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George MR, Timmons CF, Johnson K, Barak S, Berg MP, Bryant B, Childs JM, Karp JK, Knollmann-Ritschel BE, Lofgreen A, McCarthy T, Prieto VG, Procop GW, Sandersfeld T, White KL, McCloskey CB. Leadership perspectives on osteopathic medical school applicants to pathology residency training. Acad Pathol 2024; 11:100107. [PMID: 38433776 PMCID: PMC10907156 DOI: 10.1016/j.acpath.2024.100107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 12/04/2023] [Accepted: 12/10/2023] [Indexed: 03/05/2024] Open
Abstract
The number of graduating allopathic (MD) medical students matching into pathology has declined in recent years, while the number of osteopathic (DO) medical students has increased modestly, given the rapid expansion of osteopathic medical schools. Nonscholarly publications and materials on the internet often perpetuate negative perceptions of osteopathic physicians. Anecdotally, perspectives exist that some pathology residency programs are not DO-friendly; however, the reasons and how widespread an effect this might be are unclear. Our survey queried pathology chairs and residency program directors about their perceptions of osteopathic applicants and their knowledge of osteopathic medical school/training in general. This study utilized two similar, parallel surveys of pathology chairs and residency program directors with general questions structured around the perceptions and knowledge of both allopathic and osteopathic physicians, their medical training, and the consideration of osteopathic applicants to pathology residency. Pathology residency leaders acknowledge some negative perceptions of osteopathic physicians in the medical profession, the news, and social media. They also have some knowledge and perception gaps regarding osteopathic training and applicants, although experience with training osteopathic physicians as residents has been equivalent to that with allopathic physicians, and consideration appears to be fairly equal for osteopathic applicants. Even though negative perceptions of osteopathic physicians persist in news and social media, our surveys demonstrate that the leadership of pathology residency programs does not hold the same degree of bias and that DOs perform well in allopathic pathology residency programs without evidence of inferior outcomes.
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Affiliation(s)
- Melissa R. George
- Department of Pathology and Laboratory Medicine, Penn State Health Hershey Medical Center, Hershey, PA, USA
| | - Charles F. Timmons
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Kristen Johnson
- CAP Learning, College of American Pathologists, Northfield, IL, USA
| | - Stephanie Barak
- Department of Pathology, George Washington University Hospital, Washington, DC, USA
| | - Mary P. Berg
- University of Colorado, Anschutz Medical Campus, Department of Pathology, Aurora, CO, USA
| | - Bronwyn Bryant
- Department of Pathology and Laboratory Medicine, University of Vermont, Burlington, VT, USA
| | | | - Julie Katz Karp
- Department of Pathology & Genomic Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | | | - Amanda Lofgreen
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Victor G. Prieto
- The Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Kristie L. White
- Department of Laboratory Medicine, UCSF Medical Center, San Francisco, CA, USA
| | - Cindy B. McCloskey
- The Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Rao P, Jordan K, Burrows H, Helms L, Latch R, Perin R, Crawford MA, Kang D, Morgan A, Beck Dallaghan GL, Zwemer E. Association Between In-Training Exam Scores and Clinical Exposure During the COVID-19 Pandemic. Acad Pediatr 2024; 24:3-7. [PMID: 37253414 PMCID: PMC10225061 DOI: 10.1016/j.acap.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/19/2023] [Accepted: 05/22/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND We sought to evaluate changes in In-Training Examination (ITE) scores and associations with clinical work during the COVID-19 pandemic. We hypothesized that residents saw a decrease in clinical encounters during the pandemic and that this would be associated with smaller gains in ITE scores. METHODS We compared ITE score changes with data on patient notes for three classes of pediatric residents at four residency programs: one not exposed to the pandemic during their intern year who entered residency in 2018, one partially exposed to COVID-19 in March of their intern year (2019-2020), and one that was fully exposed to the pandemic, starting residency in June of 2020. RESULTS ITE scores on average improved from the PGY1 to PGY2 year in the "no covid" and "partial COVID" cohorts. The "full COVID" cohort had little to no improvement, on average. The total number of patient encounters was not associated with a change in ITE scores from PGY1 to PGY2. There was a small but statistically significant association between change in ITE score and number of inpatient H+P notes. CONCLUSIONS A drop in ITE scores occurred in pediatric residents who entered residency during the COVID-19 pandemic. This change was largely unrelated to clinical encounter number changes.
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Affiliation(s)
- Priyanka Rao
- Department of Pediatrics (A Rao, K Jordan, and E Zwemer), University of North Carolina School of Medicine, Chapel Hill.
| | - Katherine Jordan
- Department of Pediatrics (A Rao, K Jordan, and E Zwemer), University of North Carolina School of Medicine, Chapel Hill
| | - Heather Burrows
- Department of Pediatrics (H Burrows and L Helms), University of Michigan, Ann Arbor
| | - Lauren Helms
- Department of Pediatrics (H Burrows and L Helms), University of Michigan, Ann Arbor
| | - Rebecca Latch
- Department of Pediatrics (R Latch and R Perin), University of Arkansaw for Medical Sciences, Little Rock
| | - Rebecca Perin
- Department of Pediatrics (R Latch and R Perin), University of Arkansaw for Medical Sciences, Little Rock
| | | | - Daniel Kang
- Department of Pediatrics (MA Crawford and D Kang), University of California, Orange
| | - Andrew Morgan
- Department of Medicine (A Morgan), Duke University Hospital, NC
| | | | - Eric Zwemer
- Department of Pediatrics (A Rao, K Jordan, and E Zwemer), University of North Carolina School of Medicine, Chapel Hill
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Nikolla DA, Mudrakola V, Feronti CJ, Bilski SC, Bowers KM. Minimum United States Medical Licensing Examination and Comprehensive Osteopathic Medical Licensing Examination Scores Often Do Not Align. Cureus 2023; 15:e45220. [PMID: 37842409 PMCID: PMC10576438 DOI: 10.7759/cureus.45220] [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: 07/20/2023] [Accepted: 09/14/2023] [Indexed: 10/17/2023] Open
Abstract
Background Many residency programs do not accept the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) alone for osteopathic applicants. Furthermore, among those programs that do accept the COMLEX-USA, it is unknown how programs scale their minimum COMLEX-USA scores compared to their minimum United States Medical Licensing Examination (USMLE) scores. Objective Our objective was to examine the variation of relative within-program differences between minimum USMLE Step and COMLEX-USA Level scores required for consideration by United States residency programs. Methods We performed a cross-sectional analysis of the Fellowship and Residency Electronic Interactive Database Access (FREIDA) database from April 2023, including the 10 specialties with the most training spots in 2022. These specialties were internal medicine, family medicine, pediatrics, emergency medicine, psychiatry, surgery, anesthesiology, obstetrics-gynecology, orthopedic surgery, and neurology. Within-program differences were calculated by subtracting the minimum USMLE Step 1 and 2 scores from the converted minimum USMLE Step 1 and 2 scores calculated from the minimum COMLEX-USA Level 1 and 2 scores using two conversion tools. We present differences as medians with interquartile ranges (IQR). Additionally, we report the proportion of programs with greater than 10-point differences for each step (1 and 2). Results Of the 3,364 accredited programs from the examined specialties, we included 1,477 in the Step 1 analysis and 1,227 in the Step 2 analysis with complete data. The median within-program difference between the minimum Step 1 score and the predicted Step 1 score was 12.0 (IQR 2.0, 17.0) using the Barnum and colleagues' conversion tool and -1.7 (IQR -6.2, 6.3) using the Smith and colleagues' tool. The median differences for Step 2 were 2.0 (IQR -8.0, 12.0) and -6.5 (IQR -13.9, -1.5) for each tool, respectively. Using the Barnum and Smith conversion tools, 937 (63%) and 435 (29%) programs had a greater than 10-point Step 1 score difference, respectively. Similarly, for Step 2, 564 (46%) and 515 (42%) programs had a greater than 10-point difference with each conversion tool. Conclusion There is wide variation in the within-program differences between minimum USMLE and predicted minimum USMLE (from COMLEX-USA) scores. Many programs have greater than 10-point differences, which may be a source of bias in osteopathic applicant selection.
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Affiliation(s)
| | | | | | | | - Kaitlin M Bowers
- Emergency Medicine, Jerry M. Wallace School of Osteopathic Medicine, Campbell University, Lillington, USA
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Hedgepeth D. To the Editor: COMLEX-USA and USMLE-More Reasons to Unify. J Grad Med Educ 2023; 15:405-406. [PMID: 37363660 PMCID: PMC10286906 DOI: 10.4300/jgme-d-23-00243.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Affiliation(s)
- Dylan Hedgepeth
- Medical Student Year 3, Lake Erie College of Osteopathic Medicine
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Miyawaki A, Jena AB, Gross N, Tsugawa Y. Comparison of Hospital Outcomes for Patients Treated by Allopathic Versus Osteopathic Hospitalists : An Observational Study. Ann Intern Med 2023. [PMID: 37247417 DOI: 10.7326/m22-3723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND The United States has 2 types of degree programs that educate physicians: allopathic and osteopathic medical schools. OBJECTIVE To determine whether quality and costs of care differ between hospitalized Medicare patients treated by allopathic or osteopathic physicians. DESIGN Retrospective observational study. SETTING Medicare claims data. PATIENTS 20% random sample of Medicare fee-for-service beneficiaries hospitalized with a medical condition during 2016 to 2019 and treated by hospitalists. MEASUREMENTS The primary outcome was 30-day patient mortality. The secondary outcomes were 30-day readmission, length of stay (LOS), and health care spending (Part B spending). Multivariable regression models adjusted for patient and physician characteristics and their hospital-level averages (to effectively estimate differences within hospitals) were estimated. RESULTS Of 329 510 Medicare admissions, 253 670 (77.0%) and 75 840 (23.0%) received care from allopathic and osteopathic physicians, respectively. The results can rule out important differences in quality and costs of care between allopathic versus osteopathic physicians for patient mortality (adjusted mortality, 9.4% for allopathic physicians vs. 9.5% [reference] for osteopathic hospitalists; average marginal effect [AME], -0.1 percentage point [95% CI, -0.4 to 0.1 percentage point]; P = 0.36), readmission (15.7% vs. 15.6%; AME, 0.1 percentage point [CI, -0.4 to 0.3 percentage point; P = 0.72), LOS (4.5 vs. 4.5 days; adjusted difference, -0.001 day [CI, -0.04 to 0.04 day]; P = 0.96), and health care spending ($1004 vs. $1003; adjusted difference, $1 [CI, -$8 to $10]; P = 0.85). LIMITATION Data were limited to elderly Medicare patients hospitalized with medical conditions. CONCLUSION The quality and costs of care were similar between allopathic and osteopathic hospitalists when they cared for elderly patients and worked as the principal physician in a team of health care professionals that often included other allopathic and osteopathic physicians. PRIMARY FUNDING SOURCE National Institutes of Health/National Institute on Aging.
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Affiliation(s)
- Atsushi Miyawaki
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California, and Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan (A.M.)
| | - Anupam B Jena
- Department of Health Care Policy, Harvard Medical School, Boston, Department of Medicine, Massachusetts General Hospital, Boston, and National Bureau of Economic Research, Cambridge, Massachusetts (A.B.J.)
| | - Nate Gross
- Doximity, San Francisco, California (N.G.)
| | - Yusuke Tsugawa
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, and Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California (Y.T.)
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Darby A, Parascando JA, Lipinski M, Lipinski C, Mendez-Miller M, Berg A, Rabago D, Oser TK. Awareness and interest in osteopathic manipulative treatment in allopathic medical students. J Osteopath Med 2023:jom-2022-0232. [PMID: 37159913 DOI: 10.1515/jom-2022-0232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 04/11/2023] [Indexed: 05/11/2023]
Abstract
CONTEXT Osteopathic manipulative treatment (OMT) is utilized by clinicians to diagnose and treat a variety of musculoskeletal conditions including acute and chronic pain, and other medical conditions. Previous studies have examined attitudes of allopathic (MD) residents toward OMT and have implemented residency-based curricula; however, literature is lacking on the attitudes of MD students toward OMT. OBJECTIVES The objective of this study was to determine MD students' familiarity with OMT and to evaluate their interest in an elective osteopathic curriculum. METHODS A 15-item online survey was electronically sent to 600 MD students at a large allopathic academic medical center. The survey assessed familiarity with OMT, interest in OMT and in participating in an OMT elective, educational format preference, and interest in pursuing primary care. Educational demographics were also collected. Descriptive statistics and Fisher's exact test were utilized for categorical variables, and nonparametric tests were utilized for the ordinal and continuous variables. RESULTS A total of 313 MD students submitted responses (response rate=52.1 %), of which 296 (49.3 %) responses were complete and utilized for analysis. A total of 92 (31.1 %) students were aware of OMT as a modality in treating musculoskeletal disorders. Among the respondents who indicated "very interested" in learning a new pain treatment modality, the majority: (1) observed OMT in a prior clinical or educational setting (85 [59.9 %], p=0.02); (2) had a friend or family member treated by a DO physician (42 [71.2 %], p=0.01); (3) were pursuing a primary care specialty (43 [60.6 %], p=0.02); or (4) interviewed at an osteopathic medical school (47 [62.7 %], p=0.01). Among those interested in developing some OMT competency, the majority: (1) were pursuing a primary care specialty (36 [51.4 %], p=0.01); (2) applied to osteopathic schools (47 [54.0], p=0.002); or (3) interviewed at an osteopathic medical school (42 [56.8 %], p=0.001). A total of 230 (82.1 %) students were somewhat or very interested in a 2-week elective course in OMT; among all respondents, hands-on labs were the preferred method for delivery of OMT education (272 [94.1 %]). CONCLUSIONS The study found a strong interest in an OMT elective by MD students. These results will inform OMT curriculum development aimed at interested MD students and residents in order to provide them with OMT-specific theoretical and practical knowledge.
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Affiliation(s)
- Anne Darby
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Jessica A Parascando
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Matthew Lipinski
- Department of Internal Medicine, Mercy Hospital, Oklahoma City, OK, USA
| | - Chang Lipinski
- Vance Air Force Base, United States Air Force, Enid, OK, USA
| | - Megan Mendez-Miller
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Arthur Berg
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - David Rabago
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Tamara K Oser
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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Ellson L, Wong N, Harper J, Williamson G, Zapata I, Putnam K, Roberts J. Understanding and preference toward DOs and OMT before and after an osteopathic principles and practice fellow lecture series. J Osteopath Med 2023; 123:135-141. [PMID: 36448407 DOI: 10.1515/jom-2022-0139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 11/08/2022] [Indexed: 12/05/2022]
Abstract
CONTEXT One of the two major pathways to become a physician in the United States is the Doctor of Osteopathic Medicine (DO) degree. A major distinctive feature is often perceived as the addition of manual training in osteopathic manipulative treatment (OMT) in the DO education. However, the profession also has a distinct philosophy imbedded in the curriculum of all osteopathic medical schools. Many medical schools offer professional degrees with graduates who may choose to continue their education in medicine, such as the Master of Science in Biomedical Sciences (MSBS). At our institution, there is no formal exposure to the differences between osteopathic and allopathic medicine in the MSBS curriculum, and most of this understanding is gained through out-of-classroom conversations. During the SARS-CoV-2 pandemic, virtual learning prohibited the usual gathering and discourse that occurs when students are learning on campus. OBJECTIVES The objective of this study is to create a curriculum in the form of a seminar series to assist premedical students in making an informed choice about which profession is the best fit for their own education and to gain an appreciation for osteopathic medicine. This appreciation could also aid in the future collaboration of premedical students with osteopathic providers, recommendations to patients, and potentially their own medical care. Questionnaires were utilized to determine if our osteopathic seminar series was effective at changing the preferences and understanding of MSBS students. We also sought to determine the effectiveness of virtual vs. in-person delivery of our curriculum. METHODS A seminar series with pre-established objectives was developed and presented to MSBS students at an osteopathic institution during the Fall of 2020 and 2021. The 2020 seminar was delivered through a virtual conference platform, and the 2021 seminar was delivered in-person. An eight question pre-and postquestionnaire was given to participants to evaluate their preferences and understanding. Internal validity and differences between delivery formats were assessed. RESULTS Both seminar series produced equally effective, significant changes in the preferences and perceptions of osteopathic medicine in both virtual and in-person delivery formats. Differences in pre-vs. post understanding across both seminar series were not consistently significant and were smaller than those observed in preferences and perceptions. Positive changes included an increased willingness to see a DO and to recommend a loved one see a DO as their personal physician. Preference changes between the in-person vs. virtual delivery platforms did not show significant differences; however, understanding did show some inconsistent differences. CONCLUSIONS This study demonstrates the utility of a virtual or in-person seminar to improve the preferences and perceptions of the osteopathic profession in MSBS students. The seminar series was successful in its goal of offering formal exposure to the osteopathic profession. The improved preferences and perceptions will have potential substantial benefits to the field of osteopathic medicine in the future. Further research is warranted to determine the most effective way to increase understanding of the osteopathic profession.
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Affiliation(s)
- Lindsay Ellson
- Department of Clinical Anatomy and Osteopathic Principles and Practice, Rocky Vista University, Ivins, UT, USA
| | - Nicole Wong
- Department of Clinical Anatomy and Osteopathic Principles and Practice, Rocky Vista University, Parker, CO, USA
| | - Jessica Harper
- Department of Clinical Anatomy and Osteopathic Principles and Practice, Rocky Vista University, Ivins, UT, USA
| | - Gage Williamson
- Department of Clinical Anatomy and Osteopathic Principles and Practice, Rocky Vista University, Parker, CO, USA
| | - Isain Zapata
- Department of Biomedical Sciences, Rocky Vista University, Parker, CO, USA
| | - Kristin Putnam
- Department of Clinical Anatomy and Osteopathic Principles and Practice, Rocky Vista University, Parker, CO, USA
| | - Joel Roberts
- Master of Science in Biomedical Sciences Program, Rocky Vista University, Parker, CO, USA
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Jurich D, Liu C, Clauser A. To the Editor: Limitations and Alternative Solutions to a USMLE COMLEX-USA Concordance. J Grad Med Educ 2022; 14:353-354. [PMID: 35754629 PMCID: PMC9200238 DOI: 10.4300/jgme-d-22-00238.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Daniel Jurich
- Manager, Psychometrics, National Board of Medical Examiners
| | - Chunyan Liu
- Senior Psychometrician, National Board of Medical Examiners
| | - Amanda Clauser
- Vice President, Psychometrics and Data Analysis, National Board of Medical Examiners
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Sandella J, Boulet J, Barnum S, Tsai TH, Wang Y. To the Editor: Response to: Limitations and Alternative Approaches to a USMLE COMLEX-USA Concordance. J Grad Med Educ 2022; 14:355-356. [PMID: 35754642 PMCID: PMC9200257 DOI: 10.4300/jgme-d-22-00352.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jeanne Sandella
- Vice President for Professional Development Initiatives and Communications, National Board of Osteopathic Medical Examiners
| | - John Boulet
- Senior Research Consultant, National Board of Osteopathic Medical Examiners
| | - Stuart Barnum
- Psychometrician, National Board of Osteopathic Medical Examiners
| | - Tsung-Hsun Tsai
- Associate Vice President for Assessment Services and Research, National Board of Osteopathic Medical Examiners
| | - Yi Wang
- Chief Data Analyst, National Board of Osteopathic Medical Examiners
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Ahmed H, Carmody JB. COMLEX-USA and USMLE for Osteopathic Medical Students: Should We Duplicate, Divide, or Unify? J Grad Med Educ 2022; 14:60-63. [PMID: 35222822 PMCID: PMC8848882 DOI: 10.4300/jgme-d-21-01196.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Harris Ahmed
- Harris Ahmed, DO, MPH, is Resident Physician, Department of Ophthalmology, Loma Linda University Medical Center
| | - J. Bryan Carmody
- J. Bryan Carmody, MD, MPH, is Associate Professor, Department of Pediatrics, Eastern Virginia Medical School
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