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Deptola A, Hudson D, Mattar C, Chung KN, Kallogjeri D, Chamberlain A, Aagaard E. Developing an Inclusive Scholarship Curriculum for Medical Students. Acad Med 2023; 98:1396-1401. [PMID: 37478149 DOI: 10.1097/acm.0000000000005333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/23/2023]
Abstract
PROBLEM As part of a curriculum renewal, in 2020, Washington University School of Medicine in St. Louis sought to create an integrated curriculum that allows students to explore 4 academic career pathways (advocacy/global health, education, innovation, and research) and engage in scholarship activities-the Inquiry Curriculum. The curriculum needed to focus on foundational scholarship skills that would be applicable to all pathways. This article describes the process used to develop the curriculum learning objectives and lessons learned from initial implementation. APPROACH The authors used a modified Delphi process to survey faculty experts from the 4 pathways to determine the objectives (March-May 2020). Twenty-four faculty were surveyed about 48 initial objectives created using Glassick's scholarship criteria. After 2 rounds, 28 objectives met consensus. Further oversight committee review and revisions by session leads resulted in 77 unique objectives for 23 sessions in the curriculum that launched in spring 2021. OUTCOMES Four themes were identified from student feedback: (1) the Inquiry Curriculum framework creates opportunities for students to gain exposure to various approaches to understanding and addressing health care problems, (2) the curriculum targeted higher-level objectives for traditional research content and lower-level objectives for nontraditional content, (3) Glassick's criteria provided a useful structure for students to understand the rationale for and ordering of content, and (4) the curriculum had natural overlap with content often taught elsewhere in the curriculum, including evidence-based medicine, health equity, public and population health, and quality improvement and patient safety. NEXT STEPS The authors plan to consolidate sessions where there is redundancy, expand other sessions that require more time, and more purposefully discuss prior content when redundancy is intentional. Exploring other potential measures of curricular success, such as student learning outcomes, scholarly productivity, and impact on future scholarship engagement and career paths, is part of ongoing work.
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Kaltenbach T, Patel SG, Nguyen-Vu T, Malvar C, Keswani RN, Hall M, Aagaard E, Asokkumar R, Chin YK, Hammad H, Rastogi A, Shergill A, Simon V, Soetikno A, Soetikno R, Wani S. Varied Trainee Competence in Cold Snare Polypectomy: Results of the COMPLETE Randomized Controlled Trial. Am J Gastroenterol 2023; 118:1880-1887. [PMID: 37307537 DOI: 10.14309/ajg.0000000000002368] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 04/27/2023] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Cold snare polypectomy (CSP) is strongly recommended as the optimal technique for the complete removal of small polyps. Though significant variability in polypectomy technique and quality has been established, the learning curve and impact of targeted training on CSP are unknown. Video feedback has shown promise as an effective pedagogy to improve performance among surgical trainees. We aimed to compare CSP performance between trainees who received video-based feedback and those who received conventional apprentice-based concurrent feedback. We hypothesized that video-based feedback would accelerate competence. METHODS We conducted a single-blinded, randomized controlled trial on competence for CSP of polyps <1 cm, comparing video-based feedback with conventional feedback. We randomly assigned deidentified consecutively recorded CSP videos to blinded raters to assess using the CSP Assessment Tool. We shared cumulative sum learning curves every 25 CSP with each trainee. The video feedback trainees also received biweekly individualized terminal feedback. Control trainees received conventional feedback during colonoscopy. The primary outcome was CSP competence. We also assessed competence across domains and change over polypectomy volume. RESULTS We enrolled and randomized 22 trainees, 12 to video-based feedback and 10 to conventional feedback, and evaluated 2,339 CSP. The learning curve was long; 2 trainees (16.7%) in the video feedback achieved competence, after a mean of 135 polyps, and no one in the control ( P = 0.481) achieved competence. Overall and in all steps of CSP, a higher percentage of the video feedback group met competence, increasing 3% every 20 CSP ( P = 0.0004). DISCUSSION Video feedback aided trainees to competence in CSP. However, the learning curve was long. Our findings strongly suggest that current training methods are not sufficient to support trainees to competency by the completion of their fellowship programs. The impact of new training methods, such as simulation-based mastery learning, should be assessed to determine whether such methods can result in achievement of competence at a faster rate; ClinicalTrials.gov : NCT03115008.
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Affiliation(s)
- Tonya Kaltenbach
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Division of Gastroenterology, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Swati G Patel
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Division of Gastroenterology, Rocky Mountain Regional Veterans Affairs Hospital, Aurora, Colorado, USA
| | - Tiffany Nguyen-Vu
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Division of Gastroenterology, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Carmel Malvar
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Division of Gastroenterology, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Rajesh N Keswani
- Department of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois, USA
| | - Matt Hall
- Biostatistics, Children's Hospital Association, Kansas City, Kansas, USA
| | - Eva Aagaard
- Department of Medicine, Division of General Internal Medicine, Washington University School of Medicine at St. Louis, St. Louis, Missouri, USA
| | - Ravishankar Asokkumar
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Yung Ka Chin
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Hazem Hammad
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Amit Rastogi
- Division of Gastroenterology, Hepatology and Motility, University of Kansas Medical Center, Kansas City, Kansas, USA; and
| | - Amandeep Shergill
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Division of Gastroenterology, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Violette Simon
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Alan Soetikno
- Northwestern University School of Medicine, Chicago, Illinois, USA
| | - Roy Soetikno
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Division of Gastroenterology, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Sachin Wani
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Perez MJ, Omurtag K, Aagaard E, Klingensmith M, Bhayani RK. Innovative Social Media Summit: Providing a Path for Physicians on Social Media. Acad Med 2022; 97:1009-1011. [PMID: 35171121 DOI: 10.1097/acm.0000000000004633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PROBLEM Physicians' voices are valued in society and should be present in mainstream social media where they can provide valuable public health messaging and patient education as well as increase opportunities for medical education, mentoring, and collaboration. However, lack of formal education on effective use of social media prevents many physicians from using it. APPROACH The authors developed a physician-led social media training program to address the need for formal instruction on social media use. The program was presented to medical students, trainees, and faculty at an academic medical institution in August and September 2020. The virtual format included 5 hour-long sessions with presentations by peer experts in social media. Peer physicians with experience using social media presented on a range of topics, including introductions to platforms, how to reach and grow audiences, and use of social media to advance patient education, medical education, and advocacy. OUTCOMES There were 425 cumulative registrations for the 5 sessions of the Social Media Summit. The number of registrants increased for each session, suggesting that interest increased over time. Qualitative and quantitative participant feedback was collected via a brief, voluntary survey. All of the participants who completed the survey (n = 24) reported they were "very satisfied" (58.3%) or "somewhat satisfied" (41.7%) with the Summit. NEXT STEPS Physician involvement in social media presents opportunities for public health knowledge, medical education, scientific collaboration, and career advancement. Physicians who have been successful in using social media for these purposes are excellent peer educators and can fill the medical education void in social media training. Future plans include building sustainability of the program, collecting additional quantitative and qualitative feedback to guide improvement, and encouraging reproducibility.
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Affiliation(s)
- Marta J Perez
- M.J. Perez is assistant professor, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Kenan Omurtag
- K. Omurtag is associate professor, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Eva Aagaard
- E. Aagaard is professor of medical education, Department of Medicine, and senior associate dean for education, Washington University School of Medicine, St. Louis, Missouri
| | - Mary Klingensmith
- M. Klingensmith is professor, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Rakhee K Bhayani
- R.K. Bhayani is associate professor, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
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Ginzburg SB, Hayes MM, Ranchoff BL, Aagaard E, Atkins KM, Barnes M, Soep JB, Yacht AC, Alexander EK, Schwartzstein RM. Optimizing allocation of curricular content across the Undergraduate & Graduate Medical Education Continuum. BMC Med Educ 2022; 22:425. [PMID: 35655308 PMCID: PMC9161628 DOI: 10.1186/s12909-022-03489-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 05/19/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Medical educators struggle to incorporate socio-cultural topics into crowded curricula. The "continuum of learning" includes undergraduate and graduate medical education. Utilizing an exemplar socio-cultural topic, we studied the feasibility of achieving expert consensus among two groups of faculty (experts in medical education and experts in social determinants of health) on which aspects of the topic could be taught during undergraduate versus graduate medical education. METHODS A modified Delphi method was used to generate expert consensus on which learning objectives of social determinants of health are best taught at each stage of medical education. Delphi respondents included experts in medical education or social determinants of health. A survey was created using nationally published criteria for social determinants of health learning objectives. Respondents were asked 1) which learning objectives were necessary for every physician (irrespective of specialty) to develop competence upon completion of medical training and 2) when the learning objective should be taught. Respondents were also asked an open-ended question on how they made the determination of when in the medical education continuum the learning objective should be taught. RESULTS 26 out of 55 experts (13 social determinants of health and 13 education experts) responded to all 3 Delphi rounds. Experts evaluated a total of 49 learning objectives and were able to achieve consensus for at least one of the two research questions for 45 of 49 (92%) learning objectives. 50% more learning objectives reached consensus for inclusion in undergraduate (n = 21) versus graduate medical education (n = 14). CONCLUSIONS A modified Delphi technique demonstrated that experts could identify key learning objectives of social determinants of health needed by all physicians and allocate content along the undergraduate and graduate medical education continuum. This approach could serve as a model for similar socio-cultural content. Future work should employ a qualitative approach to capture principles utilized by experts when making these decisions.
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Affiliation(s)
- Samara B Ginzburg
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
| | - Margaret M Hayes
- Medical Intensive Care Unit, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School in Boston, Boston, MA, USA
| | - Brittany L Ranchoff
- Beth Israel Deaconess Medical Center, Boston, MA, USA
- University of Massachusetts, Amherst, MA, USA
| | - Eva Aagaard
- Washington University School of Medicine, St. Louis, MO, USA
| | - Katharyn M Atkins
- Harvard Medical School in Boston, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Michelle Barnes
- Clinical pediatrics and internal medicine University of Illinois College of Medicine, Chicago, IL, USA
| | | | - Andrew C Yacht
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Erik K Alexander
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Richard M Schwartzstein
- Medicine and Medical Education, Harvard Medical School, Boston, MA, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Aagaard E. CHANGE LEADERSHIP AND CRISIS MANAGEMENT: CURRICULUM TRANSFORMATION BEFORE, DURING, AND AFTER A PANDEMIC. Trans Am Clin Climatol Assoc 2022; 132:184-193. [PMID: 36196177 PMCID: PMC9480563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Washington University School of Medicine has not undergone substantive curricular change for 25 years. In 2018, we embarked on a curriculum transformation project informed by the change leadership principles of James Kotter and William Bridges. This included developing a structured process to create a sense of urgency for why we needed to change, building coalitions to support change, and developing a compelling vision across multiple stakeholder groups. Implementation work began in 2019 with a planned curriculum start of July 2020. The COVID-19 pandemic disrupted these plans. Employing the Cynefin framework for decision making and guided by our core principles, we were able to launch the new curriculum in September 2020. In this paper, I will describe the principles underpinning our curriculum transformation, how the Cynefin framework allowed us to move forward productively during the COVID-19 crisis, and the impact COVID-19 had, both positively and negatively, on the curriculum transformation process.
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Myhre P, Lyngbakken M, Berge T, Roysland R, Aagaard E, Kvisvik B, Norseth J, Pervez O, Tveit A, Steine K, Omland T, Rosjo H. Markers of subclinical cardiac disease associate with thresholds for pre-diabetes and diabetes in the general population: data from the ACE 1950 Study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Diabetes mellitus (DM) is associated with increased risk of left ventricular (LV) remodeling and incident heart failure. However, the associations between dysglycemia and subclinical cardiac disease in middle-aged subjects recruited from the general population are not established.
Purpose
To assess the associations of dysglycemia and diagnostic DM thresholds with indices of subclinical cardiac injury and dysfunction in the general population.
Methods
We included participants born in 1950 from the Akershus Cardiac Examination 1950 Study with available biomarker measurements (n=3,688). We used regression models and restricted cubic splines (knots selected from lowest Akaike Information Criterion) to assess the association between glycated hemoglobin A1c (HbA1c) and cardiac troponin T (cTnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP), C-reactive protein (CRP), and echocardiographic parameters. We classified participants with self-reported diagnosis of DM or HbA1c ≥6.5% (48 mmol/L) as DM, participants with HbA1c 5.7–6.5% as pre-DM, and participants with HbA1c <5.7% (39 mmol/mol) as no-DM.
Results
Mean age was 63.9±0.7 years, mean body mass index (BMI) 27.2±4.4 kg/m2, and 1,795 participants (49%) were women. DM was classified in 380 participants (10%), pre-DM in 1,630 participants (44%) and no-DM in 1,678 participants (46%). Increasing HbA1c concentrations were associated with younger age, male sex, obesity, hypercholesterolemia, hypertension, and established coronary artery disease in adjusted analyses. In models adjusted for age, sex, BMI, smoking, hypertension, atrial fibrillation, coronary artery disease and renal function, greater HbA1c was associated with increasing logcTnT and logCRP concentrations, decreasing logNT-proBNP concentrations and worse global longitudinal strain and E/e' (p<0.001 for all). LV mass index was not associated with HbA1c in adjusted models (p=0.23). All five associations were non-linear in the total study population (p<0.001 for non-linearity for all) with robust, linear associations in the pre-DM range of HbA1c, also in adjusted models, and attenuated associations in the no-DM and DM range (Figure 1).
Conclusion
We found robust, linear associations between HbA1c and indices of subclinical cardiac injury and dysfunction among participants classified as pre-DM, while associations were more attenuated among participants with DM. Preventive measures for cardiovascular disease should be considered also in patients with dysglycemia and HbA1c below the established cutoff for DM.
Figure 1. P-values for overall trend
Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): Akserhus University Hospital
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Affiliation(s)
- P Myhre
- Akershus University Hospital, Division of Medicine, Akershus, Norway
| | - M Lyngbakken
- Akershus University Hospital, Division of Medicine, Akershus, Norway
| | - T Berge
- Bærum Hospital, Department of Medical Research, Bærum, Norway
| | - R Roysland
- Akershus University Hospital, Department of Multidisciplinary Laboratory Medicine and Medical Biochemistry, Akershus, Norway
| | - E Aagaard
- Akershus University Hospital, Division of Medicine, Akershus, Norway
| | - B Kvisvik
- Akershus University Hospital, Division of Medicine, Akershus, Norway
| | - J Norseth
- Bærum Hospital, Department of Medical Research, Bærum, Norway
| | - O Pervez
- Akershus University Hospital, Division of Medicine, Akershus, Norway
| | - A Tveit
- Bærum Hospital, Department of Medical Research, Bærum, Norway
| | - K Steine
- Akershus University Hospital, Division of Medicine, Akershus, Norway
| | - T Omland
- Akershus University Hospital, Division of Medicine, Akershus, Norway
| | - H Rosjo
- Akershus University Hospital, Division for Research and Innovation, Akershus, Norway
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Colson ER, Nuñez S, De Fer TM, Lawrence SJ, Blaylock L, Emke A, Klingensmith ME, Gray DL, Schulte C, Aagaard E. Washington University School of Medicine. Acad Med 2020; 95:S285-S290. [PMID: 33626702 DOI: 10.1097/acm.0000000000003385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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Pierce C, Corral J, Aagaard E, Harnke B, Irby DM, Stickrath C. A BEME realist synthesis review of the effectiveness of teaching strategies used in the clinical setting on the development of clinical skills among health professionals: BEME Guide No. 61. Med Teach 2020; 42:604-615. [PMID: 31961206 DOI: 10.1080/0142159x.2019.1708294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background: Literature describing the effectiveness of teaching strategies in the clinical setting is limited. This realist synthesis review focuses on understanding the effectiveness of teaching strategies used in the clinical setting.Methods: We searched ten databases for English language publications between 1 January 1970 and 31 May 2017 reporting effective teaching strategies, used in a clinical setting, of non-procedural skills. After screening, we used consensus to determine inclusion and employed a standardised instrument to capture study populations, methodology, and outcomes. We summarised what strategies worked, for whom, and in what settings.Results: The initial search netted 53,642 references after de-duplication; 2037 were retained after title and abstract review. Full text review was done on 82 references, with ultimate inclusion of 25 publications. Three specific teaching strategies demonstrated impact on educational outcomes: the One Minute Preceptor (OMP), SNAPPS, and concept mapping. Most of the literature involves physician trainees in an ambulatory environment. All three have been shown to improve skills in the domains of medical knowledge and clinical reasoning.Discussion/conclusions: Apart from the OMP, SNAPPS, and concept mapping, which target the formation of clinical knowledge and reasoning skills, the literature establishing effective teaching strategies in the clinical setting is sparse.
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Affiliation(s)
- Cason Pierce
- Department of Medicine, University of Colorado Anschutz, Aurora, CO, USA
| | - Janet Corral
- Department of Medicine, University of Colorado Anschutz, Aurora, CO, USA
| | - Eva Aagaard
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Ben Harnke
- Strauss Health Sciences Library, University of Colorado Anschutz, Aurora, CO, USA
| | - David M Irby
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Chad Stickrath
- Department of Medicine, University of Colorado Anschutz, Aurora, CO, USA
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Han S, Obuch JC, Keswani RN, Hall M, Patel SG, Menard-Katcher P, Simon V, Ezekwe E, Aagaard E, Ahmad A, Alghamdi S, Austin K, Brimhall B, Broy C, Carlin L, Cooley M, Di Palma JA, Duloy AM, Early DS, Ellert S, Gaumnitz EA, Goyal J, Kathpalia P, Day L, El-Nachef N, Kerman D, Lee RH, Lunsford T, Mittal M, Morigeau K, Pietrak S, Piper M, Shah AS, Shapiro AB, Shergill A, Sonnier W, Sorrell C, Vignesh S, Wani S. Effect of individualized feedback on learning curves in EGD and colonoscopy: a cluster randomized controlled trial. Gastrointest Endosc 2020; 91:882-893.e4. [PMID: 31715173 DOI: 10.1016/j.gie.2019.10.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 10/22/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Gastroenterology fellowships need to ensure that trainees achieve competence in upper endoscopy (EGD) and colonoscopy. Because the impact of structured feedback remains unknown in endoscopy training, this study compared the effect of structured feedback with standard feedback on trainee learning curves for EGD and colonoscopy. METHODS In this multicenter, cluster, randomized controlled trial, trainees received either individualized quarterly learning curves or feedback standard to their fellowship. Assessment was performed in all trainees using the Assessment of Competency in Endoscopy tool on 5 consecutive procedures after every 25 EGDs and colonoscopies. Individual learning curves were created using cumulative sum (CUSUM) analysis. The primary outcome was the mean CUSUM score in overall technical and overall cognitive skills. RESULTS In all, 13 programs including 132 trainees participated. The intervention arm (6 programs, 51 trainees) contributed 558 EGD and 600 colonoscopy assessments. The control arm (7 programs, 81 trainees) provided 305 EGD and 468 colonoscopy assessments. For EGD, the intervention arm (-.7 [standard deviation {SD}, 1.3]) had a superior mean CUSUM score in overall cognitive skills compared with the control arm (1.6 [SD, .8], P = .03) but not in overall technical skills (intervention, -.26 [SD, 1.4]; control, 1.76 [SD, .7]; P = .06). For colonoscopy, no differences were found between the 2 arms in overall cognitive skills (intervention, -.7 [SD, 1.3]; control, .7 [SD, 1.3]; P = .95) or overall technical skills (intervention, .1 [SD, 1.5]; control, -.1 [SD, 1.5]; P = .77). CONCLUSIONS Quarterly feedback in the form of individualized learning curves did not affect learning curves for EGD and colonoscopy in a clinically meaningful manner. (Clinical trial registration number: NCT02891304.).
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Affiliation(s)
- Samuel Han
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
| | - Joshua C Obuch
- Division of Gastroenterology, Geisenger Medical Center, Danville, Pennsylvania, USA
| | - Rajesh N Keswani
- Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Matt Hall
- Children's Hospital Association, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Swati G Patel
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
| | - Paul Menard-Katcher
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
| | - Violette Simon
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
| | - Eze Ezekwe
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
| | - Eva Aagaard
- Washington University School of Medicine in St. Louis, St Louis, Missouri, USA
| | - Asyia Ahmad
- Division of Gastroenterology and Hepatology, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Saad Alghamdi
- Division of Gastroenterology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Kerri Austin
- Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine, Madison, Wisconsin, USA
| | - Bryan Brimhall
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Charles Broy
- Division of Gastroenterology, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA
| | - Linda Carlin
- Colorado Clinical and Translational Sciences Institute, University of Colorado Anschutz Medical Center, Aurora, Colorado
| | - Matthew Cooley
- Division of Gastroenterology, Ascension Providence Hospital, Southfield, Michigan, USA
| | - Jack A Di Palma
- Division of Gastroenterology, University of South Alabama, Mobile, Alabama, USA
| | - Anna M Duloy
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
| | - Dayna S Early
- Division of Gastroenterology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Swan Ellert
- Colorado Clinical and Translational Sciences Institute, University of Colorado Anschutz Medical Center, Aurora, Colorado
| | - Eric A Gaumnitz
- Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine, Madison, Wisconsin, USA
| | - Jatinder Goyal
- Division of Gastroenterology, University of Miami, Miami, Florida, USA
| | - Priya Kathpalia
- Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California, USA
| | - Lukejohn Day
- Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California, USA
| | - Najwa El-Nachef
- Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California, USA
| | - David Kerman
- Division of Gastroenterology, University of Miami, Miami, Florida, USA
| | - Robert H Lee
- Division of Gastroenterology, University of California, Irvine, Irvine, California, USA
| | - Tisha Lunsford
- Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Mohit Mittal
- Division of Gastroenterology, University of California, Irvine, Irvine, California, USA
| | - Kirsten Morigeau
- Division of Gastroenterology, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Stanley Pietrak
- Division of Gastroenterology and Hepatology, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Michael Piper
- Division of Gastroenterology, Ascension Providence Hospital, Southfield, Michigan, USA
| | - Anand S Shah
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Alan B Shapiro
- Division of Gastroenterology, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA
| | - Amandeep Shergill
- Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California, USA
| | - William Sonnier
- Division of Gastroenterology, University of South Alabama, Mobile, Alabama, USA
| | - Cari Sorrell
- Division of Gastroenterology, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Shivakumar Vignesh
- Division of Gastroenterology and Hepatology, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Sachin Wani
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
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Sveen KA, Aagaard E, Berge T, Enger S, Orstad Bjoerkan E, Roesjoe H, Omland T, Tveit A, Steine K. 558 Prevalence of diastolic dysfunction according to EACVI/ASE guidelines from 2009 and 2016 in a 63-65 years old general population cohort-Data from the ACE 1950 study. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Akershus University Hospital and Vestre Viken Hospital Trust
OnBehalf
ACE 1950
Background
Large surveys have previously reported a prevalence of left ventricular diastolic dysfunction (DD) between 20- and 30 % in individuals above 60 years of age. The new DD guidelines from 2016, however, have emphasized the presence of increased left ventricular filling pressure, and may result in a stricter definition of DD.
Purpose
The aim of the present study was to compare the prevalence of DD using 2009 and 2016 EACVI/ASE criteria and to identify clinical correlates of DD.
Methods
The present cross-sectional substudy consisted of 3706 indivuduals born in 1950 included in the Akershus Cardiac Examination (ACE1950) 1950 study. Comprehensive baseline cardiovascular examination was performed, including ultrasound imaging utilizing echocardiographic indices for diagnosing DD according to both the 2009 and 2016 criteria.
Results
Complete echocardiographic data were available in 3464 (93.5%) individuals. Mean age was 63.9 ± 0.7 years, and 49% were women. 11% had diabetes mellitus and 23% were obese (BMI >30). In the total cohort, 19.8% (685/3464) fulfilled the 2009 criteria for diastolic dysfunction. Of these, 7.9% (n = 273) had grade 1; 8.7% (n = 303) grade 2 and 3.1% (n = 109) grade 3 diastolic dysfunction. Only 2.0% (71/3464) of the total cohort were classified with DD according to the 2016 criteria. In individuals with known diabetes the prevalence of DD was 22% and in obese this number was 28.9% using the 2009 criteria.
Conclusions
Diastolic dysfunction is present in 1 in 5 of 63-65 years old norwegians, and higher in the obese and those with diabetes, according to the 2009 criteria. However, the prevalence was dramatically lower by applying the 2016 criteria. LV filling pressure can be looked upon as dynamic and be normalized by unloading, and therefore possibly mask DD in some individuals.
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Affiliation(s)
- K A Sveen
- Akershus University Hospital, Division of Medicine, Lorenskog, Norway
| | - E Aagaard
- Akershus University Hospital, Division of Medicine, Lorenskog, Norway
| | - T Berge
- Baerum Hospital, Vestre Viken Hospital Trust, Department of Medical Research, Gjettum, Norway
| | - S Enger
- Baerum Hospital, Vestre Viken Hospital Trust, Department of Medical Research, Gjettum, Norway
| | - E Orstad Bjoerkan
- Akershus University Hospital, Division of Medicine, Lorenskog, Norway
| | - H Roesjoe
- Akershus University Hospital, Division of Medicine, Lorenskog, Norway
| | - T Omland
- Akershus University Hospital, Division of Medicine, Lorenskog, Norway
| | - A Tveit
- Baerum Hospital, Vestre Viken Hospital Trust, Department of Medical Research, Gjettum, Norway
| | - K Steine
- Akershus University Hospital, Division of Medicine, Lorenskog, Norway
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Affiliation(s)
- Jeffrey S LaRochelle
- Department of Medical Education, University of Central Florida College of Medicine, Orlando, FL, USA.
| | - Eva Aagaard
- Washington University School of Medicine, St. Louis, MO, USA
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Hakim JG, Chidzonga MM, Borok MZ, Nathoo KJ, Matenga J, Havranek E, Cowan F, Abas M, Aagaard E, Connors S, Nkomani S, Ndhlovu CE, Matsika A, Barry M, Campbell TB. Medical Education Partnership Initiative (MEPI) in Zimbabwe: Outcomes and Challenges. Glob Health Sci Pract 2018; 6:82-92. [PMID: 29602867 PMCID: PMC5878082 DOI: 10.9745/ghsp-d-17-00052] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 09/25/2017] [Indexed: 11/21/2022]
Abstract
The 5-year medical education and research strengthening initiative in Zimbabwe increased faculty retention and student enrollment, improved information technology infrastructure, provided mentoring for postgraduates and clinical training in specialty areas, instituted a competency-based curriculum reform process, and created new departments and centers to institutionalize health education and research implementation. A comprehensive review of the curriculum is still underway and uptake of technology-assisted teaching has been slower than expected. Background: Sub-Saharan Africa has an inadequate number of health professionals, leading to a reduced capacity to respond to health challenges, including HIV/AIDS. From 2010 to 2015, the Medical Education Partnership Initiative (MEPI)—sponsored by the U.S. Presidents Emergency Plan for AIDS Relief (PEPFAR) and the National Institutes of Health (NIH)—was enthusiastically taken up by the University of Zimbabwe College of Health Sciences (UZCHS) and 12 other sub-Saharan African universities to develop models of training to improve medical education and research capacity. In this article, we describe the outcomes and challenges of MEPI in Zimbabwe. Methods: UZCHS in partnership with the University of Colorado, Denver; Stanford University; University of Cape Town; University College London; and King's College London designed the Novel Education Clinical Trainees and Researchers (NECTAR) program and 2 linked awards addressing cardiovascular disease and mental health to pursue MEPI objectives. A range of medical education and research capacity-focused programs were implemented, including faculty development, research support, mentored scholars, visiting professors, community-based education, information and technology support, cross-cutting curricula, and collaboration with partner universities and the ministries of health and education. We analyzed quantitative and qualitative data from several data sources, including annual surveys of faculty, students, and other stakeholders; workshop exit surveys; and key informant interviews with NECTAR administrators and leaders and the UZCHS dean. Findings: Improved Internet connectivity and electronic resource availability were early successes of NECTAR. Over the 5-year period, 69% (115 of 166) of faculty members attended at least 1 of 15 faculty development workshops. Forty-one faculty members underwent 1-year advanced faculty development training in medical education and leadership. Thirty-three mentored research scholars were trained under NECTAR, and 52 and 12 in cardiovascular and mental health programs, respectively. Twelve MEPI scholars had joined faculty by 2015. Full-time faculty grew by 36% (122 to 166), annual postgraduate and medical student enrollment increased by 61% (75 to 121) and 71% (123 to 210), respectively. To institutionalize and sustain MEPI innovations, the Research Support Center and the Department of Health Professions Education were established at UZCHS. Conclusion: MEPI has synergistically revitalized medical education, research capacity, and leadership at UZCHS. Investments in creating a new research center, health professions education department, and, programs have laid the foundation to help sustain faculty development and research capacity in the country.
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Affiliation(s)
- James G Hakim
- Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe.
| | - Midion M Chidzonga
- Dean's Office, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Margaret Z Borok
- Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Kusum J Nathoo
- Department of Pediatrics and Child Health, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Jonathan Matenga
- Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Edward Havranek
- Division of Cardiology, University of Colorado, Aurora, Denver, CO, USA
| | - Frances Cowan
- Research Department of Infection and Population Health, University College London, London, UK
| | - Melanie Abas
- Institute of Psychiatry, King's College London, London, UK
| | - Eva Aagaard
- Division of General Internal Medicine, University of Colorado, Aurora, Denver, CO, USA
| | - Susan Connors
- Evaluation Center, School of Education and Human Development, University of Colorado, Aurora, Denver, CO, USA
| | - Sanele Nkomani
- NECTAR Office, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Chiratidzo E Ndhlovu
- Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Antony Matsika
- NECTAR Office, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Michele Barry
- Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Thomas B Campbell
- Division of Infectious Diseases, University of Colorado, Aurora, Denver, CO, USA
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Connors SC, Nyaude S, Challender A, Aagaard E, Velez C, Hakim J. Evaluating the Impact of the Medical Education Partnership Initiative at the University of Zimbabwe College of Health Sciences Using the Most Significant Change Technique. Acad Med 2017; 92:1264-1268. [PMID: 28858884 PMCID: PMC5580049 DOI: 10.1097/acm.0000000000001519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
PROBLEM In medical education, evaluating outcomes from programs intended to transform attitudes or influence career trajectories using conventional methods of monitoring is often difficult. To address this problem, the authors adapted the most significant change (MSC) technique to gain a more comprehensive understanding of the impact of the Medical Education Partnership Initiative (MEPI) program at the University of Zimbabwe College of Health Sciences. APPROACH In 2014-2015, the authors applied the MSC to systematically examine the personal significance and level of positive transformation that individuals attributed to their MEPI participation. Interviews were conducted with 28 participants nominated by program leaders. The authors coded results inductively for prevalent themes in participants' stories and prepared profiles with representative quotes to place the stories in context. Stakeholders selected 9 themes and 18 stories to illustrate the most significant changes. OUTCOMES Six themes (or outcomes) were expected, as they aligned with MEPI goals-becoming a better teacher, becoming a better clinician, increased interest in teaching, increased interest in research, new career pathways (including commitment to practice in Zimbabwe), and improved research skills. Three themes were unexpected-increased confidence, expanded interprofessional networks, and improved interpersonal interactions. NEXT STEPS The authors found the MSC to be a useful and systematic evaluation approach for large, complex, and transformative initiatives like MEPI. The MSC seemed to encourage participant reflection, support values inquiry by program leaders, and provide insights into the personal and cultural impacts of MEPI. Additional trial applications of the MSC technique in academic medicine are warranted.
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Affiliation(s)
- Susan C Connors
- S.C. Connors is associate director, The Evaluation Center, School of Education and Human Development, University of Colorado Denver, Denver, Colorado.S. Nyaude is monitoring and evaluation specialist, Regional Office for Southern Africa, Humanist Institute for Co-operation with Developing Countries (Hivos), Harare, Zimbabwe.A. Challender is education coordinator, Colorado Family Medicine Residencies, Denver, Colorado.E. Aagaard is professor of medicine, Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.C. Velez is senior evaluation specialist, The Evaluation Center, School of Education and Human Development, University of Colorado Denver, Denver, Colorado.J. Hakim is professor of medicine, Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
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Abstract
PURPOSE During the last two decades in the United States, academies of medical educators (AMEs) have proliferated as formal organizations within faculties of health professions education to recognize teaching excellence, support faculty development, and encourage scholarly activity. AMEs have been effective at rewarding faculty for educational excellence and providing faculty development. However, the impact of an AME on campus culture remains unclear. METHOD A qualitative case study asked, How has an AME shaped organizational culture? The authors investigated the University of Colorado health sciences campus AME given its clear mandate to impact organizational culture. The authors interviewed a purposeful sample of 26 AME members and non-AME campus faculty and educational leaders during the 2014-2015 academic year. Two reviewers employed content analysis to code the transcripts. RESULTS The AME has positively impacted organizational culture by being a symbol of institutional commitment to the educational mission, and by asserting education as an evidence-based practice. At the faculty member level, the AME's impact includes creating a home and community for educators to network. Individual faculty influence departments and programs across campus through teaching and interpersonal connections. However, the AME has not impacted all of campus, due to only reaching self-identified educators, and the siloed nature of departments on campus. CONCLUSIONS Although limited to a single campus and an early established AME, this study contributes significant insight by describing how an AME as a structural unit impacts individual faculty members, who in turn impact organizational campus culture regarding the educational mission.
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Affiliation(s)
- Janet Corral
- J. Corral is assistant professor, Department of Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado.G. Guiton is associate professor, Department of Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado.E. Aagaard is professor, Department of Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado
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Stokbro K, Aagaard E, Torkov P, Bell R, Thygesen T. Surgical accuracy of three-dimensional virtual planning: a pilot study of bimaxillary orthognathic procedures including maxillary segmentation. Int J Oral Maxillofac Surg 2016; 45:8-18. [DOI: 10.1016/j.ijom.2015.07.010] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 05/31/2015] [Accepted: 07/16/2015] [Indexed: 11/29/2022]
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Ghawsi S, Aagaard E, Thygesen T. High condylectomy for the treatment of mandibular condylar hyperplasia: a systematic review of the literature. Int J Oral Maxillofac Surg 2016; 45:60-71. [DOI: 10.1016/j.ijom.2015.09.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 08/25/2015] [Accepted: 09/04/2015] [Indexed: 10/23/2022]
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Affiliation(s)
- Eva Aagaard
- Corresponding author: Eva Aagaard, MD, University of Colorado, Division of General Internal Medicine, MS F495, Room 4102A, 13070 East 19th Avenue, Aurora, CO 80045, 303.724.5866,
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Affiliation(s)
- Eva Aagaard
- University of Colorado School of Medicine, Aurora, CO, USA,
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Masanganise R, Samkange C, Mukona D, Aagaard E. Competency based ophthalmology training curriculum for undergraduate medical students in Zimbabwe. Cent Afr J Med 2015; 61:44-48. [PMID: 29144080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND The establishment of a credible, defensible and acceptable “formal competency based ophthalmology training curriculum for undergraduate medical and dental students” is fundamental to program recognition, monitoring and evaluation. The University of Zimbabwe College of Health Sciences (UZ-CHS) has never had a formal ophthalmology training curriculum for medical graduates since its inception. This has cast doubts on the quality of medical graduates produced with regards to delivery of basic primary eye care in the community. OBJECTIVE The aim of this project was to develop a formal “competency based ophthalmology training curriculum” (CBOTC) for medical graduates in Zimbabwe. DESIGN Institution based (University of Zimbabwe College of Health Sciences and Parirenyatwa Group of Hospitals), cross-sectional analytic study. METHODOLOGY A review of undergraduate medical training curriculum and literature was done to identify gaps in the ophthalmology training curriculum. A local needs assessment was conducted through interviews of major stake holders in the University of Zimbabwe College of Health Sciences and Parirenyatwa Group of Hospitals. RESULTS This project confirmed the lack of a formal ophthalmology training curriculum for medical graduates at the UZCHS, ad-hoc training of undergraduate ophthalmology and inconsistent student assessment in knowledge of and care of eye complaints. Cataract, glaucoma, refractive errors, ocular tumours, conjunctivitis, eye infection and eye injuries were suggested as priority conditions every student should learn during the rotation. A formal CBOTC for medical graduates based on identified needs and priority eye diseases has been developed in response. CONCLUSION A CBOTC based on identified needs and focused on targeted diseases has been proposed geared towards producing medical graduates with the basic knowledge, skills and attitudes to deliver adequate primary eye care.
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Bowen JL, Hirsh D, Aagaard E, Kaminetzky CP, Smith M, Hardman J, Chheda SG. Advancing educational continuity in primary care residencies: an opportunity for patient-centered medical homes. Acad Med 2015; 90:587-593. [PMID: 25470307 DOI: 10.1097/acm.0000000000000589] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Continuity of care is a core value of patients and primary care physicians, yet in graduate medical education (GME), creating effective clinical teaching environments that emphasize continuity poses challenges. In this Perspective, the authors review three dimensions of continuity for patient care-informational, longitudinal, and interpersonal-and propose analogous dimensions describing continuity for learning that address both residents learning from patient care and supervisors and interprofessional team members supporting residents' competency development. The authors review primary care GME reform efforts through the lens of continuity, including the growing body of evidence that highlights the importance of longitudinal continuity between learners and supervisors for making competency judgments. The authors consider the challenges that primary care residency programs face in the wake of practice transformation to patient-centered medical home models and make recommendations to maximize the opportunity that these practice models provide. First, educators, researchers, and policy makers must be more precise with terms describing various dimensions of continuity. Second, research should prioritize developing assessments that enable the study of the impact of interpersonal continuity on clinical outcomes for patients and learning outcomes for residents. Third, residency programs should establish program structures that provide informational and longitudinal continuity to enable the development of interpersonal continuity for care and learning. Fourth, these educational models and continuity assessments should extend to the level of the interprofessional team. Fifth, policy leaders should develop a meaningful recognition process that rewards academic practices for training the primary care workforce.
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Affiliation(s)
- Judith L Bowen
- J.L. Bowen is professor of medicine, Oregon Health & Science University, Portland, Oregon, and physician education consultant, Office of Academic Affiliations, Veterans Health Administration, Washington, DC. D. Hirsh is associate professor of medicine, Harvard Medical School, Boston, Massachusetts, and staff physician, Department of Medicine, Cambridge Health Alliance, Cambridge, Massachusetts. E. Aagaard is professor of medicine, Department of Medicine, Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado. C.P. Kaminetzky is associate chief of staff for education, VA Puget Sound Health Care System, Seattle, Washington, and assistant professor, University of Washington School of Medicine, Seattle, Washington. M. Smith is Henry A. Palmer Endowed Professor, Community Pharmacy Practice, and assistant dean, Practice and Public Policy Partnerships, University of Connecticut School of Pharmacy, Storrs, Connecticut. J. Hardman is assistant professor of medicine, associate program director, and medical director, Internal Medicine Resident Practice, Oregon Health & Science University, Portland, Oregon. S.G. Chheda is associate professor of medicine and pediatrics, Department of Medicine, Division of General Internal Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Hines K, Aagaard E. Continuing Medical Education Learning Module for the Primary Care and Emergency Medicine Physicians: Musculoskeletal Assessment of the Knee and Shoulder Joints. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.691.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kelsey Hines
- Cell and Developmental BiologyUniversity of ColoradoAuroraCOUnited States
| | - Eva Aagaard
- Cell and Developmental BiologyUniversity of ColoradoAuroraCOUnited States
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Kogan JR, Lapin J, Aagaard E, Boscardin C, Aiyer MK, Cayea D, Cifu A, Diemer G, Durning S, Elnicki M, Fazio SB, Khan AR, Lang VJ, Mintz M, Nixon LJ, Paauw D, Torre DM, Hauer KE. The effect of resident duty-hours restrictions on internal medicine clerkship experiences: surveys of medical students and clerkship directors. Teach Learn Med 2015; 27:37-50. [PMID: 25584470 DOI: 10.1080/10401334.2014.979187] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
UNLABELLED PHENOMENON: Medical students receive much of their inpatient teaching from residents who now experience restructured teaching services to accommodate the 2011 duty-hour regulations (DHR). The effect of DHR on medical student educational experiences is unknown. We examined medical students' and clerkship directors' perceptions of the effects of the 2011 DHR on internal medicine clerkship students' experiences with teaching, feedback and evaluation, and patient care. APPROACH Students at 14 institutions responded to surveys after their medicine clerkship or subinternship. Students who completed their clerkship (n = 839) and subinternship (n = 228) March to June 2011 (pre-DHR historical controls) were compared to clerkship students (n = 895) and subinterns (n = 377) completing these rotations March to June 2012 (post-DHR). Z tests for proportions correcting for multiple comparisons were performed to assess attitude changes. The Clerkship Directors in Internal Medicine annual survey queried institutional members about the 2011 DHR just after implementation. FINDINGS Survey response rates were 64% and 50% for clerkship students and 60% and 48% for subinterns in 2011 and 2012 respectively, and 82% (99/121) for clerkship directors. Post-DHR, more clerkship students agreed that attendings (p =.011) and interns (p =.044) provided effective teaching. Clerkship students (p =.013) and subinterns (p =.001) believed patient care became more fragmented. The percentage of holdover patients clerkship students (p =.001) and subinterns (p =.012) admitted increased. Clerkship directors perceived negative effects of DHR for students on all survey items. Most disagreed that interns (63.1%), residents (67.8%), or attendings (71.1%) had more time to teach. Most disagreed that students received more feedback from interns (56.0%) or residents (58.2%). Fifty-nine percent felt that students participated in more patient handoffs. INSIGHTS: Students perceive few adverse consequences of the 2011 DHR on their internal medicine experiences, whereas their clerkship director educators have negative perceptions. Future research should explore the impact of fragmented patient care on the student-patient relationship and students' clinical skills acquisition.
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Affiliation(s)
- Jennifer R Kogan
- a Department of Medicine , Perelman School of Medicine at the University of Pennsylvania , Philadelphia , Pennsylvania , USA
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Aagaard E, Thygesen T. A prospective, single-centre study on patient outcomes following temporomandibular joint replacement using a custom-made Biomet TMJ prosthesis. Int J Oral Maxillofac Surg 2014; 43:1229-35. [DOI: 10.1016/j.ijom.2014.05.019] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 05/19/2014] [Accepted: 05/26/2014] [Indexed: 11/26/2022]
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Stokbro K, Aagaard E, Torkov P, Bell R, Thygesen T. Virtual planning in orthognathic surgery. Int J Oral Maxillofac Surg 2014; 43:957-65. [DOI: 10.1016/j.ijom.2014.03.011] [Citation(s) in RCA: 123] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 03/14/2014] [Accepted: 03/19/2014] [Indexed: 10/25/2022]
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Elwell D, Junker S, Sillau S, Aagaard E. Refugees in Denver and their perceptions of their health and health care. J Health Care Poor Underserved 2014; 25:128-41. [PMID: 24509016 DOI: 10.1353/hpu.2014.0032] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Colorado receives approximately 2,500 refugees each year from countries all over the world. We assessed the self-perceived health of and barriers to care for refugees in the Denver metro area in order to understand better the needs of this population. METHODS A 61-item questionnaire was completed by a convenience sample of 120 local refugees between June and December of 2009. RESULTS Only 10% of respondents reported their health as excellent, while 31% rated it as either poor or fair. The most prominent barriers to care included unemployment (91%), language (46%), lack of health insurance (41%), lack of transportation (43%), and distrust of doctors (22%). CONCLUSIONS Our study suggests that refugees in Denver face significant barriers that affect their access to health care. Recommendations include improved job and language skill programs, a health navigator program, and health care provider training on culturally effective care of this population.
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Aagaard E, Kane GC, Conforti L, Hood S, Caverzagie KJ, Smith C, Chick DA, Holmboe ES, Iobst WF. Early feedback on the use of the internal medicine reporting milestones in assessment of resident performance. J Grad Med Educ 2013; 5:433-8. [PMID: 24404307 PMCID: PMC3771173 DOI: 10.4300/jgme-d-13-00001.1] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Revised: 03/22/2013] [Accepted: 04/01/2013] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The educational milestones were designed as a criterion-based framework for assessing resident progression on the 6 Accreditation Council for Graduate Medical Education competencies. OBJECTIVE We obtained feedback on, and assessed the construct validity and perceived feasibility and utility of, draft Internal Medicine Milestones for Patient Care and Systems-Based Practice. METHODS All participants in our mixed-methods study were members of competency committees in internal medicine residency programs. An initial survey assessed participant and program demographics; focus groups obtained feedback on the draft milestones and explored their perceived utility in resident assessment, and an exit survey elicited input on the value of the draft milestones in resident assessment. Surveys were tabulated using descriptive statistics. Conventional content analysis method was used to assess the focus group data. RESULTS Thirty-four participants from 17 programs completed surveys and participated in 1 of 6 focus groups. Overall, the milestones were perceived as useful in formative and summative assessment of residents. Participants raised concerns about the length and complexity of some draft milestones and suggested specific changes. The focus groups also identified a need for faculty development. In the exit survey, most participants agreed that the Patient Care and Systems-Based Practice Milestones would help competency committees assess trainee progress toward independent practice. CONCLUSIONS Draft reporting milestones for 2 competencies demonstrated significant construct validity in both the content and response process and the perceived utility for the assessment of resident performance. To ensure success, additional feedback from the internal medicine community and faculty development will be necessary.
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Stickrath C, Noble M, Prochazka A, Anderson M, Griffiths M, Manheim J, Sillau S, Aagaard E. Attending rounds in the current era: what is and is not happening. JAMA Intern Med 2013; 173:1084-9. [PMID: 23649040 DOI: 10.1001/jamainternmed.2013.6041] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE General medicine rounds by attending physicians provide the foundation for patient care and education in teaching hospitals. However, the detailed activities of these rounds in the current era are not well characterized. OBJECTIVE To describe the characteristics of attending rounds for internal medicine inpatients in a large teaching hospital system. DESIGN A cross-sectional observational study of attending rounds in internal medicine. Rounds were observed directly by research assistants. SETTING Four teaching hospitals associated with a large public medical school. PARTICIPANTS Fifty-six attending physicians and 279 trainees treating 807 general medicine inpatients. MAIN OUTCOMES AND MEASURES Duration and location of rounds, composition of teams, and frequency of 19 potential activities during rounds. RESULTS We observed 90 days of rounds. A typical rounding day consisted of 1 attending with 3 trainees visiting a median of 9 (range, 2-18 [SD, 2.9]) patients for a median of 2.0 hours (range, 25-241 [SD, 2.7] minutes). On rounds, teams most frequently discussed the patient care plan (96.7% of patients), reviewed diagnostic studies (90.7%), communicated with patients (73.4%), and discussed the medication list (68.8%). Teams infrequently discussed invasive lines or tubes (9.3%) or nursing notes (6.2%) and rarely communicated with nurses (12.0%) or taught physical examination skills (14.6%), evidence-based medicine topics (7.2%), or learner-identified topics (3.2%). Many commonly performed activities occurred infrequently at the bedside. CONCLUSIONS AND RELEVANCE Most activities on attending rounds do not take place at the bedside. The teams discuss patient care plans and test results most of the time but fail to include many items that may be of significant value, including specific aspects of patient care, interprofessional communication, and learner-centered education. Future studies are needed to further assess the implications of these observations.
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Affiliation(s)
- Chad Stickrath
- Department of Medicine, University of Colorado Denver School of Medicine, Denver, CO 80220, USA.
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Abstract
Clinician educators and medical trainees face intense pressure to complete numerous patient care and teaching activities in a limited amount of time. To address the need for effective and efficient teaching methods for use in the inpatient setting, the authors used constructivist learning theory, the principles of adult learning, and their expertise as clinician educators to develop the MiPLAN model for bedside teaching. This three-part model is designed to enable clinical teachers to simultaneously provide care to patients while assessing learners, determining high-yield teaching topics, and providing feedback to learners.The "M" refers to a preparatory meeting between teacher and learners before engaging in patient care or educational activities. During this meeting, team members should become acquainted and the teacher should set goals and clarify expectations. The "i" refers to five behaviors for the teacher to adopt during learners' bedside presentations: introduction, in the moment, inspection, interruptions, and independent thought. "PLAN" is an algorithm to establish priorities for teaching subsequent to a learner's presentation: patient care, learners' questions, attending's agenda, and next steps.The authors suggest that the MiPLAN model can help clinical teachers gain more confidence in their ability to teach at the bedside and increase the frequency and quality of bedside teaching. They propose further research to assess the generalizability of this model to other institutions, settings, and specialties and to evaluate educational and patient outcomes.
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Affiliation(s)
- Chad Stickrath
- University of Colorado School of Medicine, Aurora, Colorado, USA.
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Castiglioni A, Aagaard E, Spencer A, Nicholson L, Karani R, Bates CK, Willett LL, Chheda SG. Succeeding as a Clinician Educator: useful tips and resources. J Gen Intern Med 2013; 28:136-40. [PMID: 22836953 PMCID: PMC3539043 DOI: 10.1007/s11606-012-2156-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2011] [Revised: 06/11/2012] [Accepted: 06/19/2012] [Indexed: 10/28/2022]
Abstract
Clinician Educators (CEs) play an essential role in the education and patient care missions of academic medical centers. Despite their crucial role, academic advancement is slower for CEs than for other faculty. Increased clinical productivity demands and financial stressors at academic medical centers add to the existing challenges faced by CEs. This perspective seeks to provide a framework for junior CEs to consider with the goal of maximizing their chance of academic success. We discuss six action areas that we consider central to flourishing at academic medical centers: 1. Clarify what success means and define goals; 2. Seek mentorship and be a responsible mentee; 3. Develop a niche and engage in relevant professional development; 4. Network; 5. Transform educational activities into scholarship; and 6. Seek funding and other resources.
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Affiliation(s)
- Analia Castiglioni
- Division of General Internal Medicine, University of Alabama at Birmingham, Birmingham VA Medical Center, Birmingham, AL, USA.
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Guerrasio J, Cumbler E, Trosterman A, Wald H, Brandenburg S, Aagaard E. Determining need for remediation through postrotation evaluations. J Grad Med Educ 2012; 4:47-51. [PMID: 23451306 PMCID: PMC3312533 DOI: 10.4300/jgme-d-11-00145.1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 10/13/2011] [Accepted: 10/18/2011] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Postrotation evaluations are frequently used by residency program directors for early detection of residents with academic difficulties; however, the accuracy of these evaluations in assessing resident performance has been questioned. METHODS This retrospective case-control study examines the ability of postrotation evaluation characteristics to predict the need for remediation. We compared the evaluations of 17 residents who were placed on academic warning or probation, from 2000 to 2007, with those for a group of peers matched on sex, postgraduate year (PGY), and entering class. RESULTS The presence of an outlier evaluation, the number of words written in the comments section, and the percentage of evaluations with negative or ambiguous comments were all associated with the need for remediation (P = .01, P = .001, P = .002, P = < .001, respectively). In contrast, United States Medical Licensing Examination step 1 and step 2 scores, total number of evaluations received, and percentage of positive comments on the evaluations were not associated with the need for remediation (P = .06, P = .87, P = .55, respectively). DISCUSSION Despite ambiguous evaluation comments, the length and percentage of ambiguous or negative comments did indicate future need for remediation. CONCLUSIONS Our study demonstrates that postrotation evaluation characteristics can be used to identify residents as risk. However, larger prospective studies, encompassing multiple institutions, are needed to validate various evaluation methods in measuring resident performance and to accurately predict the need for remediation.
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Aagaard E, Thygesen T. A Prospective, Single-Center Study on Patient Outcomes Following Temporomandibular Joint Replacement Using a Custom-Made Biomet TMJ Prosthesis. J Oral Maxillofac Surg 2011. [DOI: 10.1016/j.joms.2011.06.091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Torre DM, Aagaard E, Elnicki DM, Durning SJ, Papp KK. Simulation in the internal medicine clerkship: a national survey of internal medicine clerkship directors. Teach Learn Med 2011; 23:215-222. [PMID: 21745055 DOI: 10.1080/10401334.2011.586912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Simulation in medical education offers the promise of safely and effectively preparing trainees for a variety of tasks encountered in clinical medicine. PURPOSE The objective was to determine internal medicine (IM) clerkship directors' perceptions of the use of simulations during the medicine clerkship. METHODS A cross-sectional survey of 110 Clerkship Directors in Internal Medicine (CDIM) institutional members was presented. The survey contained 24 questions including multiple-choice responses with Likert scale and open-ended questions. Descriptive and correlational statistical analyses were performed. A thematic qualitative analysis was performed. RESULTS Response rate was 78% (86/110). Simulation was used in the IM clerkship in 84% (72) of responding schools. Simulations were used to teach a variety of clinical skills and concepts such as history taking and diagnostic reasoning. The intended goal of simulations was teaching in 39% (28), formative assessment in 49% (35), summative assessment in 38% (27), and compliance with Liaison Council for Medical Education requirements in 19% (14). Most of clerkships (54%, 49) use standardized patients, with 37.5 % (27) using them for formative purposes, whereas 33% (24) used them for summative purposes. Support for simulation was provided by the school of medicine in 57% (41) of clerkships, by the department of medicine in 30% (22) of clerkships. CONCLUSIONS Simulations are used to teach clinical skills and for formative and summative assessments. Standardized patients and simulation mannequins are the most commonly used simulations types. Further research is needed to assess clerkship directors' needs, knowledge, and use of simulation in specific learning and training contexts.
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Affiliation(s)
- Dario M Torre
- Department of Medicine, University of Pittsburgh Medical School–Shadyside, 5230 Centre Avenue, Pittsburgh, PA 15232, USA.
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Westermark A, Leiggener C, Aagaard E, Lindskog S. Histological findings in soft tissues around temporomandibular joint prostheses after up to eight years of function. Int J Oral Maxillofac Surg 2011; 40:18-25. [PMID: 21044827 DOI: 10.1016/j.ijom.2010.09.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Accepted: 09/13/2010] [Indexed: 11/30/2022]
Affiliation(s)
- A Westermark
- Department of Maxillofacial Surgery, Karolinska University Hospital, Stockholm, Sweden.
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Bray-Hall S, Schmidt K, Aagaard E. Toward safe hospital discharge: a transitions in care curriculum for medical students. J Gen Intern Med 2010; 25:878-81. [PMID: 20443072 PMCID: PMC2896603 DOI: 10.1007/s11606-010-1364-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2009] [Revised: 12/19/2009] [Accepted: 04/05/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Medical errors often occur when patients move between care settings. Physicians generally receive little formal education on improving patient care transitions. OBJECTIVE To develop a sustainable and effective Transition in Care Curriculum (TICC). Specific goals were to increase student confidence in and knowledge of skills necessary during care transitions at the time of hospital discharge, and to quantify the frequency of student-identified medication discrepancies during a post-discharge home visit. DESIGN TICC was delivered to 136 3rd-year medical students during their required inpatient medicine clerkship at six urban Denver hospitals. TICC consists of small and large group interactive sessions and self-directed learning exercises to provide foundational knowledge of care transitions. Experiential learning occurs through direct patient care at the time of discharge and during a follow-up home, hospice, or skilled nursing visit. Students completed a pre-post confidence measure, short answer and multiple choice questions, a post-clerkship satisfaction survey, and a standardized medication discrepancy tool. MAIN RESULTS Overall combined confidence in transitional care skills improved following the TICC from an average score of 2.7 (SD 0.9) to 4.0 (SD 0.8) (p < 0.01) on a 5-point confidence scale. They scored an average of 77% on the written discharge plan portion of the final exam. Students rated the usefulness of TICC at a mean of 3.1 (SD 0.7), above the combined mean of 2.7 for project work in all required clerkships. Students identified medication discrepancies during 43% of post-discharge visits (58 of 136). The most common reasons for discrepancies were patient lack of understanding of instructions and intentional non-adherence to medication plan. CONCLUSION TICC represents a feasible and effective program to teach evidence-based transitional care.
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Affiliation(s)
- Susan Bray-Hall
- Division of Geriatrics, Department of Medicine, University of Colorado, Aurora, CO, USA.
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Lyss-Lerman P, Teherani A, Aagaard E, Loeser H, Cooke M, Harper GM. What training is needed in the fourth year of medical school? Views of residency program directors. Acad Med 2009; 84:823-9. [PMID: 19550170 DOI: 10.1097/acm.0b013e3181a82426] [Citation(s) in RCA: 179] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
PURPOSE To identify common struggles of interns, determine residency program directors' (PDs') views of the competencies to be gained in the fourth year of medical school, and apply this information to formulate goals of curricular reform and student advising. METHOD In 2007, semistructured interviews were conducted with 30 PDs in the 10 most common specialty choices of students at the University of California, San Francisco, School of Medicine to assess the PDs' priorities for knowledge, skills, and attitudes to be acquired in the fourth year. Interviews were coded to identify major themes. RESULTS Common struggles of interns were lack of self-reflection and improvement, poor organizational skills, underdeveloped professionalism, and lack of medical knowledge. The Accreditation Council for Graduate Medical Education competencies of patient care, practice-based learning and improvement, interpersonal and communication skills, and professionalism were deemed fundamental to fourth-year students' development. Rotations recommended across specialties were a subinternship in a student's future field and in internal medicine (IM), rotations in an IM subspecialty, critical care, and emergency and ambulatory medicine. PDs encouraged minimizing additional time spent in the student's future field. Suggested coursework included an intensively coached transitional subinternship and courses to improve students' medical knowledge. CONCLUSIONS PDs deemed the fourth year to have a critical role in the curriculum. There was consensus about expected fourth-year competencies and the common clinical experiences that best prepare students for residency training. These findings support using the fourth year to transition students to graduate medical training and highlight areas for curricular innovation.
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Nolt BR, Gonzales R, Maselli J, Aagaard E, Camargo CA, Metlay JP. Vital-sign abnormalities as predictors of pneumonia in adults with acute cough illness. Am J Emerg Med 2007; 25:631-6. [PMID: 17606087 DOI: 10.1016/j.ajem.2006.11.031] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2006] [Revised: 10/30/2006] [Accepted: 11/12/2006] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This study examines the strength of the association between vital-sign abnormalities, advanced age, and the diagnosis of community-acquired pneumonia (CAP) in the evaluation of adults with acute cough illness. METHODS A random sample of adult visits for acute cough to 15 EDs during the winter period of 2 consecutive years (2003-2005) was selected for medical record abstraction. Visits were initially sampled based on discharge diagnoses for a broad range of acute respiratory tract infection diagnoses. Participating sites were a national sample of EDs in Veterans Administration and non-Veterans Administration hospitals stratified across the US region. RESULTS Of 4464 charts reviewed, 421 had a diagnosis of CAP based on physician discharge diagnosis and radiographic findings. Age greater than 50 years and vital-sign abnormality (including fever, hypoxemia, tachycardia, or tachypnea) were the only significant predictors of CAP. Hypoxemia had the strongest association with CAP diagnosis (odds ratio, 3.5; 95% confidence interval, 2.4-5.0). A greater number of abnormalities were associated with a higher prevalence of CAP, from 12% with 1 abnormality to 69% with 4 vital-sign abnormalities (P < .001). Most vital-sign abnormalities were predictive of CAP regardless of age. CONCLUSIONS Increases in vital-sign abnormalities are associated with a greater probability of CAP, and the strength of the association does not vary substantially by age.
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Affiliation(s)
- Brendon R Nolt
- The Center for Health Equity Research and Promotion, VA Medical Center and the University of Pennsylvania School of Medicine, Philadelphia, PA 19104-6021, USA
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Abstract
OBJECTIVES The authors examine which clinical factors contribute to the clinician suspicion of pneumonia, as well as the relationship between clinical factors, clinician suspicion of pneumonia, and ordering chest X-rays (CXR). METHODS Three hundred consecutive adults presenting to the clinic with acute cough in the winter of 2003 were studied. Using standardized encounter forms, data were collected on sociodemographics, illness impact, symptoms, tobacco use, past medical history, vital signs, physical examination findings, chest X-ray result, and clinician diagnoses. Clinicians rated their suspicion of pneumonia on a 5-point Likert scale. Multivariable logistic regression analysis was used to determine independent predictors of clinician suspicion of pneumonia and of ordering of CXRs. RESULTS Clinician suspicion of pneumonia was low in the majority of patients presenting for evaluation of cough (63%). Higher clinician suspicion of pneumonia was predicted by advanced patient age (odds ratio [OR]: 4.6; 95% confidence interval [CI] [1.2-18.1]), shortness of breath (2.4; [1.0-6.0]), fever (5.5; [1.8-17.5]), tachycardia (3.8; [1.1-13.1]), rales (23.8; [5.7-98.7]), and rhonchi (14.6; [5.2-40.5]). CXRs were ordered in 19% of patients presenting with acute cough. Intermediate clinician suspicion of pneumonia (OR: 7.9; 95% CI: [2.8, 22.5]) (v. low suspicion), advanced patient age ([.greaterequal] 65 years) (9.2; [2.7, 31.6]) (v. ages 18-44 years), and decreased breath sounds on examination (5.1; [1.8, 14.3]) are independent predictors of ordering a CXR. Among patients with a clinical diagnosis of pneumonia (n = 31), CXRs were ordered in only 61%. CONCLUSIONS Advanced patient age and physical findings on chest examination influence clinician practice in obtaining CXRs, beyond their contribution to clinician suspicion of pneumonia. Physicians do not appear to endorse recommendations that the diagnosis of community-acquired pneumonia be based on or confirmed by CXR.
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Affiliation(s)
- Eva Aagaard
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, USA
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Lai CJ, Aagaard E, Brandenburg S, Nadkarni M, Wei HG, Baron R. Brief report: Multiprogram evaluation of reading habits of primary care internal medicine residents on ambulatory rotations. J Gen Intern Med 2006; 21:486-9. [PMID: 16704393 PMCID: PMC1484781 DOI: 10.1111/j.1525-1497.2006.00432.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the reading habits and educational resources of primary care internal medicine residents for their ambulatory medicine education. DESIGN Cross-sectional, multiprogram survey of primary care internal medicine residents. PARTICIPANTS/SETTING Second- and third-year residents on ambulatory care rotations at 9 primary care medicine programs (124 eligible residents; 71% response rate). MEASUREMENTS AND MAIN RESULTS Participants were asked open-ended and 5-point Likert-scaled questions about reading habits: time spent reading, preferred resources, and motivating and inhibiting factors. Participants reported reading medical topics for a mean of 4.3+/-3.0 SD hours weekly. Online-only sources were the most frequently utilized medical resource (mean Likert response 4.16+/-0.87). Respondents most commonly cited specific patients' cases (4.38+/-0.65) and preparation for talks (4.08+/-0.89) as motivating factors, and family responsibilities (3.99+/-0.65) and lack of motivation (3.93+/-0.81) as inhibiting factors. CONCLUSIONS To stimulate residents' reading, residency programs should encourage patient- and case-based learning; require teaching assignments; and provide easy access to online curricula.
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Affiliation(s)
- Cindy J Lai
- University of California, San Francisco, CA 94143, USA.
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Abstract
Acute respiratory infections (ARIs) are the most common infections in humans, accounting for half of all acute conditions each year in the United States. Acute bronchitis episodes represent a significant portion of these illnesses. This article focuses on acute bronchitis in otherwise healthy individuals.
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Abstract
PURPOSE This study examined the teaching points made by preceptors in response to two videotaped teaching encounters to determine if (1) different preceptors use similar teaching points in response to the same case, (2) preceptors' teaching points vary by case, and (3) preceptors' teaching points vary by teaching model (One-Minute Preceptor and traditional preceptor models). METHOD Preceptors (n = 116) at seven universities participated in a within-groups experimental design study in 2000. The preceptors viewed videotaped encounters depicting two cases and two precepting models. They were asked to list two teaching points after viewing the initial case presentations and after the teaching encounters were completed. Frequency of teaching points listed by preceptors was examined for each case and teaching model. Teaching points were coded using qualitative methods and then analyzed using repeated-measures analysis of variance. RESULTS Of the 843 total teaching points identified by preceptors, 63 were discrete teaching points that were aggregated into 15 categories. Most preceptors (82%) listed three to five separate teaching points, which varied significantly by case and model. Those observing the traditional precepting model were more likely to teach generic skills such as history-taking skills, presentation skills, and risk factors, and those observing the One-Minute Preceptor were more likely to teach about the illness focusing on a broader differential diagnosis, further diagnostic tests, and the natural presentation of disease. CONCLUSIONS Preceptors use three to five common teaching points that vary by case and teaching model. The One-Minute Preceptor model shifted teaching points away from generic clinical skills toward disease-specific teaching.
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Affiliation(s)
- David M Irby
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco 94143-0410, USA.
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Abstract
PURPOSE To compare the One-Minute Preceptor (OMP) and traditional models of ambulatory teaching in terms of the preceptors' (1) ability to correctly diagnose patients' medical problems, (2) ability to rate students' skills and confidence in doing so, and (3) satisfaction with both models. METHOD A within-groups experimental design study was conducted with 116 preceptors at seven universities in 2000. Participants viewed scripted, videotaped precepting encounters of both models using two cases and were asked to rate students' abilities, their confidence in rating the students' abilities, and the effectiveness and efficiency of the teaching encounters. RESULTS Preceptors who viewed the videotapes of the OMP model were equally or better able to correctly diagnose the patients' medical conditions than those viewing the traditional model. Preceptors viewing the OMP rated students' abilities higher on history taking/physical examination, presentations, clinical reasoning, and fund of knowledge than did those viewing the traditional model. Preceptors viewing the OMP rated themselves as more confident in rating students' abilities in presentation, clinical reasoning, and fund of knowledge. Preceptors rated the OMP as more effective and more efficient than the traditional model. CONCLUSIONS Preceptors viewing scripted, videotaped teaching encounters using the OMP model were equal to or better able to correctly diagnose patients' medical problems, had greater self-confidence in rating students, and rated the encounter as more effective and efficient than when viewing the traditional model.
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Affiliation(s)
- Eva Aagaard
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco 94143-0410, USA
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Wenzel A, Aagaard E, Sindet-Pedersen S. Evaluation of a new radiographic technique: outcome following removal of mandibular third molars. Dentomaxillofac Radiol 1998. [DOI: 10.1038/sj.dmfr.4600358] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Wenzel A, Aagaard E, Sindet-Pedersen S. Evaluation of a new radiographic technique: outcome following removal of mandibular third molars. Dentomaxillofac Radiol 1998; 27:264-9. [PMID: 9879214 DOI: 10.1038/sj/dmfr/4600358] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To compare the effect on outcome of third molar removal of pre-operative radiographic assessment by two different techniques. METHODS Two hundred and sixty three patients were allocated prior to surgery to one of two diagnostic groups. One hundred and thirty-seven were examined by the Scanora and 126 by a panoramic plus three intra-oral radiographs. Ten oral surgeons recorded their operating time in minutes. Postoperative pain was recorded 4 h after the operation by the patients on a Visual Analog Scale (VAS). The following clinical parameters were recorded at the 1-week postoperative examination: alveolitis, bleeding, and swelling related to the operation area, and any other complications such as paresthesia, nausea and trismus. RESULTS There was no significant difference in operation time between the two groups of patients (t-test; P > 0.82) nor in the frequency of immediate postoperative pain (chi 2-test; P > 0.5). There were no statistically significant differences in pain score between patients who experienced pain in the two groups (P = 0.10). Sixty-four patients experienced one or more postoperative complications, but the differences between the two groups were not statistically significant (chi 2-test; P > 0.05). There were no significant differences between the surgeons in the number of patients they operated on who experienced pain (chi 2-test; P = 0.18) or who developed complications (chi 2-test; P = 0.27). CONCLUSION There are no adverse effects on the rate of postoperative complications when surgeons with little experience with it base their diagnosis and treatment plan on Scanora compared with conventional radiography.
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MESH Headings
- Adult
- Chi-Square Distribution
- Clinical Competence
- Evaluation Studies as Topic
- Female
- Humans
- Male
- Mandible/diagnostic imaging
- Molar, Third/diagnostic imaging
- Molar, Third/surgery
- Pain Measurement
- Pain, Postoperative
- Radiography, Dental, Digital
- Radiography, Panoramic
- Statistics, Nonparametric
- Tooth, Impacted/diagnostic imaging
- Tooth, Impacted/surgery
- Tooth, Unerupted/diagnostic imaging
- Tooth, Unerupted/surgery
- Treatment Outcome
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Affiliation(s)
- A Wenzel
- Department of Oral Radiology, Royal Dental College, University of Aarhus, Denmark
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Wenzel A, Aagaard E, Sindet-Pedersen S. Evaluation of a new radiographic technique: diagnostic accuracy for mandibular third molars. Dentomaxillofac Radiol 1998; 27:255-63. [PMID: 9879213 DOI: 10.1038/sj/dmfr/4600359] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To compare the accuracy of Scanora with that of traditional panoramic and intra-oral radiography for the assessment of impacted mandibular third molars. METHODS Two hundred and fifty-four patients referred for removal of impacted or partly erupted third molars were randomly allocated to one of two groups; 133 were examined by the Scanora system and 121 by a panoramic plus a series of three intra-oral radiographs. The radiographs were read by a trained oral radiologist and her diagnoses validated against the surgeons' findings at operation. RESULTS There was agreement about the state of tooth eruption in 71.4% of Scanora and 74.4% of conventional examinations and about tooth position in 77.2 and 69.7% respectively (P < 0.05). The number of roots was assessed more accurately by Scanora (82.7% agreement) than by conventional (71% agreement) examination (P < 0.05). There was agreement about the root morphology in 70.4% of Scanora and 62.4% of conventional examinations. In 12% of the patients, the roots were in very close contact with the canal determined by the surgeon. In approximately 50% of these cases, the close contact to the canal was found by radiography with no significant differences between the methods. CONCLUSION The Scanora method was more accurate when validated against the surgeons' findings for the position and number of roots of ectopic mandibular third molars while both methods were equally accurate in demonstrating the relation between the roots and the inferior alveolar nerve.
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MESH Headings
- Adolescent
- Adult
- Evaluation Studies as Topic
- Female
- Humans
- Male
- Mandible
- Molar, Third/diagnostic imaging
- Molar, Third/surgery
- Radiography, Dental, Digital
- Radiography, Panoramic
- Reproducibility of Results
- Statistics, Nonparametric
- Tooth, Impacted/diagnostic imaging
- Tooth, Impacted/surgery
- Tooth, Unerupted/diagnostic imaging
- Tooth, Unerupted/surgery
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Affiliation(s)
- A Wenzel
- Department of Oral Radiology, Royal Dental College, University of Aarhus, Denmark
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Nørholt SE, Aagaard E, Svensson P, Sindet-Pedersen S. Evaluation of trismus, bite force, and pressure algometry after third molar surgery: a placebo-controlled study of ibuprofen. J Oral Maxillofac Surg 1998; 56:420-7; discussion 427-9. [PMID: 9541340 DOI: 10.1016/s0278-2391(98)90705-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE This study evaluated trismus, bite force, and pressure algometry as measures of analgesic efficacy after third molar removal. PATIENTS AND METHODS Fifty-seven patients (36 females and 21 males) developed at least moderate pain after surgical removal of a mandibular third molar and were given either ibuprofen, 400 mg (n = 26), or placebo (n = 31) in a double-blind study. Pain intensity and pain relief were rated on a five-point verbal rating scale during the 4-hour study period. Recordings of trismus, bilateral pressure pain detection and tolerance thresholds, and bite force were performed before surgery, at medication, and hourly for 4 hours. Changes in the functional variables were calculated as percent change from baseline (before surgery). RESULTS The pain intensity and pain relief ratings showed significant differences between the ibuprofen- and placebo-treated patients in the 4-hour study period. The changes in trismus, bite force, and pressure pain thresholds were in accordance with these pain ratings. Pressure pain detection threshold on the operated side was significantly lower in the placebo-treated patients compared with the ibuprofen-treated patients 2 and 3 hours after medication, whereas pressure tolerance threshold showed a significant difference after 2 hours. Bite force on the operated side was significantly less reduced 3 hours after treatment with ibuprofen when compared with placebo. CONCLUSIONS The functional measures used support the results obtained by rating of pain intensity and pain relief, and could be of value as measures of the efficacy of an analgesic to reduce functional impairment caused by postoperative pain.
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Affiliation(s)
- S E Nørholt
- Department of Oral and Maxillofacial Surgery; Royal Dental College, Aarhus University and Aarhus University Hospital, Denmark
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Abstract
The aim of this study was to evaluate the effect on subtraction image quality of number of a) gray shades sampled during camera recording, and b) reference points positioned in the two images to be subtracted. Intraoral radiographs were obtained in each of 12 patients, one at 0 degrees and one at 15 degrees horizontal angulation in a standardized recording procedure. The radiographs were videorecorded twice sampling 1) 160-180 and 2) 200-220 shades of gray. The 0 degrees radiographic image was digitally copied. Subtractions were performed between the identical (0 degrees/0 degrees) and the non-identical (0 degrees/15 degrees) radiographs from both gray shade samples after positioning 5, 10, 15, and 20 reference points, respectively, in each of the images to be subtracted. The standard deviation in the subtraction image histogram was used as the test parameter for image quality. No differences existed between image quality obtained from the radiographs sampled using 160-180 and 200-220 shades of gray (P greater than 0.05). The standard deviation fell continuously, the more reference points were positioned in the images. For the 0 degrees/0 degrees images the difference was statistically significant between the 5 and 10 point images (P = 0.045) while for the 0 degrees/15 degrees images differences existed between 5 and 10 point images (P = 0.077) and the 10 and 15 point images (P = 0.048). The precision of reference point positioning as evaluated in the two identical images was satisfactory, the divergence being on average 1.4 pixels.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- E Aagaard
- Department of Radiology, Royal Dental College, Aarhus, Denmark
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47
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Abstract
The concentration of purines in plasma and urine from a 37-yr-old healthy man with a very low plasma urate concentration was measured by HPLC. A persistent increase in xanthine and a slight elevation of hypoxanthine was found. The metabolic response to intensive treadmill running and long distance running was investigated. The hypoxanthine concentration increased to about the same level as in healthy controls, but the elimination from plasma was considerably slower. The high xanthine level was practically unchanged by exercise.
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Affiliation(s)
- S Landaas
- Central Laboratory, Ullevaal University Hospital, Oslo, Norway
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