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Mun F, Scott AR, Cui D, Lehman EB, Jeong S, Chisty A, Juliano PJ, Hennrikus WL, Hennrikus EF. Correction to: A comparison of orthopaedic surgery and internal medicine perceptions of USMLE Step 1 pass/fail scoring. BMC Med Educ 2021; 21:543. [PMID: 34706734 PMCID: PMC8554851 DOI: 10.1186/s12909-021-02988-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
An amendment to this paper has been published and can be accessed via the original article.
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Affiliation(s)
- Frederick Mun
- Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
| | - Alyssa R Scott
- Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - David Cui
- Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Erik B Lehman
- Public Health Sciences at Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Seongho Jeong
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, Yale New Haven Hospital, New Haven, CT, USA
| | - Alia Chisty
- Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
- Department of Internal Medicine, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Paul J Juliano
- Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - William L Hennrikus
- Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Eileen F Hennrikus
- Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
- Department of Internal Medicine, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
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Abstract
Postoperative acute kidney injury occurs in 7% to 11% of orthopedic surgeries. The effect of preoperative angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) on the development of postoperative acute kidney injury remains controversial. Adipose tissue has its own independently regulated angiotensin system. The primary aim of this study was to examine the effects of obesity and preoperative ACEIs and ARBs on postoperative acute kidney injury. Charts were reviewed of adult elective orthopedic surgery patients during a 2-year period when patients were instructed to take their ACEI or ARB on the morning of surgery. The patients were divided into an obese cohort (body mass index [BMI] ≥30 kg/m2) and a nonobese cohort (BMI <30 kg/m2). A multivariable model was created for the outcome of acute kidney injury, using obesity as a primary predictor and adjusting for demographics, medications, comorbidities, and intraoperative parameters in a logistic regression analysis. Obesity increased the likelihood of developing acute kidney injury after orthopedic surgery (odds ratio [OR], 1.86; 95% CI, 1.07-3.22; P=.028). For every 5-unit increase in BMI, the odds of acute kidney injury were 1.43 (95% CI, 1.26-1.62; P<.001). When receiving ACEIs or ARBs, only the nonobese patients had a statistically increased likelihood of postoperative acute kidney injury (OR, 3.30; 95% CI, 1.12-9.70; P=.030). Obesity is an independent risk factor for postoperative acute kidney injury. Obesity appears to influence the effect that preoperative ACEIs and ARBs have on postoperative acute kidney injury. [Orthopedics. 2021;44(2):e253-e258.].
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Mun F, Scott AR, Cui D, Lehman EB, Jeong S, Chisty A, Juliano PJ, Hennrikus WL, Hennrikus EF. A comparison of orthopaedic surgery and internal medicine perceptions of USMLE Step 1 pass/fail scoring. BMC Med Educ 2021; 21:255. [PMID: 33941167 PMCID: PMC8091716 DOI: 10.1186/s12909-021-02699-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 02/12/2021] [Accepted: 04/23/2021] [Indexed: 06/07/2023]
Abstract
BACKGROUND United States Medical Licensing Examination Step 1 will transition from numeric grading to pass/fail, sometime after January 2022. The aim of this study was to compare how program directors in orthopaedics and internal medicine perceive a pass/fail Step 1 will impact the residency application process. METHODS A 27-item survey was distributed through REDCap to 161 U.S. orthopaedic residency program directors and 548 U.S. internal medicine residency program directors. Program director emails were obtained from the American Medical Association's Fellowship and Residency Electronic Interactive Database. RESULTS We received 58 (36.0%) orthopaedic and 125 (22.8%) internal medicine program director responses. The majority of both groups disagree with the change to pass/fail, and felt that the decision was not transparent. Both groups believe that the Step 2 Clinical Knowledge exam and clerkship grades will take on more importance. Compared to internal medicine PDs, orthopaedic PDs were significantly more likely to emphasize research, letters of recommendation from known faculty, Alpha Omega Alpha membership, leadership/extracurricular activities, audition elective rotations, and personal knowledge of the applicant. Both groups believe that allopathic students from less prestigious medical schools, osteopathic students, and international medical graduates will be disadvantaged. Orthopaedic and internal medicine program directors agree that medical schools should adopt a graded pre-clinical curriculum, and that there should be a cap on the number of residency applications a student can submit. CONCLUSION Orthopaedic and internal medicine program directors disagree with the change of Step 1 to pass/fail. They also believe that this transition will make the match process more difficult, and disadvantage students from less highly-regarded medical schools. Both groups will rely more heavily on the Step 2 clinical knowledge exam score, but orthopaedics will place more importance on research, letters of recommendation, Alpha Omega Alpha membership, leadership/extracurricular activities, personal knowledge of the applicant, and audition electives.
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Affiliation(s)
- Frederick Mun
- Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
| | - Alyssa R Scott
- Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - David Cui
- Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Erik B Lehman
- Public Health Sciences at Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Seongho Jeong
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, Yale New Haven Hospital, New Haven, CT, USA
| | - Alia Chisty
- Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
- Department of Internal Medicine, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Paul J Juliano
- Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - William L Hennrikus
- Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Eileen F Hennrikus
- Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
- Department of Internal Medicine, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
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Mun F, Scott AR, Cui D, Chisty A, Hennrikus WL, Hennrikus EF. Internal medicine residency program director perceptions of USMLE Step 1 pass/fail scoring: A cross-sectional survey. Medicine (Baltimore) 2021; 100:e25284. [PMID: 33847625 PMCID: PMC8052063 DOI: 10.1097/md.0000000000025284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 03/08/2021] [Indexed: 01/04/2023] Open
Abstract
The United States Medical Licensing Examination Step 1 will transition to a pass/fail exam starting no earlier than January 2022. Internal medicine residency programs will need to adapt to these changes. The purpose of this study was to investigate: 1. internal medicine residency program directors’ perceptions on the change of Step 1 to a pass/fail exam, and 2. the impact on other factors considered for internal medicine residency selection. A validated REDCap survey was sent to 548 program directors at active Accreditation Council for Graduate Medical Education internal medicine residency programs. Contact information from the American Medical Association's Fellowship and Residency Electronic Interactive Database was used. The survey had 123 respondents (22.4%). Most internal medicine program directors do not support the pass/fail change. A greater importance will be placed on Step 2 Clinical Knowledge exam, personal knowledge of the applicant, clerkship grades, and audition electives. Allopathic students from less highly regarded medical schools, as well as osteopathic and international students, will be disadvantaged. About half believe that schools should adopt a graded pre-clinical curriculum (51.2%) and that there should be residency application caps (54.5%). Internal medicine program directors mostly disagree with the pass/fail Step 1 transition. Residency programs will need to reevaluate how applicants are evaluated. Other factors, such as Step 2 Clinical Knowledge score, personal knowledge of the applicant, grades in clerkships, and audition rotations will now be emphasized more heavily.
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Affiliation(s)
| | | | - David Cui
- Pennsylvania State University College of Medicine
| | - Alia Chisty
- Pennsylvania State University College of Medicine
- Department of Internal Medicine
| | - William L. Hennrikus
- Pennsylvania State University College of Medicine
- Bone and Joint Institute, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Eileen F. Hennrikus
- Pennsylvania State University College of Medicine
- Department of Internal Medicine
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Abstract
Purpose To determine how hospitals across the United States determined allocation criteria for remdesivir, approved in May 2020 for treatment of coronavirus disease 2019 (COVID-19) through an emergency use authorization, while maintaining fair and ethical distribution when patient needs exceeded supply. Methods A electronic survey inquiring as to how institutions determined remdesivir allocation was developed. On June 17, 2020, an invitation with a link to the survey was posted on the Vizient Pharmacy Network Community pages and via email to the American College of Clinical Pharmacy’s Infectious Disease Practice and Research Network listserver. Results 66 institutions representing 28 states responded to the survey. The results showed that 98% of surveyed institutions used a multidisciplinary team to develop remdesivir allocation criteria. A majority of those teams included clinical pharmacists (indicated by 97% of respondents), adult infectious diseases physicians (94%), and/or adult intensivists (69%). Many teams included adult hospitalists (49.2%) and/or ethicists (35.4%). Of the surveyed institutions, 59% indicated that all patients with COVID-19 were evaluated for treatment, and 50% delegated initial patient identification for potential remdesivir use to treating physicians. Prioritization of remdesivir allocation was often determined on a “first come, first served” basis (47% of respondents), according to a patient’s respiratory status (28.8%) and/or clinical course (24.2%), and/or by random lottery (22.7%). Laboratory parameters (10.6%), comorbidities (4.5%), and essential worker status (4.5%) were rarely included in allocation criteria; no respondents reported consideration of socioeconomic disadvantage or use of a validated scoring system. Conclusion The COVID-19 pandemic has exposed the inconsistencies of US medical centers’ methods for allocating a limited pharmacotherapy resource that required rapid, fair, ethical and equitable distribution. The medical community, with citizen participation, needs to develop systems to continuously reevaluate criteria for treatment allocation as additional guidance and data emerge.
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Affiliation(s)
- Frederick Mun
- Pennsylvania State University College of Medicine, Hershey, PA
| | - Cory M Hale
- Department of Pharmacy, Penn State Milton S. Hershey Medical Center and Penn State College of Medicine, Hershey, PA
| | - Eileen F Hennrikus
- Department of Internal Medicine, Penn State Milton S. Hershey Medical Center and Penn State College of Medicine, Hershey, PA
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Hennrikus EF, Skolka MP, Hennrikus N. Social Constructivism in Medical School Where Students Become Patients with Dietary Restrictions. Adv Med Educ Pract 2020; 11:505-511. [PMID: 32801986 PMCID: PMC7395697 DOI: 10.2147/amep.s259727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/10/2020] [Indexed: 06/02/2023]
Abstract
BACKGROUND Experiential vertical integration of basic science with clinical concepts remains a challenge in medical school curricula. In addition, training physicians in nutritional competency that translates into patient care is a challenging endeavor ranging from biochemical mechanisms to socioeconomic challenges. METHODS Employing a social constructivism paradigm, we implemented a collaborative cook-off competition in a basic science course where 140 first-year medical students per year translated their studies of inborn errors of metabolism, energy metabolism, micronutrients and immunology into edible creations intended for people with disorders requiring dietary management. After learning about the disorders in lecture, problem-based learning, team-based learning and through patient interviews, four problem-based learning groups (7 students per group) were assigned to prepare food dishes for one of the five assigned disorders. Together, students researched the dietary requirements, shopped, paid for, prepared, presented and shared their food. To the class, faculty and re-invited patients, the groups explained the dietary restrictions, the chosen ingredients, how they prepared the food, and why their dish was suitable for the disorder. Each category was judged and awarded a first-place food prize with a grand prize at the end. At the completion of the course, student feedback was elicited via anonymous evaluations. Over 3 years, 380 comments were collected. We used grounded theory to generate a codebook that was then analyzed by the authors for overarching themes. RESULTS Qualitative results described three major themes: increased relevance of basic science to real life, increased empathy towards complying with dietary restrictions, and increased student group cohesiveness. CONCLUSION The patient-centered cook-off competition taught students the relevance of basic science but in addition, it taught empathy towards the patient experience. We also discovered that the process of food preparation was a bonding experience that promoted collaboration, cohesiveness and friendship within the student class.
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Affiliation(s)
- Eileen F Hennrikus
- Department of Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Michael P Skolka
- Department of Neurology, Mayo Clinic Hospital, Rochester, MN, USA
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Skolka M, Hennrikus WL, Khalid M, Hennrikus EF. Attitude adjustments after global health inter-professional student team experiences. Medicine (Baltimore) 2020; 99:e19633. [PMID: 32311933 PMCID: PMC7220238 DOI: 10.1097/md.0000000000019633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 02/22/2020] [Accepted: 02/24/2020] [Indexed: 11/26/2022] Open
Abstract
How medical inter-professional (IP) education should be introduced to students is still a matter of research. We evaluated IP student attitudes before and after a busy "hands-on" clinical experience.During 3 separate trips, first/second year medical and physician assistant students and third/fourth year nursing students traveled to Central America to work together for 1 week in an underserved clinical setting. Student opinions on inter-professional education were obtained before and after Brigade-1 using the Readiness for Inter-professional Learning Scale validated questionnaire. From these results, a modified version of the survey was developed that included quantitative and qualitative responses. For brigades-2 and -3, students received this modified version of the survey pre and post brigade. Quantitative data was analyzed via paired student t test, and qualitative data was analyzed to identify emerging themes using constant comparative methodology by three separate investigators.No significant quantitative differences between IP student groups were observed in their evaluation of the importance of inter-professional education either before or after the brigades. Qualitative data noted pre-brigade expectations of positive IP, experiential and patient-centered cultural learning. Pre- and post-brigade student perspectives maintained a strong belief that high functioning IP care benefited the patient. Post-brigade perspectives revealed a shift in attitude from purely positive expectations to more practical aspects of teamwork, respect, and interpersonal relationships.Students believe that patient care benefits from IP collaboration. After a busy clinical experience requiring collaboration, students realized that functional teams require appropriate skills, roles, and respectful interpersonal relationships.
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Affiliation(s)
- Michael Skolka
- Department of Neurology, Mayo Clinic Hospital, Rochester, MN
| | - William L. Hennrikus
- Department of Orthopedics, Pennsylvania State University College of Medicine, Hershey, PA
| | - Muhammad Khalid
- Department of Internal Medicine, Pennsylvania State University College of Medicine, Hershey, PA
| | - Eileen F. Hennrikus
- Department of Internal Medicine, Pennsylvania State University College of Medicine, Hershey, PA
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Hennrikus EF, Skolka MP, Hennrikus N. Applying Metacognition Through Patient Encounters and Illness Scripts to Create a Conceptual Framework for Basic Science Integration, Storage, and Retrieval. J Med Educ Curric Dev 2018; 5:2382120518777770. [PMID: 29845119 PMCID: PMC5967154 DOI: 10.1177/2382120518777770] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 04/25/2018] [Indexed: 06/02/2023]
Abstract
PROBLEM Medical school curriculum continues to search for methods to develop a conceptual educational framework that promotes the storage, retrieval, transfer, and application of basic science to the human experience. To achieve this goal, we propose a metacognitive approach that integrates basic science with the humanistic and health system aspects of medical education. INTERVENTION During the week, via problem-based learning and lectures, first-year medical students were taught the basic science underlying a disease. Each Friday, a patient with the disease spoke to the class. Students then wrote illness scripts, which required them to metacognitively reflect not only on disease pathophysiology, complications, and treatments but also on the humanistic and health system issues revealed during the patient encounter. Evaluation of the intervention was conducted by measuring results on course exams and national board exams and analyzing free responses on the illness scripts and student course feedback. The course exams and National Board of Medical Examiners questions were divided into 3 categories: content covered in lecture, problem-based learning, or patient + illness script. Comparisons were made using Student t-test. Free responses were inductively analyzed using grounded theory methodology. CONTEXT This curricular intervention was implemented during the first 13-week basic science course of medical school. The main objective of the course, Scientific Principles of Medicine, is to lay the scientific foundation for subsequent organ system courses. A total of 150 students were enrolled each year. We evaluated this intervention over 2 years, totaling 300 students. OUTCOME Students scored significantly higher on illness script content compared to lecture content on the course exams (mean difference = 11.1, P = .006) and national board exams given in December (mean difference = 21.8, P = .0002) and June (mean difference = 12.7, P = .016). Themes extracted from students' free responses included the following: relevance of basic science, humanistic themes of empathy, resilience, and the doctor-patient relationship, and systems themes of cost, barriers to care, and support systems. LESSONS LEARNED A metacognitive approach to learning through the use of patient encounters and illness script reflections creates stronger conceptual frameworks for students to integrate, store, retain, and retrieve knowledge.
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Affiliation(s)
- Eileen F Hennrikus
- Department of Medicine, Penn State College of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | | | - Nicholas Hennrikus
- Science Department, Chula Vista Learning Community Charter School, Chula Vista, CA, USA
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Hennrikus EF, Pederson L. Disseminated actinomycosis. West J Med 1987; 147:201-4. [PMID: 3660783 PMCID: PMC1025789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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