/s13643-019-1056-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 05/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Telemedicine use is increasing in many specialties, but its impact on clinical outcomes in infectious diseases has not been systematically studied and reviewed. The proposed systematic review will evaluate the current evidence regarding the effect of telemedicine infectious diseases consultation on a range of clinical outcomes, including mortality, hospital readmission, antimicrobial use, and cost. METHOD/DESIGN Standard systematic review methodology will be used, with searches of Ovid MEDLINE 1946-, https://embase.com/ 1947-, Scopus 1823-, Cochrane Database of Systematic Reviews (CDSR), Cochrane Central Register of Controlled Trials (CENTRAL), and https://clinicaltrials.gov/ 1997-. There will be no restriction on language or year of publication. The primary outcome will be 30-day all-cause mortality and secondary outcomes will include readmission within 30 days after discharge from an initial hospitalization with an infection, patient compliance/adherence, patient satisfaction, cost or cost effectiveness, length of hospital stay, antimicrobial use, and antimicrobial stewardship. Bias will be assessed using standard Cochrane methodologies. Data will be grouped by outcome and narratively synthesized. Meta-analysis will be performed for outcomes with clinical or methodological homogeneity. The systematic review and meta-analysis will be registered through PROSPERO. Pre-planned subgroup analyses will be detailed. DISCUSSION A number of studies have documented the feasibility of telemedicine for infectious diseases, but a synthesis of clinical outcomes data with telemedicine infectious diseases consultation has not been performed. This systematic review will analyze many clinical outcomes of telemedicine infectious diseases consultation. The findings of this study will add to established literature about feasibility of telemedicine consultation by synthesizing the evidence for clinical effectiveness. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018105225.
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Affiliation(s)
- Jason P. Burnham
- Division of Infectious Diseases, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8051, St. Louis, MO 63110 USA
| | | | - Lauren H. Yaeger
- Bernard Becker Medical Library, Washington University, St. Louis, MO USA
| | - Graham A. Colditz
- Division of Public Health Sciences, Washington University School of Medicine, St Louis, MO USA
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18
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Valenti S, Johnson L, Szpunar S, Hilu R, Saravolatz L. Training Internal Medicine Residents to Provide Care and Treatment for Human Immunodeficiency Virus-1-Infected Patients. Open Forum Infect Dis 2019; 6:ofz093. [PMID: 30949537 PMCID: PMC6441781 DOI: 10.1093/ofid/ofz093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 02/21/2019] [Indexed: 11/13/2022] Open
Abstract
Background Human immunodeficiency virus (HIV) infection is now considered a chronic infection manageable on antiretroviral therapy. If trained in HIV care, primary care physicians would be well suited to work in consultation with infectious disease specialists to provide care for HIV patients. Methods Human immunodeficiency virus training was incorporated into our internal medicine residency program. All residents were given an internally developed preprogram survey about HIV infection to establish a baseline level of HIV knowledge; at the end of 1 year, a postprogram survey was distributed. These results were compared. Human immunodeficiency virus didactic lectures were mandatory for attendance. Human immunodeficiency virus training included methods of testing, treatment including all classes of antiretroviral therapy, and prevention methods. Additional, mandatory online training modules were used. All program year-2 residents were assigned to an outpatient HIV clinical rotation. Results Eighty-three residents participated. Residents received either 1 or 2 years of training. Results of preprogram scores and postprogram scores were calculated for each resident. Year 1-test scores preprogram were 52.2% vs postprogram 87.1%; year 2-test scores preprogram were 56.3% vs postprogram 89.8% (both P < .0001). There was no difference in posttest scores among residents who attended a clinical rotation. Conclusions Residents showed significant improvement in HIV knowledge between preprogram and postprogram test scores. Postgraduate surveys showed among those who completed the survey, and most found the program helpful to in their current practice.
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Affiliation(s)
- Sharon Valenti
- Department of Internal Medicine, Ascension St. John Hospital, Detroit, Michigan
| | - Leonard Johnson
- Department of Internal Medicine, Ascension St. John Hospital, Detroit, Michigan.,Department of Internal Medicine, Division of Infectious Diseases, Ascension St. John Hospital, Detroit, Michigan.,Wayne State University School of Medicine, Detroit, Michigan
| | - Susan Szpunar
- Department of Internal Medicine, Ascension St. John Hospital, Detroit, Michigan.,Department of Medical Education, Epidemiology, Biostatistics, Ascension St. John Hospital, Detroit, Michigan
| | - Raymond Hilu
- Department of Internal Medicine, Ascension St. John Hospital, Detroit, Michigan.,Wayne State University School of Medicine, Detroit, Michigan
| | - Louis Saravolatz
- Department of Internal Medicine, Ascension St. John Hospital, Detroit, Michigan.,Wayne State University School of Medicine, Detroit, Michigan
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Bland CM, Bookstaver PB, Griffith NC, Heil EL, Jones BM, Ann Justo J, Staicu ML, Torney NP, Wall GC. A practical guide for pharmacists to successfully implement penicillin allergy skin testing. Am J Health Syst Pharm 2019; 76:136-147. [DOI: 10.1093/ajhp/zxy043] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
| | - P Brandon Bookstaver
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Palmetto Health Richland Department of Pharmacy, Columbia, SC
| | | | - Emily L Heil
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD
| | - Bruce M Jones
- St. Joseph’s/Candler Health System, Inc., Savannah, GA
| | - Julie Ann Justo
- Department of Clinical Pharmacy & Outcomes Sciences, University of South Carolina College of Pharmacy, Palmetto Health Richland Department of Pharmacy Columbia, SC
| | | | - Nicholas P Torney
- Department of Pharmacy and Infectious Diseases, Munson Medical Center, Traverse City, MI
| | - Geoffrey C Wall
- Drake University College of Pharmacy and Health Sciences, Iowa Methodist Medical Center, Des Moines, IA
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20
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All aboard!: Involvement of medical and pharmacy trainees in antimicrobial stewardship. Infect Control Hosp Epidemiol 2018; 40:200-205. [DOI: 10.1017/ice.2018.332] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractAntimicrobial stewardship (AS) involves the appropriate selection of antimicrobials. Antimicrobial stewardship programs are mandated in hospitals and are expanding to involve outpatient arenas. Multiple articles have been published describing the need for AS education for medical and pharmacy students, beginning early in the students’ career to develop into competent AS practitioners. Additionally, publications have described the role and impact of medical and pharmacy trainees on AS programs. Here, we review the published evidence describing medical and pharmacy trainees’ involvement in AS and call for future research in this area.
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Townsend J, Vishnupriya KS, Klein E, Spoelhof B, Zenilman J. Hospitalist Infectious Disease Service in Academic Medical Centers: A Win-Win for Hospitalists and Fellows. South Med J 2018; 111:534-536. [PMID: 30180249 DOI: 10.14423/smj.0000000000000858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Supplemental digital content is available in the text.
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Affiliation(s)
- Jennifer Townsend
- From the Divisions of Infectious Disease and Hospitalist Medicine, and the Department of Pharmacy, Johns Hopkins Bayview Medical Center, and the Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Kittane Srinivas Vishnupriya
- From the Divisions of Infectious Disease and Hospitalist Medicine, and the Department of Pharmacy, Johns Hopkins Bayview Medical Center, and the Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Eili Klein
- From the Divisions of Infectious Disease and Hospitalist Medicine, and the Department of Pharmacy, Johns Hopkins Bayview Medical Center, and the Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Brian Spoelhof
- From the Divisions of Infectious Disease and Hospitalist Medicine, and the Department of Pharmacy, Johns Hopkins Bayview Medical Center, and the Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jonathan Zenilman
- From the Divisions of Infectious Disease and Hospitalist Medicine, and the Department of Pharmacy, Johns Hopkins Bayview Medical Center, and the Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
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22
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Blyth DM, Barsoumian AE, Yun HC. Timing of Infectious Disease Clinical Rotation Is Associated With Infectious Disease Fellowship Application. Open Forum Infect Dis 2018; 5:ofy155. [PMID: 30087906 DOI: 10.1093/ofid/ofy155] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 07/30/2018] [Indexed: 11/13/2022] Open
Abstract
Background With declining interest in infectious disease (ID) noted among internal medicine (IM) residents, national attention has been directed at methods to recruit more prospective ID applicants. The factors driving the recent decline in ID fellowship applications have thus far only been evaluated in survey studies. Since 2008 at our institution, all IM interns were required to complete a 4-week inpatient ID rotation. We evaluated this rotation to determine if any experiential factors could be linked to future ID interest. Methods Categorical IM interns rotating on the mandatory ID rotation at our institution between July 1, 2008, and June 30, 2015, were included. Interns were grouped by eventual application to ID fellowship (IDA) and nonapplication (non-IDA). Consult numbers and types and characteristics of team members during the rotation were compared. Results Between July 2008 and June 2015, 143 IM interns met inclusion criteria. Ten (7%) were IDA. There was no difference in number of consults seen, intern, team member, faculty, or fellow characteristics among groups. However, 90% of IDA compared with 46% of non-IDA rotated during the first 6 months of internship (P = .01). Conclusions During a 7-year period, those interns randomly assigned to rotate on ID in the first 6 months of their intern year were more likely to become future ID applicants. This supports prior self-reported survey data that early exposure to the field may impact future career choice and suggests that incorporating ID early into the intern experience may increase recruitment.
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Affiliation(s)
- Dana M Blyth
- Infectious Disease Service, Department of Medicine, Brooke Army Medical Center, Houston, Texas
| | - Alice E Barsoumian
- Infectious Disease Service, Department of Medicine, Brooke Army Medical Center, Houston, Texas
| | - Heather C Yun
- Infectious Disease Service, Department of Medicine, Brooke Army Medical Center, Houston, Texas
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Wenzler E, Wang F, Goff DA, Prier B, Mellett J, Mangino JE, Bauer KA. An Automated, Pharmacist-Driven Initiative Improves Quality of Care for Staphylococcus aureus Bacteremia. Clin Infect Dis 2018; 65:194-200. [PMID: 28379326 DOI: 10.1093/cid/cix315] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 03/31/2017] [Indexed: 01/07/2023] Open
Abstract
Background Infectious diseases (ID) consultation and antimicrobial stewardship intervention have been shown to improve the management of Staphylococcus aureus bacteremia (SAB). As the workload of antimicrobial stewardship programs (ASPs) continues to increase, ASPs must find a way to maximize the efficiency of the program while optimizing patient outcomes. The objective of this study was to evaluate the impact of incorporating health informatics into the management of SAB via a pharmacist-driven initiative. Methods Retrospective, single-center quasi-experimental study of hospitalized patients with SAB. During the intervention period, pharmacists were alerted to patients with SAB via a patient scoring tool integrated into the electronic medical record. Pharmacists utilized the scoring tool and the institution's evidence-based practice guideline to make standardized recommendations to promote adherence to SAB quality-of-care measures and encourage ID consultation. The primary outcome was overall compliance along with adherence to individual quality-of-care components. Secondary clinical outcomes were also analyzed. Results In sum, 84 patients were identified for study inclusion, 45 in the pre-intervention and 39 in the intervention group. As a whole, all 4 quality-of-care components for the management of SAB were significantly more frequently adhered to in the intervention group (68.9% vs 92.3%; P = .008). The incidence of ID consult improved significantly by almost 20% in the intervention group (75.6% vs 94.9%, P = .015). No statistically significant differences in duration of bacteremia, length-of-stay, infection-related length-of-stay, or readmission were observed between the groups. The incidence of all-cause mortality was 6-fold higher in the pre- intervention group compared to the intervention group (15.6% vs 2.6%, P = .063). Conclusion An automated, pharmacist-driven intervention for the management of patients with SAB demonstrated a significant improvement in patients receiving an ID consult, targeted antimicrobial therapy, and adherence to all SAB quality-of-care measures. As antimicrobial stewardship becomes a mandatory aspect of healthcare in all hospitals in the United States, ASPs will be forced to find ways to provide more efficient, impactful, disease state-based patient care. Our study provides the framework for and data to support this intervention in one of the most clinically important infectious diseases.
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Affiliation(s)
- Eric Wenzler
- College of Pharmacy, University of Illinois at Chicago
| | | | | | | | | | - Julie E Mangino
- Internal Medicine, Division of Infectious Diseases, The Ohio State University Wexner Medical Center, Columbus
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Patel RR, Chan PA, Harrison LC, Mayer KH, Nunn A, Mena LA, Powderly WG. Missed Opportunities to Prescribe HIV Pre-Exposure Prophylaxis by Primary Care Providers in Saint Louis, Missouri. LGBT Health 2018; 5:250-256. [PMID: 29688800 DOI: 10.1089/lgbt.2017.0101] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
PURPOSE Optimal HIV pre-exposure prophylaxis (PrEP) scale-up in the United States requires prescribing by primary care providers (PCPs). We assessed barriers to patients obtaining PrEP from their PCPs. METHODS Patients seeking PrEP at an Infectious Diseases (ID) Clinic in St. Louis, Missouri from 2014 to 2016 were asked about demographics, sexual behaviors, whether PrEP was initially sought from their PCP, and barriers to obtaining PrEP from their PCP. Multivariable logistic regression was performed to identify predictors for having asked a PCP for PrEP. RESULTS Among 102 patients, the median age was 29 years, 58% were white, and 88% were men who have sex with men. Most (65%) had a PCP and, of these, 48% had asked their PCP for PrEP, but were not prescribed it. About half (52%) reported that their PCPs perceived prescribing PrEP as specialty care. Many (39%) indicated that they felt uncomfortable discussing their sexual behaviors with their PCP. Patients with an HIV-positive sex partner in the last 3 months were less likely to ask for PrEP from their PCPs than others (Adjusted Odds Ratio: 0.07; 95% CI: 0.01-0.53). Eighty-three percent of patients were referred to a new PCP with whom they could feel more comfortable discussing PrEP. CONCLUSIONS During initial PrEP implementation, ID specialists can play an important role in providing education and linking PrEP patients to PCPs. However, PCPs may need additional training about PrEP and how to provide culturally sensitive sexual healthcare, if widespread scale-up is to be effective in decreasing HIV incidence.
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Affiliation(s)
- Rupa R Patel
- 1 Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine , St. Louis, Missouri
| | - Philip A Chan
- 2 Division of Infectious Diseases, Department of Medicine, Brown University , Providence, Rhode Island
| | - Laura C Harrison
- 1 Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine , St. Louis, Missouri
| | - Kenneth H Mayer
- 3 Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center , Boston, Massachusetts.,4 Department of Medicine, Harvard Medical School , Boston, Massachusetts.,5 The Fenway Institute , Fenway Health, Boston, Massachusetts
| | - Amy Nunn
- 6 Department of Behavioral and Social Sciences, Brown University School of Public Health , Providence, Rhode Island.,7 The Rhode Island Public Health Institute , Providence, Rhode Island
| | - Leandro A Mena
- 8 Division of Infectious Diseases, Department of Medicine, University of Mississippi , Jackson, Mississippi
| | - William G Powderly
- 1 Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine , St. Louis, Missouri
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25
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McCarthy MW, Walsh TJ. The rise of hospitalists: an opportunity for infectious diseases investigators. Expert Rev Anti Infect Ther 2018; 16:385-389. [PMID: 29620478 DOI: 10.1080/14787210.2018.1462158] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Despite the essential role played by infectious diseases specialists in patient care, public health, cost-containment, and biomedical research, the field has a substantially higher percentage of vacant positions than other medicine sub-specialties. While much has been written about what this disturbing trend means for patient care, comparatively little attention has been focused on the dire implications for clinical research and the development of novel anti-infective therapy. Areas covered: We examine the ways that hospitalists and infectious disease specialists might collaborate to study emerging diagnostic platforms, novel antimicrobial agents, and strengthen antimicrobial stewardship programs to improve the delivery of high-quality health care. Through the use of PubMed, the manuscript reviews existing collaborations as well as those that might develop in the years to come. Expert commentary: In this paper, we propose potential strategies to confront this emerging problem, focusing on novel collaborations with the hospitalist - the specialist in inpatient medicine - to bolster the pipeline of funding for clinical infectious diseases investigators.
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Affiliation(s)
- Matthew W McCarthy
- a Medicine, Weill Cornell Medical College, Division of General Internal Medicine , New York-Presbyterian Hospital , New York , NY , USA
| | - Thomas J Walsh
- b Transplantation-Oncology Infectious Diseases Program, Medical Mycology Research Laboratory, Medicine, Pediatrics, and Microbiology & Immunology, Weill Cornell Medical Center, Henry Schueler Foundation Scholar , Sharpe Family Foundation Scholar in Pediatric Infectious Diseases , New York , NY , USA
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26
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Tucker JD, Hughes MA, Durvasula RV, Vinetz JM, McGovern VP, Schultz R, Dunavan CP, Wilson ME, Milner DA, LaRocque RC, Calderwood SB, Guerrant RL, Weller PF, Taylor TE. Measuring Success in Global Health Training: Data From 14 Years of a Postdoctoral Fellowship in Infectious Diseases and Tropical Medicine. Clin Infect Dis 2018; 64:1768-1772. [PMID: 28369324 DOI: 10.1093/cid/cix242] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 03/14/2017] [Indexed: 11/13/2022] Open
Abstract
Background. In modern academic medicine, especially in the fields of infectious diseases and global health, aspiring physician-scientists often wait years before achieving independence as basic, translational, and clinical investigators. This study employed mixed methods to evaluate the success of the Burroughs Wellcome Fund/American Society for Tropical Medicine and Hygiene (BWF/ASTMH) global health postdoctoral fellowship in promoting scientific independence. Methods. We examined quantitative data obtained from the National Institutes of Health (NIH) and qualitative data provided by the ASTMH and program participants to assess BWF/ASTMH trainees' success in earning NIH grants, publishing manuscripts, and gaining faculty positions. We also calculated the return on investment (ROI) associated with the training program by dividing direct costs of NIH research grants awarded to trainees by the direct costs invested by the BWF/ASTMH fellowship. Results. Forty-one trainees received fellowships between 2001 and 2015. Within 3 years of completing their fellowships, 21 of 35 (60%) had received career development awards, and within 5 years, 12 of 26 (46%) had received independent research awards. Overall, 22 of 35 (63%) received 1 or more research awards. BWF/ASTMH recipients with at least 3 years of follow-up data had coauthored a mean of 36 publications (range, 2-151) and 29 of 35 (82%) held academic positions. The return on investment was 11.9 overall and 31.8 for fellowships awarded between 2001 and 2004. Conclusions. Between 2001 and 2015, the BWF/ASTMH postdoctoral training program successfully facilitated progress to scientific independence. This program model underscores the importance of custom-designed postdoctoral training as a bridge to NIH awards and professional autonomy.
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Affiliation(s)
- Joseph D Tucker
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill.,UNC Project-China, Guangdong Provincial STD Control Center, and.,SESH Global, Guangzhou, China
| | - Molly A Hughes
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia School of Medicine, Charlottesville
| | - Ravi V Durvasula
- Center for Global Health and Department of Internal Medicine, University of New Mexico School of Medicine, and.,Department of Medicine, New Mexico Veterans Affairs Health Care System, Albuquerque
| | - Joseph M Vinetz
- Division of Infectious Diseases, Department of Medicine, University of California, San Diego
| | | | - Rhonda Schultz
- American Society of Tropical Medicine and Hygiene, Oakbrook Terrace, Illinois
| | - Claire Panosian Dunavan
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles
| | - Mary E Wilson
- Internal Medicine and Microbiology, University of Iowa, Iowa City
| | - Danny A Milner
- American Society of Clinical Pathology, Chicago, Illinois.,Harvard T.H. Chan School of Public Health
| | - Regina C LaRocque
- Division of Infectious Diseases, Massachusetts General Hospital, Departments of.,Medicine, and
| | - Stephen B Calderwood
- Division of Infectious Diseases, Massachusetts General Hospital, Departments of.,Medicine, and.,Microbiology and Immunobiology, Harvard Medical School, and
| | - Richard L Guerrant
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia School of Medicine, Charlottesville
| | - Peter F Weller
- Harvard T.H. Chan School of Public Health.,Medicine, and.,Infectious Diseases Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Terrie E Taylor
- Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing ; and.,Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre
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Whither the Pulmonary Ward Attending? Preserving Subspecialty Exposure in United States Internal Medicine Residency Training. Ann Am Thorac Soc 2018; 14:565-568. [PMID: 28362539 DOI: 10.1513/annalsats.201612-995oi] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Twenty years ago, the term "hospitalist" was coined at the University of California-San Francisco (San Francisco, CA), heralding a new specialty focused on the care of inpatients. There are now more than 50,000 hospitalists practicing in the United States. At many academic medical centers, hospitalists are largely replacing subspecialists as attendings on the inpatient medicine wards. At University of California-San Francisco, this has been accompanied by declining percentages of residency graduates who enter subspecialty training in internal medicine. The decline in subspecialty medicine interest can be attributed to many factors, including differences in compensation, decreased subspecialist exposure, and a changing research funding landscape. Although there has not been systematic documentation of this trend in pulmonary and critical care medicine, we have noted previously pulmonary and critical care-bound trainees switching to hospital medicine instead. With our broad, multiorgan system perspective, pulmonary and critical care faculty should embrace teaching general medicine. Residency programs have instituted creative solutions to encourage more internal medicine residents to pursue careers in subspecialty medicine. Some solutions include creating rotations that promote more contact with subspecialists and physician-scientists, creating clinician-educator tracks within fellowship programs, and appointing subspecialists to internal medicine residency leadership positions. We need more rigorous research to track the trends and implications of the generalist-specialist balance of inpatient ward teams on resident career choices, and learn what interventions affect those choices.
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28
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Miller CS, Fogerty RL, Gann J, Bruti CP, Klein R. The Growth of Hospitalists and the Future of the Society of General Internal Medicine: Results from the 2014 Membership Survey. J Gen Intern Med 2017; 32:1179-1185. [PMID: 28744705 PMCID: PMC5653553 DOI: 10.1007/s11606-017-4126-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 06/12/2017] [Accepted: 06/22/2017] [Indexed: 11/30/2022]
Abstract
According to the most recent annual membership surveys, hospitalists are a rapidly growing component of the Society of General Internal Medicine (SGIM). Should this trend continue, hospitalists could increase from 22% of SGIM membership in 2014 to nearly 33% by 2020. Only 34% of hospitalists who responded to the survey, however, consider SGIM their academic home, compared to 54% of non-hospitalist respondents. Based on these survey findings, it is clear that the landscape of general internal medicine is changing with the growth of hospitalists, and SGIM will need to strategize to keep these hospitalist members actively engaged in the organization.
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Affiliation(s)
- Chad S Miller
- Department of Internal Medicine, Saint Louis University, St. Louis, MO, USA.
| | - Robert L Fogerty
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Jillian Gann
- Society of General Internal Medicine, Alexandria, VA, USA
| | - Christopher P Bruti
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Robin Klein
- Department of Medicine, Emory University, Atlanta, GA, USA
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Monsees E, Goldman J, Popejoy L. Staff nurses as antimicrobial stewards: An integrative literature review. Am J Infect Control 2017; 45:917-922. [PMID: 28768593 DOI: 10.1016/j.ajic.2017.03.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 03/08/2017] [Accepted: 03/08/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Guidelines on antimicrobial stewardship emphasize the importance of an interdisciplinary team, but current practice focuses primarily on defining the role of infectious disease physicians and pharmacists; the role of inpatient staff nurses as antimicrobial stewards is largely unexplored. METHODS An updated integrative review method guided a systematic appraisal of 13 articles spanning January 2007-June 2016. Quantitative and qualitative peer-reviewed publications including staff nurses and antimicrobial knowledge or stewardship were incorporated into the analysis. RESULTS Two predominant themes emerged from this review: (1) nursing knowledge, education, and information needs; and (2) patient safety and organizational factors influencing antibiotic management. DISCUSSION Focused consideration to empower and educate staff nurses in antimicrobial management is needed to strengthen collaboration and build an interprofessional stewardship workforce. CONCLUSIONS Further exploration on the integration and measurement of nursing participation is needed to accelerate this important patient safety initiative.
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Donskey CJ. Never Let a Crisis Go to Waste: Recruiting the Next Generation of Infectious Diseases Physicians. Pathog Immun 2017; 2:270-273. [PMID: 28819651 PMCID: PMC5557299 DOI: 10.20411/pai.v2i2.197] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Curtis J Donskey
- Infectious Diseases Section, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio.,Case Western Reserve University School of Medicine, Cleveland, Ohio
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Casadevall A. Crisis in Infectious Diseases: 2 Decades Later. Clin Infect Dis 2017; 64:823-828. [PMID: 28362950 PMCID: PMC5849092 DOI: 10.1093/cid/cix067] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 02/22/2017] [Indexed: 12/13/2022] Open
Affiliation(s)
- Arturo Casadevall
- Department of Molecular Microbiology and Immunology and Department of Medicine, Division of Infectious Diseases, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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32
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Heil EL, Bork JT, Schmalzle SA, Kleinberg M, Kewalramani A, Gilliam BL, Buchwald UK. Implementation of an Infectious Disease Fellow-Managed Penicillin Allergy Skin Testing Service. Open Forum Infect Dis 2016; 3:ofw155. [PMID: 27704011 PMCID: PMC5047432 DOI: 10.1093/ofid/ofw155] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 07/19/2016] [Indexed: 11/17/2022] Open
Abstract
An inpatient penicillin allergy skin testing program can be successfully managed by infectious diseases fellows under attending supervision offering a novel practice area for infectious diseases practitioners. Background. A large percentage of patients presenting to acute care facilities report penicillin allergies that are associated with suboptimal antibiotic therapy. Penicillin skin testing (PST) can clarify allergy histories but is often limited by access to testing. We aimed to implement an infectious diseases (ID) fellow-managed PST program and to assess the need for PST via national survey. Methods. We conducted a prospective observational study of the implementation of an ID fellow-managed penicillin allergy skin testing service. The primary outcome of the study was to assess the feasibility and acceptability of an ID fellow-managed PST service and its impact on the optimization of antibiotic selection. In addition, a survey of PST practices was sent out to all ID fellowship program directors in the United States. Results. In the first 11 months of the program, 90 patients were assessed for PST and 76 patients were tested. Of the valid tests, 96% were negative, and 84% with a negative test had antibiotic changes; 63% received a narrower spectrum antibiotic, 80% received more effective therapy, and 61% received more cost-effective therapy. The majority of survey of respondents (n = 50) indicated that overreporting of penicillin allergy is a problem in their practice that affects antibiotic selection but listed inadequate personnel and time as the main barriers to PST. Conclusions. Inpatient PST can be successfully managed by ID fellows, thereby promoting optimal antibiotic use in patients reporting penicillin allergies. This model can increase access to PST at institutions without adequate access to allergists while also providing an important educational experience to ID trainees.
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Affiliation(s)
- Emily L Heil
- Department of Pharmacy Practice and Science , University of Maryland School of Pharmacy
| | - Jacqueline T Bork
- Department of Medicine, Division of Infectious Diseases , Johns Hopkins School of Medicine
| | | | | | - Anupama Kewalramani
- Department of Pediatrics, Division of Pulmonology and Allergy , University of Maryland School of Medicine , Baltimore
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Kadri SS, Rhee C, Magda G, Strich JR, Cai R, Sun J, Decker BK, O'Grady NP. Synergy, Salary, and Satisfaction: Benefits of Training in Critical Care Medicine and Infectious Diseases Gleaned From a National Pilot Survey of Dually Trained Physicians. Clin Infect Dis 2016; 63:868-875. [PMID: 27358351 DOI: 10.1093/cid/ciw441] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 05/27/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND An increasing number of physicians are seeking dual training in critical care medicine (CCM) and infectious diseases (ID). Understanding experiences and perceptions of CCM-ID physicians could inform career choices and programmatic innovation. METHODS All physicians trained and/or certified in both CCM and ID to date in the United States were sent a Web-based questionnaire in 2015. Responses enabled a cross-sectional analysis of physician demographics and training and practice characteristics and satisfaction. RESULTS Of 202 CCM-ID physicians, 196 were alive and reachable. The response rate was 79%. Forty-six percent trained and 34% practice in the northeastern United States. Only 40% received dual training at the same institution. Eighty-three percent identified as either an intensivist with ID expertise (44%) or as equally an intensivist and ID physician (38%). Median salary was $265 000 (interquartile range [IQR], $215 000-$350 000). Practice settings were split between academic (45%) and community settings (42%). Two-thirds are clinicians but 62% conduct some research and 26% practice outpatient ID. Top reasons to dually specialize included clinical synergy (70%), procedural activity (50%), and less interest in pulmonology (49%). Although 38% cited less proficiency with bronchoscopy as a disadvantage, 87% seldom need pulmonary consultation in the intensive care unit. Median career satisfaction was 4 (IQR, 4-5) out of 5, and 76% would dually train again. CONCLUSIONS CCM-ID graduates prefer the acute care setting, predominantly CCM or a combination of CCM and ID. They find combination training and practice to be synergistic and satisfying, but most have had to seek CCM and ID training independently at separate institutions. Given these findings, avenues for combined training in CCM-ID should be considered.
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Affiliation(s)
- Sameer S Kadri
- Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Chanu Rhee
- Division of Infectious Diseases, Brigham and Women's Hospital.,Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Gabriela Magda
- Department of Medicine, Medstar/Georgetown University Hospital, Washington D.C
| | - Jeffrey R Strich
- Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Rongman Cai
- Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Junfeng Sun
- Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Brooke K Decker
- Infectious Diseases Section, VA Pittsburgh Healthcare System, Pennsylvania
| | - Naomi P O'Grady
- Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland
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Bonura EM, Lee ES, Ramsey K, Armstrong WS. Factors Influencing Internal Medicine Resident Choice of Infectious Diseases or Other Specialties: A National Cross-sectional Study. Clin Infect Dis 2016; 63:155-63. [PMID: 27126345 DOI: 10.1093/cid/ciw263] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 03/18/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Only 49% of infectious diseases (ID) fellowship programs were filled in 2015 through the national match, but little is known about internal medicine (IM) resident perceptions of ID and factors related to IM resident career choice. METHODS We conducted 25 interviews and disseminated a Web-based survey to graduating IM residents in the United States utilizing a 2-stage sampling strategy. Participants were categorized into 3 groups based on interest in ID: (1) applied/intended to apply to ID; (2) interested in ID but did not apply; (3) never interested in ID. We conducted all analysis using poststratification adjustment weights with survey data analysis procedures. RESULTS Of the 590 participants, 42 (7%) selected category 1, 188 (32%) category 2, and 360 (61%) category 3. Most (65%) developed an interest in their ultimate career before residency. Of those interested in ID, >52% rated their ID medical school curriculum as very good and influential on their interest in ID. Ninety-one percent of category 2 participants felt mentorship was influential on career choice, although 43% identified an ID mentor. Category 2 chose salary as the most dissuading factor and the most likely intervention to increase ID interest. CONCLUSIONS In this nationally representative sample of graduating IM residents, most develop an interest in their ultimate career before residency. Factors influencing this decision reside in both medical school and residency, which is consistent with career decision-making constructs. By identifying career determining factors and understanding how they fit into medical training frameworks, we can develop targeted initiatives to reinvigorate interest in ID.
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Affiliation(s)
| | - Eun Sul Lee
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland
| | - Katrina Ramsey
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland
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Hale A, Glassman R, Fessler D, Mukamal KJ, Stead W. Meeting the needs of the resident trainee during an elective subspecialty rotation. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2016; 7:115-118. [PMID: 27062221 PMCID: PMC4826764 DOI: 10.5116/ijme.56f5.c7ec] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 03/25/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To examine and compare perceptions between resident-trainees and faculty-educators on goals and reasons why resident trainees choose certain subspecialty elective rotations. METHODS In June 2013 residents and faculty-educators at a large tertiary care academic medical center were surveyed regarding perceived resident goals for subspecialty electives. Each group was sent a different electronic survey of parallel questions assessing agreement on an ordered scale with statements about which factors impacted resident choice. RESULTS The survey was sent to 154 residents and had 75 (49%) respondents, as well as 20 faculty-educators with 12 (60%) respondents. Residents and faculty did not differ in their responses that electives were chosen to fill perceived knowledge gaps (exact Cochran-Armitage p = .51). However, educators and residents significantly varied in the degree to which they thought resident choice was based on networking within the field (exact Cochran-Armitage p = .01), auditioning for fellowship (exact Cochran-Armitage p < .01), or exploring career options (exact Cochran-Armitage p = .01), with educators overestimating the degree to which these impacted resident choice. CONCLUSIONS Resident trainees and faculty educators agree that subspecialty electives are most frequently chosen in order to meet resident educational goals, highlighting the importance of developing and delivering high quality subspecialty curricular content for the internal medicine resident learner during electives. Many residents choose electives for career development reasons, but faculty educators overestimate this motivation.
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Affiliation(s)
- Andrew Hale
- Division of Infectious Disease at Beth Israel Deaconess Medical Center and Harvard Medical School, USA
| | - Rebecca Glassman
- Division of General Medicine and Primary Care at Beth Israel Deaconess Medical Center and Harvard Medical School, USA
| | - David Fessler
- Division of Infectious Disease at Beth Israel Deaconess Medical Center and Harvard Medical School, USA
| | - Kenneth J. Mukamal
- Division of General Medicine and Primary Care at Beth Israel Deaconess Medical Center and Harvard Medical School, USA
| | - Wendy Stead
- Division of Infectious Disease at Beth Israel Deaconess Medical Center and Harvard Medical School, USA
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Infectious Disease Manpower. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2015. [DOI: 10.1097/ipc.0000000000000262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kadri SS, Rhee C, Fortna GS, O'Grady NP. Critical Care Medicine and Infectious Diseases: An Emerging Combined Subspecialty in the United States. Clin Infect Dis 2015; 61:609-14. [PMID: 25944345 DOI: 10.1093/cid/civ360] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 04/24/2015] [Indexed: 12/16/2022] Open
Abstract
The recent rise in unfilled training positions among infectious diseases (ID) fellowship programs nationwide indicates that ID is declining as a career choice among internal medicine residency graduates. Supplementing ID training with training in critical care medicine (CCM) might be a way to regenerate interest in the specialty. Hands-on patient care and higher salaries are obvious attractions. High infection prevalence and antibiotic resistance in intensive care units, expanding immunosuppressed host populations, and public health crises such as the recent Ebola outbreak underscore the potential synergy of CCM-ID training. Most intensivists receive training in pulmonary medicine and only 1% of current board-certified intensivists are trained in ID. While still small, this cohort of CCM-ID certified physicians has continued to rise over the last 2 decades. ID and CCM program leadership nationwide must recognize these trends and the merits of the CCM-ID combination to facilitate creation of formal dual-training opportunities.
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Affiliation(s)
- Sameer S Kadri
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Chanu Rhee
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Naomi P O'Grady
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland
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Gutiérrez F, Masiá M. [Teaching infectious diseases in the Medical Degree within the European higher education area]. Enferm Infecc Microbiol Clin 2015; 34:372-83. [PMID: 25746206 PMCID: PMC7103342 DOI: 10.1016/j.eimc.2015.01.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 01/20/2015] [Accepted: 01/21/2015] [Indexed: 11/29/2022]
Abstract
Durante los estudios de Medicina deben adquirirse competencias básicas en diferentes áreas de conocimiento, una de ellas es la patología infecciosa. La formación en enfermedades infecciosas es imprescindible para la práctica médica general y para la especialización académica o profesional en muchas áreas de la Medicina, tanto médicas como quirúrgicas. La gran cantidad de conocimientos que se genera continuamente sobre las enfermedades infecciosas exige un programa de aprendizaje bien estructurado y enmarcado en un entorno dominado por la globalización. La incorporación de España al espacio europeo de educación superior ha obligado a adecuar los planes de enseñanza de las facultades de Medicina y establecer los contenidos y objetivos docentes de todas las materias de estudio. En este artículo comentamos las implicaciones de la integración del sistema universitario español en el espacio europeo de educación superior («Plan Bolonia») en la docencia de las enfermedades infecciosas en el grado de Medicina, y describimos el programa de aprendizaje de la patología infecciosa en la Universidad Miguel Hernández de Elche (Alicante) basado en resultados y competencias.
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Affiliation(s)
- Félix Gutiérrez
- Departamento de Medicina Clínica, Universidad Miguel Hernández de Elche, Campus de San Juan, Alicante, España; Unidad de Enfermedades Infecciosas, Hospital General Universitario de Elche, Alicante, España.
| | - Mar Masiá
- Departamento de Medicina Clínica, Universidad Miguel Hernández de Elche, Campus de San Juan, Alicante, España; Unidad de Enfermedades Infecciosas, Hospital General Universitario de Elche, Alicante, España
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Chandrasekar PH. Bad news to worse news: 2015 infectious diseases fellowship match results. Clin Infect Dis 2015; 60:1438. [PMID: 25632009 DOI: 10.1093/cid/civ037] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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