As a fourth-year medical student from a new medical school who just finished interviewing for ophthalmology residency, I can credit much of my interview season experience to intentional career planning and preparation early on. The ultimate impact of the upcoming changes to the USMLE Step 1 to Pass/Fail is yet to be fully determined. However, in my perspective, this monumental shift in medical education will place a greater emphasis on the need for thoughtful career planning earlier in medical school.

For context, my medical school is recently established and lacks a home ophthalmology department. I recognized that it would be challenging to match into a competitive medical specialty, such as ophthalmology, back in my first year of medical school as I would not have robust institutional connections and research opportunities. Since then, I worked carefully to connect with mentors across the United States to cultivate research experiences and thoughtful advice that would ultimately allow me to successfully apply to ophthalmology residency. Nevertheless, like many of my peers, our emphasis was placed early on the need to perform well on the USMLE Step 1 exam. The USMLE Step 1 exam score was classically viewed as a major marker for successfully matching into ophthalmology, with the national average in 2021 as 245. In all specialties that use the NRMP system to match in 2021, 86.2% of program director survey respondents endorsed the USMLE Step 1 score as a way to decide who to interview at their program.

I believe many of my peers would agree that the Step 1 exam is a relatively challenging exam to study for, with the necessity to study mechanisms of diseases down to their biochemical pathways and memorize minutiae associated with scores of different medications or (often rare) disease processes. Nevertheless, the three-digit score allowed one to distinguish themselves objectively against other applicants. From a new medical school, this was a dream the exam score allowed me to walk onto the same stage as other students from more established programs.

With the shift of the USMLE Step 1 to Pass/Fail, this objective marker will be effectively eliminated. The big question is what will be the next significant indicator for matching into ophthalmology? To me, the most significant question is: How will medical students from new medical schools, especially those that lack institutional specialty departments and resources, distinguish themselves to be able to apply successfully to residency?

Step 2 CK is generally a more clinically-focused examination compared to Step 1, which focuses more closely on basic sciences. Step 2 CK average scores are typically higher across all medical specialties compared to Step 1. In the past, the USMLE Step 2 CK was an optional component of the application and its absence did not adversely impact ophthalmology applicants.

The new theory is that the emphasis on the Step 2 CK exam will hold greater emphasis on an application in the absence of a scored Step 1 exam. In a survey completed by 56 ophthalmology residency program directors, most did not support binary Step 1 scoring and many raised concerns regarding the overemphasis on Step 2 CK. These concerns were similarly echoed in a survey of dermatology residency program directors. This makes sense the desire for an objective marker will always exist when residency programs are receiving hundreds of applications created by talented students. There will always be a natural desire to screen for the students that displayed the most academic potential with an objective measure.

All of the other components of our applications such as letters of recommendation, rotations, clinical clerkship grades are highly variable and subjective measures that depend significantly on ones institutional policies and available resources. These educational performance aspects and personal characteristics have been voted by program directors as highly influential aspects in the interview and ranking process in a 2021 survey of NRMP specialties. I imagine the emphasis on these other components will increase with the Step 1 changes. Other medical students have expressed that the binary Step 1 scoring system will likely impact certain groups (such as international medical graduates and osteopathic applicants) since institutional prestige will take on a greater emphasis.

In my perspective, the binary scoring system will underscore a greater need for applicants from new medical schools like myself to determine their intended specialty early on in medical school to maximize their chances of applying successfully to a competitive field. I would advise not to be fooled by the perception of alleviated anxiety that a Pass/Fail scoring system provides I predict the applicant pool will become more competitive as students double-down on the other application characteristics. Since the emphasis will likely be magnified on aspects such as research experiences and letters of recommendations, students that lack institutional resources in their specialty of interest will need to thoughtfully and carefully discover opportunities outside of their institutional boundaries in order to craft an application robust enough to compete against applicants from highly established programs.

If you are entering medical school or are currently a first year medical student, I would take it upon yourself to independently explore various medical specialties especially competitive ones to see if you happen to have an interest in any of them. A little shadowing goes a long way. Even if you arent certain about one specialty as you are early on in medical training, I would still begin to discover research opportunities and mentors in that field of interest. Ive written elsewhere in greater detail about specific strategies for getting involved in a medical field that is lacking at your medical institution. With careful planning earlier on in medical school, the ultimate impact of the Step 1 binary scoring system will not need to surprise you in a negative way. The key is to start now.

Contributing Writer

City University of New York School of Medicine

Gabriella Schmuter is a fourth-year medical student at Sophie Davis / City University of New York School of Medicine, a seven-year combined B.S./M.D. program in New York City. She graduated college summa cum laude, and is one of four students in the class to receive Honors on all clerkships. Gabriella recently applied for ophthalmology residency. Her research interests are within ophthalmology and medical education. In her free time, Gabriella likes to ski, go to restaurants, and find stylish shoes.

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With Step 1 Changes, Earlier Planning is Key from a New Medical School in-Training, the online peer-reviewed publication for medical students - Pager...

Paulo Pea, a first-year medical student at the University of Arizona (UArizona) College of Medicine - Phoenix, was struck by the living conditions of the people staying in Tijuana, Mexico, while they waited to see if they might be allowed to enter the United States.

He was in Tijuana the weekend after Thanksgiving 2021 as part of a medical service trip that he and several other medical students at his institution had organized to help provide basic medical care and prescription medications to migrants staying in the border town. At one of the shelters Peas team visited, families lived in a warehouse with only tents for privacy. Many had gone without medical care and important medications during their migration journey.

It was a very eye-opening experience, he says.

As the child of immigrants his mother from the Philippines and his father from Ecuador Pea couldnt help but think about how easily his life might have been different, and more like those of the people he met in the camps, had his father been deported before he became a legal citizen.

In fact, it was his desire to work with immigrants who have difficulty accessing health care that inspired Pea to apply to medical school and join the Migrant Health Interest Group (MHIG) at the UArizona College of Medicine - Phoenix in his first year.

Hes following in the footsteps of two third-year UArizona College of Medicine - Phoenix students, Rebecca Paxton and Matthew Campanella, who started the MHIG in their first year of medical school and have grown its outreach activities to include volunteering at a local free clinic, starting a medical-legal clinic for people seeking asylum the legal protection granted to someone who cannot return to their home country for fear of persecution and organizing the annual Tijuana medical service trip.

The MHIG is one example of how people within the academic medicine community from students to administrators are working to provide medical services to immigrants who face significant barriers to accessing the traditional health care system in the United States.

A great many asylum and refugee clinics are affiliated with an academic medical center. These tend to be partnerships between passionate faculty and passionate students to create pro bono clinics.

Holly G. Atkinson, MDAffiliate clinical professor at the CUNY School of Medicine

As of 2019, there were 21.3 million noncitizens living in the United States, with 24% of those lawfully present and nearly half of those who are undocumented being uninsured, according to the Kaiser Family Foundation.

In 2014, about 75% of U.S. medical schools had at least one student-run free clinic dedicated to serving the uninsured, according to a study published in the Journal of the American Medical Association.

As the number of people across the globe seeking refuge or asylum reached a record-breaking 84 million last year, the needs of those seeking to enter or who have recently arrived in the United States have grown.

Often, it is medical students and faculty who have stepped up to meet those needs.

A great many asylum and refugee clinics are affiliated with an academic medical center, says Holly G. Atkinson, MD, an affiliate clinical professor at the CUNY School of Medicine and a member of Physicians for Human Rights (PHR), an organization that coordinates medical forensic evaluations which document physical or psychological harms suffered for asylum-seekers. These tend to be partnerships between passionate faculty and passionate students to create pro bono clinics.

While these volunteer services have limits, they can have a powerful impact on the trainees and physicians who can better serve patients when they better understand their experiences.

The more experience that you have as a physician with working with those populations, the more you're going to help your patient get a better health outcome and be able to mitigate barriers that prevent a person from thriving, Campanella says.

Before starting at the UArizona College of Medicine - Phoenix, Campanella made documentaries about the immigration experience at the southern U.S. border and volunteered at a community clinic that served recently arrived migrants. He witnessed firsthand the danger, trauma, and difficulties migrants face when seeking refuge in the United States.

He had these issues in mind when he met Paxton in their first weeks at medical school. Both students were passionate about migrant health and set to work forming a student group focused on outreach to three groups of people: those journeying to the United States, those held in detention facilities, and immigrants living in the Phoenix area.

I thought it was very, very important to expose students and doctors to what [migrants] go through and what health problems they have before they get to the United States, Campanella says.

To reach the people still journeying, Paxton and Campanella partnered with the Refugee Health Alliance, a nonprofit organization that runs two clinics and provides medical care to 30 shelters in Tijuana, to plan a single-day service trip for interested medical students and faculty. The first trip took place in 2019, but because of the COVID-19 pandemic, the 2020 trip was canceled. With all volunteers vaccinated and providing a negative COVID-19 test, the trip resumed in November 2021.

It really is a student-driven event, says Barbara Garcia, MD, an associate professor of family, community, and preventive medicine at the UArizona College of Medicine - Phoenix who accompanied the students on the trip. [In medical school, students] practice in a controlled environment ... with standardized patients, but nothing really cements your learning like putting those skills in real-life situations. Volunteer experiences like this [trip are] what will reinforce all that they have learned so far in our doctoring curriculum.

The trip, as well as the weekly opportunities to volunteer at the Phoenix Allies for Community Health free clinic, give students a chance to practice their interview and cultural competency skills while also doing something that serves the community.

Its been the most meaningful work of my career, Paxton says of working with immigrants through the MHIG. It really keeps me going in many ways.

She adds that medical students are particularly well positioned to lead and participate in this kind of volunteer work.

Honestly, we just have more time. I do a lot of wrangling of physicians to make these happen. Theyre busy, she says. Also, medical trainees are not hindered by the baselines of what we should or should not be doing. We have enough gumption and hope still to say we can do something about this.

But to create systemic change, Paxton says academic medicine institutions have a responsibility to take an active role in using resources and influence to reach out to migrant populations.

Richard Lange, MD, can see Mexico from the office where he serves as president of Texas Tech University Health Sciences Center El Paso and dean of the Paul L. Foster School of Medicine (PLFSOM).

As the first four-year medical school located on the U.S.-Mexico border, PLFSOM serves a unique and integral role in the diverse migrant, refugee, and asylum-seeking populations that both live and pass through the city.

Its all part of being a central member of the community, Lange says. We tell [prospective] students, If you dont want to be involved in the community, dont come here. Youre not going to like it, because thats what were all about.

Last year, students logged about 19,000 hours of community engagement through the many outreach programs the institution is involved with, says Jose Manuel de la Rosa, MD, vice president for outreach and community engagement at TTUHSC El Paso.

The pathology we see becomes a very fertile ground for teaching. The focus really is to teach our students about our populations about our communities. It's a wonderful opportunity to teach cultural sensitivity and cultural humility.

Jose Manuel de la Rosa, MDVice president for outreach and community engagement at Texas Tech University Health Science Center El Paso

Over the past two years, the activities have included volunteering at the free clinics that provide primary care to migrant farmworkers who cross the border every day and to recently arrived immigrants staying in local shelters, organizing clothing drives for people living at a refugee camp set up for those who fled Afghanistan and were transported to the country through U.S. Army post Fort Bliss, performing welfare checks on people who test positive for COVID-19 and must isolate in filter hotels upon arrival, and aiding at a vaccination clinic for thousands of Mexican factory workers who were allowed to cross the border briefly for the shot.

Whats the role of a medical school in a community? Whats the role of a physician in a community? says de la Rosa. We think a physician should set an example [and] be cognizant of all the factors that impact health: nutrition, migration, cultural humility, racism, [etc.].

Learning to work with patients who experience the distinct health, psychological, and social challenges that come with migration whether that be the trauma of fleeing a war-torn home country, the physical effects of a dangerous cross-border journey, or the confusion of seeking medical care in a foreign country is woven into the curriculum at PLFSOM and is integrated into clinical training.

The pathology we see becomes a very fertile ground for teaching, says de la Rosa, who helped develop the curriculum, including a proficiency in Spanish required for graduation. The focus really is to teach our students about our populations about our communities. It's a wonderful opportunity to teach cultural sensitivity and cultural humility.

In early 2020, just as the COVID-19 pandemic was beginning to sweep across the world, Katherine Peeler, MD, an assistant professor of pediatrics at Harvard Medical School and head of the Peeler Immigration Lab there, was brainstorming with the medical and graduate students she works with about what topic they could focus on that would be most relevant to the health of asylum-seekers. The group landed on investigating how well Immigration and Customs Enforcement (ICE) detention facilities were instituting public health protocols like social distancing and providing masks, soap, and hand sanitizer.

Detention, to a lot of us, is a black box, Peeler says. What are the conditions like? What happens if you get sick? Those of us who work in asylum medicine have been interested in what happens there to inform policy and, ideally, to end detention. The vast majority of persons are there for administrative reasons, not for committing a crime.

If academic medicine is going to be on the cutting edge of training physicians and research into health, it's important to know the context of this patient population: how they came to be here, what health problems they have, and what structural barriers they face in achieving health.

Katherine Peeler, MDAssistant professor of pediatrics at Harvard Medical School

Peeler and her students partnered with PHR to connect with 50 people who had recently been released from detention to conduct anonymous interviews with them about their experiences.

We found that ICE was not following its own protocols, she says. PHR published the results of the study in a report entitled Praying for Hand Soap and Masks: Health and Human Rights Violations in U.S. Immigration Detention during the COVID-19 Pandemic.

To Peeler, whose immigration lab has focused on different aspects of public health and immigration detention, research into the issues affecting the health of asylum-seekers in the United States is an imperative for academic medicine institutions.

If academic medicine is going to be on the cutting edge of training physicians and research into health, it's important to know the context of this patient population: how they came to be here, what health problems they have, and what structural barriers they face in achieving health, she adds.

A research study led by Atkinson from CUNY in partnership with PHR and published in the Journal of Forensic and Legal Medicine last year found that asylum cases that included a forensic medical evaluation were granted relief 90% of the time, compared with the national average of 42%. PHR organizes a network of trained clinicians who volunteer to conduct physical and psychological exams to include as evidence in an asylum case.

The basic skills of being a physician taking a good history and conducting a physical exam can be absolutely lifesaving, says Atkinson, who is also an expert advisor and asylum network member of PHR. Not only for an individual, but for a family as well.

The study authors recommended conducting additional research into the role forensic evidence plays in the asylum adjudication process a role that Atkinson says academic medicine institutions can help fill.

She also believes that the study findings show the need for training more clinicians including future physicians on how to do trauma-informed forensic evaluations.

Given where we are in this country given the number of people seeking asylum and refugees this kind of health care is central to training, Atkinson says, adding that it would ideally be included in the core medical school curriculum.

The work is not only a service to the community but also a way to help restore purpose to clinicians, many of whom are facing staggering rates of burnout, she says.

Its one of the ways you keep hope alive.

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People seeking asylum in the United States have little access to health care. Medical schools are working to change that. - AAMC

People living in rural areas in the U.S. are less likely to have health insurance, have less access to health care services for urgent conditions, and are more likely to encounter lower quality care than their urban counterparts, according to the U.S. Centers for Disease Control and Prevention.

These and other factors mean that the 46 million people, or 15 percent of the U.S. population, who live in rural locations are more likely to die of cancer, respiratory diseases, and cardiovascular diseases than those in urban areas.

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In a nationwide study of Medicare beneficiaries, researchers at Harvard Medical School and Beth Israel Deaconess Medical Center evaluated differences in procedural care and mortality for acute cardiovascular conditions between rural and urban hospitals.

The physician-scientists found significant disparities, including demonstrating that older adults initially seeking care at rural hospitals are less likely to receive important procedures and treatments for heart attack and stroke.

Mortality rates were also higher at rural hospitals for patients accessing care for heart attack, heart failure, or stroke than at urban hospitals. The findings are published in the Journal of the American College of Cardiology.

Although public health and policy efforts to improve rural health have intensified over the past decade, our findings highlight that large gaps in clinical outcomes for cardiovascular conditions remain in the United States, said corresponding author Rishi Wadhera, HMS assistant professor of medicine at Beth Israel Deaconess.

These disparities suggest that rural adults continue to face challenges accessing the care they need for urgent conditions, an issue that has likely been magnified by the rapid rise in rural hospital closures over the past decade.

Our findings highlight that ongoing public health, policy, and clinical efforts are needed to close the gaps in outcomes for urgent cardiovascular conditions, such as heart attacks and stroke, said Emfah Loccoh, first author of the study and a clinical fellow in medicine at HMS.

In this retrospective cross-sectional study, Wadhera, Loccoh, and colleagues looked at data from more than 2 million Medicare beneficiaries age 65 or older who were hospitalized with acute cardiovascular conditions at more than 4,000 urban and rural hospitals across the U.S. from 2016 to 2018.

Medicare beneficiaries accessing care for acute cardiovascular conditions at rural hospitals were older, more likely to be female, and more likely to be white than their urban counterparts.

These patients were less likely to receive procedural care such as cardiac catheterization for heart attack or thrombolysis and endovascular therapy for stroke. Moreover, mortality rates were higher among patients seeking care at rural hospitals than at urban hospitalsa pattern the researchers saw both at 30 days after initial presentation and 90 days after.

The researchers suggest several factors that may be contributing to worse outcomes in rural areas, despite significant public health and policy efforts to reduce rural-urban inequities.

Even as the rate of uninsured rural Americans declined over recent years, a spate of rural hospital closures over the past decade has resulted in longer travel times and delays in emergency medical services and treatments that adversely affected outcomes for emergent cardiac conditions.

One bright spot is that we found that the subgroup of older adults who present to rural hospitals with a very severe type of a heart attack known as ST-elevation myocardial infarction, or STEMI, experience similar outcomes to their urban counterparts, said Wadhera.

This is good news and suggests that concerted public health initiatives over the past decade, like regional systems of care and transfer protocols, have helped eliminate the rural-urban gap in outcomes for the most emergent type of heart attack.

In addition, rural areas have experienced a decline in primary care physicians and specialties which may make access to follow-up care after discharge more difficult. These challenges, coupled with worse access to cardiac rehab and important rehab services after stroke may contribute to worse outcomes in rural areas and may disproportionately affect minorities.

Beyond challenges with access to care, the researchers cite a relative lack of intensity of care, or a lack of resources and infrastructure in the rural setting, as another factor that may contribute to these rural-urban disparities.

These findings may reflect rural-urban gaps in telestroke services that are secondary to financial constraints, the lack of high-speed internet, and regulatory barriers, said Loccoh.

Within rural areas, the researchers saw significant disparities in care received at critical access hospitals (CAHs) versus noncritical access hospitals. Federally designated as part of the Medicare Rural Hospital Flexibility Program, critical access hospitals are intended to improve health care and emergency services in remote rural areas.

However, Wadhera and colleagues found that Medicare beneficiaries were actually less likely to receive procedural care for heart attack or stroke when initially seeking care at CAHs than they were at noncritical access sites. The risk of mortality was higher among patients accessing care at CAHs as well.

This work was supported by the Sarnoff Cardiovascular Research Fellowship; grants from the National Institutes of Health, National Heart, Lung, and Blood Institute (grants K23HL14852500, R01HL143421, R01HL136708, R01HL157530 and K23HL14852500); the National Institute on Aging (grant R018G060935).

Co-authors include Yun Wang, Dhruv Kazi, and Karen Joynt Maddox of Brigham and Womens Hospital.

Robert Yeh, a co-author of the paper at Beth Israel Deaconess, receives personal fees from Biosense Webster, grants and personal fees from Abbott Vascular, AstraZeneca, Boston Scientific, and Medtronic, outside the submitted work. Wadhera serves as a consultant for Abbott, outside the submitted work. All other authors have no disclosures.

Adapted from a Beth Israel Deaconess news release.

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The Importance of Access | Harvard Medical School - Harvard Medical School

On Jan. 22, students at the School of Medicine organized a rally outside of Cafe Med in support of reproductive justice.

Veronica Lee 12:38 am, Jan 25, 2022

Staff Reporter

Nicole Rodriguez, Contributing Photographer

The Yale chapter of the Medical Students for Choice organization rallied Saturday in support of the protection of reproductive care, as the Supreme Court seems poised to dismantle Roe v. Wade nearly a half-century after it was first decided.

On Jan. 22, the 49th anniversary of the landmark Supreme Court decision Roe v. Wade, first-year medical students and co-leaders of Medical Students for Choice Siddhi Nadkarni MED 25 and Kate Callahan MED 25 gathered fellow organizers, students and faculty members on the green outside of Cafe Med to call for the provision of reproductive care. Medical Students for Choice, a national organization, has chapters at medical schools across the country and seeks to raise awareness about abortion and reproductive healthcare.

Although it was originally founded to raise awareness during a time when abortion wasnt taught in the medical curriculum, Medical Students for Choice has expanded its reach in recent years, Nadkarni said. Something [Callahan] and I are passionate about for our chapter is thinking holistically about how reproductive justice intersects with racism, public health and gender issues.

At the center of the event were three speakers, including physicians at Yale New Haven Health and local community activists.

Nancy Stanwood, section chief of family planning and associate professor at the medical school, said that her ability to provide compassionate reproductive care was integral to her role as a physician.

I live out my values every day as a doctor by providing abortion care to my patients when they need it, how they need it, centered on their reproductive lives and their hopes and dreams, Stanwood said. Abortion care is healthcare. It is critically important for people to be able to direct their lives and dream and live and thrive.

Stanwood also addressed the physicians and future physicians in the crowd, highlighting the new challenges they will face if Roe v. Wade is overturned, which she believes will happen soon. According to Stanwood, as medical students go out into the world and serve patients across the country some of them in states where abortion may soon be illegal they may come face to face with laws that punish providers and anyone else involved in providing abortions to patients. Stanwood encouraged the assembled crowd of medical students to be brave and keep fighting for reproductive rights.

The Supreme Court is set to decide by this summer on Mississippis abortion law in the case Dobbs v. Jackson Womens Health by this summer. Given the current conservative majority in the Court, Stanwood and many others believe that this decision will overturn Roe v. Wade, essentially knocking down the foundation of legalized abortion in the U.S.

Liz Gustafson, state director of Pro-Choice Connecticut, also spoke on the day about her personal experience with abortion and how both legislation and societal perceptions of abortion should change.

My decision to have an abortion was not a difficult one; Being pregnant when I did not want to be was, Gustafson said. Abortion is not merely a concept or debate topic. It is healthcare. It is freedom. It is normal. And our stories deserve to be respected and heard.

Gustafson continued, saying that even the protection of Roe v. Wade is not enough. She highlighted the fact that systemic racism, economic injustice, documentation status and the criminalization of pregnancy outcomes over the past 49 years have kept abortion access out of reach for people of color and other marginalized groups. In response, she argued, states like Connecticut must continue to fight for public policy changes and work to destigmatize abortion.

Last to speak at the rally was Complex Family Planning Fellow Blythe Bynum, who was raised in Mississippi, a state with some of the most aggressive anti-abortion laws in the country. During her speech, Bynum described the difficulty of growing up and receiving her medical training in a state that openly challenges Roe v. Wade. However, it was these experiences that pushed her to become a provider who advocates for her patients and their bodily autonomy.

To be a clinician these days honestly is to be an activist. Its unavoidable, Bynum said. If my patient comes to me and tells me they dont want to be pregnant, Im there to make them unpregnant. And thats because I trust my patients. This is the same trust that legislators should have in their constituents.

The rally also raised money for the Lilith Fund, the oldest abortion fund in Texas, and Pro-Choice Connecticut, a grassroots organization dedicated to pro-choice advocacy. By supporting organizations like these, Nadkarni and Callahan hope to help change the future of reproductive rights in the US.

In 2019, over 600,000 legally induced abortions in the United States were reported to the CDC.

Veronica Lee covers breakthrough research for SciTech. She is a sophomore in Branford College majoring in molecular, cellular, and developmental biology.

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Yale medical students rally for abortion rights on 49th anniversary of Roe v. Wade - Yale Daily News

Senior Director of Curricular Affairs Mary Hauser and Senior Director of Medical Student Education Elizabeth Steadman will lead a range of initiatives.

The UNC School of Medicine Office of Medical Education has recently welcomed two new staff leaders.

Senior Director of Curricular Affairs Mary Hauser, PhD, joined the team from Public Impact, a not for profit organization that works to improve K-12 education across the country. She has a PhD in curriculum design from Stanford University and is an experienced teacher. She will lead staff on the curricular side of the medical education program and will work closely with course directors and other faculty to refine curriculum and assessments.

Senior Director of Medical Student Education Elizabeth Steadman, PhD, has worked in the School of Medicine since 2017, most recently as senior director of Student Affairs. She was instrumental in enhancing mental health and wellness services for UNC School of Medicine students and played a key role in the recent successful Liaison Committee on Medical Education visit. In her new role, she will help with strategic oversight of the different parts of the medical education program, will supervise the senior directors of Student Affairs and the senior director of Curricular Affairs, and help with budgets.

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Office of Medical Education Welcomes Two Staff Leaders | Newsroom - UNC Health and UNC School of Medicine

BOSTON (January 24, 2022) A new study published today in the Journal of the American Medical Association Internal Medicine (JAMA IM) found several factors including staff assumptions about minoritized groups may play a role in the variability in the quality of care provided to U.S. nursing home residents with advanced dementia

T.he study, Nursing Home Organizational Culture and Staff Perspectives Influencing Variability in Advanced Dementia Care: The ADVANCE Study, identified organizational factors and staff perceptions at nursing homes that may drive known variability in the type of care provided nursing home residents with advanced dementia, especially in the use of more aggressive interventions like tube-feeding or hospitalizations. These aggressive interventions are considered by many to be markers of poor quality of care, as they often do not promote clinical benefits or comfort among persons with advanced dementia.

Prior research has shown Black residents (versus white residents and those in facilities in the southeastern part of the United States) get more aggressive care, including greater use of feeding tubes and hospital transfers.

Ruth Palan Lopez, Ph.D., G.N.P.-B.C., F.A.A.N., Professor and Associate Dean of Research, Jacques Mohr Chair at MGH Institute of Health Professions School of Nursing, and Susan L. Mitchell, M.D., M.P.H., Senior Scientist, Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife and Professor of Medicine at Harvard Medical School, are the lead authors of the study. Their research was supported by the National Institute on Aging of the National Institutes of Health Award Number R01AG058539.

The study identified several factors that nursing homes could target to improve delivery of goal-directed care to all residents. One is to improve provider knowledge and communication skills that less aggressive interventions may be more in line with the residents wishes and best evidence, said Dr. Lopez. For example, many nurses may believe that feeding tubes prolong the life of advanced dementia patients, but this is not borne out by existing studies. Nursing homes need to make sure their staff is aware that hand feeding is better for residents. Based on prior research, aggressive interventions can be less effective compared to less-intensive interventions, like feeding residents manually, while requiring more time of the nursing staff provides better care to their patients.

The most concerning finding was that staff in nursing homes had preconceptions that families of Black residents did not want to engage in advance care planning and preferred more aggressive care.

"Staff preconceptions that Blacks are less willing to engage in advance care planning and want more aggressive care speaks to the need to address systemic racial biases in nursing homes, said Dr. Mitchell, noting that nursing homes in the United States tend to be racially segregated and low-resource homes tend to have more Black residents. Achieving health equity for all nursing home residents with advanced dementia must be the driving force behind all efforts aimed at reducing disparities in their care.

Researchers conducted 169 staff interviews at 14 nursing homes in four states. They identified factors that were typical of nursing homes that provided less intensity of care including: the quality of the physical environment (e.g., good repair, non-malodorous), the availability of standardized advance care planning, greater staff engagement in shared decision-making, and staff understanding that feeding tubes do not prolong life. Aggressive intervention was considered suboptimal.

More equitable advanced dementia care, the study concluded, may be achieved by addressing several factors, including staff biases towards Black residents. Other solutions include increasing support and funding for low-resourced facilities, standardizing advance-care planning, and educating staff, patients, and their families about evidenced-based care and goal-directed decision-making in advanced dementia.

Other researchers collaborating in this study work at Beth Israel Deaconess Medical Center, Harvard Medical School, Meyers Primary Care Institute, University of Massachusetts Medical School, Oregon Health & Science University School of Nursing, the University of Tennessee at Martin, Emory Center for Health in Aging and the Nell Hodgson Woodruff School of Nursing at Emory University, the Center for the Study of Aging and Human Development at Duke University School of Medicine, and the Geriatrics Research Education and Clinical Center at Veteran Affairs Medicine Center.

About MGH Institute of Health ProfessionsTeam-based care, delivered by clinicians skilled in collaboration and communication, leads to better outcomes for patients. Thats why MGH Institute of Health Professions graduate school in Boston integrates interprofessional education into its academic programs. Approximately 1,600 students at its Charlestown Navy Yard campus learn and collaborate in teams across disciplines as they pursue post-baccalaureate, masters, and doctoral degrees in genetic counseling, nursing, occupational therapy, physical therapy, physician assistant studies, speech-language pathology, health professions education, and rehabilitation sciences. The interprofessional learning model extends to hundreds of hospital, clinical, community, and educational sites in Greater Boston and beyond. The MGH Institute is the only degree-granting affiliate of Mass General Brigham, New Englands largest health provider. It has educated more than 9,000 graduates since its 1977 founding. It is fully accredited by the New England Commission of Higher Education. Several programs are highly ranked by U.S. News & World Report.

About Hebrew SeniorLife

Hebrew SeniorLife, an affiliate of Harvard Medical School, is a national senior services leader uniquely dedicated to rethinking, researching, and redefining the possibilities of aging. Hebrew SeniorLife cares for more than 3,000 seniors a day across six campuses throughout Greater Boston. Locations include: Hebrew Rehabilitation Center-Boston and Hebrew Rehabilitation Center-NewBridge in Dedham; NewBridge on the Charles, Dedham; Orchard Cove, Canton; Simon C. Fireman Community, Randolph; Center Communities of Brookline, Brookline; and Jack Satter House, Revere. Founded in 1903, Hebrew SeniorLife also conducts influential research into aging at the Hinda and Arthur Marcus Institute for Aging Research, which has a portfolio of more than $63 million, making it the largest gerontological research facility in the U.S. in a clinical setting. It also trains more than 1,000 geriatric care providers each year. For more information about Hebrew SeniorLife, visithttps://www.hebrewseniorlife.org or follow us on our blog, Facebook,Instagram, Twitter, andLinkedIn.

About the Hinda and Arthur Marcus Institute for Aging ResearchScientists at theMarcus Instituteseek to transform the human experience of aging by conducting research that will ensure a life of health, dignity, and productivity into advanced age. The Marcus Institute carries out rigorous studies that discover the mechanisms of age-related disease and disability; lead to the prevention, treatment, and cure of disease; advance the standard of care for older people; and inform public decision-making.

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JAMA Internal Medicine

Nursing Home Organizational Culture and Staff Perspectives Influencing Variability in Advanced Dementia Care: The ADVANCE Study,

24-Jan-2022

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New study finds staff assumptions about race play a role in the variability of care of nursing homes residents with advanced dementia - EurekAlert

An online webinar, the 17th Coronavirus (COVID-19) Symposium is sponsored byNew York Medical Collegeof the Touro College and University System. Continuing Medical Education credits are available upon request.

A presentation by the Center for Disaster Medicine of New York Medical College of the Touro College and University System.

by Edward C. Halperin, M.D., M.A.Chancellor and CEO, Professor of Radiation Oncology, Pediatrics and History, New York Medical College | Provost for Biomedical Affairs, Touro College and University System

byRobert Amler, M.D., MBADean, School of Health Sciences and Practice, Vice President for Government Affairs, New York Medical College | Former Regional Health Administrator, U.S. Dpartment of Health and Human Services | Former Medical Epidemiologist, Centers for Disease Control and Prevention (CDC)

by Marisa A Montecalvo, M.D.Medical Director, Health Services, New York Medical College | Infectious Disease Specialist

byMill Etienne, M.D., M.P.H., FAAN, FAESVice Chancellor for Diversity and Inclusion, Associate Dean for Student Affairs, Associate Professor of Neurology and Medicine, School of Medicine House Advisory Dean, New York Medical College

byTami Hendriksz, DO, FACOP, FAAPDean and Chief Academic Officer, Professor of Pediatrics, Touro University California College of Osteopathic Medicine

byDaniel ShallitDirector of Global Store Development for New York City, Long Island and New Jersey, Starbucks and Princi Italian Bakery Real Estate/Development | Co-Chair of the Real Estate Entrepreneurship Advisory Board, Touro College Graduate School of Business

Hosted by Alan Kadish, M.D.Cardiologist | President, Touro College and University System | President, New York Medical College

Responses will be provided to the questions submitted in advance of the webinar. Questions may be submitted tocovid19updates@touro.edu

Register in advance for the webinar

This meeting has been approved for 1.5 CME credits by the Office of Continuing Medical Education, New York Medical College free of charge as a community service to our Healthcare Providers.

Accreditation Statement:New York Medical College is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Target Audience:Hospital-based physicians; Community physicians; Nurses; Pharmacists; Medical Students; Residents/Fellows; Public Health; Other Healthcare Providers; and Press.

Credit Designation:The New York Medical College designates this live activity for a maximum of 1.5AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Disclosure Statement:All activity faculty and planners participating in continuing medical education activities provided by New York Medical College are expected to disclose to the audience any significant support or substantial relationship(s) with commercial entities whose products are discussed in their presentation and/or with any commercial supporters of the activity. In addition, all faculty are expected to openly disclose any off-label, experimental, or investigational use of drugs or devices discussed in their presentations.

Commercial Support:There is no outside funding for this activity.

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17th Symposium on COVID-19: What Have We Learned? How Can We Use What We Have Learned? - Touro College News

Campus News

By ELLEN GOLDBAUM

Published January 21, 2022

Eat healthy and exercise: Its the most common New Years resolution people make and often fail to achieve. But this year, UB students have acquired new skills they are putting to use in local clinics in an effort to motivate their patients and themselves to make better lifestyle choices.

In partnership with the Buffalo Niagara Medical Campus, 170 third-year students in the Jacobs School of Medicine and Biomedical Sciences and 30 dietetics students in the School of Public Health and Health Professions took part earlier this month in a two-week intersession with a Food as Medicine focus.

Marla Guarino, associate director of health and well-being at the BNMC, kicked off the event by discussing the national Food As Medicine movement, and BNMCs conference on the topic last fall. Beth Machnica, director of health and well-being, joined the sessions final day to describe how Jacobs School students can participate in the Food as Medicine research study that BNMC has launched with its recent Blue Fund award.

Food as Medicine grant

In 2022, BNMC will conduct a Food as Medicine research study, supported by HighMark Blue Cross Blue Shield, that aims to contribute to the existing body of research while continuing to foster clinical-community partnerships including with the Jacobs School, Guarino said. The UB/Jacobs School/BNMC partnership will help ensure future health care practitioners acquire an in-depth understanding of the link between food and health to use in their continuum of care.

The advantages of this interprofessional session will prove to be far more than academic, according to Jacobs School faculty organizers. This semester, armed with their new, Food as Medicine knowledge and skills, Jacobs School students will be incorporating into third-year clerkship and clinic rotations in the community new ways to motivate patients to eat healthier.

Our students are not just vessels to be filled with knowledge, noted Daniel Sheehan, associate director of medical curriculum and professor of pediatrics who has directed the annual intersession for third-year students for the past seven years. They are a great value to our health care system and they can be co-agents of change with us.

This is the whole point of an academic medical center, Sheehan continued. In a world where doctors and medical residents are busier than ever, our students provide such great value.

Sourav Sengupta, assistant professor of psychiatry and pediatrics, talks about "motivational interviewing" during the Zoom session. Photo: Sandra Kicman

Appreciating the care team

The intersession Food as Medicine Friday on Jan. 7 was designed as an interprofessional activity to get UBs aspiring physicians and dietitians to appreciate how the health care team of the future is better equipped to meet the needs of patients and clients.

The two weeks culminated with a final day devoted to discussion of findings in scientific papers that have demonstrated, for example, how dietary interventions with patients with diabetes can result in better outcomes than pharmacological interventions.

Having an event where medical and dietetic students come together to share their knowledge can help learners develop an attitude of appreciation for other health care professionals and reinforce the need to seek interdisciplinary solutions for their patients problems, said Alison Vargovich, assistant professor of medicine in the Division of Behavioral Medicine in the Jacobs School.

Interprofessional opportunities are not generally built into the traditional curricula of the health sciences, so these sessions are extremely valuable, added Jill Tirabassi, clinical assistant professor of family medicine.

The sooner that students see the integration between the different facets of the health care team and gain an understanding of what their colleagues do, the better they can utilize their expertise when they enter their profession, she explained. Our educational systems have not been designed to do this naturally, so being able to make this happen now is wonderful and will foster future collaboration.

Supermarket challenges

Under the direction of Nicole Klem, director of the Clinical Nutrition MS/dietetic internship in the School of Public Health and Health Professions, second-year dietetics students developed a presentation for medical students about specific aisles in the supermarket that pose unique challenges for consumers.

Medical students learned that contrary to what some people have heard, low-fat dairy products dont necessarily have a higher sugar content. They discussed alternatives to dairy milk centered on soy, oat, almond, pea and other non-dairy milks; it was noted that while cows milk contains about 8 grams of protein, soy and pea milk might be comparable, but almond and oat milk provide less protein per serving.

Cereals, notorious for their high sugar content, were also discussed, and it was recommended that patients should choose cereals with 5 grams of sugar or less. Canned goods were singled out as being convenient and affordable, but they can contain excessive amounts of sodium, which can often be significantly reduced simply by rinsing the contents before cooking.

After a lively discussion of healthy eating tips, the medical students began to tackle the much harder question of how to motivate patients to make healthier lifestyle choices. Its an issue, faculty stressed, that lies at the very essence of the practice of medicine.

Getting patients unstuck

I posit to each of you that no matter what house of medicine you go into, 90% of the job is convincing your patients to get a little unstuck, to get off the fence, to take new action to improve their health, said Sourav Sengupta, assistant professor of psychiatry and pediatrics, who sees patients through UBMD Psychiatry.

Sengupta noted that Jacobs School students have been hearing about behavioral change in medicine since year one of their training, and that a key skill is the technique called motivational interviewing, or MI.

Motivational interviewing is a way to be centered on where the patient is, how they may be stuck and how we can help them take that next step, he said.

Its a technique that has been described less as a way of pushing someone to do something and more as a way to cultivate the conditions where change is more likely.

Motivational interviewing is a style of communication that should feel like dancing rather than wrestling with a patient, Vargovich explained. This creates a patient-centered focus, giving the patient autonomy over their health choices and fostering rapport between the doctor and patient. The aim is never to force a change, but it makes it easier to understand a patients perspective and concerns, plant seeds related to making important health changes and provide education as needed.

Starting Jan. 10, the third-year Jacobs School students headed back out to local clinics to start sharing what they had learned. Our students have gained a great understanding of food as medicine, said Sheehan. They will be going out into the community as messengers to talk to patients and other health care providers about healthy diets and brainstorm how to improve nutrition when patients are living in food deserts.

With training like this, we are empowering them to help us transform health care in Buffalo.

Other faculty involved in the intersession included Michael Morales, research associate professor of physiology and biophysics; A. John Ryan, clinical associate professor of medicine; Helen Cappuccino, clinical assistant professor of surgery at UB and assistant professor of oncology at Roswell Park Comprehensive Cancer Center; and Gary Giovino, SUNY Distinguished Professor Emeritus in the School of Public Health and Health Professions.

Funding for the four-module, online nutrition course What Every Clinician Needs to Know (from the Gaples Institute, a physician-led, educational, nonprofit organization) that was completed by all third-year medical students was provided by the Gerald Friedman, MD 57 and Roberta Friedman Medical School Curriculum Research and Education Fund.

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During 'Food as Medicine' intersession, UB students develop skills to help motivate patients to make healthier lifestyle choices - UB Now: News and...

Newswise CLEVELANDThe Inamori International Center for Ethics and Excellence at Case Western Reserve University will award Paul Farmer, a physician and medical anthropologist who has dedicated his life to improving healthcare for the world's most in need, with the 2022 Inamori Ethics Prize.

Farmer, the Kolokotrones University Professor and chair of the Department of Global Health and Social Medicine at Harvard Medical School, is chief strategist and co-founder of Partners In Health (PIH), a 35-year-old international non-profit that brings the benefits of modern medicine to those who have suffered from the overt and subtle injustices of the world, in the past and in the present.

Farmer will be awarded the prize and deliver a free public lecture about his work as part of an academic symposium and panel discussion during Inamori Center events Oct. 27-28 on the Case Western Reserve campus in Cleveland.

Case Western Reserve has awarded the Inamori Ethics Prize annually since 2008 to honor outstanding international ethical leaders whose actions and influence have greatly improved the condition of humankind.

Dr. Farmer exemplifies every aspect of this honor, said Case Western Reserve President Eric W. Kaler. The work hes done through Partners In Health has had a tremendous impact on the lives of people in the worlds rural, impoverished and marginalized communities. And, importantly, his community-based treatment strategies to deliver high-quality health care to patients in the U.S. and around the world address one of the greatest issues of our timeinequities and inequalities in healthcare.

Farmer, also a professor of medicine and chief of the Division of Global Health Equity at Brigham and Womens Hospital in Boston, has written extensively on health, human rights and social inequality affecting health and healthcare globally. In 2020, he received the $1 million Berggruen Prize in recognition of his lifes work and, more specifically, contributions during the pandemic. He also received a MacArthur Fellowship in the early 1990s.

He is a member of the American Academy of Arts and Sciences and the Institute of Medicine of the National Academy of Sciences, which awarded him the 2018 Public Welfare Medal. In 2005, Tracy Kidders Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, a Man

Who Would Cure the World was CWRUs Common Reading selection for incoming first-year students. In 2006, Case Western Reserve awarded Farmer an Honorary Doctor of Science degree from the School of Medicine.

In 1987, Farmer and his colleagues co-founded PIH, which began in Cange in the Central Plateau of Haiti. PIH has developed into a worldwide health organization with a model for providing healthcare. The PIH hospital in Haiti provides free treatment to patients, and PIH helps patients living in poverty to obtain effective drugs to treat diseases such as tuberculosis and AIDS.

Farmer also served as U.N. Special Adviser to the Secretary-General on Community-based Medicine and Lessons from Haiti and is best known for his humanitarian work providing suitable healthcare to rural and under-resourced areas in developing countries, beginning in Haiti.

The Inamori Ethics Prize is, at its very core, a celebration of those who have contributed to the betterment of humankind, said CWRU Provost and Executive Vice President Ben Vinson III. Dr. Farmer is the very epitome of a humanitarian and incredibly deserving of this award.

Farmer has received many additional honors, including the Bronislaw Malinowski Award and the Margaret Mead Award from the Society for Applied Anthropology, the Outstanding International Physician (Nathan Davis) Award from the American Medical Association, and, with his PIH colleagues, the Hilton Humanitarian Prize.

We are delighted to welcome Dr. Farmer back to our campus and the Cleveland community and share his story and message locally and globally during the Inamori Ethics Prize ceremony, symposium, and associated events, said Inamori Center Acting Director Beth Trecasa. Dr. Farmers authentic compassion for humanity is as clear as the global improvement he has been able to make through his own actions and the collective impact of Partners In Health.

Previous Inamori Ethics Prize winners:

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Case Western Reserve University is one of the country's leading private research institutions. Located in Cleveland, we offer a unique combination of forward-thinking educational opportunities in an inspiring cultural setting. Our leading-edge faculty engage in teaching and research in a collaborative, hands-on environment. Our nationally recognized programs include arts and sciences, dental medicine, engineering, law, management, medicine, nursing and social work. About 5,800 undergraduate and 6,300 graduate students comprise our student body. Visitcase.eduto see how Case Western Reserve thinks beyond the possible.

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Paul Farmer to be awarded 2022 Inamori Ethics Prize by Inamori International Center for Ethics and Excellence - Newswise

Students at Ohio Universitys Heritage College of Osteopathic Medicine have collaborated with faculty in the medical school and staff from Community Health Programs to offer a new option for quality primary care services for southeast Ohioans who are uninsured or underinsured through the Care Clinic.

The Care Clinic is a student-organized and student-run clinic that is staffed predominantly by first- and second-year medical students who are mentored by a third- or fourth year medical student. All patient care is overseen by attending physicians and a member of the Heritage Community Clinic staff is present at every clinic to help with logistical concerns.

In early summer 2020, Caroline Hyman, now a third-year medical student, approached Sherri Oliver, executive director of Community Health Programs and the Area Health Education Center, about the possibility of establishing a student-run free clinic.

Hyman, who is currently doing clinical rotations at Kettering Health Dayton (previously known as Grandview Medical Center),first got the idea for the free clinic after her summer research experience was cancelled due to the pandemic and she transitioned to volunteering at a free clinic in her hometown.

I really wanted to volunteer as a medical student that summer and started looking into whether a student-run free clinic was an option once I came back to Athens in the fall, Hyman explained. Upon not finding a clinic, I hoped to start one up, and with the pandemic shutting down the possibility of most volunteering that year, it gave us the perfect opportunity to take our time and plan a foundation that would allow this student-run free clinic to last.

To start the clinic, Oliver and Hyman approached Beth Longenecker, (D.O., 91), Heritage College, Athens, dean and medical director of the Heritage Community Clinic, as well as Carole Merckle, assistant director of Community Health Programs and the Area Health Education Center. They formed a planning group with several dedicated students, spending the 2020-2021 academic year working to make the clinic a reality. The first clinic officially kicked off in September 2021.

The Care Clinic, as part of the Heritage Community Clinic system, is another access point for people who are uninsured or underinsured in our community to receive free quality health care, Oliver said. The Heritage Community Clinic has offered free primary care to residents of southeast Ohio for over two decades, and the Care Clinic provides our Heritage College students with a firsthand opportunity to provide care to those who need it most.

Aside from the clinical experience, students have also gained organizational experience by planning clinics and being part of the Care Clinics board of directors. The board consists of six second-year Heritage College students, who apply and are selected at the end of their first year of medical school, as well as a group of advisors who are faculty or staff in the Heritage College.

The Care Clinic benefits the students learning on multiple fronts, Longenecker said. They are able to directly care for patients at their level of experience and learn from each other in the care process. They are able to interact directly with more senior level students to hone their clinical reasoning skills and also are able to have more one-on-one time with the faculty physician than may be possible in a fast-paced primary care clinic. And they also are learning the background of what it takes to operationalize a practice, something that is not typical during their usual third- and fourth-year clinical rotations.

AashikaKatapadi, a second-year medical student and current president of the student board, was on the advising committee for the Care Clinic last year and helped lay the groundwork for the free clinic. She worked with her team over the summer to ensure the clinic could open and to recruit student volunteers to staff the clinic.

The Care Clinic is a fabulous opportunity for the different communities it brings together, Katapadi said. The clinic provides access to free medical care and resources to members of the Athens community who are in need.Medical students can also help patients and put our knowledge to use while learning about social determinants of health in action.It also provides a mentorship opportunity between students of various years within the school.

Students in all four years of medical school volunteer at the Care Clinic, while volunteer faculty physicians also provide integral help and support for the clinics.

I feel so fortunate to have put in the work to create a strong foundation for the Care Clinic, Hyman said. I wish that I could have been able to volunteer with the clinic once it was up and running, but am hopeful for the opportunities it will offer for future students. I still hope to have the opportunity to volunteer directly with patients at the Care Clinic at some point before I graduate.

The Care Clinic takes place once a month on Saturday mornings in the Heritage Community Clinic, located on the ground floor of Grosvenor Hall West on Ohio Universitys West Green in Athens. Free parking is available for patients outside the clinic entrance.

Holding the clinic on the weekend is critical for community members who are unable to attend other primary care clinics offered by Heritage Community Clinic during the week due to work schedules, Oliver added.

For more information on the next scheduled Care Clinic, please call 740.593.2432 or emailcareclinic@ohio.edu.

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Medical students collaborate to offer accessible primary care to southeast Ohioans - Ohio University

Since 1993, Amy Goldberg has been a trauma surgeon at Temple University Hospital, which has the distinction of treating more gunshot patients than any other hospital in the state. Last year, there were 747, up from 576 the year before.

Goldberg, a native of Broomall who went to the University of Pennsylvania and Icahn School of Medicine at Mount Sinai, says shes treated thousands here, in rare cases those who have been shot on more than one occasion. And though Goldberg and Scott Charles, Temples trauma outreach manager, over the last 15 years have started programs to advocate for and assist victims, educate schoolchildren about gun violence, and train community members on how to provide first aid to gunshot victims, they have watched as the citys gun violence has escalated again this past year.

In the early hours of New Years Day, after two were killed and 12 injured in three separate shootings one of them near Temples campus Goldberg tweeted: Last night was an abomination in our city. Our community is dying. Where is the outrage ... from everyone?

READ MORE: 14 shot as deadly gun violence in Philly carries into the early hours of the new year

We sat down with Goldberg and Charles, a University of Pennsylvania alumnus, to talk about that tweet, her work as both a surgeon and more recently the interim dean of Temples medical school, and what she would like to see from Philadelphians in response to the violence epidemic.

This interview has been edited for length and clarity.

Goldberg: I was just so angry, as we all should be. The number of homicides are outrageous, more than ever. I just couldnt understand. We need to be moved. Whats it going to take [for] us to be moved to do something?

Im a Broad Street runner, so I know that Temple Hospital is mile marker 2 and City Hall is mile marker 6, and within four short miles all of this violence is going on. Where was that outrage?

READ MORE: Temple's campus is on edge after a student was shot to death: Students are afraid

Goldberg: So I do have a communication team. I write my tweets and off they go. And off it went, Hope everybody has a good new year. And then I turned on the news. And I thought I cant leave that tweet out there. I called up Scott: It cant be like a tone-deaf tweet on New Years Day.

How could the trauma surgeon for 30 years in North Philadelphia put out a goddamn tone-deaf tweet?

Goldberg: Yes.

Goldberg: What I felt.

Goldberg: Some people were supportive and other people thought I was just pointing fingers and blaming people. I wasnt. I wasnt blaming police and I wasnt blaming [District Attorney Larry] Krasner. I wanted this to be a call for sustained action ... that all of us should care about whats going on.

READ MORE: Philly's homicide crisis in 2021 featured more guns, more retaliatory shootings, and a decline in arrests and convictions

Charles: Im proud of the fact that she sent that tweet, because I think there have been a lot of people standing on the sidelines. ... What shes going to succeed in doing is emboldening a lot of people.

Goldberg: Do you think any tweet, that something happens from tweets?

Goldberg: The attention to the issue shouldnt wax and wane. Its like maybe The Inquirer should keep track of what were doing every day to solve this, as we would in our units that we work in. We need to work on more gun laws that make sense. ... It just cant be so easy to get a gun.

Then the issue of poverty and structural racism in the city. All of these things need to be addressed.

READ MORE: When you enter Temple University Hospitals ER, trauma advocates will help you with more than your injuries

Goldberg: There are so many. Thousands. Its just relentless.

Goldberg: When I was a fellow, my first big case was a 16-year-old who got shot. I saw him in the clinic. He wasnt in school and then I realized that we hadnt really provided any services to help him. We just did this operation and took good care of him, got him eating and walking, but I wasnt really sure we helped him the best we could, and I kept that in my mind ... to when Scott and I met.

Goldberg: Before Christmas, three people came in all at once, 15-, 16-, 17-year-olds. One of them needed an operation. A big blood-vessel injury. The patients are younger and younger.

Charles: The thing that sets the last few years apart, since the pandemic, is how many women, how many children. You hear this from guys who are also engaged in the streets. They lament the loss of the code that used to protect women and children from gun violence.

The way the numbers spiked in 2020 is just insane. It feels like youre digging a hole in sand sometimes. Weve been doing this a very, very long time, having these same conversations.

Goldberg: And its worse. Here we are all these years later, and its now worse. Trauma surgeons know that maybe Thursdays and Fridays and Saturdays are busy days, nights busier than days, and now it doesnt matter what day of the week or what time of day. It doesnt matter at all.

But we are doing so much more for the patients. Were so fortunate that now we really are providing those services to our patients that I wanted to all those years ago for that 16-year-old boy.

Goldberg: Probably a little PTSD.

Goldberg: We are going to try to develop a center within the school, a center for violence prevention intervention. We have some great programs within the medical school and the hospital. Now that I sit in the interim dean position, were going to bring these programs from both sides of the street together and be more unified.

Charles: It really does feel like a make-or-break moment.

Goldberg: Care. We could ask every person to care about this issue, to be moved by this issue, and to not think that this is OK and to speak for people who arent spoken for.

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Where is the outrage ... from everyone? The story behind this Temple trauma surgeons tweet. - The Philadelphia Inquirer

The new affiliation offers New Jersey residents access to enhanced otolaryngology and allergy healthcare services across a wide variety of specialties and sub-specialties, provided by CBMC.

Tarrytown, New York, Jan. 24, 2022 (GLOBE NEWSWIRE) -- ENT and Allergy Associates, LLP (ENTA) is pleased to announce that the practice has formed a clinical affiliation with Cooperman Barnabas Medical Center (CBMC), formerly Saint Barnabas Medical Center.

We are thrilled to affiliate and collaborate with ENT and Allergy Associates. ENTA is recognized throughout the region as a leader providing outstanding care to their patients, states Richard L. Davis, President and CEO, Cooperman Barnabas Medical Center.

This affiliation offers New Jersey residents access to enhanced otolaryngology and allergy healthcare services across a wide variety of specialties and sub-specialties, provided by CBMC.

ENTA plans to integrate its NextGen Electronic Health Records system with CBMC to create a single button protocol that will help quickly and efficiently coordinate care between physicians and facilities. Patients who are found to need tertiary care will be quickly seen by the specialist within 48 hours. This seamless protocol allows ENTA physicians to quickly direct patients to one of CBMC physicians through an approved HIPAA compliant method of communication. Physicians at CBMC will be able to instantly receive a patients diagnosis, relevant images, chart notes, and the clinical description of why they are being sent for more advanced care.

This affiliation will provide a unique opportunity to deliver comprehensive medical and surgical services and provide timely and convenient access to some of the best physicians in the region. ENTA considers itself a university without walls and prides itself on the affiliations it has fostered over the years, including clinical alliances with The Mount Sinai Hospital, Montefiore Medical Center and Northwell Health.

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Robert Glazer, CEO of ENTA, stated Its very exciting to be able to partner with Cooperman Barnabas Medical Center. We are dedicated to the patients of New Jersey and adding an affiliation with a hospital as well-regarded as CBMC is a huge advantage for our physicians and patients.

By working closely with leading community providers like ENT and Allergy Associates, we can greatly improve access to the convenient, superior services they offer to the thousands of New Jersey residents impacted by Head, Neck and ENT disorders, said Jean Anderson Eloy, M.D., Chairman of Otolaryngology at Cooperman Barnabas Medical Center and Vice Chairman, Department of Otolaryngology - Head and Neck Surgery at Rutgers New Jersey Medical School.

Robert Green, M.D., President of ENTA, added, ENTAs prestigious affiliations are what set us apart in the fields of ear, nose, throat, allergy, and audiology care. Working with the physicians at CBMC provides yet another level of quality care for our New Jersey patients.

We are proud to align ourselves with CBMC explained Steven Gold, M.D., Vice President of ENTA. By forming a clinical affiliation with CBMC, this allows our patients to have seamless access to leading-edge treatments that only a universitybased medical enterprise such as CBMC provides.

To learn more about the benefits of ENT and Allergy Associates, or to conveniently find an ENT or Allergy doctor and then easily book an appointment at the nearest New York or New Jersey location, please visit http://www.entandallergy.com or call 1-855-ENTA-DOC.

About ENT & Allergy Associates, LLP:

ENT and Allergy Associates LLP (ENTA) has more than 220 physicians practicing in 44 office locations in Westchester, Putnam, Orange, Dutchess, Rockland, Nassau and Suffolk counties, as well as New York City and northern/central New Jersey. The practice sees over 90,000 patients per month. Each ENTA clinical location provides access to a full complement of services, including General Adult and Pediatric ENT and Allergy, Voice and Swallowing, Advanced Sinus and Skull Base Surgery, Facial Plastics and Reconstructive Surgery, Disorders of the Inner Ear and Dizziness, Asthma, Clinical Immunology, Diagnostic Audiology, Hearing Aid dispensing, Sleep and CT Services. ENTA has clinical alliances with Cooperman Barnabas Medical Center, Mount Sinai Hospital, Montefiore Medical Center, Northwell Health, and a partnership with the American Cancer Society.

About Cooperman Barnabas Medical Center (Formerly Saint Barnabas Medical Center):

Since 1865, Cooperman Barnabas Medical Center (CBMC), formerly known as Saint Barnabas Medical Center, New Jerseys oldest nonsectarian hospital, has worked to exceed our communitys highest expectations for compassionate, comprehensive health care. The 597-bed institution is one of the largest health care providers in the state, treating more than 32,000 inpatients and 80,000 Emergency Department patients each year. Cooperman Barnabas Medical Center and the Barnabas Health Ambulatory Care Center provide treatment and services for more than 300,000 outpatient visits annually. Cooperman Barnabas Medical Center has long been recognized as a leader in providing world-class caredelivering 6,400 babies annually which is one of the largest programs in the state, leading the nation in Kidney Transplant, and providing more than 100 medical and surgical specialty and subspecialty services. RWJBarnabas Health and Cooperman Barnabas Medical Center in partnership with Rutgers Cancer Institute of New Jersey - the state's only NCI-designated Comprehensive Cancer Center - brings a world class team of researchers and specialists to fight alongside you, providing close-to-home access to the latest treatment and clinical trials. For more information, call 1.973.322.5000 or visit http://www.rwjbh.org/cbmc. Cooperman Barnabas Medical Center is located at 94 Old Short Hills Road, Livingston, NJ 07039.

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ENT and Allergy Associates, LLP and Cooperman Barnabas Medical Center (CBMC) Join Forces to Form a Clinical Affiliation in New Jersey - Yahoo Finance

1. Despite low absolute risk, BNT162b2 COVID-19 vaccine associated with increased risk of carditis

Markedly increased risk in adolescents after 2nd dose may warrant refined vaccination strategies

Abstract: https://www.acpjournals.org/doi/10.7326/M21-3700

URL goes live when the embargo lifts

A case-control study found that despite low absolute risk, there is an increased relative risk of carditis associated with BNT162b2 (commonly-known as Pfizer/BioNTech vaccine) vaccination. Considering the markedly increased risk in adolescents after the second dose, vaccination strategies may need to continuously consider the risk and benefits for different sub-populations, rather than taking a one-size-fits-all approach. The findings are published in Annals of Internal Medicine.

Carditis is a rare inflammation of the heart often caused by bacterial, viral, and parasitic infections. Common subtypes of carditis include myocarditis, an inflammation of the heart muscle, and pericarditis, an inflammation of the outer lining of the heart. Case reports of carditis after BNT162b2 vaccination have accrued globally. Several studies have also reported similar findings, but analytic research on the speculative association is limited.

Researchers from the University of Hong Kong studied 160 case patients (with carditis) and 1,533 control patients (without carditis) to examine the potential risk of carditis associated with vaccination with BNT162b2 or CoronaVac. Ten control patients were matched with case patients based on age, sex, and date of hospital admission. After conducting analyses, the authors found 20 cases of carditis associated with BNT162b2 and 7 associated with CoronaVac vaccination. Patients who received BNT162b2 were 3 times more likely to experience carditis than unvaccinated patients. On the other hand, patients who received CoronaVac had a similar chance as unvaccinated patients to experience carditis. The authors also observed that risk increase associated with BNT162b2 was predominant in males and was more likely to be seen after the second dose. Cumulative incidence of carditis after vaccination was 0.57 per 100,000 doses of BNT162b2 and 0.31 per 100,000 doses of CoronaVac, demonstrating a very low absolute risk of carditis after vaccination. According to the authors, none of the 20 case patients with carditis after BNT162b2 vaccination were admitted to the ICU or died within the observation period, compared with 14 of 133 unvaccinated patients admitted to the ICU and 12 deaths.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. The corresponding author, Ian Chi Kei Wong, PhD, can be reached directly at wongick@hku.hk or +44 (0) 7931566028.

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2. ACP updates Rapid, Living Practice Points on antibody response and its role in conferring natural immunity after SARS-CoV-2 infection

Practice Point: https://www.acpjournals.org/doi/10.7326/M21-3272

Review: https://www.acpjournals.org/doi/10.7326/M21-4245

The American College of Physicians (ACP) has updated its Rapid, Living Practice Points on the antibody response to SARS-CoV-2 after initial infection and protection against reinfection with SARS-CoV-2. ACP's evidence-based clinical advice for physicians is published in Annals of Internal Medicine.

Researchers from the Agency for Healthcare Research and Quality (AHRQ) Evidence-based Practice Center Program's Scientific Resource Center at the Portland VA Research Foundation identified new studies on the risk of reinfection and duration of protection following SARS-CoV-2 to inform ACPs update. That data provided strong evidence that the immunity afforded by recent infection conferred substantial protection against symptomatic reinfection with the Alpha variant of COVID-19 for at least 7 months. However, that durability of protection in the setting of the Delta and Omicron variants is unknown.

Based on the evidence, ACP advises against using SARS-CoV-2 antibody tests for the diagnosis of SARS-CoV-2 infection. ACP also advises against using SARS-CoV-2 antibody tests to predict the degree or duration of natural immunity conferred by antibodies against reinfection, including natural immunity against different variants. The authors note that these practice points do not evaluate vaccine-acquired immunity or cellular immunity. Vaccination is currently the best clinical recommendation for preventing infection, reinfection and serious illness from SARS-CoV-2 infection and its variants. Additionally, a previous practice point concerning the use of antibody tests to estimate community prevalence of SARS-CoV-2 infection has been retired due to limited relevance, as vaccinations have become widely available in the U.S.

According to ACP, evidence is emerging about natural immunity from COVID-19 but there is still important uncertainty about how protection varies between individuals, how long it lasts, and the role of variants. In light of these evidence gaps, it is important that individuals and communities continue to use all available tools to help slow and reduce further spread.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with someone from ACP, please contact Andy Hachadorian at AHachadorian@acponline.org.

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3. Allopurinol treatment not associated with increased mortality rate in patients with CKD and gout

Abstract: https://www.acpjournals.org/doi/10.7326/M21-2347

URL goes live when the embargo lifts

A population-based cohort study found that a using allopurinol to achieve target serum urate levels did not increase mortality risk in patients with gout and chronic kidney disease (CKD). These findings provide reassurance that a treat-to-target strategy does not have an apparent harmful effect in these patients. The study is published in Annals of Internal Medicine.

CKD is a common comorbidity in patients with gout. The recommended treatment for long-term gout management is lowering serum urate levels to below 0.36 mmol/L for patients experiencing flares, tophi, or radiographic joint damage. Lowered serum urate levels are also considered a potential therapeutic option for halting the progression of CKD. Allopurinol is a commonly used medication for gout treatment, but two recent randomized control trials indicated that allopurinol was associated with a 2-fold increased risk for death in patients with renal disease but without gout.

Researchers from Xiangya Hospital, Central South University, Harvard Medical School, and several other institutions studied electronic health records for 5,277 adults in the United Kingdom with gout and moderate to severe CKD to examine the relation of allopurinol initiation, allopurinol dose escalation, and achieving target serum urate level after allopurinol initiation to all-cause mortality. Mortality over 5-year follow-up in propensity scorematched cohorts was examined for each dosing stage/strategy. The data showed that neither allopurinol initiation, nor achieving target SU level with allopurinol, nor allopurinol dose escalation were associated with an increased risk for death in patients with gout and concurrent CKD. According to the authors, these findings may alleviate concern about utilizing allopurinol in this patient population.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding authors, Guanghua Lei, MD, PhD, and Yuqing Zhang, DSc, please email Noah Brown at nbrown9@partners.org.

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4. Racial/ethnic minorities still widely underrepresented in internal medicine residency programs

Abstract: https://www.acpjournals.org/doi/10.7326/M21-3287

Editorial: https://www.acpjournals.org/doi/10.7326/M22-0121

URL goes live when the embargo lifts

A brief research report found that marked disparities in racial/ethnic representation still persist in internal medicine residency programs, despite efforts to increase diversity. These findings suggest that significant transformative work remains to be done to increase representation of minoritized populations that are underrepresented in medicine among students, residents, and faculty. The report is published in Annals of Internal Medicine.

A racially and ethnically diverse physician workforce could improve access to care, communication, patient satisfaction, and health outcomes, particularly for underserved and systemically marginalized patients. Despite this need, members of racially/ethnically minoritized groups are still underrepresented in medicine. These include those identifying as American Indian or Alaska Native; Native Hawaiian or other Pacific Islander; Black or African American; and Hispanic, Latino, or of Spanish origin.

Researchers from the University of Washington School of Medicine studied data from the American Association of Medical Colleges to elucidate trends in representation for internal medicine residency applicants and matriculants who identify as underrepresented in medicine. Between 2010 and 2018, a total of 214,656 individuals applied to internal medicine residency programs and 87,489 matriculated. Of those 13.2% of the applicants and 10.6% of the matriculated students identified as a member of a race or ethnicity underrepresented in medicine. In examining disaggregated matriculant data for those in underrepresented groups, only the proportion of matriculants who were Hispanic, Latino, or of Spanish origin significantly changed. For every year studied, a greater proportion of White persons were represented among matriculants compared with applicants. According to the study authors, diversifying internal medicine residencies will require dramatic, innovative approaches before, during, and after the application process.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author, Joanna Liao, BS, please contact Kim Blakeley at krb13@uw.edu or Brian Donohue at bdonohue@uw.edu.

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Annals of Internal Medicine

Case study

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Carditis After COVID-19 Vaccination With a Messenger RNA Vaccine and an Inactivated Virus Vaccine

25-Jan-2022

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BNT162b2 COVID-19 vaccine associated with increased risk of carditis - EurekAlert

That individual physicians might wish to avoid turning themselves and, potentially, their patients, co-workers and families into targets of wrath and violence is understandable. Less understandable is the failure of the mainstream medical community, and an array of powerful institutions within it, to respond to the hostility and violence directed at clinics and abortion providers by affirming support for them. Hospital officials could have stepped forward to assert that they, too, would help ensure that abortion services remained available, particularly in states and communities where clinics were under siege. Medical school deans could have announced that they would redouble their commitment to providing training in abortion to residents at teaching hospitals.

Taking such steps would have demanded courage. Little such courage was shown. By 2017, the percentage of all abortions done in hospitals had dwindled to 3 percent, and many teaching hospitals impose restrictions on performing abortions that are more stringent than the legal requirements in their states. Although the reasons for this vary, the desire to avoid the stigma associated with abortion, and the risk of provoking abortion opponents, looms large, according to Lori Freedman, a medical sociologist who has studied the phenomenon. Some hospital administrators are afraid the hospital will become targeted by anti-abortion forces for doing procedures at all, she said. Some have had such experiences already.

Residents and medical students affiliated with the group Medical Students for Choice have pushed for more comprehensive abortion education. But at many universities and residency programs, in-house abortion services do not exist and residents must go to an outside facility such as a local Planned Parenthood clinic to receive training in the procedure.

To be sure, the relationship between mainstream medicine and abortion was ambivalent even before such concerns became widespread. As the sociologist Carole Joffe has noted, most of the nations leading medical organizations failed to issue any significant guidelines on abortion immediately after Roe was decided. That reticence reflected the conflicted feelings many doctors had about a procedure that some linked to infamous back-alley butchers, and that others associated with feminists who were claiming authority over their bodies in ways that made many male doctors uncomfortable. (Notably, although the American Medical Association asserted in a 1970 resolution that the principles of medical ethics do not prohibit a physician from preforming an abortion, the document stated that abortion procedures should be determined by the sound clinical judgment of medical professionals, not mere acquiescence to the patients demand.) Some doctors also believed that abortion was morally wrong.

In subsequent decades, professional associations such as the American College of Obstetricians and Gynecologists danced around the issue of abortion for fear of alienating members who might not support abortion rights, said Doug Laube, an abortion provider who served as ACOGs president from 2006-2007. Though the organization is formally pro-choice, Dr. Laube told me that during his tenure as president he observed that the stigma associated with abortion made ACOG reluctant to advocate for abortion services as regular, normal medical care.

There has been some recent progress on this front, most notably an amicus brief submitted to the Supreme Court by dozens of medical organizations, including ACOG and the A.M.A., in Dobbs v. Jackson Womens Health Organization, the case that could lead to Roes reversal later this year. The brief affirms that the restrictive Mississippi abortion law under review in the case is fundamentally at odds with the provision of safe and effective health care. Meanwhile, a new generation of abortion providers, many of them women motivated by a sense of social justice, has begun to emerge, in a field that includes family medicine doctors as well as OB-GYNs.

But even if Roe somehow survives the Dobbs case, the provision of abortion already has been transformed in ways that have left millions of women, particularly poor women and women of color, without access to services. The failure to embed abortion in mainstream medicine has made it easier for abortion opponents to target clinics with so-called TRAP (targeted regulation of abortion providers) laws that impose increasingly onerous rules and regulations on them. A wave of restrictive state measures has been enacted in recent years. It has also set the stage for laws like S.B. 8, the Texas statute enacted last year that encourages private citizens to sue anyone who performs or abets abortions after six weeks of pregnancy, including medical practitioners.

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Opinion | Why the Medical Establishment Shied Away From Abortion - The New York Times

Boutique or specialty fitness studios offer all sorts of ways to exercise, such as strength training, indoor cycling, and kickboxing. Other popular options, like yoga and Pilates, are less likely to leave you sweaty and breathless, emphasizing flexibility and measured movement. Now a new trend has emerged: studios that focus solely on stretching. What are these studios offering, and will you benefit from this focus?

These studios, which include StretchLab, StretchMed, LYMBYR, and others, provide assisted stretching sessions, either one-on-one or in small groups. The promised benefits range from reasonable goals of increasing flexibility and range of motion to more questionable assertions, such as preventing injuries and eliminating chronic pain.

"If you participate in certain sports that require flexibility, like dance or gymnastics, stretching may be important to maintain range of motion," says Dr. Adam Tenforde, associate professor of physical medicine and rehabilitation at Harvard Medical School, and sports medicine physician at Spaulding Rehabilitation and Mass General Brigham.

But if your focus is on improving your overall health, the evidence to support stretching is sorely lacking especially compared with the wealth of evidence supporting the benefits of regular, moderate physical activity.

"Contrary to popular belief, theres no consistent evidence that stretching helps prevent injuries," says Dr. Tenforde. And if you have an existing injury, such as a muscle or joint sprain, aggressively stretching that tissue could actually make the injury worse, he adds.

The "stretch therapists" and "flexologists" at stretching studios may have certain certifications and training, but theyre probably not qualified to recognize and address health-related causes for pain or stiffness. If you have a previous or current musculoskeletal injury, youre much better off going to a physical therapist who has the expertise and training to treat you correctly.

If youre free from injuries but just feel tight and stiff, try a yoga class, which can provide added benefits like improving your balance and helping you relax and de-stress. Or consider tai chi, a gentle, meditative form of exercise that can help lower blood pressure and enhance balance. Another option is to get a massage.

If you decide to try assisted stretching offered at a studio, listen to your body, and make sure you communicate how youre feeling with the therapist working on you, Dr. Tenforde advises.

But youll probably do more for your overall health by spending that time taking a brisk walk or some other type of exercise instead, he says. Most Americans dont meet the federal recommended guidelines for physical activity, which call for 150 minutes per week of moderate-intensity exercise and muscle-strengthening activities twice weekly. "As doctors, were dealing more with diseases related to inactivity, not diseases of inflexibility, says Dr. Tenforde.

Three easy morning exercises an A-B-C routine of arm sweeps, back bend, and chair pose can help ease morning stiffness. This also works well during the day if you spend too much time sitting.

Stretching at home could save you money and time. These tips can help you get the most out of at-home morning stretches or other flexibility routines.

As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

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Stretching studios: Do you need what they offer? - Harvard Health

Dartmouth College in the northeastern state of New Hampshire recently announced need-blind admissions for international undergraduate students.

Need-blind means a university offers admission to students without considering their ability to pay.

With the move, Dartmouth, which is the smallest of the famous Ivy League schools, joins other universities including Harvard, Princeton, and Yale. The Massachusetts Institute of Technology (MIT) and Amherst, also in Massachusetts, are other examples.

A number of U.S. colleges offer need-blind admissions but only six offer it to international students.

At one time, Dartmouth did make need-blind offers to international students. But, the school changed the policy after it became too costly. The new policy comes thanks to a $40 million gift from a person who did not want to be named. The school said it is working to establish a $90 million fund to pay for need-blind admissions for international students.

International students face high costs

Syed Rakin Ahmed is a 2018 Dartmouth graduate from Bangladesh. He is working on an advanced science degree in Boston and plans to return to Dartmouth to finish medical school.

Rakin received financial aid to go to Dartmouth. He noted the high cost of higher education in the U.S. does present a significant challenge for any international student, and even more specifically for international students from low-income countries, such as myself.

He said he expects the school to receive more interest from international students because of the change.

The current cost of attending Dartmouth is about $75,000 per year.

The policy will take effect immediately. That means students currently applying to Dartmouth may go for free if they can show their family cannot pay.

In a question-and-answer page on the Dartmouth website, the school said it did not make the change to bring in more international students. Instead, the college noted that it gives an equal chance to students around the world. The school notes that interest from international students was rising before the news.

International students make up about 10 percent of the undergraduate student population at Dartmouth. That is similar to the numbers at Harvard and MIT. The school notes international students make up 14 percent of the current first-year class, that is up from eight percent in 2016.

Christine Chu advises international students at a company called IvyWise based in New York City. She said the high cost of higher education is one of the first things she discusses when she meets new students. She said Dartmouths policy should increase interest among international students.

Having a need-blind policy opens up that international realm for Dartmouth, Chu said.

She added that the decision may help Dartmouth admit international students who would otherwise go to school in a large city like New York, Chicago, or Los Angeles. She offered these thoughts on how Dartmouths officials might think of their new policy.

Were not in New York City, were not a Columbia, were not in Washington, D.C., were not a Georgetown. People may not immediately think of us. They know were an Ivy League school but were not in Chicago or Los Angeles, these metropolises. How can we still draw really talented and excellent students? And I think financial aid is a wonderful way...

Dartmouths top official for admissions and financial aid said the schools move will influence the world for many years.

Lee Coffin said: The students enrolling today will have lives and careers that stretch into the 2070s and beyondWere announcing to the worldthat international citizens are full and equal members of our applicant pool and ultimately our student body.

Students who have applied to attend a school are often described as the applicant pool by admissions officials.

Different lived experiences

Rakin, the future medical student, gave an example why it is valuable for Dartmouth to have students from many countries and different economic levels. One of his future goals, he said, is to help prevent women in his home country from getting cervical cancer. This form of cancer is limited in the U.S. because many young women get a vaccine.

But, the vaccine is not widely available in Bangladesh. He said the medical community is not invested in caring for women in the same way that it is in the U.S. He was able to share this information with his American classmates during public health discussions at Dartmouth.

Having international students and having students who have had different lived experiences outside of the U.S. enriches these conversations further and the need-blind policy certainly makes it easier and I would say creates more of an opportunity for international students to consider Dartmouth as a strong option.

Both Rakin and Chu said the true result of Dartmouths decision and the schools that follow may be in how international students see U.S. universities. Are universities welcoming to students? Do schools value what international students bring?

Chu noted that the COVID-19 pandemic has made it harder for international students to come to the U.S. Rakin agreed, noting that government offices that process visas for students reduced their hours. Also, he said he knew students from Bangladesh who chose to apply to universities in Canada and Australia because of the political environment in America.

Chu and Rakin said the move by Dartmouth shows that it is worth the extra effort to come to the U.S. Rakin called the move toward need-blind admissions for international students a refreshing change for the better.

Will other universities follow Dartmouth?

Chu said other universities may want to, but change comes slowly in higher education.

Universities are big, theyre bureaucratic. It just takes time to change and consider these factors. Now Dartmouth has been added to this very short list of schools, to me, thats a positive thing.

Im Dan Friedell.

Dan Friedell wrote this story for Learning English.

If you are thinking about applying to university in the U.S. which schools would you like to see become need-blind for international students? Write to us in the Comments Section and visit our Facebook page.

___________________________________________________________________

graduate n. a person who has received a degree showing they have finished studies at a school, college or university

significant adj. important, noticeable

challenge n. an issue or problem that is difficult to deal with or solve

realm n. an area of activity, interest or knowledge

talented adj. having a special ability to do something well

enroll v. to enter something, such as a school, as a member or student

option n. something that can be chosen; a choice or possibility

refreshing adj. pleasantly new, different, or interesting

bureaucratic adj. using or connected with many complicated rules and ways of doing things; relating to a bureaucracy

factor n. something that helps produce a result

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Dartmouth to Admit International Students Without Considering Ability to Pay - VOA Learning English

Issued on: 22/01/2022 - 02:54

Karachi (AFP) Friends and former classmates of the Pakistan-born surgeon behind the world's first pig-to-human heart transplant say they earmarked him for greatness from his medical school days.

Karachi-born Muhammad Mansoor Mohiuddin made headlines last week as the co-founder of the US university programme that successfully transplanted the heart of a genetically modified pig into a gravely ill American man.

While hailed as a medical breakthrough, the procedure also raised ethical questions -- particularly among some Jews and Muslims, who consider pigs to be unclean and avoid pork products.

None of that worried Mohiuddin's friends and former colleagues in Pakistan, who remember him as an ace student with a passion for medicine.

"He would be so interested, always there, always available and always ready to get involved in surgery," said Muneer Amanullah, a specialist who attended Karachi's Dow Medical College with Mohiuddin in the 1980s.

College vice-chancellor Muhammad Saeed Qureshi said pride in Mohiuddin's achievement had flooded the campus.

"There was exhilaration that this has been done by a graduate from this college," he told AFP.

Mohiuddin was quick to share the limelight with a team of 50 from the University of Maryland Medical School.

"They were all experts of their respective fields," he told AFP by phone.

"They are the best surgeons, the best physicians, the best anaesthetists, and so on."

While the prognosis for the recipient of the pig's heart is far from certain, the surgery represents a major milestone for animal-to-human transplants.

About 110,000 Americans are currently waiting for an organ transplant, and more than 6,000 patients die each year before getting one, according to official figures.

To meet demand, doctors have long been interested in so-called xenotransplantation, or cross-species organ donation.

"We were working on this model for 18 years," Mohiuddin said.

"Those 18 years were dotted with different phases of frustration -- as well as breakthroughs -- but finally we have done it."

The surgery is not without controversy, however, especially given Mohiuddin's Islamic faith.

Pigs are considered unclean by Muslims and Jews -- and even some Christians who follow the Bible's Old Testament literally.

"In my view, this is not permissible for a Muslim," said Javed Ahmed Ghamdi, a prominent Islamic scholar, in a video blog where he discussed the procedure.

But another Islamic scholar in Pakistan gave the procedure a clean bill of health.

"There is no prohibition in sharia," Allama Hasan Zafar Naqvi told AFP, calling it a "medical miracle".

"In religion, no deed is as supreme as saving a human life," added Mohiuddin.

In Karachi, the surgeon's fellow alumni feel their former colleague may now be destined for even greater glory -- medicine's top prize.

"I think... the whole team is in for it, in for the Nobel Prize," said vice-chancellor Qureshi.

2022 AFP

Excerpt from:

Pakistan proud of pig-to-human heart transplant pioneer - FRANCE 24

The coming weeks should bring a new phase in the pandemic, as policy shifts and a supply of up to a billion free, government-issued rapid test kits for home use promise to make diagnosing COVID-19 at home cheaper and easier.

Vaccines are the most effective way to prevent serious illness and death, but variants such as omicron have made breakthrough cases more commonplace, and testing has become an essential companion to vaccination in a COVID-cautious persons toolbox.

Although rapid antigen test results can be done at home and produce results quickly, the gold standard for accuracy remains the PCR lab test though it can take days. Experts say the value of rapid testing varies, depending on circumstances. Some who already feel sick may want to confirm whether they have COVID-19, while others may use the tests to protect themselves or a loved one from potential exposure to the virus. Many are optimistic that the tests will be a passport back to normalcy, adding a new level of confidence that its safe to travel and see family or attend a wedding.

But misunderstanding the usefulness of rapid tests could give people false confidence, possibly leading them to unwittingly transmit the virus.

The general population that uses the test would like a simple, direct, straightforward, easy answer, said William Schaffner, professor of infectious diseases at the Vanderbilt University Medical Center. Unfortunately, life is more complicated than that.

The kits the government provides are rapid antigen tests. Samples are collected with nasal swabs and the instructions included are straightforward. They deliver results in less than a half-hour.

READ MORE: How to get free COVID-19 tests from the federal government

Studies have shown antigen tests have a sensitivity of 80% to 90%, which means that if one shows you have COVID-19, thats very likely accurate. They are more likely than PCR tests to produce a false negative result meaning that you get a negative test result but actually have the virus. Antigen tests were designed to confirm the presence of COVID-19 in highly infectious people, but people recently exposed might not have enough viral particles in their nose for the test to detect, causing a false negative though they might still be contagious.

People may use a negative rapid test result to justify social activities and ignore a recent exposure or symptoms that should keep them at home, said Ryan McCormick, a primary-care doctor at Virtua Health in Marlton.

The binary thinking were all prone to positive or negative it can definitely be problematic, he said. With testing, its important to not think they are 100% accurate.

Omicron appears to show up in the upper airways and saliva a couple of days before it can be detected in the nasal passages, which could partly explain why nasal-swab rapid tests have not been quite as effective in detecting it.

Doctors debate whether swabbing the back of the throat might better detect omicron, but, McCormick said, That would be hard to do at home because it stimulates a gag reflex.

Tests are useful only as part of a fuller strategy to prevent the spread of the virus.

The problem is when people use them and they dont react accordingly, said Karen Coffey, an assistant professor of epidemiology and public health and medicine at the University of Maryland School of Medicine. Its that behavioral component that really has an impact.

European countries had ready access to rapid COVID-19 tests before Americans, but even countries that tested aggressively, such as Germany, werent spared from an omicron surge. People have to make good decisions with the data the tests provide.

With sufficient supply and appropriate frequency of testing, we can actually make a big dent in how many people end up getting infected by this simply by people knowing their status and being able to isolate during that time, said David Walt, a professor of bioinspired engineering at Harvard Medical School. The problem, of course, is if people say, Im infected, but Ill wear a mask and go to the grocery store, its not going to work.

If you have such symptoms as sore throat, fever, or cough, have been around a COVID-19 patient, or youve been in a high-risk environment, hanging out in bars with unmasked friends and you test positive you need to take it seriously.

If they test and they get a positive, they have COVID. No ifs, ands, or buts, Walt said. You dont have to retest. You dont have to go out and get a PCR test. You have COVID.

All those risk factors plus a negative test result, though, should be followed by two days of isolation and another home test. If that test, too, is negative, you can have more confidence youre COVID-free. Until you put yourself at risk again.

If a person is fully vaccinated and boosted, has no symptoms, wears masks, limits indoor contacts, and has had no known exposure to the virus, a single negative test result can offer added assurance before meeting up with friends or family, or attending an event.

If youre vaccinated, youre boosted, youre being careful, Schaffner said, then you do the rapid test and youre negative, youre in pretty good shape.

False positives you test positive but really dont have COVID are rare but possible, Walt said. If you doubt a positive test result, take another test immediately. Two consecutive false positives are extremely unlikely, he said.

At $10 to $15 a test, routine antigen tests quickly become expensive. Every household is eligible for one four-pack of tests, which can be ordered online from the federal government for free, with no shipping charge, through COVIDtest.gov. The first orders are expected to be delivered by early February.

READ MORE: Why is it so hard to find a COVID-19 test? Sites are short-staffed, and rapid supply is low.

With demand for at-home tests outstripping supply since the holiday season, people should take advantage of the free tests, doctors said.

Its important to not stockpile them, but going forward they are such a valuable tool in getting the pandemic under control and resuming life as usual, McCormick said. Take the government up on the offer if you dont have any.

Aside from the governments supply of free tests, insurance companies are required to cover the cost of up to eight at-home rapid tests per member per month. People may be able to use their insurance to pay for tests up front, or they can file a claim with their insurer for reimbursement so dont throw out that receipt.

State-run Medicaid and Childrens Health Insurance Plan programs are also required to cover COVID-19 testing without cost-sharing.

While the tests are widely covered by private health insurance, Medicare, Medicaid, and a federal fund for the uninsured, the rules on payment can be confusing.

Insurance companies cover up to $12 per test. If the ones you buy cost more than that, you will end up paying the difference out-of-pocket.

PCR tests should be free regardless of whether theyre done at a hospital or test site. Private health plans are required to cover PCR tests when ordered by a medical provider or when an individual is symptomatic. As of Jan. 15, insurers must also cover PCR tests taken at home and sent to a lab for analysis without a doctors note.

Health plans do not have to cover the tests when required by schools or employers, though, and people have encountered problems with being billed a copay or for the full cost of the test.

For instance, an insurer could deny covering a test for a person without symptoms or COVID-19 exposure, said Sabrina Corlette, codirector of the Center on Health Insurance Reforms at Georgetown University.

But in practice, I think that is hard for many carriers to do with these large testing sites it is burdensome to try to go through each persons claim and figure out the purpose for the test.

As for at-home tests, those done entirely at home must be covered by insurance without cost-sharing and without a doctors note. But if you must send in a sample collected at home to a lab, insurers can require a doctors note, she said.

Clear as mud, right? Corlette said.

To make matters even more confusing, prices for tests can vary widely. In an April 2021 analysis of prices from 93 hospitals, Kaiser Family Foundation found that prices for a PCR test ranged from $20 to $1,419, with a median cost of $148.

The new accessibility to tests is likely coming too late to make a big difference during the omicron surge, Coffey said, which should be subsiding in many parts of the country by the time tests arrive. Having them available will continue to be valuable, though.

I would like to say that this is the last wave that we will get, she said, but I think that is unlikely.

Before the pandemic, using the equivalent of a Q-Tip and some chemicals to diagnose a virus at home was unheard of. Now, its likely the technology will be adapted to hamper the spread of an array of other illnesses. If someone in your home has a fever, its likely youll soon have a test available to tell you whether its the flu.

Youll be able to rule out that you have flu, Walt said, youll be able to rule out that you have COVID, youll be able to rule out that you have RSV.

The government shipping a ration of tests to homes is a cumbersome distribution system, experts said, and ideally tests will become more widely available and easy to pick up.

I think its a good starting place, and maybe itll make people more comfortable with using these tests and encouraging them to buy their own, Coffey said. Its not going to support the entire nation through the entire pandemic.

Link:

At-home COVID-19 tests could be a passport to normalcy. But they can also give us false confidence. - The Philadelphia Inquirer

Chief Information Officer Gregory R. Wolf has received a 2021 BostonCIO of the Year ORBIE Award. Awards were presented in eight categories during a virtual ceremony on June 18; Wolf received the ORBIE in the health care category.

This past year showed just how impactful information technology is in the service of health care, Wolf said.My team is honored to support the amazing researchers, students, faculty, clinicians and health care professionals at UMass Medical School.Im proud to accept the 2021 BostonCIO of the Year Award in Healthcare on behalf of the entire UMass Medical School ITdepartment, the most passionate and dedicated group of technologists Ive had the privilege to lead.

Wolf oversees a team of more than 200 people who work in productivity services, academic technology, research technology, information security, operations and engineering. The ORBIE honors chief information officers who have demonstrated excellence in technology leadership. Finalists and winners are selected through an independent peer review process led by prior ORBIE recipients. BostonCIO has presented the awards in partnership with the Boston Business Journal since 2015.

The BostonCIO ORBIE winners demonstrate the significance of strong technology leadership in these uncertain times, said Brenda Shield, executive director of BostonCIO. Over the past year, CIOs are leading in unprecedented ways and enabling the largest work-from-home experiment in history. The ORBIE Awards are meaningful because they are judged by peersCIOs who understand how difficult this job is and why great leadership matters.

Looking back on his eight years as CIO at UMass Medical School, Wolf said he is most proud of how UMMS IT responded to the COVID-19 pandemic. In collaboration with various stakeholders on campus, the department participated in regular meetings to develop COVID-19 response plans in February 2020.

By March 1, we knew COVID-19 was going to directly affect the Medical School. Within a rapid two-week succession, it was, Lets execute these what-if scenarios, Wolf said.

One challenge arose when the state needed additional staffing for long-term care facilities. IT and Commonwealth Medicine automated the matching of long-term care facilities with available and certified care workers.

The need to develop a self-reporting health status tool also presented an opportunity for the team.

Its not that we hadnt done data integrations before, but it was like, wait a minute, this is very sensitive data. We generally dont keep this data in these locales. How do we integrate this? How do we quickly build campus safety tools? How do we get information to the deans office on a daily basis? Wolf recalled.

Prior to coming to UMass Medical School, Wolf served as the executive director of research computing platforms at the Novartis Institutes for Biomedical Research. Hes also held IT positions at Athenahealth, Parametric Technology Corporation and State Street Bank. Wolf has a bachelors in operational research and information engineering from Cornell University.

Related stories on UMassMed News:UMass Medical School CIO Greg Wolf selected as finalist for CIO of the Year awardGregory Wolf named UMMS CIO

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UMass Medical School CIO Greg Wolf receives CIO of the Year award - UMass Medical School

Life changing moments during Match Week at the University of Massachusetts Medical School

We catch-up with physicians we met in 2015 to learn what awaits todays medical students about to embark on their journeys

Updated: 8:40 PM EDT Jun 29, 2021

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ANTHONY: IT IS MATCHEE WK AT UMASS MEDICAL SCHOOL. THE THIRD WEEK IN MARCH SIENC -- IN MARCH WHEN EVERY YEAR SINCE 1952, MEDICAL STUDENTS ACROSS THE COUNTRY COLLECTIVELY FIND OUT IF THEY HAVE MAHETCD INTO A RESIDENCY PROGRAM. WHERE? THAT REMAINS SEALED IN AN ENVELOPE UNTIL FRIDAY. >> THIS IS CHRONICLE ON WCVB CHANNEL 5. ANTHONY: THIS IS NOTOW H IT IS SUPPOSED TO BE. QU IET HALLWAYS, CLOSED CLASSROOMS, EMPTY LECTURE HALLS. UMASS MEDICAL SCHOOL, THE STATES FIRST AND ONLY PUBLIC MEDICAL SCHOOL, IS ABOUT TO GRADUATE ITS LARGEST CLASS IN 50 YEARS. >> WE HAVE ACCOMPLISHED WHAT OUR STUDENTS NEED TO ACCOMPLISH, THEY ARE ALL ON TRACK AND ETH STUDENTS FEEL THEY HAD A UNIQUE OPPORTUNITY TO PRACTICE IN A TIME LIKE NO OTHER. THANONY: WHAT AWAITS THESE STUDEN OTSTHN E VERGE OF LAUNCHING THEIR MEDICAL CAREERS? WHO BETTER TO ASK THAN PAST GRADUATES. IN 2015, WE CHRONICLED SEVERAL STUDENTS AND WITNESSED THEIR MATCH DAY. >> YOU CANNOT OPEN THE ENVELOPES UNTIL I COUNT THEM DOWN. ANTHONY: FROM DUKE TO THE MAYO CLINIC IN MINNESOTA, WHERER. D MICELI IS FINISHING A FELLOW.IPSH >> THIS BLEW ME AWAY. I ASKED MY WIFE WHO WAS IN TRNIAING WITH ME IN NORTH CAROLINA IF WE COULD PACK UP AND MOVE TO MIESNNOTA, AND SHE IS A PRIMARY CARE PHYSICIAN IN MINNESA.OT WE WELCOMED OUR SON, MIL.ES WE WILL BE MOVING TO TENNESSEE IN A FEW MONTHS TO DO THE NEXT STEPS IN OUR TRAINING AT VANDERBILT. >> WE ARE GETTING MAREDRI ONE WEEK AFTER OUR GRADUATION AND PROBABLY ONE WEEK BEFORE WE START OUR RESIDENCIES. WE ARE MOVING TO PROVIDENCE, RHODE ISLAND. >> PROBABLY. >> 3, 2,. 1 ANTHONY: JOSH AND MCKENZIE DID MOVE TO PROVEN.ID >> IT WAS A GREAT FIT, WE HAD GREAT TRAINI.NG WE HAD OUR FIRST DAUGHTER REAGAN, IN THE SECOND YEARF O , RESIDENCY. ANTHY:ON DR. BARTLEY IS A PEDIATRIC HOSPITALI.ST >> WE WERE LOOKING FOR NEW ENGLAND AREA JOBS AFTER OUR RESIDENCY. I WANTED TO DO INPATIENT PEDIATRICS AND THERE ARE ONLY SO MANY HOSPITALS THAT ADMIT KIDS. >> WE PRACTICED OUT OF EXETER, NEW HAMPSHE.IR THE ORGANIZATION WAS A GREAT FIT. I WORKED WITH SPECIALISTS AND IT FELT LIKE A GREAT FIRST STEP AT A RESIDENCY BECAUSE THERE WERE A LOT OF RELATIONSHIPS I FORME ANTHONY: THIS MANS DESIRE TO BE A DOCTOR RUNS DEEP. IN HIGH SCHOOL HE PARTICIPATED IN THE PIPELINE PROGRA AM, PARTNERSHIP WITH UMASS MEDICAL. >> GROWING UINP CAMEROON, I SPENT A LOT OF TIME IN THE HOSPITAL BEING SICK WITH A LOT OF DIFFERENT DISEASES. BEING SURROUNDED BY PHYSICIA,NS NURSES AND SEEING HOW THEY HAD SO LITTLE RESOURCES BUT WERE ABLE TO DO SO MUCH TO CAREOR F PATIENTS, I THOUGHT THAT WAS SOMETHING I WOULD LIKEO DO T WITH MY LIFE. ANTHONY: HIS MATCH BROUGHT HIM ONE STEP CLOSER. >> NOW I AM IN NORTH CAROLINA. I AM PRACTICING NEUROLOGY. I HAVE A FAMILY. I HAVE A WIFE AND AN 18-MONTH-OLD DAUGHR.TE >> I ALWAYS LOOK FONY ONDL YOU. THEY INTRODUCE YOU TO PATIENT CARE THROUGH STANDARDIZED PATIENTS AND SHADOWING. THE EXPOSURE EARLY ON IS WHAT DLE TO A LEVEL OF COMFORT BY THE TIME RESIDENCY ROLLED AR.NDOU I WANT TO BE TAKING CARE OF PATITSEN FOR THE REST OF MY LIFE. THE OTHER DEMOGRAPHIC THAT GETS ME UP IN THE MORNING IS STUDENT LEARNERS. SO FINDING MYSELF AT AN ACADECMI INSTITUTION THAT WILL GIVE ME THE OPPORTUNITY TO TAKE CARE OF PATIENTS AND TEACH ON THE WARDS. THAT IS GOING TO BE THE CORNERSTONE. ANTHONY: SIX YEARS AGO, NONE O IMAGINED THEY WOULD BE PRACTICING MEDICINE IN THE THROES OF A PANDEMIC. >> HEARING PEOPLE ACKNOWLEDGE THAT A LOT OF US HAVE PUT OURSELVES ON THENTRO F LINES AND HAVE BEEN TRYING TO MANAGE A DISEASE WE KNOW VERY LITTLE ABOUT HAS BEEN NICE, I THINK IT HAS CHANGED A LITTLE BIT AUTBO HOW I REFLECT ON BEI ANG PHYSICIAN. ANTHONY: HOPES AND DRESAM REALIZED AT2:00 1 NOON, THE THIRD FRIDAY IN MARCH. SHAY:NA JOSH AND MCKENZIE WELCOMED THEIR SECOND CHILD, A SON, AFTER OUR INTERVIEW. ANTHY:ON THE FOUNDING MISSION OF THE MEDICAL SCHOOL WAS TO TRAIN DOCTORS WHO WOULD THEN PRACTICE IN THE COMMUNITIES THEY CAME FROM. THE SCHOOL IS IN THE 82ND PERCENTILE OF GRADUATES WHO GO BACK AND PRACTICE IN THEIR HOME

Life changing moments during Match Week at the University of Massachusetts Medical School

We catch-up with physicians we met in 2015 to learn what awaits todays medical students about to embark on their journeys

Updated: 8:40 PM EDT Jun 29, 2021

The University of Massachusetts Medical School, the states first and only public medical school, is about to graduate its largest class in nearly 50 years.

The University of Massachusetts Medical School, the states first and only public medical school, is about to graduate its largest class in nearly 50 years.

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Life changing moments during Match Week at the University of Massachusetts Medical School - WCVB Boston