The work details the steps of a complex signaling cascade, showing that pain neurons engage in direct cross talk with mucus-containing gut cells, known as goblet cells.

It turns out that pain may protect us in more direct ways than its classic job to detect potential harm and dispatch signals to the brain. Our work shows how pain-mediating nerves in the gut talk to nearby epithelial cells that line the intestines, said study senior investigator Isaac Chiu, associate professor of immunobiology in the Blavatnik Institute at HMS. This means that the nervous system has a major role in the gut beyond just giving us an unpleasant sensation and that its a key player in gut barrier maintenance and a protective mechanism during inflammation.

Our intestines and airways are studded with goblet cells. Named for their cup-like appearance, goblet cells contain gel-like mucus made of proteins and sugars that acts as protective coating that shields the surface of organs from abrasion and damage.

The new research found that intestinal goblet cells release protective mucus when triggered by direct interaction with pain-sensing neurons in the gut.

In a set of experiments, the researchers observed that mice lacking pain neurons produced less protective mucus and experienced changes in their intestinal microbial composition an imbalance in beneficial and harmful microbes known as dysbiosis.

To clarify just how this protective cross talk occurs, the researchers analyzed the behavior of goblet cells in the presence and in the absence of pain neurons.

They found that the surfaces of goblet cells contain a type of receptor, called RAMP1, that ensures the cells can respond to adjacent pain neurons, which are activated by dietary and microbial signals, as well as mechanical pressure, chemical irritation or drastic changes in temperature.

The experiments further showed that these receptors connect with a chemical called CGRP, released by nearby pain neurons, when the neurons are stimulated. These RAMP1 receptors, the researchers found, are also present in both human and mouse goblet cells, thus rendering them responsive to pain signals.

Experiments further showed that the presence of certain gut microbes activated the release of CGRP to maintain gut homeostasis.

This finding tells us that these nerves are triggered not only by acute inflammation, but also at baseline, Chiu said. Just having regular gut microbes around appears to tickle the nerves and causes the goblet cells to release mucus.

This feedback loop, Chiu said, ensures that microbes signal to neurons, neurons regulate the mucus, and the mucus keeps gut microbes healthy.

In addition to microbial presence, dietary factors also played a role in activating pain receptors, the study showed. When researchers gave mice capsaicin, the main ingredient in chili peppers known for its ability to trigger intense, acute pain, the mices pain neurons got swiftly activated, causing goblet cells to release abundant amounts of protective mucus.

By contrast, mice lacking either pain neurons or goblet cell receptors for CGRP were more susceptible to colitis, a form of gut inflammation. The finding could explain why people with gut dysbiosis may be more prone to colitis.

When researchers gave pain-signaling CGRP to animals lacking pain neurons, the mice experienced rapid improvement in mucus production. The treatment protected mice against colitis even in the absence of pain neurons.

The finding demonstrates that CGRP is a key instigator of the signaling cascade that leads to the secretion of protective mucus.

Pain is a common symptom of chronic inflammatory conditions of the gut, such as colitis, but our study shows that acute pain plays a direct protective role as well, said study first author Daping Yang, a postdoctoral researcher in the Chiu Lab.

The teams experiments showed that mice lacking pain receptors also had worse damage from colitis when it occurred.

Given that pain medications are often used to treat patients with colitis, it may be important to consider the possible detrimental consequences of blocking pain, the researchers said.

In people with inflammation of the gut, one of the major symptoms is pain, so you might think that wed want to treat and block the pain to alleviate suffering, Chiu said. But some part of this pain signal could be directly protective as a neural reflex, which raises important questions about how to carefully manage pain in a way that does not lead to other harms.

Additionally, a class of common migraine medications that suppress the signaling of CGRP may damage gut barrier tissues by interfering with this protective pain signaling, the researchers said.

Given that CGRP is a mediator of goblet cell function and mucus production, if we are chronically blocking this protective mechanism in people with migraine and if they are taking these medications long-term, what happens? Chiu said. Are the drugs going to interfere with the mucosal lining and peoples microbiomes?

Goblet cells have multiple other functions in the gut. They provide a passage for antigens proteins found on viruses and bacteria that initiate a protective immune response by the body and they produce antimicrobial chemicals that protect the gut from pathogens.

One question that arises from our current work is whether pain fibers also regulate these other functions of goblet cells, Yang said.

Another line of inquiry, Yang added, would be to explore disruptions in the CGRP signaling pathway and determine whether malfunctions are at play in patients with genetic predisposition to inflammatory bowel disease.

Co-authors included Amanda Jacobson, Kimberly Meerschaert, Joseph Sifakis, Meng Wu, Xi Chen, Tiandi Yang, Youlian Zhou, Praju Vikas Anekal, Rachel Rucker, Deepika Sharma, Alexandra Sontheimer-Phelps, Glendon Wu, Liwen Deng, Michael Anderson, Samantha Choi, Dylan Neel, Nicole Lee, Dennis Kasper, Bana Jabri, Jun Huh, Malin Johansson, Jay Thiagarajah, and Samantha Riesenfeld.

The work was supported by the National Institutes of Health (grants R01DK127257, R35GM142683, P30DK034854, and T32DK007447); the Food Allergy Science Initiative; the Kenneth Rainin Foundation; and the Digestive Diseases Research Core Center under grant P30 DK42086 at the University of Chicago.

Jacobson is an employee of Genentech Inc.; Chiu serves on scientific advisory boards of GSK Pharmaceuticals and Limm Therapeutics. His lab receives research support from Moderna Inc. and Abbvie/Allergan Pharmaceuticals.

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Study Finds Unexpected Protective Properties of Pain | Harvard Medical School - Harvard Medical School

Most sixth graders dont know what they want for lunch, much less what they want to be when they grow up. But first-year MUSC College of Medicine student Joshua Kim wasnt like most sixth graders. While most of his friends were playing video games or watching their hometown Chicago White Sox win the World Series, Kim was reading up on a pediatric neurosurgeon named Ben Carson.

In particular, it was Carsons work separating conjoined twins that most fascinated a then 11-year-old Kim. So, for his year-end class project, he dressed up in scrubs and latex gloves and gave his report on Carson. And a flame was lit.

Kims father, a successful podiatrist with a passion for his work, had already piqued an interest in the middle schooler, so it was practically inevitable that he would be drawn to medicine.

During high school, Kim never wavered on his dream of following in Carsons footprints by becoming a pediatric surgeon, but an undeniable talent for making things with his hands took him on a few detours along the way.

I always wanted to figure out how things work and make the next big thing, he said.

In high school, he taught himself how to build jet-powered rockets. (Yes, you read that right.) In undergraduate school at Northwestern University, he made a fully functioning Ironman suit so detailed that you would have sworn it came from the Marvel Studios props department. And thats when an idea was formed: What if he was able to combine his love of building things with his passion to heal?

I feel like I was always balancing this duality between medicine and design. It just took me a while to realize I didnt have to choose one or the other, he said.

After receiving his undergraduate degree, Kim was accepted to the Segal Design Institutes Engineering Design Innovation Masters Program at Northwestern University. It was there that he took his creations to the next level. There was the gadget to help people who were recovering from strokes, the device to speed up the time a cancer patient spent going through radiation, the pediatric-focused injection device that aimed to decrease anxiety caused by getting a shot.

I saw just how powerful human-centered and empathetic design could be in the health care field, he said. And I just wanted to keep making more things to help.

With the ink still wet on his diploma and a prestigious job offer already in hand, he was poised for his next big move. But a professor asked Kim if, before making any career decisions, hed do him one favor and meet with a former colleague of his first. So Kim sat down with MUSC oncologist, David Mahvi, M.D., and a fork in the road quickly appeared.

It was just immediately evident that he saw the world through a different lens, Mahvi said. He looked at things from a design standpoint, which is so refreshing in the medical field. He just came at things from a totally different angle.

So Mahvi offered him a job.

Within a month, Kim moved to Charleston and found himself working alongside Mahvi and Michael Yost, Ph.D. The task: leverage his unique skills and help create the Human-Centered Design Program at MUSC. The program would teach its students how to blend medicine, design and technology to make health care better. Kim lent his design expertise and passion for medicine to get the program up and running immediately.

Now in its third year, Kim designed a lot of the curriculum that exists in the program today. He even did a fair amount of teaching along the way.

When I came here, I literally had no teaching experience, he laughed. But now its something I really enjoy.

Well, enjoyed. Right now, Kim is on the other end learning right now. The first-year medical student has embarked on the second part of his master plan this time looking to add a hands-on element to his health care contributions.

The act of going to medical school and, in turn, temporarily stepping away from the Human-Centered Design Program something Mahvi always knew was something Kim aspired to do has proven bittersweet for both.

He has been really important to me, Kim said. He made me feel like I was one of his own kids that he was sending off to college.

Mahvis father-like pride is evident: Its crazy to think, but Josh became an educator within the Department of Surgery that transcended MUSC. He actually did Grand Rounds. Thats unheard of for somebody whos not a surgeon.

This means Mahvi is left with a gaping hole to fill in the program. Our hope is to bring him back one day so he can help us grow it even further, he said. I see him as this bridge between design and health care. There just arent that many people out there like him.

Kim shares his hopes.

I really hope I find time to come back and work with the program again. Marrying these two worlds together is so exciting, he said. Yes, Im in medical school right now, but Im always thinking ahead to whats next. Im a designer, a maker, a dreamer. Thats the core of who I am. So, Im always going to be thinking about innovation and how we can bring those innovations to life.

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Inventor-turned-medical student thinks good design just might be the key to improving health care - Medical University of South Carolina

Pictured is the first Black woman to be appointed dean of Howard University College of Medicine, Dr. Andrea Hayes Dixon. Photo Courtesy of Howard University Hospital.

Andrea Hayes Dixon, M.D., FACS, FAAP is now the first Black woman to be appointed as Dean of Howard University College of Medicine (HUCM).

After the announcement of her appointment was made on Sept. 22 by Howard Universitys newsletter, The Dig, Hayes Dixon officially began her role on Oct. 3 as the new dean of HUCM. This addition increases the number of academic deans who are women at Howard University to 11.

This is one of Dr. Hayes Dixons many firsts, as she has a track record of making history. In 2006, she was the first Black woman to become a board-certified pediatric surgeon in the U.S. and became the first woman to serve as chair of the Department of Surgery at Howard in 2021.

Ill be able to use my knowledge and experience here at Howard College of Medicine because of all of the adverse circumstances that have happened to me that Ive overcome, Hayes Dixon said. And I can use those experiences to help other students and trainees overcome some of the things that they may be encountering.

Hayes Dixon has many plans shed like to implement for HUCM, such as adding more outstanding faculty to the college of medicine. What excites her the most, however, are her students. I think Howard medical students are a really important set of students. Many of them in fact this was the only medical school that they were admitted to and they are very motivated to do well, she said.

She is also excited to provide a special environment for students where they are able to think creatively with medicine. I believe research is the way we can change how we treat patients in the future and I would like to inspire the next generation of physicians to think outside the box as they say, to try to be able to provide cures for several illnesses that we dont even think are curable today, she said.

According to 2021 data by the Association of American Medical Colleges, a nonprofit organization focused on educating others on health, out of all of the deans at U.S. medical schools, 22 percent of them are women in permanent positions. 12 percent of deans in permanent positions at U.S. medical schools are in racial/ethnic groups that are underrepresented in medicine.

Representation is very important to Hayes Dixon for a multitude of reasons. Its really important for the healthcare system to have representatives from every race, religion and nationality. I think because when youre ill, youre very stressed and you want to be in the most comfortable environment possible, and if you see someone who looks similar to you, whos your physician, it makes you more relaxed and helps you get through whatever illness it is, she said.

Toni Jenkins, 28 year-old, third-year medical student at HUCM from Charlotte, North Carolina spoke on the importance of representation in the medical field.

Having different perspectives is essential in having appropriate health care and having good health outcomes if you cant connect with your patients then youre not going to give them the best care possible, Jenkins said.

Jenkins was excited to hear of Dr. Hayes Dixons appointment, but she thought it was usual for Howard to prompt historical firsts.

I think Howard is known to have many firsts. When we think of civil rights leaders, we think of the vice president of the United States [Kamala Harris]. Howard is just known to be kind of that platform for building people into those types of positions,.. so I feel like Dr. Dixons position as the first female dean at Howard College of Medicine is a first but its not uncommon for Howard to have firsts. Jenkins said.

Roger A. Mitchell Jr. M.D. is a full tenure professor and chairman of pathology for Howard University College of Medicine. He believes that the future of leadership in medicine is enhanced with Hayes Dixon becoming the dean at HUCM.

[Howard University] College of Medicine started in 1868 and since then we have not had a female woman who is the dean and so I think its monumental. Then her as a person you know, I think shes pragmatic and shes thoughtful. Shes a strong physician and pediatric surgeon, but on top of that she has 20 years of experience with a basic science molecular lab. So I think you know shell be a huge asset to the college of medicine. Mitchell expressed.

Alicia Edwards, 29 year-old, second-year medical student at HUCM from Savannah, Georgia finds the appointment of Hayes Dixon to be affirming for her journey through medical school.

Im really excited, I came to Howard because I wanted to see representation. I wanted to see myself in medicine. I wanted to just see that, so its a constant reminder that I can do it too, she said.

Hayes Dixon succeeds former dean Hugh Mighty, who has served as dean of HUCM since 2015. Mighty expressed excitement for the appointment of Hayes Dixon in a statement on Howard Universitys newsletter The Dig.

This is an exciting moment in the history of the College of Medicine as we look forward to the continued rise of the University in training the next generation of medical leaders and providers, he said.

Hayes Dixon expressed that her appointment will be one of many in changing the trajectory of leadership in medicine.

I think you know that maybe not just my appointment but my appointment in addition to many other female deans appointments across the country will really change how medical education is viewedthis historic position will allow not only other black female doctors who want to be deans but also the majority population to really understand that we can lead as well if not better than others in the position before. Hayes Dixon said.

Hayes Dixon studied religion at Dartmouth College, a private university in Hanover, New Hampshire, where she earned her bachelors degree. She also attended the Geisel School of Medicine at Dartmouth College, where she earned her Doctor of Medicine (M.D.).

She previously worked as surgeon-in-chief and division chief of pediatric surgery at University of North Carolina (UNC) Childrens Hospital. She was also a professor of pediatric surgery and surgical oncology at UNC. Hayes Dixon is also a researcher and has been leading a basic science laboratory for about 20 years according to Dr. Mitchell, which focuses on rare sarcomas and maintains clinical research efforts.

Copy edited by Jadyn Barnett

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Howard University College of Medicine Appoints Their First Black Woman Dean - The Hilltop Online

As he assists doctors at a Missouri hospital as a medical scribe, Benedictine College senior Joe Roberts, 22, is getting experience that will help him become an emergency physician. Along with working in emergency medicine, he hopes to one day use his faith and knowledge of Catholic bioethics to help a hospital system more fully embrace the culture of life.

Roberts graduates from the Atchison, Kansas, college next spring and probably wont wait to start his formal medical training until a proposed Catholic-focused medical school opens on the Benedictine campus in 2026. But hes not ruling out attending the St. Padre Pio Institute for the Relief of Suffering, School of Osteopathic Medicine because he loves the idea of training faithful doctors who share his hopes for medicine.

I do think [the proposed school] is going to transform medicine, said Roberts, who is from Littleton, Colorado. The hope for medicine to change, I think, comes with schools like this and students, like my classmates and myself, who want to really just go back to how medicine should be and thats to heal and restore relationships.

If plans to establish the St. Padre Pio Institute for the Relief of Suffering, School of Osteopathic Medicine continue to go forward its initial step was last month its students will be the first in the world to receive training as osteopathic medical doctors with a grounding in Catholic theology and bioethics in the model of St. Pios care. The Kansas college already has a well-recognized nursing school.

Catholicism and the practice of medicine in faith are integral, part and parcel, to the medical school, said Dr. George Mychaskiw, the proposed schools founding president and CEO and an osteopathic physician who specializes in pediatric cardiac anesthesiology.

This is a medical school that is unapologetically and joyfully Catholic, that will stand for the sanctity of human life, from conception to natural death, and will put forth the clear Catholic position on the morality of certain practices of medicine, added Mychaskiw, who is based at the Ochsner-LSU Health Science Center in Shreveport, Louisiana.

The proposed school will be an independent, licensed, accredited, governed and financed entity co-located on the campus of Benedictine College. While it seeks funding and accreditation, the school has already received the support of Benedictine and Church leaders, the student and Atchison communities and Catholic osteopathic physicians.

The medical school completes the vision of Catholic Healthcare International (CHI) to expand St. Pios legacy of faith and health care in the United States, an effort named Casa USA, after the 1,000-bed hospital the saint founded that opened in 1956 in San Giovanni Rotondo, Italy.

Also part of Casa USA are plans for a prayer campus and hospital replicating St. Pios Casa Sollievo della Sofferenza (Home for the Relief of Suffering) that will include a home for the brain injured and a center for religious liberty for medical professionals. The other facilities are being developed in the Diocese of Lansing, Michigan.

St. Pio focused on relieving suffering while acknowledging its redemptive, salvific and emotional and spiritual aspects, said Jere Palazzolo, CHIs founder and president and a hospital administrator who lives in St. Louis.

Padre Pio, the well-known Capuchin friar who bore the stigmata for 50 years until his 1968 death, saw each patient individually, which aligns with the more holistic osteopathic philosophy, Mychaskiw said, adding that he hopes the school will train as many as 180 compassionate doctors per year.

We need faithful Catholic physicians taking the good news to people who need it most, he said, people the American health system forgot about.

The schools founding comes as the number of students attending the 38 U.S. accredited osteopathic medical schools has grown 77% over the past decade, according to a 2022 report by the America Osteopathic Association (AOA).

Osteopathic doctors, or D.O.s, use the same conventional medical tools including x-rays, pharmaceutical drugs and surgery as M.D. or allopathic doctors, but have a different philosophical focus on more holistic health and prevention on all parts of a person, including their mind, body and emotions, according to WebMD. Osteopathic doctors also use a system of physical manipulations and adjustments in diagnosis and treatment, and 57% work in primary care, according to the AOA study.

Overall, there are 178,259 osteopathic physicians and students in the United States, according to the AOA study. By comparison, a 2019 report from the American Association of Medical Colleges revealed there are 620,520 active M.D. doctors.

The idea to establish a Catholic medical school near a faithfully Catholic U.S. college campus came around 2009, as CHI was seeking approval from leaders of Padre Pios hospital for the Casa USA idea.

In a conversation with CHI for an informational brochure, Cardinal Raymond Burke mentioned the importance of training faithful doctors. The St. Padre Pio Institute for the Relief of Suffering will train generations of physicians who understand and foster life, from conception to natural death, who love as Jesus loved and who are faithful to the magisterium of the Holy Catholic Church, he commented this summer. It is a noble and just cause. Cardinal Burke is one of CHIs episcopal advisers and incumbent patron of the Sovereign Military Order of Malta.

Mychaskiw read about the Casa USA plan and the goal of starting a medical school and contacted Palazzolo. Mychaskiw, an Eastern Rite Catholic, was interested in founding a faithful Catholic osteopathic medical school using the model he developed while founding four independent medical schools in proximity to larger college or university campuses.

The other medical schools, including Burrell College of Osteopathic Medicine at New Mexico State University in Las Cruces, focus on areas of societal need for physicians, he said.

After approaching several other faithful Catholic schools, Mychaskiw and Palazzolo chose Benedictine. The colleges president, Stephen Minnis, immediately saw the synergy between the college and the proposed medical school, Palazzolo said.

A faithful Catholic medical school named for St. Pio, a patron saint of healing, will form physicians to maintain their faith and relate it to the practice of medicine in a secular society, Minnis said. It also will offer quality medical education as well as a focus on Catholic medical ethics and other Church teaching not offered at secular schools.

It also adds another level of prestige to the colleges reputation for success and excellence, Minnis said, noting also that the independent medical schools marketing efforts will also build awareness of Benedictine.

The medical school will automatically admit qualified Benedictine students, and Minnis said he expects an increase in the colleges enrollment of biology, chemistry and pre-med majors.

Not all Catholic medical schools in North America include faith in their programs, but the St. Pio medical school will be the only medical school in the world that is in accordance with Ex Corde Ecclesiae, explained Mychaskiw, referring to Pope St. John Paul IIs 1990 apostolic constitution on Catholic universities. In addition, the proposed school also will offer significant coursework in Catholic bioethics, theology of the body and theology of suffering, and students will receive spiritual direction in their own faith tradition.

Students will be taught clearly the Catholic moral positions on abortion, euthanasia and other practices, Mychaskiw underscored, adding that he is working with Benedictine to enable students to receive a masters degree in Catholic bioethics along with a medical degree from the medical school.

After the first two years of clinical education, students will train in the National Christian Clinical Network of hospitals and clinics, with doctors who are practicing, faithful Catholics, and complete rotations at the Casa Sollievo della Sofferenza in Italy.

The medical school also will work with Catholic health-care systems to develop residency programs in the areas most relevant to Catholic ethical concerns, including OB-GYN, psychiatry, pediatrics, family medicine and internal medicine areas, Mychaskiw said.

The proposed medical school will cost at least $70 million, Mychaskiw said. Another $50 million will be needed for a building.

Benedictine Colleges commitment to renewing and transforming American culture through its education and formation makes it an ideal location for the medical school seeking to form future Catholic physicians, said Archbishop Joseph Naumann, of Kansas City, Kansas.

Today more than ever, we need a Catholic medical school committed to providing future doctors with scientific and academic excellence, high-quality training in medical ethics anchored in Catholic moral principles, and sound spiritual formation, he said.

Lester Ruppersberger, a retired osteopathic OB-GYN doctor from Langhorne, Pennsylvania, called the future graduates of the proposed school the future of health care in the U.S. They will learn early in their careers the ethical and moral truths about issues such as contraception, which he learned only after 20 years of practice, said Ruppersberger, who served as the Catholic Medical Associations 2016 president.

To know that these medical schools are starting out upfront philosophically and spiritually with being dedicated to the teachings of the Church, bodes well for the future, he said, adding, Any hospital that is modeled after the Casa in [Italy], that hospital will also subscribe to the same principles, and you will know which physicians will protect the lives of patients and not do abortions and not participate in physician-assisted suicide.

Brendan Rhatican, an osteopathic physician in his second year of residency in Lexington, Kentucky, said he also would have benefitted from courses on faithful bioethics in medical school but instead had to learn about them on his own. The need for them in medicine is great because secular bioethics are philosophically and anthropologically bankrupt, he said.

Christianity has so much to offer bioethics and medicine, said Rhatican, who is specializing in radiology in part because other specializations may pressure him to violate his conscience. I just feel like the time is so right for it, when no one can stop from making ethical decisions, but [many dont know] how to think about even the most basic ethical dilemmas, and the Church has so much to offer.

An unapologetically Catholic medical school will not be without critics, Palazzolo predicted, but it could revolutionize health care.

The medical school completes this whole concept that we have, the whole mission, because it allows us to bring faithfully trained physicians out into the community around the world, he said. Its going to be the grassroots. Theyre going to go out into the community, into the hospitals and have that influence that this is the way that Catholic health care should be provided and delivered.

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Following in the Medical Footsteps of St. Luke and Padre Pio - National Catholic Register

This transcript has been edited for clarity.

Hi. I'm Art Caplan. I run the Division of Medical Ethics at New York University Grossman School of Medicine.

Many of you know that President Biden created a loan forgiveness program, forgiving up to $10,000 against federal student loans, including graduate and undergraduate education. The Department of Education is supposed to provide up to $20,000 in debt cancelation to Pell Grant recipients who have loans that are held by the Department of Education. Borrowers can get this relief if their income is less than $125,000 for an individual or $250,000 for married couples.

Many people have looked at this and said, "Hey, wait a minute. I paid off my loans. I didn't get any reimbursement. That isn't fair."

One group saddled with massive debt are people who are still carrying their medical school loans, who often still have huge amounts of debt, and either because of the income limits or because they don't qualify because this debt was accrued long in the past, they're saying, "What about me? Don't you want to give any relief to me?"

This is a topic near and dear to my heart because I happen to be at a medical school, NYU, that has decided for the two medical schools it runs our main campus, NYU in Manhattan and NYU Langone out on Long Island that we're going to go tuition free. We've done it for a couple of years.

We did it because I think all the administrators and faculty understood the tremendous burden that debt poses on people who both carry forward their undergraduate debt and then have medical school debt. This really leads to very difficult situations which we have great empathy for about what specialty you're going to go into, whether you have to moonlight, and how you're going to manage a huge burden of debt.

Many people don't have sympathy out in the public. They say doctors make a large amount of money and they live a nice lifestyle, so we're not going to relieve their debt. The reality is that whoever you are, short of Bill Gates or Elon Musk, having hundreds of thousands of dollars of debt is no easy task to live with and to work off.

Still, when we created free tuition at NYU for our medical school, there were many people who paid high tuition fees in the past. Some of them said to us, "What about me?" We decided not to try to do anything retrospectively. The plan was to build up enough money so that we could handle no-cost tuition going forward. We didn't really have it in our pocketbook to help people who'd already paid their debts or were saddled with NYU debt. Is it fair? No, it's probably not fair, but it's an improvement.

That's what I want people to think about who are saying, "What about my medical school debt? What about my undergraduate plus medical school debt?" I think we should be grateful when efforts are being made to reduce very burdensome student loans that people have. It's good to give that benefit and move it forward.

Does that mean no one should get anything unless everyone with any kind of debt from school is covered? I don't think so. I don't think that's fair either.

It is possible that we could continue to agitate politically and say, let's go after some of the healthcare debt. Let's go after some of the things that are still driving people to have to work more than they would or to choose specialties that they really don't want to be in because they have to make up that debt.

It doesn't mean the last word has been said about the politics of debt relief or, for that matter, the price of going to medical school in the first place and trying to see whether that can be driven down.

I don't think it's right to say, "If I can't benefit, given the huge burden that I'm carrying, then I'm not going to try to give relief to others." I think we're relieving debt to the extent that we can do it. The nation can afford it. Going forward is a good thing. It's wrong to create those gigantic debts in the first place.

What are we going to do about the past? We may decide that we need some sort of forgiveness or reparations for loans that were built up for others going backwards. I wouldn't hold hostage the future and our children to what was probably a very poor, unethical practice about saddling doctors and others in the past with huge debt.

I'm Art Caplan at the Division of Medical Ethics at New York University Grossman School of Medicine. Thank you for watching.

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Loan Forgiveness and Med School Debt: What About Me? - Medscape

The poster and oral presentation winners of the Wayne State University School of Medicines ninth annual Vision Research Workshop have been announced.

The workshop, held Oct. 12, was presented by the Department of Ophthalmology, Visual and Anatomical Sciences, and the Kresge Eye Institute.

Presentation winners included:

Poster Presentations

First place: Nicholas Pryde, Assessment of NanodropperTM eyedropper attachment

Second place: Bing Ross, Mechanism of Preferential Calcification in Hydrophilic Versus Hydrophobic Acrylic Intraocular Lens

Third place: Pratima Suvas, Expression, Localization, and Characterization of CXCR4 and its ligand CXCL12 in herpes simplex virus-1 infected corneas

Oral Presentations

First place: Ashley Kramer, A comparative analysis of gene and protein expression in a zebrafish model of chronic photoreceptor degeneration

Second place: Jeremy Bohl, Long-distance cholinergic signaling contributes to direction selectivity in the mouse retina

Third place: Zain Hussain, Diagnostic and Treatment Patterns of Age-Related Macular Degeneration among Asian Medicare Beneficiaries

Mark Juzych, M.D., chair of the Department of Ophthalmology, Visual and Anatomical Sciences, and director of the Kresge Eye Institute, gave welcome remarks.Linda Hazlett, Ph.D., vice dean of Research and Graduate Programs and vice chair of the department, provided an overview of research.

The keynote speaker giving the annual Robert N. Frank, M.D., Clinical Translational Lecture, was Reza Dana, M.D., M.P.H., the Claes H. Dohlman Chair and vice chair for Academic Programs in Ophthalmology at Harvard Medical School, who presented New Ways of Doing Old Things: Translational Investigations in Management of Common Corneal and Ocular Surface Disorders.

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Winners of ninth annual Vision Research Workshop named - Wayne State University

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Scientists Uncover Nearly All Genetic Variants Linked to Height - Harvard Medical School

In the past century, Henrietta Lacks has, arguably, done more to advance medicine than any other person. She played a material role in the development of polio vaccines, cancer treatments, HPV vaccines, and mapping the human genome. This young Black woman died from cervical cancer in 1951. It was cells taken during her cancer treatment that became one of the most powerful research tools ever, but she did not know about or give permission for their retrieval. What can we learn from such wrongs committed in the name of science?

In January 1951, a few months after giving birth to her fifth child, Henrietta Lacks, a 30-year-old Black woman, became concerned about a lump on her cervix. This, and unexplained vaginal bleeding, led her to seek medical attention.

She went to Johns Hopkins in Baltimore, the only hospital in the area that would provide treatment to Black people at that time.

Doctors there diagnosed a particularly aggressive form of cervical cancer. She did not tell her husband or family, informing them only that she had to go to the doctor for medicine.

The standard treatment at the time was radium therapy. During her first treatment, under sedation, the surgeon took a tissue sample from her tumor. He passed this on to the head of tissue culture research at Johns Hopkins, Dr. George Otto Gey.

When Henrietta Lacks sought care at Johns Hopkins University one of the few segregated hospitals to serve Black patients in Baltimore, MD, at the time a biopsy of her cervical cells was extracted to diagnose her cervical cancer. The original doctor did not keep her sample for his own research but immediately shared it broadly with the larger scientific community. In 1951, the informed consent process as we now know it did not exist to protect patient privacy, rights or govern scientific and clinical research.

Dr. Maranda C. Ward, assistant professor and director of Equity, Department of Clinical Research and Leadership, School of Medicine and Health Sciences, The George Washington University

Taking cell samples for research was routine practice at the time, and doctors rarely asked patients for consent. As a result, most patients were, like Henrietta, completely unaware of what would happen to their cells.

The cells that doctors took from Henriettas tumor were then placed in a culture medium, labeled HeLa to identify them. The researchers expected that, like most cell samples, they would multiply a few times, then die.

After her first treatment, doctors discharged Henrietta from the hospital, and she went back to work in the tobacco fields, oblivious to the fact that doctors had taken her cells for research purposes.

In the lab, the HeLa cells not only remained alive, but multiplied at an astonishing rate.

Dr. Gey informed colleagues that his lab had grown the first immortal cell line, and shared samples of HeLa cells with them.

What was done to her, the reuse of her information, the attaching of her name to the cells the HeLa cells are named after her thats a massive violation of her privacy. All of those practices are of a bygone era where consent and privacy were just not taken as seriously or even thought about at all.

Dr. Sean Valles, director and associate professor, Center for Bioethics and Social Justice, Michigan State University

Although Henriettas initial treatment led to the tumor shrinking, by September, her cancer had spread to many of her internal organs.

Henrietta Lacks died, aged just 31, on October 4, 1951, unaware that she had unwittingly left behind an extraordinary legacy.

Some 70 years on, the cell line from the original HeLa cells is still proliferating. In that time, more than 11,000 research publications have involved HeLa cells.

In 1953, two researchers from Tuskegee University cultured HeLa cells, and mass-produced them for use throughout the United States in the development of the first successful polio vaccine.

Later in the 1950s, researchers used the cells to investigate the effects of X-rays, and to develop a method, still used today, of testing whether cells are cancerous.

Cells from the HeLa line have also been sent into space, used to investigate the effects of space travel and radiation on human cells, used to determine how Salmonella causes infections, to investigate blood disorders, to advance understanding of HIV, and in unraveling the secrets of the human genome.

Only some of the research stated that HeLa cells had been used.

Most pertinently, given that Henrietta Lacks died from cervical cancer, HeLa cells were vital in discovering how HPV causes cervical cancer, and in the development of the vaccine against HPV.

It is particularly troubling that, as Dr. Valles stated: In the U.S., Black women have especially poor outcomes with cervical cancer, because thats why she went to the hospital in the first place. Theyre seeing the doctor, but theyre not getting treated in a timely way.

Dr. Harald zur Hausen, an author on the HPV study, went on to win the 2008 Nobel prize in Physiology or Medicine for his work on viruses and cancer.

This was just the first of three Nobel prizes from research using HeLa cells, the others being for research on telomeres in 2009, and live viewing of cellular growth in 2014.

Unlike almost all other cell samples, HeLa cells continued to replicate in cell culture and the line has survived for more than 70 years. So what was it about these cancer cells that made them so powerful?

Although scientists do not fully understand what gives HeLa cells their unique properties, research has shown that there are three ways in which HeLa cells are different from normal human cells:

Whatever the reason, HeLa cells have proved a vital tool in biomedical research.

Henrietta also experienced the untreated effects of syphilis on the birth outcomes of her children before seeking out care for unexplained abdominal pain, which doctors described as impacting her disease prognosis once they identified her cancer. So, racism, gender oppression, and poverty most certainly shaped her life chances and opportunities for health.

Dr. Maranda Ward

Henrietta Lacks cells played a material role in work that led to three Nobel prizes and many other scientific discoveries but they were used and shared without consent from her, or from any member of her family.

At the time, permission was neither required, nor sought, for cells to be used for research.

This was normal procedure in the 1950s, as Dr. Valles pointed out: There was non-consensual research happening everywhere, because consent didnt really matter, but it always happens to be the case that people being burdened by this, people being taken advantage of, disproportionately end up being Black Americans [] something happens, and it works out worse for this population.

The billion-dollar industry tied to the immortal HeLa cell line is yet another example of how the U.S. has exploited and profited off the bodies of Black people. Once informed consent processes established that obtaining and researching the HeLa cells was unethical because it violated human rights, privacy, and bodily autonomy, its continued use represented a blatant disregard for Henriettas humanity, let alone scientific integrity and ethical conduct of research.

Dr. Maranda Ward

For around 25 years, researchers used HeLa cells without any acknowledgment of where they had originated.

Then, in 1976, a reporter, Michael Rogers, uncovered the origin of the name HeLa, revealing in Rolling Stone magazine that the cells were from Henrietta Lacks.

And it was only then, long after her cells had been shared around the world and played a part in many medical breakthroughs, that her family became aware of what had happened.

Some years later, Rebecca Skloot, an investigative journalist, picked up the story. She contacted Henriettas family, who were at first reluctant to talk to her. Eventually, she persuaded Henriettas youngest daughter, Deborah, to provide personal insight into her mothers story.

Skloots book, The Immortal Life of Henrietta Lacks, was published in 2010, and made into a film in 2017.

Following the publication of her book, Rebecca Skloot established the Henrietta Lacks Foundation, with the purpose of [h]elping individuals who have made important contributions to scientific research without personally benefiting from those contributions, particularly those used in research without their knowledge or consent.

Several of Henrietta Lacks descendants have been helped by the foundation one small step, perhaps, in making reparation for the wrong done to Henrietta Lacks.

In the U.S., the Common Rule, instigated in 1981 and updated since, sets out ethical guidelines for biomedical and behavioral research involving humans. Among other issues, it covers compliance, record keeping, and, most importantly, informed consent.

A 2013 paper described the role of informed consent in research as the [b]asic ethical principle behind informed consent legalities is to protect the autonomy of human subjects which states that welfare and interests of a subject participating into clinical research are always above the societys interests and welfare. Medical research directed towards treatment advances for societys benefit and betterment can never be built on sacrificing the rights and health of research participants.

However, as Dr. Ward noted, the consent system is imperfect:

Current consent procedures are highly varied and therefore remain inadequate. This partly explains why the U.S. health goals (Healthy People 2030) include a new aim to attain health literacy. We recognize that we will not be able to eliminate health disparities and achieve health equity if patient populations do not know where to access credible health information or make sense of the information they do receive for what it means for their own health.

I do believe not enough attention is paid to the right to refusal as a part of informed consent nor is the idea that you can change your mind and withdraw participation at any point without any effect to the relationship with the clinical team or type of care you receive, she added.

Henrietta Lacks, like so many others, had no right to refusal.

Henrietta Lacks was taken advantage of and the fruits of her body were taken without her knowledge and without her consent, and even after all these decades of improvements of the American medical system and the system worldwide, somehow still, people who are black Americans, like Henrietta Lacks, are still disadvantaged.

Dr. Sean Valles

This is just one case that has damaged trust in medical science among Black, American Indian, and people of color, in general, in the U.S.

It came in the midst of the Tuskegee Syphilis study where between 1932 and 1972 doctors denied treatment to Black men with syphilis even after penicillin was identified as an effective cure so that they could study the course of the disease.

More recently, during the COVID-19 pandemic, in both the U.S. and the United Kingdom people of color were at far greater risk of mortality than white people. In the U.K., Black African men were 3.7 times more likely to die from COVID-19 than white men.

And according to the CDC, Black or African American, American Indian or Alaska Native, and Hispanic or Latino individuals were around twice as likely to die from COVID-19 than white people.

Has there been an effort to earn back that lost trust? Dr. Valles is not convinced, asking: What has the biomedical system, whether its individual hospitals, like Johns Hopkins University Hospital, or any other university hospital, what have they done to earn the trust of people who dont trust them?

Currently, most research is carried out in white, educated, industrialized, rich, democratic (WEIRD) people. Scientists have acknowledged that such data are not representative, and that research must include data from diverse populations.

These are the privileged social identities that default as the standard of health within Westernized medicine and codified as metrics for what gets valued. Until scientists and researchers center the experiences of Black women the most disrespected and categorically disadvantaged U.S. group racial injustice and therefore uneven and unfair opportunities for health will persist.

Dr. Maranda Ward

Henrietta Lacks was taken advantage of because, perhaps, doctors thought she did not matter. Her cells were just tools for research. We might hope that such attitudes are a thing of the past, but inequity still exists.

Dr. Ward commented: Medical and scientific research needs to first understand what equity is before they can apply an equity lens to their research. Equity has become a buzz term for some resulting in it being used erroneously and interchangeably with concepts of diversity and inclusion.

If a researcher understands that macro social issues such as segregation, mass incarceration, poverty, and racism are at the root of unfair health differences, their research will be designed to mitigate social and economic barriers that patients face when accessing healthcare let alone accessible and ethical research. This is what equity looks like, she added.

Henrietta Lacks became known because of the wrong done to her in the name of science. Perhaps her most lasting legacy will be to raise awareness of the inequities in health provision and research and lead the way to a fairer, more inclusive healthcare system.

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The story of Henrietta Lacks and the uniqueness of HeLa cells - Medical News Today

The importance of undergraduate surgical education

Undergraduate medical education is designed to enable future doctors to attain the knowledge and skills needed to ensure they are competent junior doctors. Upon graduating, junior doctors are expected to be able to contribute to the safe care of patients [1]. However, undergraduate surgical education specifically is more complex due to the practical and labour-intensive requirements of the experience. The website of the Royal College of Surgeons England has useful aids for surgeons who will be teaching medical students. It provides a more uniform curriculum so that all students attain the same core competencies irrespective of the institution. These can be found for each surgical subspeciality [2].

Perioperative care should be covered in its entirety. This is important for aspiring surgeons and future general practitioners and physicians who are likely to manage patients during the pre-operative workup of patients as well as in their post-operative recovery and beyond [3]. The need for multidisciplinary team involvement and effective communication between the different specialities is evident. Surgeons and anaesthetists should be in regular dialogue with general practitioners regarding patients who are due to undergo surgery and require optimisation of chronic or acute conditions that may have adverse impacts on prognosis [4].

This is specifically laid out in the General Medical Council (GMC) of the United Kingdoms agreed-upon "outcomes for graduates". This states that students who graduate must show competency in diagnosing, investigating, and managing clinical presentations across the community and in secondary care [5].

This is especially important as most newly qualified doctors in the United Kingdom rotate through surgical specialities [6]. Therefore, they need to be prepared for practice [7]. However, the learning needs are typically not comprehensively addressed. This is believed to be largely due to the gap between the theory taught and the limitations in practical, experiential learning [3]. Ultimately, this means that new graduates are unfamiliar with the all-encompassing clinical knowledge and skills required in treating patients with surgical conditions. As a result, newly qualified doctors have reported that they feel they are not as well prepared to manage emergency surgical on-calls and surgical placements as they are in dealing with medical placements and on-calls, even prior to the outbreak of the pandemic [8].

The aims and objectives of the systematic review were to review all appropriate current feedback regarding students impressions of undergraduate surgical education during the coronavirus disease 2019 (COVID-19) pandemic, both from qualitative and quantitative forms. The aims were as follows: (i) review innovative teaching delivery implemented by UK medical schools/universities during the pandemic to ensure the GMC graduate outcomes and similar pre-pandemic student experiences were minimally derailed; (ii) review students experience of these innovative teaching delivery methods; (iii) review whether undergraduate surgical education will likely progress with the use of technology discussed in this review.

This systematic reviews scope will focus on undergraduate medical students of any year group who are subjected to surgical education modules. Since this is not an original study, we will follow strict inclusion and exclusion criteria to ensure appropriate studies are included. There will be no limitation to population size, geographical location, or social demographics. Any study which has qualitative or quantitative feedback will be analysed and included.

The purpose of this search was to identify all eligible studies featuring the impact of COVID-19 on undergraduate surgical education.The present systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.In June 2022, a comprehensive search was conducted for all non-grey literature published using the online platforms PubMed, MEDLINE, and Scopus. No similar articles were found in the Cochrane Library.

The following search termswere used to ensure all appropriate studies were captured: "COVID-19" or "coronavirus*" or "2019-nCoV*" or "SARS-CoV-2" or "COV-19" or "outbreak" or "pandemic" or "novel coronavirus" and "surgical" and "education or curricul*" and "undergrad" and "virtual learning" or "online learning" or "e-learning" or "remote learning" or "distance learning" or "blended learning" or "electronic learning" or "teaching" or "online teaching". In addition, all relevant studies published up to and including June 2022 discussing the impact of COVID-19 on undergraduate surgical education were included. There was no dedicated publication time limitation as such, but by definition, as COVID-19 began in late 2019, all studies were limited to 2019 onwards. We further supplemented our search by exploring the reference list of all the included articles for additional eligible studies.

The aim was to include all published articles that discussed the impact of the COVID-19 pandemic on undergraduate surgical education. All study designs were retained due to the limited number of meta-analyses and the lack of historical data. In addition, due to the limited number of papers, all papers were subject to a full-text review. This included randomised controlled trials, cohort studies, case-control studies, case series, and case reports. Population, Intervention, Comparison, and Outcome (PICO) criteria were further specified to determine certain inclusion and exclusion criteria. The population was specifically medical students. All other studies focused on physicians, non-medical students, and school education reports, and other healthcare professionals such as dentistry, nursing, or veterinary were excluded. The intervention included innovations in surgical education used to mitigate the COVID-19 pandemic. All prospective or retrospective studies, non-randomised comparison studies, and case series were considered for inclusion. If more than one study was conducted at the same institution, the article with the most complete or recent data was selected. Basic science or animal studies, expert opinions, and grey literature were excluded.

All potentially relevant articles were identified via the search strategy, and no further pertinent studies were identified when references were reviewed. Following the exclusion of duplicates, a total of 96 articles were included, and an additional six were identified that were not highlighted in the original search, totalling 112. All studies were subject to full-text review by the author, which led to 18 studies being included in this systematic review (Figure 1).

Participants in the studies reviewed included 1,529 medical students and addressed various areas of pedagogy such assynchronous and asynchronous online teaching, blended teaching, live virtual shadowing, and augmented reality (AR) teaching. The number of students participating in each study was between six and 763. One study did not disclose the number of students involved; however, it was included due to the impactful feedback. The next section will discuss the 18 relevant studies to assess the impact of COVID-19 on undergraduate surgical education as seen in Figure 1.

Online Teaching

Most of the studies that will be discussed contain a mixture of synchronous virtual teaching and asynchronous internet-based teaching. However, for the benefit of this review, the author will encompass these forms of delivery of pedagogy as "Online Teaching". This will comprise all virtual teaching that does not include live shadowing clinical environments or patient encounters.

In a study by Pettitt-Schieber et al., when reviewing students' understanding of the subspeciality surgical course, a four-point Likert scale found a post-course score of 3.3 +/- 0.5 vs. a pre-course score of 2.0 +/- 0.8. All sessions were held over Zoom (Zoom Video Communications, Inc., San Jose, CA). Feedback in qualitative and quantitative forms was collected following the synthesis of questionnaires by each speciality. Eighteen virtual surgical electives (VSEs) were carried out with a minimum of two iterations of each surgical speciality. Out of the 67 students who filled out feedback forms, 67.2% and 25.4% reported feeling "very comfortable" and "comfortable", respectively, when using the Zoom videoconferencing software. In addition, 98.5% felt the course objectives were met either "very well" or "well" [9].

Schmitz et al.s study had an experimental group that was required to utilise online platforms, while the control group received book chapters related to these specific anatomical regions.An interactive platform was synthesised for the online material to enable the teaching of operative techniques and skills. After examination, the students in the video group scored a higher percentage of correct answers (0.67 vs. 0.60)[10].

Chandrasingheet al.s study recruited 754 students via Facebook for an online teaching session [11]. Junior medical students presented the basic science on specified topics, while more senior medical students discussed a clinical case. Over 98% of the respondents felt that the discussions improved their clinical understanding. Also, 96% scored 4 or above (out of 5) on the question of how well they felt the sessions ran [11].

Shin et al. found that virtual case-based discussions improved medical students confidence in independently conducting initial assessments for surgical patients. For example, 16 students would each take a history and orally request examination findings from the tutor who acted as the patient. This was highlighted by a pre-course and post-course understanding with a Likert score of 2 and 4 out of 5, respectively [12].

At the Emory University School of Medicine in Atlanta, Georgia, a two-week VSE that involved direct interaction with the surgical faculty and self-directed learning was created. This involved didactic synchronous and asynchronous methods of teaching and a skills lab facilitated by the Zoom videoconference app to aid in the teaching of basic surgical skills. Of the 14 participating medical students,91% felt the course met their learning needs very well or well. Pre-course and post-course understanding scores highlighted that 27% reported a good understanding of general surgery, and 100% reported either a good or very good understanding, respectively. In addition, 82% reported increased interest in general surgery [13].The same institution synthesised a one-week virtual urology course, which consisted of interactive lectures, case-based discussions, and surgical reviews conducted via video. All nine medical students reported an increased understanding of the common urological conditions by an average of 2.5 points on a 10-point Likert scale. The majority of the students (56%) also responded by stating they had an increased interest in urology, while 22% reported a decreased interest [14].

Williams et al. conducted a study in Philadelphia, USA. They enrolled 10 senior medical students who undertook a two-week synchronous and asynchronous virtual urological surgery clinical rotation.This included pre-recorded lectures, video content, self-directed problem-based learning modules, an online discussion board, and real-time case discussions via videoconferences to name a few.

Median Likert scores out of five pre-course and post-course were as follows for each domain: overall knowledge (pre-course = 3and post-course = 4);naming urological conditions: (pre-course = 2and post-course = 4.5); urological evaluation confidence (pre-course = 2and post-course = 3.5); urology consult confidence (pre-course = 3and post-course = 5) [15].

Pang et al. conducted a study in the USA analysing the students' perspectives on a virtually informed consent activity. The majority of students stated they felt their ability was satisfactory or above on completion of the module [16].

A study by Newcomb et al. reviewed six medical students who attended a two-hour virtual class designed to improve their communication and rapport-building skills through video platforms. As an outcome, four out of the five student participants graded the class as "A+" [17].

A study by McGann et al. with 60 students responding to the feedback on an online basic surgical skills course they attended revealed that 83.7% felt the teaching was satisfactory, and the course either met or exceeded their expectations [18].

A study by Quaranto et al. on interactive remote basic surgical skills sessionsfound an improvement in the 31 participating medical students confidence scores in suturing and knot tying. Knot tying and suturing improved on completion of the course from 7.9 to 9.7/18 and 8.0 to 13.8/30, respectively [19].

A survey in India looking into students feedback regarding their online teaching experience yielded some adverse results. A total of 389 students completed the questionnaire, and 71.98% felt that the overall online classrooms adversely affected their learning. In addition, 93.32% felt their practical learning suffered, and 60.93% felt their theory learning was adversely affected [20].

In Co et al.s study, before the pandemic, 30 final-year medical students were taught basic surgical skills face-to-face. The same group was then invited to attend an online web-based surgical skills learning (WSSL) session via Zoom with the same tutor, and the feedback was evaluated via standardised questionnaires [21]. The result indicated that 73.4% of the students felt that learning and demonstrating surgical knot-tying WSSL was no more difficult or easier than the face-to-face session. Of the students, 10% felt that WSSL was easier to follow than the face-to-face sessions. Of the students, 40% highly recommended WSSL with a score of 9 or greater out of 10, while 50% gave a score of 6-8 out of 10 [21].

Blended Teaching

Blended teaching involves integrating traditional tutor-led classroom activities with technology [22].Lindeman et al. studied 29 participants impressions of blended learning. Feedback regarding the blended course and face-to-face teaching using a five-point Likert scale was 3.80 vs. 3.52 for the lecture series. Teaching effectiveness was 4.30 vs. 3.93 [22].

Live Virtual Shadowing

This section will cover studies that discuss the use of technology in the live clinical environment.In Byrnes et al.'s study, a two-week virtual elective was offered to medical students at the University of Pennsylvania in which six participated [23].The virtual elective is comprised of the following three major components:

Virtual operating room (OR): The attending surgeon would wear a head-mounted GoPro camera (GoPro, Inc.,San Mateo, CA) allowing students to watch the procedures and communicate with the surgeon.

Telehealth: It allowed surgeons to have students join them when conducting video conferences with patients. Students could conduct the initial consultation with the patient and then report back to the surgeon.

Virtual didactics: Students would present patients at the virtual multidisciplinary head and neck tumour board.

On the five-point Likert scale, the average student rating of the telehealth sessions was 4.2, the virtual operating room was 4.0, and the overall virtual didactics was 4.5 [23].

At the same institution, a virtual otolaryngology surgery rotation, which comprised livestream interactive surgeries, virtually run small group didactics, and outpatient telehealth visits were synthesised. The findings were that the virtual elective was not a suitable replacement for a true experience in the clinical environment. However, students responded that they felt the virtual week gave them more one-on-one time with senior surgeons compared to traditional electives and that they could see more of the operation than if they were in the operating theatre [24].

Across the USA, the Vanderbilt Otolaryngology online medical student experience was a virtual coursethat enabled online grand rounds, teaching led by residents, and simulated "on-call" sessions. The average Likert score out of 5 was 4.05 for demonstrating interest and 4.62 for supporting students during the pandemic. Demonstrating average knowledge score was 3.57 [7].

Augmented RealityTeaching

Augmented learning is a learning medium in which the environment adapts to the learner[25].Luck et al. used the HoloLens headset (Microsoft Corporation, Redmond, WA) that utilises a mixed reality optic display capability to supplement a "surgeons eyes", allowing the 60 student participants in a series of remotely-delivered simulated ward rounds.

Feedback came from 47 students. Of the respondents,90% "agreed" or "strongly agreed" that AR could improve undergraduate surgical training. They recommended and would like to see the HoloLens AR workshop continue post-COVID-19 pandemic. Furthermore, 85% of students responded that they enjoyed the AR workshop (Table 1) [25].

There has been a drift from traditional didactic classroom teaching to a student-centred learning environment. As a result, the principles that guide education delivery have drastically changed over the past few decades [27]. Acquiring feedback from students involved in educational activities has become integral; hence, this systematic review only includes studies where student feedback was recorded.

Prior to the pandemic, synchronous distant education (SDE) was used widely in varied health science cohorts with higher overall satisfaction compared to traditional education [28].

On reviewing the literature, it is clear to see that existing teaching and learning technologies, which include hardware and software in many institutions, were enhanced in an attempt to mitigate the negative impacts the COVID-19 pandemic was having on undergraduate surgical education.

Distance learning delivered online can typically be done in two formats: asynchronous and synchronous. Asynchronous involves techniques such as recorded videos, podcasts, and other miscellaneous e-learning content accessible to students at any time. In contrast, synchronous teaching involves, but is not limited to, live virtual classrooms and video conferences [29].

A combination of both synchronous and asynchronous pedagogy is termed the flipped classroom. This allows both the benefits of interaction in synchronous and the flexibility of asynchronous to be experienced by the students [1]. The author's view is derived from the literature and experiential learning. This variation is one of the keys to maximising educational performance. Varying the delivery method of the teaching content and adding new innovative media is of value to students, as long as it is implemented effectively. This view is supported by the positive feedback from the studies discussed in this review and the single study that yielded adverse feedback regarding the use of distant-based learning. When the adverse outcomes from Ray et al.s study were critiqued, the reason was poor implementation [20].

Four specific types of technology, i.e., online teaching, blended teaching, live virtual shadowing, and ARteaching, used to mitigate the lost face-to-face learning time were reviewed. These pedagogy methods fall into the online distance education (ODE) category. ODE allows greater flexibility with location and time, increasing convenience for all involved stakeholders [29]. ODEs cost-effectiveness compared to classroom-based learning is also noteworthy [29]. This type of teaching may not only help bridge a deficit but also provide an opportunity for improved learning away from traditional teaching environments. Being able to replace certain aspects of the curriculum with asynchronous, readily available teaching material, which students can access at their convenience, is advantageous for all stakeholders. Pre-recorded videos, if created appropriately and comprehensively, at most may need periodical updates [30]. Online learning assists students in becoming familiar with the inevitable transition into the web-based medical world and the digital health technology that will be more prevalent as time passes [29]. Regarding digital health technology, research has shown comparable clinical outcomes found in person and telehealth post-operative visits [17]. Therefore, if it is integrated into surgical care, students must be exposed to and familiar with the technology to ensure they are competent when graduating.

The student feedback regarding the variations of online teaching they received has been largely positive. Population sizes varied between six and 754. Outcome measures were varied and subjective. However, the most commonly assessed outcome measure was pre- and post-course "understanding" using either a five- or 10-point Likert scale. All but one of the studies have shown a statistically significant improvement in all the domains in which they have collected feedback. It is clear that outcomes cannot be solely attributed to pedagogy reliably. Other factors include but are not exclusive to the facilitator not being experienced or well prepared, the content of the teaching not being at an optimum and appropriate level, the teaching not meeting the learning outcomes, and so on. The need to teach particular video-based communication skills to ensure future clinicians have the necessary skills to build rapport with patients and their next of kin is evident. This is especially important in this commonly two-dimensional distant communication method. In an interview with Association of American Medical Colleges, Neal Sikka, MD, discussed the evolving need for telemedicine training in medical school. He stated that "there really is an art to providing a good video consultation that needs to be taught, just like we teach bedside manner and patient interviewing skills" [17]. Students are required to learn how to be empathetic and show attention when separated from patients by a video screen. The lack of direct eye contact and appropriate physical contact can be mitigated to a degree by increased vocalisation of empathy and other appropriate verbalised emotional responses. Experts in medical education have aptly named this "digital empathy", and there has been a recommendation to include this in the undergraduate curriculum along with the advised increased practice in telemedicine [31].

On the whole, the general perception of medical students who received online surgical education was that they attained both what they needed and wanted [32]. However, for students to be able to make an informed decision about whether or not they want to pursue a career in a specific speciality, they need to discern whether the daily work of a said speciality fits in with the students professional and personal aspirations. Distance learning is limited in this aspect of education [24].

Undergraduate surgical education is more challenging for inexperienced medical students with access to delicate clinical environments where highly specialised skills are practisedwhile keeping patients safe. Achieving this throughout an entire cohort of medical students makes this even more challenging. Distance learning may provide a means of improving this difficult situation, although it cannot be considered a total replacement. Therefore, a continually thorough and thoughtful evaluation of the efforts made by various institutions during the pandemic is necessary and is the only way serial improvement in medical education will progress.

It is also important to note that in the studies included, only one study by Schmitz et al. had controls, and another study by Co et al. subjected the same group of students to the traditional face-to-face and online methods. This impacts the effectiveness of the online teaching method, which needs to be considered as the students have already been exposed to the teaching material and their baseline understanding had been altered. One could therefore argue that the results from this study could be met with caution. The remaining studies were observational in nature.

Meta-analysis could not be performed due to the heterogeneity of data as there are many other variables that could not be reliably controlled. These include but are not exclusive toinstitutions, the technology available, and student engagement/receptiveness to the technology offered.

Successful execution of remote learning courses needs significant technological input. All systems and software must be optimised, maintained, and function at both ends for the students and the teachers. This is even more sensitive when the teaching is synchronous.

With regard to video conferencing software, teachers may default to the technology available at the institution. However, it is also imperative that the students can install the software on their devices.

Regular feedback from all stakeholders, including the facilitators, is important to ensure the continual development of the teaching session.

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A Systematic Review of the Medical Student Feedback on Undergraduate Surgical Education During the Pandemic - Cureus

Faezeh Shahidinejad (Photo courtesy: Faezeh Shahidinejad)

Anti-government protests and demonstrations have continued in Iran over the past month, despite violent government crackdowns. The protests were sparked when 22-year-old Mahsa Amini died while in police custody after being arrested for allegedly wearing her hijab improperly and showing a small amount of hair, breaking Irans strict hijab rules. More than 200 people have died as of mid-October in the protests, the most extensive in decades in Iran. Many of the protesters are university and high school students.

Faezeh Shahidinejad is a University of Hawaii at Mnoa biology pre-med student and an alumna of Honolulu Community College. She graduated from high school in Iran in 2017 and came to Hawaii six months later with her mother and brother. Shahidinejad is closely following the news back home and is greatly affected by what she is witnessing.

It breaks me to see that people of my age and generation are dying only because they are peacefully asking for freedom, Shahidinejad said. I have friends who have joined the protests and they were beaten and tear gassed by the guards. It is hard for me to carry on and live a normal life here when I know that the people in my home are losing their lives every day. Young people with a future ahead of them are risking their lives to fight for justice and basic human rights. I know that if I was in Iran I would also be joining the protests and possibly risk my life.

Shahidinejad says she was personally stopped by the morality police several times when she lived in Iran and told to correct her hijab.

I was told that if I dont correct my hijab or my behavior that I would be arrested and taken away by them, said Shahidinejad I know other students from Iran are also affected by this situation. We do not have a way of contacting our family and friends, we do not know if they are safe or even alive.

Shahidinejad, her mother and brother came to Hawaii because her brother was almost 18 years old, and in Iran every 18-year-old male is required to serve in the military for two years. She and her brother were able to get visas because her mother is a U.S. born citizen. Shahidinejads intention was not to stay in America, rather she wanted to go back to Iran and attend a medical school. She brought her books with her to Hawaii to keep studying for the medical school entrance exam, and wanted to go back to Iran as soon as she received her green card, which took about a month.

However, after arriving in the U.S. she contemplated whether to stay or return home. Staying in the U.S. at the time meant starting over in academics. Shahidinejad was not able to transfer any advanced placement courses, and she was not familiar with the language or the process to even attend a university here. On the other hand, she could leave and return to Iran where she was almost ready to attend medical school. However, that meant Shahidinejad would give up on the freedom that she experienced in the short time she was in the U.S.

In the end I decided that having freedom and liberty as a woman was worth sacrificing my academic progress in Iran and starting over here in the U.S., Shahidinejad said.

After almost two years of working full time in a corporate office and learning English, she decided to go back to school and attended Honolulu CC for about three years, and was able to complete an associates degree in liberal arts with focus on natural science. Shahidinejad then enrolled at UH Mnoa in spring 2022. Aside from pursuing a degree in biology, she is a member of the Pre-Medical Association, Medical Student Mentorship Program, Health Occupations Students of America and CORPS Hawaii. Shahidinejad is also a learning assistant in the School of Life Sciences.

While she is excelling in the classroom, her thoughts continue to be with her people in Iran.

I want people to know that what is happening in Iran is not about religion or hating Islam. It is about women having the right to choose what they want to wear whether it is hijab or not. It is about people wanting to have a normal life and not being afraid to live a life that most people have around the world, Shahidinejad said. They need people like me and you who have the right to speech and expression to be their voice and bring attention to this crisis. Many major national news outlets do not cover what is happening in Iran for political reasons. That is why everyone else who has the resources and is able to talk about this issue needs to do so.

Shahidinejad said that by choosing to share her story means she will not be able to go back to Iran until the current regime is over. She said her name will be added to their list of people who need to be prosecuted for talking against the regime. She made this choice, however, to fight for freedom and justice even when it means she possibly can never return to her homeland again.

This is why I am using my voice and freedom to talk about this issue and be the voice of the voiceless, Shahidinejad said. This is about human rights, and it is a fight for freedom more than anything else.

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UH student from Iran is 'voice of the voiceless' for her people amid deadly protests | University of Hawaii System News - University of Hawaii

image:Of the 10 richest countries in the world, the U.S. ranks last in vaccination rates and first in both numbers and rates of COVID-19 deaths, view more

Credit: Alex Dolce, Florida Atlantic University

The United States Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA), which was immediately endorsed by the U.S. Centers for Disease Control and Prevention (CDC), for new booster shots created to combat the most recent and highly prevalent omicron variants of COVID-19, specifically BA.4 and BA.5. Fortunately, these most recent and very highly prevalent variants, while more communicable, are less lethal.

In a commentary published in The American Journal of Medicine, researchers from Florida Atlantic Universitys Schmidt College of Medicine and collaborators, provide the most updated guidance to health care providers and urge how widespread vaccination with these boosters can now avoid the specter of future and more lethal variants becoming a reality.

Of the 10 richest countries in the world, the U.S. ranks last in vaccination rates and first in both numbers and rates of COVID-19 deaths, said Charles H. Hennekens, M.D., Dr.PH, senior author, first Sir Richard Doll Professor of Medicine and senior academic advisor, FAU Schmidt College of Medicine. The dedicated health care professionals in communities and hospitals across the nation continue to try to address existing and new challenges of COVID-19. We must redouble our efforts to promote evidence-based clinical and public health practices, which should include vaccination of all U.S. adults and eligible children based on the most recent FDA and CDC guidance.

The authors point out that, compared with influenza, the mortality rate from COVID-19 is about 30 times higher. Further, a positive COVID-19 patient is likely to transmit to about six people compared with one or two for influenza. Finally, the boosters will reduce the risk of dying and hospitalization by more than 90 percent.

The most simple and straightforward newest guidance we can now offer to health care providers is that all individuals ages 5 and older should receive a booster shot, said Alexandra Rubenstein, first author, clinical research coordinator, Department of Neurology, Boston Medical Center, and an aspiring physician. Specifically, based on the recent EUAs issued by the FDA and CDC, those 5 and older may receive Pfizer bivalent boosters, and those ages 6 and older may receive bivalent boosters from Moderna. While the absolute risks of severe COVID-19 are low in youths, the benefit-to-risk ratio was deemed to be favorable in a 13-to-1 vote of independent external advisers to the FDA.

According to the authors, vaccines to prevent common and serious infectious diseases have had a greater impact on improving human health than any other medical advance of the 20th century. Nonetheless, since 2019, the percentages of children in the U.S. vaccinated against common and serious childhood diseases has decreased.

In the U.S., diphtheria-pertussis-tetanus or DPT immunizations have decreased from 85 percent in 2019 to 67 percent in 2021, said co-author Sarah K. Wood, M.D., professor of pediatrics and interim chair, Department of Womens and Childrens Health and vice dean for medical education, FAU Schmidt College of Medicine. Recently, a young adult unvaccinated against polio in a neighborhood in Rockland County, New York, contracted a paralytic disease raising concerns that the loss of herd immunity may portend new epidemics of avoidable serious morbidity and mortality in the U.S. and worldwide.

Ironically, the authors note, virtually all Americans would seek effective and safe therapies for any communicable diseases. Most individuals routinely accept major surgery, toxic chemotherapy and/or radiation therapy for cancer, which result in a far greater number of side effects than are caused by vaccinations. The authors encourage health care providers to recommend a COVID-19 booster vaccine to all eligible patients to protect individuals and communities.

Other co-authors are Vama Jhumkhawala, a first-year FAU medical student; and Mark DiCorcia, Ph.D., associate professor of obstetrics and gynecology and assistant dean for medical education, FAU Schmidt College of Medicine, as well as Dennis G. Maki, M.D., Ovid O. Meyer professor of medicine, director of the COVID-19 Intensive Care Unit and an internationally renowned infectious disease clinician and epidemiologist from the University of Wisconsin School of Medicine and Public Health.

Maki and Hennekens served together for two years as lieutenant commanders in the U.S. Public Health Service as epidemic intelligence service (EIS) officers with the CDC. They served under Alexander D. Langmuir, M.D., who created the EIS and epidemiology program at the CDC, and Donald A. Henderson, M.D., chief of the virus disease surveillance program at the CDC. Langmuir and Henderson made significant contributions to the eradication of polio and smallpox using widespread vaccinations and public health strategies of proven benefit.

- FAU -

About the Charles E. Schmidt College of Medicine:

FAUs Charles E. Schmidt College of Medicine is one of approximately 156 accredited medical schools in the U.S. The college was launched in 2010, when the Florida Board of Governors made a landmark decision authorizing FAU to award the M.D. degree. After receiving approval from the Florida legislature and the governor, it became the 134th allopathic medical school in North America. With more than 70 full and part-time faculty and more than 1,300 affiliate faculty, the college matriculates 64 medical students each year and has been nationally recognized for its innovative curriculum. To further FAUs commitment to increase much needed medical residency positions in Palm Beach County and to ensure that the region will continue to have an adequate and well-trained physician workforce, the FAU Charles E. Schmidt College of Medicine Consortium for Graduate Medical Education (GME) was formed in fall 2011 with five leading hospitals in Palm Beach County. The Consortium currently has five Accreditation Council for Graduate Medical Education (ACGME) accredited residencies including internal medicine, surgery, emergency medicine, psychiatry, and neurology. The colleges vibrant research focus areas include healthy aging, neuroscience, chronic pain management, precision medicine and machine learning. With community at the forefront, the college offers the local population a variety of evidence-based, clinical services that treat the whole person. Jointly, FAU Medicines Primary Care practice and the Marcus Institute of Integrative Health have been designed to provide complete health and wellness under one roof.

About Florida Atlantic University: Florida Atlantic University, established in 1961, officially opened its doors in 1964 as the fifth public university in Florida. Today, the University serves more than 30,000 undergraduate and graduate students across six campuses located along the southeast Florida coast. In recent years, the University has doubled its research expenditures and outpaced its peers in student achievement rates. Through the coexistence of access and excellence, FAU embodies an innovative model where traditional achievement gaps vanish. FAU is designated a Hispanic-serving institution, ranked as a top public university by U.S. News & World Report and a High Research Activity institution by the Carnegie Foundation for the Advancement of Teaching. For more information, visitwww.fau.edu.

The American Journal of Medicine

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Newest guidance and evidence for health care providers: COVID-19 and other vaccines

3-Oct-2022

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Needs and challenges for COVID-19 boosters and other vaccines in the US - EurekAlert