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...

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

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

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

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

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

Read the original post:

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

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...