Mark Hamilton won a World Series ringin unusual fashion as a member of the St. Louis Cardinals in 2011.

This week, in a major career transition, he begins his residency as a physician in New York City a city hard hit by COVID-19.

Hamilton was a backup first baseman for the Cardinals for half of the2011 season, but was playing in the Dominican Republic when the team won the World Series. He still received a World Series ring.

After a few years of playing internationally and in the minor league system, Hamilton was released. He retired from baseball in 2014.

"While you never want to be released and it definitely hurts, it actually worked out perfectly. The timing of it couldn't have been better," he said.

He had a plan:go back to university and,eventually, go to medical school.

Hamilton spoke with Day 6 host Brent Bambury about making the shift MLB to MD.

Ten years ago, you made your Major League Baseball debut. And then this month, you're making your debut as a doctor. Which one feels like the better fit for Mark Hamilton?

You know, I think the truth is that they're both a good fit for me. They're both a big part of who I am, and a big part of my journey and my story.

When I was young, my father wasa very prominent researcher in oncology and pathology, and I always wanted to be a physician. My grandfather was a professional basketball player for several years in the precursor of the NBA, and I always wantedto play professional sports.

I'm glad I was able to play baseball while I was young. It's a young man's game, and you can't continue playing it forever. And now I'm glad that I can go into a medical career that I can continue practising for the rest of my life.

Your residency is in New York, and this is a city that's been hit hard by COVID-19. You're starting off in internal medicine. What types of patients do you think you'll be working with?

I anticipate there being a lot of COVID patients still. I know that, you know, our hospitals here have discharged several thousand already. They've done an incredible job.

I'm with Northwell Health, which is the largest health-care employer in the Northeast. And we have a lot of COVID patients remaining, some that have been sick for a while, who have needed intensive care that hopefully, you know, we're anticipating or hoping moving them along to recovery.

And we are well aware that this isn't over, especially in population density like New York. We're anticipating having continued new cases, and we're expecting those people to come in the door.

When you were in baseball you spent a long time on the road. You didn't get to see your family as much as you would have wanted.

But now you're going to be working in this field and then coming home to your family, your wife, your two young daughters. Are you concerned for their safety because of the COVID infections?

It's definitely a concern. It's something we're going to try to mitigate a little bit.

My kids and wife are going to go up to my in-laws in Connecticut at the beginning of my residency, and that'll give me a little bit of time to kind of get my feet under me, see how many COVID patients I'm directly in contact with, and kind of let them be at a distance for a short period of time there. And then we'll make a decision from there.

Obviously, I'd want to see them every day. One of the biggest things [when I played baseball] was how much I was away. It's been wonderful being home for these last six years and in school and seeing them all the time. But at the same time, you know, safety is paramount.

I'm wondering what it feels like to be starting your medical career during a global pandemic. Is there any way that this could be an advantage for you? Does it feel like this is a challenge that is going to require dexterity?

Yeah, I mean, absolutely. I think that there's a lot of things to navigate with this.

We've seen it before, actually. And there's been a lot of people writing about it lately, which is: people that enter medicine during a dire time, during a time of uncertainty, typically kind of get forged in the fire more rapidly. I'm hoping that's the case for me.

One of your baseball heroes is former Yankee Bobby Brown. What made you a fan of Bobby Brown?

So, that was my dad's doing. When I was young, my dad really inspired me with his work. But also, clearly I had an affinity for baseball.

It was clear at an early age that I was at the very least going to have an opportunity to play collegiately, if not beyond. And he really fostered this idea that I could do both.

And hisrole model he supplied me with is Bobby Brown, who played for the Yankees, won a couple of World Series with them, and went on to become a doctor.[He] went to Tulane Medical School and was a cardiologist for a long time. [He] was also the president American League.

And I'll tell you, one of the best experiences of my entire life has actually come out of this situation, where I've gone into medicine and gotten a little bit of press with my graduation.

Tulane University Alumni Association actually reached out to me, and I was able to have a conversation with Bobby Brown about two weeks ago. And we spoke on the phone for about two hours discussing baseball, his career and my career, medicine, listening to his advice about how to go about things. And it was really incredibly special to go full circle.

Written and produced by Laurie Allan. Q&A edited for length and clarity.

To hear the full interview with Mark Hamilton,download our podcastor click Listen above.

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From MLB to MD: Former baseball player Mark Hamilton begins his medical career in midst of a pandemic - CBC.ca

By every measure, the journey of Carl Allamby, MDculminating in his graduating medical school at 47 in 2019was an unlikely one.

He is among the 6.2% of 2019 medical school graduates identified as Black, according to the Association of American Medical Colleges. And in 2018, only5% of US physicianswere Black andless than half of them were men, according to the AAMC. Furthermore, only 5.6% of 2019 medical school graduates were older than 32,AAMC data indicated. Black people account for 12% of the United States population.

Among the barriers that Dr. Allamby, an AMA member, cited in his forging a career in medicine: A lack of Black physician role models in his life.

One of the biggest obstacles was just having it in my mind that you could be African American and become a physician, Dr. Allamby said during an interview with JAMA. All the physicians I had seen during childhood and probably into early adulthood were everything but African American.

I grew up in a blue-collar town where unemployment was pretty high, he added. I remember some of the people who lived in my neighborhood. They were bus drivers and garbage men. A lady who lived across the street was a librarian. All of these were noble professions. But there just wasn't that example to follow at a young age in order to become a physician.

Learn whats needed to improve physician diversity pipeline programs.

Diversity in the physician workforce has known benefitsincluding improved patient outcomesand medical schools are working to create more of it. Morehouse School of Medicine (MSM), is a gold standard in doing so. About 75% of the medical students enrolled at the historically Black Atlanta institution are African American.

That success in attracting Black studentsand those from other racial and ethnic groups underrepresented in medicineis the outgrowth of more than 30 years of work. Some of that work starts with teaching students about careers in science as early as kindergarten.

Unfortunately, there are leaks throughout the pipeline to medicine and health professions, but in particular, for those students on the younger end, being able to see what is possible, is very important, said Rita Finley, PhD, an assistant dean for educational outreach at MSM. It becomes especially difficult if you dont have anyone at home who can help guide you in the right direction.

Many students that I have spoken with in the K12 space dont think that being a physician is an option. They feel that there are limits to what they can do and achieve. We want them to know that there are no limits.

TheAMA Doctors Back to School program also aims to increase the number of minority physicians and work toward eliminating racial and ethnic health disparities. The program sends minority physicians and medical students into the community as a way to introduce children to professional role models and show kids of all ages from underrepresented racial and ethnic groups that a career in medicine is attainable for everyone. Learn more about theAMAs work to reduce disparities in health care.

For older learners, MSMs Reach One Each One Program offers high school aged students a hospital-based, multidisciplinary medical mentoring program. Past cohorts that have gone through the intensive multiweek course have shown that they are more likely to pursue careers in health care, according to a 2016 study.

Morehouses programs to diversify the physician pipeline exist through and beyond K12 and undergraduate programsan on-campus masters degree program in medical science that serves an academic enhancerhave proven to be a valuable resource for students pursuing medical careers.

Once students arrive on campus, faculty members take an active interest in their lives and learning. Morehouse considers its family atmosphere and involved faculty to be keys to its success.

This anecdote shared by Martha L. Elks, MD, PhD, MSMs senior associate dean of educational affairs, reflects what that looks like.

One medical student said that as the work got tough at Morehouse and doubt started to creep in, the student looked up and saw a Black physician faculty member.

The student reflected on what that faculty member had been through and concluded, I can make it.

That was the very essence of the quiet role modeling that our faculty do, Dr. Elks said. Their presenceand caring about the studentsis such a link to what is possible. We dont just tell them, we show them.

Dr. Elks shared the Morehouse strategy with members of the AMA Accelerating Change in Medical Education Consortium at a conference last year during her presentation, Creating the future health care workforce: Promoting equity in admissions and throughout the educational continuum.

As for Dr. Allamby, he hopes that his story can offer evidence of the possibilities to students from disadvantaged backgrounds.

Theres nothing special about me, he told JAMA. If I can do this, if I can face the challenges of a robust medical education, then almost anybody else is capable of that exact same thing. Thats the kind of image I try to portraythat this is something thats totally within your scope. If its something you want to do, you should go for it.

Launched last year, theAMA Center for Health Equityhas a mandate to embed health equity across the organization so that health equity becomes part of the practice, process, action, innovation and organizational performance and outcomes.

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Why this Black intern, a grandfather, worked many years as mechanic - American Medical Association

AUSTIN, Texas Patients with BRCA1/2 mutations are at higher risk for breast, ovarian and prostate cancers that can be aggressive when they develop and, in many cases, resistant to lifesaving drugs. Now scientists at The University of Texas at Austin and Ajou University in South Korea have identified a driver of the drug resistance that can make a life or death difference for patients with these cancers.

A major issue with cancer treatments is the development of resistance, said Kyle Miller, a UT Austin associate professor of molecular biosciences. When treatments stop working for patients, its incredibly demoralizing and its been a huge drive in research to understand these resistance mechanisms.

In a paper published today in the journal Molecular Cell, the researchers describe a protein that may help doctors predict which patients will become resistant to a class of drugs frequently used to treat BRCA 1/2-deficient tumors. The finding could help create more effective treatment plans for their patients.

The scientists identified that a protein called PCAF promotes DNA damage in BRCA 1/2-mutated cancer cells. Patients with low levels of this protein are likely to have poor outcomes and develop resistance to a type of drug that is used to treat BRCA-deficient tumors, called a PARP inhibitor.

PARP inhibitors are an important breakthrough in treating these aggressive cancers, Miller said. What we found is that when levels of PCAF are low, it actually protects the cancer cells from this drug. By testing biopsy samples, doctors may be able to tell using PCAF as a molecular marker for PARP inhibitor responses what treatment may work best for a patient.

Fortunately, there is already another class of drugs on the market, called HDAC inhibitors, that can boost the effectiveness of the PCAF protein. HDAC inhibitors and PARP inhibitors have the potential to be prescribed as a combination therapy.

Previous studies have shown that these two drugs work well together, Miller said. We believe weve found the reason why.

It is possible to test for PCAF levels in biopsy or tissue samples, Miller said, and in the future, the test could be included on a standard panel for cancer testing.

But unlocking the workings of PCAF doesnt just offer clues to combatting cancer. Because this protein is responsible for modifying chromatin, the stuff that organizes 6 feet of DNA in each of our cells so that it fits into its nuclear volume, PCAF also may offer important clues about cell replication.

The focus in my lab is on understanding chromatin and its impact on replicating DNA, protecting DNA and controlling access to DNA, Miller said. Our goal is to understand how every molecule is interacting inside our cells, as this gives clues to what is going wrong in human diseases.

Jae Jin Kim and Seo Yun Lee from the Miller lab were first authors on the paper, and Blerta Xhemalce, an associate professor of molecular biosciences at UT Austin, and Ji-Hye Choi and Hyun Goo Woo of Ajou University contributed to the research.

The research was funded by the National Cancer Institute, the National Institutes of Health, the American Cancer Society, the Department of Defense Congressionally Directed Medical Research Program Breast Cancer Breakthrough Award and the National Research Foundation of Korea. Miller is a CPRIT scholar with the Cancer Prevention & Research Institute of Texas, a member of the Livestrong Cancer Institutes of Dell Medical School and a member of the Dan Duncan Cancer Center at the Baylor College of Medicine.

Excerpt from:
Why Some Cancers May Respond Poorly to Key Drugs Discovered - UT News | The University of Texas at Austin

The medical schools in the state of Florida are consistently very competitive. Top ranked Florida medical schools require students to have a bachelors or masters degree plus a MCAT (Medical College Admission Test) score above a designated threshold to be considered for admissions. Core med school programs generally take four years of full-time study to complete, resulting in a Doctor of Osteopathic Medicine (D.O.) or Doctor of Medicine (M.D.). Once a degree is conferred, students must complete an internship and residency at approved hospital facilities. This phase is followed by a practical and written examination prior to applying for state licensure in Florida. Visit our med school degree page about a degree in medicine or our PreMed portal for additional educational insights and advice.

Get information on the best med schools in Florida today with state listings or by with exclusive search technology. The trove of educational resources will help students better understand how to become a doctor in Florida plus illuminate what it takes to enter other medical fields like neuroscience, bioinformatics, genetics, and cytotechnology. Discover the best path for you and collect information from the top rated med schools in Florida today.

The Florida medical schools listed below are accredited by the Liaison Committee on Medical Education, which is an organization that provides accreditation for medical education nationwide.

Schools are sorted by size with the largest medical schools first, based on the number of medical student graduates per year.

Visit the website for University of Miami at http://welcome.miami.edu/

Visit the website for University of Florida at http://www.ufl.edu/

Visit the website for University of South Florida at http://www.usf.edu

The medical school is located on the Florida State University College of Medicine Campus in Tallahassee. Visit the website for Florida State University at http://www.fsu.edu

Visit the website for Florida International University at http://www.fiu.edu

Visit the website for University of Central Florida at http://www.ucf.edu/

Visit the website for Florida Atlantic University at http://www.fau.edu/

Physicians can work in many types of specialties which may cause a large range in salary expectations. Here is a list of average annual salaries for general practitioners working in major cities in Florida.

+520% Above State Median Income

+449% Above National Median Income

Doctor's in Florida take home an average 97.79 per hour. Annual earnings for Doctor's working in the State of Florida average $203,410 which is 520% above the state median income and 449% above the national median income for all occupations. Employment for a Doctor makes up just 0.02% of the working population in Florida and is limited due to the specific qualifications required along with the schooling involved in this career path. The increasing demand for qualified Doctors coupled with the educational barrier to enter the field is met with a steady supply of eager college graduates anxious to make a long-lasting impact in the lives of others in and around Florida.

Notes: Tuition & fee amounts are for both Florida in-state residents and out of state students, unless noted otherwise. The tuition information displayed is an estimate, which we calculated based on historical data and should be solely used for informational purposes only. Please contact the respective doctor school for information about the current school year.

Source: IPEDS Survey 2012-2015: Data obtained from the US Dept. of Education's Integrated Postsecondary Education Data System (IPEDS). Data may vary depending on school and academic year.

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Best Medical Schools in Florida | Top Med Schools

Novant Health Inc.'s bid to take over operations of New Hanover Regional Medical Center advanced Tuesday when that hospital's board of trustees approved recommending the offer.

The next step is the New Hanover Board of Commissioners addressing Novant's $5.3 billion offer at its July 13 meeting.

Novant is attempting to establish a third flagship in North Carolina. Novant operates Brunswick Medical Center in neighboring Bolivia, where it opened a $100 million, 78-bed community hospital in July 2011.

As part of its bid to manage or own the Wilmington hospital, Novant has agreed to form its first-ever medical education partnership with UNC Health and its medical school. UNC Health already provides educational and clinical services to the New Hanover system, which is made up of 855 licensed beds at three hospital campuses.

Last Thursday, the Novant offer was recommended to the trustees by a 21-member group made up of trustees, hospital physicians and local community advocates.

If the commissioners approve the recommendations, the advisory group said, there will be multiple other steps and considerations over the coming months, and the public will continue to be kept informed." One would involve the hospital and New Hanover County executing a letter of intent with Novant Health.

The Wilmington Star-News, quoting New Hanover chief communications officer Jessica Loeper, said it could take until September or October for a final vote.

Daily management decisions would remain based in Wilmington, according to the Novant proposal.

Novant said the New Hanover hospital would have a representative on Novants board if a joint venture is formed, or two members with a fully integrated partnership with Novant as the parent company.

The trustees passed a resolution Tuesday to place $200 million from the sale into a fund that would support hospital employees and area providers.

While we firmly believe a partnership is in the best interest of the community and the NHRMC team, we know any transition is difficult for those doing the work and continuing to provide care, Jason Thompson, the trustees' chairman, said in a statement.

We want to provide the resources to help them personally and professionally so they will stay with NHRMC and grow with the organization for many years to come.

The $200 million would come out of the estimated $1.9 billion in proceeds going to New Hanover County.

Another $300 million could go toward a New Hanover County Revenue Stabilization fund to help protect local taxpayers from unexpected expenses and downturns, Another $50 million would be placed in a mental and behavioral health fund.

The trustees endorsed establishing a $1.25 billion community foundation to provide financial support to health and social equity, local education, community development and community safety.

We see the partnership with Novant Health as the best way to meet the growing needs of the region with expanded services, more affordable care options and a culture that is similar to NHRMCs," Thompson said.

The advisory group has been in place since October and listed Atrium Health and Duke Health as finalists. Bon Secours/Mercy Health, HCA Healthcare and UNC Health also submitted proposals.

Carl Armato, Novants president and chief executive, has said Novant and the Wilmington hospital are natural partners with aligned values and not-for-profit charitable missions.

Maintaining and expanding medical education at (the hospital) will allow Novant Health to best serve the Wilmington community, while continuing to build the pipeline of physician talent for North Carolina.

The attempt to find a new management team or owner has drawn opposition from community members, and a Save Our Hospital advocacy group is pursuing internal financial options.

"Save Our Hospital Inc. is a group of concerned citizens in New Hanover County who believe county leaders have endorsed a flawed process with a pre-determined outcome to sell our community hospital to the highest bidder," said Gene Merritt, the group's president.

"If not stopped, this deal will mean higher costs with no guarantees of better access or quality of care for our community."

Read more:
Novant wants to buy or manage a Wilmington hospital. The medical center's trustees have OK'd the bid. - Winston-Salem Journal

A national television audience learned about Aaron Palmer this month because he is a rarity.

Palmer, 33, a graduate of Akrons East high school and Walsh University in North Canton, is one of relatively few Black doctors and one of even fewer training to be a neurosurgeon.

Palmer, who graduated from East in 2005 and had a bumpy road to get where he is, is a "minority within a minority," CBS news correspondent Adriana Diaz said in her report for the "CBS This Morning" show.

Diaz noted that the number of Black males attending U.S. medical schools has dropped since the 1980s.

"I often get mistaken for whoever works at the hospital, [every kind of worker] but a doctor," Palmer said in an interview with the Beacon Journal.

He spoke from Chicago, where he works at a downtown hospital. Hes in his fourth year of a seven-year residency program for those training to be neurosurgeons. The program is part of Northwestern Universitys Feinberg School of Medicine.

Palmers journey started in Akron, where he grew up in a struggling neighborhood on the east side.

"There were seven of us [his parents and their five children] in a two-bedroom house," Palmer said.

His mother, Amy, now retired, was an LPN and then a registered nurse. His father, Hollis, who died in 2010, was a tree trimmer for Summit County.

The house was affordable and it was next door to Hollis mother, Amy said, explaining why the family stayed in the home. Amy lives in New Franklin these days, where the family moved in 2004.

While Aaron Palmer was in high school in Akron, he had no dream of going to medical school.

"I had no idea of what degree to get," Palmer said. "It sounds very foolish, but my 18-year-old mindset at the time was to get a scholarship so I could play football at a university."

He ended up at Walsh University after a brief stint playing football at a school out of state.

At Walsh, he barely played a season of football before he lost interest. He wasnt interested in applying himself to his studies, either, after choosing chemistry as a major because it "sounded cool."

His GPA reflected his lack of interest, hovering around a 1.5-2.0 for his first three years at Walsh.

Something clicked

In 2009, "something clicked," Palmer said, as his dad was growing sicker from esophageal cancer from which he died in 2010.

That year, Palmer had shadowed a Black surgeon at Summa Akron City Hospital for a couple of days and glimpsed a possible future for himself.

The surgeon, Palmer said, "reminded me of my dad [in the way] people really looked up to him and he helped people out."

Palmers father, who served in the U.S. Marine Corps and the U.S. Navy, was a leader in the familys neighborhood, devoted to his family and helped lead the East Pee Wee Football program.

"He was a mentor and a male figure to a lot of people who didnt have that," Palmer said. "Hed break up fights in the street. Hed fix appliances for people."

"My husband said a child does better than their father and their mother," Amy Palmer said.

"Im proud of all my children," she said of her four sons and one daughter.

Around this time, Ann Caplea, a professor at Walsh, reentered Palmers life.

Palmer had earlier taken an anatomy and physiology course from Caplea and had not done well, earning a D.

Caplea, director of human anatomy at the school, advised pre-med students at the time. Palmer sought her out, asking her if medical school was attainable.

"I knew she would be honest and tell me if I had a chance," Palmer said in a talk he gave this month to Walsh freshmen.

Caplea, who has kept in touch with Palmer, recalled that life-changing meeting.

"I really felt like he was capable [of getting in] if he put his mind to it," she said.

Palmer "would have moments of brilliance" in the class in which he got a D, she explained. "I thought, You know, he knows this [material]."

Palmer needed motivation, Caplea said.

"Thats what happens with students sometimes, they dont have the motivation, and they just do enough to get the minimum," she said. "And that was Aaron before he decided he wanted to go to medical school.

She helped Palmer lay out a plan. For three semesters over a period of more than two years, Palmer loaded up on classes. He retook ones in which he had done poorly while also taking needed prerequisites.

He had to drop out at times to earn money to continue. To raise cash, he and his older brother, Timothy, who now owns a used-car dealership in Tallmadge, bought and sold used cars.

Finally, in 2011, Palmer graduated from Walsh with a 3.1 GPA.

Exposed to neurosurgery

His senior year, he applied to numerous medical schools and received many rejection letters. Boonshoft School of Medicine at Wright State University accepted him, awarding him a scholarship that substantially reduced his tuition.

He laminated his acceptance letter to medical school and placed it on his fathers grave.

He vowed to not repeat his initial performance at Walsh and buckled down from the start.

In his third year at Wright State, Palmer was in a clinical rotation when a neurosurgeon let him assist in a surgery. Palmer was hooked.

"It was the fist time I saw the brain," Palmer said, recalling the surgery on the brain of a comatose man who had been in a car accident.

"We went to patients room the next day the guy is there changing the channels on his TV, watching the news. I thought, Oh wow, this is what I need to do."

But there was yet another hurdle ahead.

In their fourth year of medical school, students go through a process to be "matched" with residency programs. Palmer failed to land a match with a program in neurosurgery, a highly competitive specialty.

But Palmer wasnt defeated.

He spent a year working in general surgery at a hospital in Michigan and tried again.

"I felt like I had let everybody down," Palmer said. "I felt I had come too far to not truly do more" more clinical research to bolster his application, more networking and more applying.

He got accepted at Northwestern Universitys Feinberg School of Medicine and works at Northwestern Memorial Hospital in Chicago.

Giving back

"I have stumbled every step of the way," he said.

Now, he said, he feels obligated to give back to other struggling students, helping them study, serving as an example of what can be accomplished despite myriad struggles.

He speaks out about the lack of racial diversity in medicine.

Only about 5% of physicians identify as Black, while African Americans account for 13% of the countrys population. Only 6% of graduates at U.S. medical schools are Black, according to the Association of American Medical Colleges.

"We have a lack of role models," he said.

"The only reason Im here is because people reached out and said, Hey, I can help you. Thats how we can really make a huge impact on peoples lives."

More Black doctors would mean better health outcomes for Black patients, Palmer said, echoing studies that show theres a greater sense of trust and communication between Black physicians and patients.

Health inequality is playing out in the ongoing novel coronavirus pandemic, health experts note, pointing out the disproportionate number of Blacks, as well as other minorities, and the poor who are at risk from COVID-19, the disease caused by the virus.

When he completes his residency in Chicago, Palmer would like to return to Northeast Ohio. Hes intrigued with the possibility of combining medicine and public policy.

"A lot of the issues [of racial and socioeconomic disparities in medicine] they've been politicized heavily. I dont think these are political issues. I just think these are human rights issues."

Beacon Journal reporter Katie Byard can be reached at kbyard@thebeaconjournal.com.

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East grad overcomes challenges on journey to be a neurosurgeon - Akron Beacon Journal

Virtual medical appointments are more common since the coronavirus pandemic began. But without physical exams, doctors may miss certain diagnoses and miss out on building relationships with patients. filadendron/Getty Images hide caption

Virtual medical appointments are more common since the coronavirus pandemic began. But without physical exams, doctors may miss certain diagnoses and miss out on building relationships with patients.

Despite a foothold in medicine that predates Hippocrates himself, the traditional physical exam might be on the verge of extinction. The coronavirus crisis has driven more routine medical appointments online, accelerating a trend toward telemedicine that has already been underway.

This worries Dr. Paul Hyman, author of a recently published essay in JAMA Internal Medicine, who reflects on what's lost when physicians see their patients almost exclusively through a screen.

A primary care physician in Maine, Hyman acknowledges he'd already begun second-guessing routine physicals on healthy patients as insurance requirements pushed doctors away from them.

But while Hyman is now providing mostly telemedicine, like many doctors during the pandemic, he writes that he has gained a clearer sense of the value of the age-old practice of examining patients in person. He notes the ability to offer reassurance, be present for his patients and find personal fulfillment as a doctor.

"I think there's something therapeutic about seeing a physician and having them lay their hands on you, and my sense from the feedback I've gotten from the article already is that a lot of people agree that it's therapeutic in its own right and that can be lost without the physical exam," Hyman told NPR.

Hyman spoke with NPR about his experience adjusting to a new world of medicine, one that eases access to health care providers yet has the potential to erode basic human connection.

This interview has been edited for clarity and length.

How has the sudden shift toward mostly virtual visits changed the way you practice medicine?

It's changing almost week to week as I go through and learn, then try to understand what the virtual visit is providing and what it's not providing. It's kind of a learning experiment in real time. In some ways, I am more cautious because I am not sure what I am missing from not seeing the patient in person. And so I try to think through what I would have gained from the physical exam. And if there is enough of a concern about that, then I will advocate for the patient to be examined.

It does give me, for some patients, a lot of insight into the way they live their lives and what their home or work environment is like, which can help me understand more about where their health concerns fit into their overall priorities. I think it's helped me connect with patients in different ways.

What are some things that are much easier to catch through a physical exam or might be missed using telehealth?

We don't really completely understand sometimes what we're missing because we haven't really done medicine this way. I give the example of a patient whose heart is not working as well, and that's causing fluid buildup in their body. For that specific patient, it would have been challenging to make the diagnosis over the video or a phone; it takes touching the patient, being able to listen to their heart, legs, look at their blood pressure and look at the veins in their neck to make that diagnosis.

Another one that I often worry about is dizziness. People can feel dizzy for many reasons. Some of them are very common and not concerning, but occasionally the reason is serious. It's very hard to distinguish some of those reasons on a video trying to walk a patient through an exam.

Beyond the obvious potential for missing a diagnosis, what else is lost in the doctor-patient relationship when you can't do physical exams?

I have to agree with [Abraham Verghese's] description of a ritual, that there's something about coming into the office and going through a history and being examined and that ritual provides real comfort and meaning to both a physician and to the patient.

I mentioned in the article, too, that the exam is an objective piece of data. The patient has a narrative of their illness that the physician is trying to understand to help them feel better, but then the patient may think one thing is going on and the physician may think another. The exam can really be helpful as a piece of science or data that helps clarify what should happen next.

Especially in our world of electronic health records and a lot of other things that can be very distracting, it's that moment in time when the physician is fully present. And I think that can be really supportive, meaningful and important.

You mentioned in the essay that one of the primary roles of a physician is listening to the patient. Are there instances where a virtual visit provides a better environment for doing that?

I think there are, if the patient is fully present during the visit. Sometimes patients can be distracted, doing other things. But there are opportunities in the virtual visit to actually really connect and listen without some of the distractions of a busy office and an exam room. We still have to remember that most of what we're going to learn about a patient's illness is going to be through listening to them.

Insurance providers and volume-based metrics have already reduced the frequency of performing routine physical exams on healthy patients. Has the business of medicine already started to devalue a doctor's touch?

I think what is devalued is humanistic interaction between a patient and a physician development of a relationship and good listening. The way billing codes have worked for primary care, you could put down parts of your physical exam, so it wasn't being completely devalued. But I think it is devaluing to patients to request doctors do visits so quickly. More time is needed, as physicians, to listen to our patients and develop relationships, to think critically about them.

Less time with patients seems to be the enemy for doctors, both virtually and in person.

Yeah, time is the most critical part. And we're just getting less and less of it. I just got an email from a doctor, a pediatric specialist, about how he always does a very complete physical exam because he needs, as we've learned in medical school, to take a step back, think about the big picture and not miss something. That mindset is not valued in the current situation.

You anticipated some wearable technologies that might give more objective information about patients during virtual visits in the future. Are you worried technology may replace the physical exam?

I think there's tremendous benefit to some of the wearable technologies, but I think that society is going to need people to interpret what the wearable technology is telling you. But, we're primary care physicians, we're detectives and we still follow the rules of "when in doubt, examine the patient," right? Right. So a lot of times where I see a patient, when it's not clear what is going on and I'm trying to figure [it] out, I put all these puzzle pieces together.

I think that [the physical exam is] a skill and a tool. I still agree it's a core and fundamental part of being a physician. This isn't, you know, the end to our identity as physicians. I think that we need to evolve. As our data evolves and technology evolves, we need to evolve with it. But we just can't leave it fully behind.

Kristen Kendrick is a board-certified family physician in Washington, D.C., and a health and media fellow at NPR and Georgetown University School of Medicine.

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Is The Pandemic Fast-Tracking The Disappearance Of The Physical Exam? : Shots - Health News - NPR

UPDATED

Written long ago but resulted in a very painful trigger for many of you

Before I cant breathe became the rallying cry of the Black Lives Matter movement, the phrase was simply a direct way for patients to tell medical personnel that they couldnt breathe.

Medical patients may want to find a new way to convey their pulmonary distress, lest they be accused of triggering someone.

The Indiana University School of Medicine apologized to students for a question on a cardiovascular exam that included the phrase I cant breath[e], according to screenshots of the question (above) and message to seniors in All Sections (below) that were forwarded to The College Fix. The question reads:

A patient who missed dialysis suddenly becomes pale, diaphoretic, and screams, I cant breath! [sic] You glance at the monitor and notice the following rhythm. You are unable to palpate a pulse and initiate immediate CPR. The most appropriate next step in therapy is: [the options for answers are not visible]

The apology message, which is undated, was written by Daniel Corson-Knowles, assistant professor of clinical emergency medicine.

We are very sorry to have included content, specifically the words used to express difficulty breathing, within a case presented last week in the cardiovascular quiz in a context that was insensitive and upsetting due to the similarity to phrases associated with the killing of George Floyd and several other instances of police violence against black people in the U.S., he wrote. (The phrase took on political significance, however, because Eric Garner said it several times as New York City police pinned him down.)

Seeing the phrase in this context resulted in a very painful trigger for many of you, and the school adjusted this material as soon as we learned of this oversight on Friday, Corson-Knowles continued. (This is dubious: Robby Soave at Reason said he reviewed messages in an online chat forum from the class, which suggested most students did not seem personally offended by it, but rather were worried that others were offended.)

Corson-Knowles said the question was written long ago and reflected phrasing that patients might use when experiencing cardiac or pulmonary difficulties, but that does not excuse the school for not catching this very phrase and removing it when preparing the quiz material.

The professor added that the school was in the process of reviewing practices cases for the potential presence of intrinsic bias, microaggressions and other content that can help perpetuate stereotypes and affect how students feel, learn, perceive and treat their patients and how this translates into patients outcomes.

The medical student who shared the screenshots wrote in an email that the IU School of Medicine education overall has been effective at preparing me for a career in medicine, but this apology for a quiz questions phrasing is among the incidents that give me pause:

This is the most recent and most egregious example of the PC, trigger warning, and safe space culture that has permeated my education. [] I find it unacceptable and outrageous that my institution of medical education is not only allowing the training of physicians who can be upset and destabilized by extremely common patient presentations, but is consistently encouraging and supporting such an attitude. These are future physicians who will be expected to save lives in difficult circumstances. []

Ihave to say, this should be concerning for anyone who may find themselves in an emergency room in the future.

The student continued that many classmates expressed their outrage and fear at the prospect of being required to attend their clinical rotations during the beginning of COVID-19, slandered those who protested the lockdowns, audibly defamed the president and conservatives during class time, yet still had the ability to be active participants in the round of protests in Indianapolis and on the IU campus.

Other parts of the med school curriculum are feeding lack of trust in healthcare professionals, the student said, including required classes that teach us that transgenderism is not something to question and that gender identity can and should be chosen by pre-K children without any sort of parental interference or input.

UPDATE: Robby Soave at Reason said he reviewed classmates discussion of the quiz phrasing in an online chat forum, finding few personally offended by it. The new material has been added.

MORE: Georgetown med school will fight microaggressions for years to come

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Health workers and others rallied in Seattle during a Doctors For Justice event on June 6, protesting police brutality in the wake of George Floyd's death. Medical training needs a hard look too, doctors say: Students of color and LGBTQ people often bear the brunt of what can be a bullying culture. David Ryder/Getty Images hide caption

Health workers and others rallied in Seattle during a Doctors For Justice event on June 6, protesting police brutality in the wake of George Floyd's death. Medical training needs a hard look too, doctors say: Students of color and LGBTQ people often bear the brunt of what can be a bullying culture.

As doctors and nurses across the United States continue to gather outside hospitals and clinics to protest police brutality and racism as part of the White Coats for Black Lives movement, LaShyra Nolen, a first-year student at Harvard Medical School, says it's time to take medical schools to task over racism, too.

The fight for equality in medical education isn't new, says Nolen, the first black woman to serve as Harvard Medical School's student council president. But she's hopeful that the national conversation around racism in society will force hospitals and medical schools to address racism within their own institutions.

"It wasn't until over a week of riots that people started to pay attention," Nolen says. "We bring black med students to these institutions, and they fill quotas, and they make institutions look good. But we're not protecting them. We need to protect them."

Studies show that students of color and those who are LGBTQ are more likely than other classmates to experience mistreatment during their training. Research published earlier this year in JAMA Internal Medicine, for example, suggests that minority students are more likely to face discriminatory comments, public humiliation and inappropriate sexual advances during their medical education.

Nolen has been heartened by the outpouring of online and in-person activism she's seen, ranging from Twitter testimonials to opinion pieces in major medical journals. She's been involved in efforts at Harvard and nationally to combat racism in medical education.

But there is much work to be done, she says.

The JAMA Internal Medicine study of more than 27,500 medical students in 2016 and 2017 found that 38% of students nationwide from racial and ethnic groups that are under-represented in medicine including students who are black, Latino or Native American reported mistreatment. That's compared to only 24% of white students across the U.S. who said they had been mistreated during medical school.

The results raise questions, the study authors say, about racism in medical education and its implications for the persistently low numbers of people of color who become doctors.

"If these small disadvantages accrue throughout medical school, it could be contributing to keeping certain populations out of medicine," says Katherine Hill, the study's lead author and a medical student at Yale. "Discriminatory comments can have a negative impact both on the people who are targeted, and on bystanders."

Hill and her team used a data set known as the Association of American Medical Colleges Graduation Questionnaire. It's a survey about medical school experiences that almost every medical student completes right before graduation, covering topics ranging from student debt to how prepared they feel they are to practice medicine. The data in Hill's study included responses from about 72 percent of all med school graduates in 2016 and 2017.

Mistreatment during training was a major focus of the survey. Students were asked if they had been publicly humiliated, for example, or been asked to perform sexual favors in exchange for good grades, or been subjected to offensive remarks or names.

More than 35% of the students responding to the survey said they had experienced some kind of mistreatment during medical school.

"It's almost part of the medical school culture that a faculty member may try to embarrass you or humiliate you," says Dr. Dowin Boatright, an assistant professor of emergency medicine at Yale and the study's senior author.

The roots of that bullying culture in medical training are complex, Boatright adds, but he guesses it often occurs in high-stress environments in the hospital, or because it's perceived as an accepted hazing ritual.

Previous research corroborates Boatright's observation that these kinds of experiences are common for students of all races, particularly during clinical training, when students are no longer in the classroom. During that clinical period, students are the least powerful members of a hierarchy, joining teams of medical residents and attending physicians, nurses, and other health care professionals as they care for patients.

What's new in his study, Boatright says, is just how much more likely minority students are to experience this harassment, bullying behavior and abuse.

Women and students who identified as lesbian, gay, bisexual, or transgender were also more likely to experience mistreatment, whatever their race or ethnic group. Above 40% of women reported that they experienced mistreatment, compared to about 25% of men. Similarly, about 43% of LGBTQ students reported an incident of mistreatment, while just over 23% of heterosexual students did.

Boatright and Hill both note that not only are minority students more likely to experience racist or bigoted incidents, they are also more likely to experience mistreatment in general such as being humiliated in front of a team even when the harassment doesn't seem specifically related to race or ethnicity.

Take the experience of Dr. Michael Mensah, who had to listen as one of his professors repeatedly used the N-word at work when Mensah was a medical student in 2015 at the University of California, San Francisco.

Mensah, who is now a psychiatry resident at the University of California, Los Angeles, says he and colleagues were sitting in a hospital workroom at the time, listening to music as they prepared to round on their patients. A song came on that used the expletive. To Mensah's shock and to the shock of everyone else on his team his supervisor casually repeated the expletive multiple times.

"I had a repugnant choice: swallow my lump of anger and sadness to preserve group harmony, or risk my grade and reputation by confronting my superior," he wrote in a 2017 essay in JAMA Internal Medicine about the incident.

More than five years later, the words still sting.

"If that person was willing to speak so frankly to us, and so rudely ... Imagine how that person treats their patients of color," Mensah tells NPR.

While he says he heard from many other students who experienced racism during training physicians mocking non-white patients, peers telling their classmates of color they were accepted to medical school because of their race some other people who read the essay dismissed his experience as a one-time incident.

Instead of questioning whether structural racism might be built into medical training, they dismissed that supervising physician as "only one bad apple," Mensah says.

Evidence from the JAMA Internal Medicine study and others like it confirm that these types of racist incidents are common in health care.

"It really validates my personal experience, which is remarkable because of how isolating these experiences can be," he says. "It makes clear that I wasn't the only one to experience differential, unequal and discriminatory treatment. It helps me feel like what I went through wasn't my fault."

Mensah worries that the prevalence of mistreatment toward students of color, women, and LGBTQ students has another legacy: normalizing discrimination in health care, and ultimately affecting the way future doctors treat their patients.

"There's a direct link between this abuse and how some of our health care disparities play out," he says.

Now, Mensah is focusing much of his energy on addressing racism in health care institutions. He recently wrote, along with several co-authors, an op-ed in Scientific American about how the misuse of medical language in George Floyd's initial autopsy report overemphasized the role of coronary artery disease and hypertension in his death.

Mensah also spoke at a rally this month in Los Angeles sponsored by White Coats for Black Lives. But because there are still such persistently low numbers of black people working in medicine, Mensah found himself addressing a sea of white faces.

"I was the only black male there, unfortunately," he says.

Mara Gordon is a family physician in Camden, N.J., and a contributor to NPR. You can follow her on Twitter: @MaraGordonMD.

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Medical Schools Taken To Task Over Racism, Hazing And Other Abuse : Shots - Health News - NPR

Tens of thousands of residents are beginning medical careers as a new wave of coronavirus patients threaten to overwhelm hospitals and the doctors who care for them.

Its not quite what these new doctors signed up for or expected when they entered medical school four years ago. But they are providing reinforcements to a stretched corps of health care providers desperate for help as cases of COVID-19, the disease caused by the coronavirus, surge in Texas.

Dr. Rachel Boren, a pediatrics resident at the University of Texas Health Science Center at Houston, heard the stories about doctors falling ill and, in some cases, dying from the coronavirus. Like many of her fellow residents, who graduated in May, she is nervous about entering the medicine when doctors and nurses are at high risk of contracting the disease.

At the same time, said Boren, 26, who graduated from the University of Texas Rio Grande Valley School of Medicine. I don't see another way because I think that all these patients need the best health care they can receive.

Boren and other new doctors are beginning careers at a particularly uncertain period for their profession and the health care industry. Not only must they contend with a global pandemic in the short-term, they also face the long-term prospect of working in health care systems stressed by a shortage of physicians.

The Association of American Medical Colleges projects a shortage between 46,900 and 121,900 physicians by 2032 as the U.S. population grows at a faster rate than new doctors enter the health care system. At the same time, the nations aging population will require more care.

For patients, that would mean longer wait times for medical specialists, such as pulmonologists who focus on respiratory systems, and a worse shortage of doctors in rural and low-income communities, said Dr. Janis Orlowski, chief health care officer at the Association of American Medical Colleges.

UNINSURED RATES: Report: 1.6 million Texans lost employer-sponsored health insurance

During the pandemic, hospitals are seeking all the help they can get. Texas loosened medical licensing requirements in March to allow retired nurses and doctors and medical practitioners with out-of-state licenses to treat patients.

The recently graduated residents are also boosting the local health care workforce, as infection rates rise in Houston, said Dr. Richard Hamill, who oversees the Baylor College of Medicines internal medicine residency program.

Hes divided his residents into three groups: the first as clinical workers on the front lines treating patients; the second as backup in case residents or attending doctors get sick and the third on standby, mostly studying for their board certifications and taking online classes focused on technical and policy issues in health care.

In the three months since the pandemic broke out, a handful of his doctors have contracted COVID-19 as well as other illnesses unrelated to the virus, leaving gaps in care for patients. Thats where the residents can fill in, he said.

Hamill said he sees parallels to his own residency, which he completed during the height of the AIDS/HIV pandemic in the 1980s. At the time, those doctors had few clues how HIV was transmitted or when a drug treatment or vaccine would be available.

None of the residents have backed off, Hamill said. A lot stepped up.

A lot are stepping up now. Dr. Daniel Bajwa, who in mid-June started his residency in internal medicine at the University of Texas Health Science Center at Houston, sees the pandemic providing an on-the-ground training experience that he would have never gotten otherwise. He expects his residency to be a long course in patient safety, giving extra care to prevent transmitting COVID-19 infection to patients who come the hospital for other reasons.

Bajwa, 28, also expects to encounter COVID-19 patients when he begins his rotation in the emergency room in July in the emergency department. He admitted hes worried about catching the virus.

At least for my sanity, I try not to dwell on that, he said.

Dr. Amy Engler, who began her residency as an internal medicine physician in mid-June, sees the opportunity to help when doctors are needed more than ever. Engler, 29, graduated from Baylor College of Medicine in March, and will stay at Baylor to complete her residency.

I feel the responsibility to my community to take care of my patients and be there for my city, she said.

NEW GRADS: Pompless circumstance: Houstons graduating class of 2020

Many other new and aspiring doctors feel the same way. Researchers at the Association of American Medical Colleges at one time worried that COVID-19 would scare students from the profession, worsening projected physician shortages.

But number of people applying to take medical licensing exams hasnt declined. Nor has the number of students wanting to become doctors.

People take a look at what we are doing, said Orlowski, the associations president, and theyre saying, you know, I want to have a profession like that. I want to be able to serve people, I want to be able to help them.

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Joining the front lines: Texas medical residents begin rotations during the pandemic - Houston Chronicle

Wake County EMS (N.C.) shared with us the following story.

For two medical fellows, the EOC is as much a classroom as a jobsite.

This springs sudden outbreak of COVID-19 has upended lives. Gatherings have been canceled, weddings postponed, businesses shuttered, families separated and, tragically, lives have been lost.

Yet, for some, this time of trial is an opportunity to grow and learn.

During the pandemic, the Wake County Emergency Operations Center is helping forge two future leaders of emergency medicine. The young doctors were wrapping up EMS fellowships at the UNC-Chapel Hill School of Medicine when the crisis hit, and since then, Dr. Johannah Merrill and Dr. Mariecely Luciano-Feijoo have served in equal measure alongside Wake Countys full-time emergency medicine staff in the EOClearning firsthand more they ever could about public health response from a text book.

This is a horrible thing to have happened, but Im glad it happened at this point in my training and not next year, when I wouldnt have had the experience that I have now, said Dr. Johannah Merrill, who will move to Massachusetts next month to become an EMS medical director.

For Dr. Mariecely Luciano-Feijoo, who was born and raised in San Juan, Puerto Rico, the eventual goal is to take what shes learned stateside back home to improve her islands EMS system.

I could not have asked for better teaching than to be actively learning like this, Dr. Luciano-Feijoo said. It is easy to read and try to understand certain things, but theyre not easy to apply unless youve lived through them.

It takes a certain personality to thrive in EMS.

Where most grow flustered when a days plans go awry, these women thrive on the chaos of a day spent running from crisis to crisis. Sit them down for an interview, and they exude that powerful, calm sense of energy that comes with competence, and they look ready to leap into action at any moment.

Dr. Merrill, who graduated in 2016 from the University of Virginia School of Medicine in her hometown of Charlottesville, said the fast-paced, ever-changing nature of EMS work drew her to the field. In 2019, she completed a residency in emergency medicine at the University of Rochester Medical Center in New York.

Aside from the thrill of the job, Dr. Merrill said she appreciates being the first physician to see a patient after an emergency.

Some of a patients most critical moments occur in the pre-hospital environment, she said. Thats when we have a really big ability to make a difference.

For Dr. Luciano-Feijoo, COVID-19 is the second disaster to have shaped her career. She completed medical school in 2016 at the University of Puerto Rico and, the following year, Hurricane Maria hit during her residency in emergency medicine at a local hospital. In the days and weeks that followed, Dr. Luciano-Feijoo found her homes emergency medical infrastructure to be underfunded and out of date.

Our EMS system has a lot of limitations, and that did not help the Puerto Rican population in that kind of disaster, she said. That brought me to the states to get a better sense of a proper EMS system, and a better understanding of how I could bring that knowledge back to Puerto Rico.

The program at UNC-Chapel Hill caught her eye, because fellows split their time between Wake County and neighboring Orange County. Working with Wake County has allowed her to see whats possible in a large EMS system, Dr. Luciano-Feijoo said, and Orange County, which has about 1/7th of Wakes population, has taught her how to operate on a scale closer to what shell see back in Puerto Rico.

Although she didnt set out for a career in EMS, Dr. Luciano-Feijoo has a heritage of running toward disasters. Her mother, Celia Feijoo-Nieves, was one of the first two women to become firefighters in Puerto Rico in 1989. It was later that year, during a routine physical following her first big fire, an examiner told her she was pregnant.

So Ive been going into emergencies since before I was born, Dr. Luciano-Feijoo joked. And throughout my childhood, I sometimes went with my mother to emergencies on the fire truck when she was able to take me.

The fellows will tell you theyre learning a lot in the EOC, and most of that comes as a byproduct of hard work. Each takes turns rotating into the role of EMS medical director, which is a position with defined duties in the EOC command structure.

The days vary widelyjust how the doctors like italthough their time is spent planning and directing others rather than rendering aid. Wake County activated its EOC in response to COVID-19 on March 5 and, as the county moved to combat a never-before-seen virus, the fellows helped create new workflows and protocols for public health and EMS staff.

These days, Drs. Luciano-Feijoo and Merrill are working closely with facilities that have reported outbreaks, making sure theres follow-up on positive tests results and coordinating strike teams, along with any other tasks that arise throughout the day.

The EOC brings together staff from across disciplines to coordinate quick and decisive action. While Dr. Merrill has years of experience in EMS, she said her time in the EOC has helped her see how various departments fit together into the bigger picture of emergency management.

The thing thats been the most beneficial has been learning how to coordinate between a bunch of different services, such as fire and law enforcement, she said. They all have different priorities, because they have different things to worry about, and its been beneficial to see how that all fits together.

In addition to their long hours in the Wake County EOC, each doctor works shifts as attending physicians in the emergency department at UNC Hospitals in Chapel Hill and Hillsborough, and they provide telemedicine for troopers at the N.C. State Highway Patrol.

At the end of the month, Drs. Merrill and Luciano-Feijoo will complete their yearlong fellowships and begin the next chapter of their careers.

Dr. Merrill will head up to Lawrence, Mass., a city of about 80,000 near the border with New Hampshire, where shes slated to become the next EMS medical director at Lawrence General Hospital. She will have a few months as an attending physician to work alongside the current director before taking over.

While shes eager to get home to friends, family and tropical weather, Dr. Luciano-Feijoo will join the faculty at UNC-Chapel Hill and spend another year working as an attending physician in the universitys hospitals. She plans to keep soaking up the best practices of how EMS operates in the states, and then shell work to understand how things can change back home.

I am not well-versed on the pre-hospital system in Puerto Rico yet, she said. Thats one of my next projects.

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COVID-19 Puts EMS Fellows to the Test at N.C. EOC - EMSWorld

COVID-19 cases may be on the rise in at least 20 states, but some doctors suspect the severity of the disease may be decreasing a bit.

Doctors at University of Pittsburgh Medical Center (UPMC) say people with COVID-19 dont seem to be getting as sick, and those who recently tested show a lower viral amount than what was being detected in people earlier in the pandemic.

According to the doctors at UPMC, the number of COVID-19 patients needing ventilators has also decreased.

A similar trend was recently observed in Italy.

One Italian doctor suggested the new coronavirus was weakening, as some people in Italy newly diagnosed with an infection showed a smaller viral load than those who were tested a month ago.

But health experts are skeptical.

Many say theres not enough evidence to conclude that the virus is, in fact, losing steam.

The changes in severity may have less to do with mutations within the virus itself, and more so with improvements in treatment and testing.

Health experts say theres no evidence the new coronavirus has mutated into a weaker version.

Research has shown the virus mutated already, which is normal for a virus, but theres no proof its going through more mutations affecting the severity of the disease it causes.

I dont think we have evidence of this yet, says Dr. Heidi Zapata, a Yale Medicine infectious disease doctor and assistant professor at the medical school. The study concluded that most of the mutations were largely neutral and did not affect its lethality.

Dr. Amesh Adalja, an infectious disease physician and senior scholar for Johns Hopkins University Center for Health Security, suspects the changes in the new coronaviruss behavior are caused by multiple factors the first of which is testing.

At the start of the pandemic, we hadnt yet ramped up testing, and there were delays between when people developed symptoms and when they were tested.

Now its become routine to test people for COVID-19 earlier in the disease process.

Were also testing more people with milder symptoms who may have lower viral loads, according to Adalja.

We are getting much better at testing, and we test much quicker now, Adalja said.

Another theory is that people may be getting infections with lower-infecting doses of the virus.

With physical distancing, peoples exposure to infectious viral material is likely much less than it was before safety guidelines were mandated.

The amount of the virus a person is exposed to when they get an infection might influence their later viral loads, according to Adalja.

It may be that people are getting infected with a lower amount of virus now because so much social distancing has been put into place, Adalja said.

One of the bigger questions about COVID-19, especially as we dive into summer, is if the warmer weather will affect transmission. Its a possibility infectious disease experts have toyed at for months.

Zapata says its definitely a possibility that environmental factors like ultraviolet light, heat, and humidity are influencing the viruss behavior. For example, influenza becomes more transmissible during the winter months due to the cold, dry air.

However, we still dont know for certain how weather and the environment will affect the new coronavirus, Zapata notes.

Early studies find heat and dry air may help keep the virus from surviving on surfaces. But the virus is mainly spread via peoples respiratory droplets, not through surface contamination.

One should note that rising COVID-19 in tropical countries may go against the idea that with summer will come the end of COVID-19, Zapata said.

Just look at whats unfolding in South America, where countries like Brazil, Chile, and Peru have become new epicenters of the pandemic.

Its much more plausible that physical distancing has led to a decline in cases in some areas.

This most likely has to do with the effectiveness of social distancing and the precautions we are taking, Zapata said.

Its worth noting that SARS the coronavirus that struck in 2003 mysteriously burnt out 7 to 8 months after it had been spreading.

Scientists still dont understand how or why SARS died out.

COVID-19 and SARS share genetic material, but SARS was much easier to contain since all people with an infection had symptoms.

With this new coronavirus, many people with infections are asymptomatic, making it difficult to blunt the spread of the virus and disease.

We dont have clear answers as to why the virus appears to be changing.

I think its important to study to see whats going on, Adalja said.

Researchers will have to look at all the patients and their disease characteristics at the start of the pandemic and now to identify any changes in peoples viral loads or disease trajectories.

Adalja says we need more data to help us understand if there is a real phenomenon going on here, or if its a testing artifact.

Some doctors say people with COVID-19 dont seem to be getting as sick, and that people recently tested are showing a lower viral load compared to those who tested positive for COVID-19 a few months ago.

Health experts say it doesnt look like the virus has mutated to be weaker, but this observation is likely a result of amplified testing capabilities and increased physical distancing measures.

More research is needed before scientists can say whether this is a phenomenon or simply due to better testing.

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Is the New Coronavirus Getting Weaker? What to Know - Healthline

Posted on: May 28, 2020; Updated on: May 28, 2020By Chris Horn, chorn@sc.edu, 803-777-3687

Bryce Jerin isnt an international student he grew up in Harrisburg, North Carolina, near Charlotte. But spending the first eight years of his life in India indelibly shaped Bryces view of life, education and what matters most.

Bryce Jerin walks around campus with his grandfather.

I consider myself much more American than Indian, but because I had Indian perspectives instilled in me at a very young age, I never really let go of that, says Jerin, an Honors College graduate who majored in experimental psychology. In India, its God, education and family, and thats how every family sees their life. They focus on their religion, on sending their children to school and making sure they do well.

Jerin certainly checked the do well box in college. Hes graduating summa cum laude and with leadership distinction in peer and civic engagement, having served as a supplemental instructor for five semesters. Engaging with others is why he chose South Carolina a large university with opportunities to cross paths with a lot of people. Thinking back to my first semester, I really enjoyed getting to meet a lot of new people, many of whom I am still friends with, says Jerin.

I also became really involved in Alpha Epsilon Delta, a pre-professional honors society for students pursuing health care fields, where I made a lot of friends, got the chance to develop relationships with professionals in the health care field, and ended up becoming the chapter president. It helped me gain a lot of perspective and receive advice for how to get into medical school.

He credits Eileen Korpita, director of the Office of Pre-professional Advising, for his destination this fall the universitys School of Medicine campus in Columbia. She connected me with a lot of opportunities and gave me perspective on how to write my personal statement in the application. She was also just an awesome person to talk to.

Jerin also points to Erin Gatrone, his organic chemistry professor, and Charles Schumpert, his biochemistry professor, with inspiring him to do well in two challenging courses. But when it comes to inspiration, no one can really compare with his grandfather, the man who helped raise him in those early years in India.

Because I never really had a dad, my grandpa has always been a father figure to me. When he called me and said he was planning on coming to visit me in America, I could not hold my excitement. Even in his old age, my grandpa traveled over three days and thousands of miles to come all the way to the university to see where I lived, offer valuable life advice, and remind me of where I came from.

We took a walk through my favorite place on campus, the Horseshoe, and he told me in our native language, Whatever you do, whoever you become, always remember to thank God for the blessings you have been given in this life. I will always cherish the memory of that walk, and I am grateful for the support, guidance and values he instilled in me since my childhood.

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For potential medical students with a passion for science and research, an MD-Doctor of Philosophy (PhD) dual degree program may hold some appeal. Because its a path that differs from the traditional medical school trajectory, here are a few things that students weighing this less-traveled road should keep in mind.

Medicine can be a career that is both challenging and highly rewarding, but figuring out a medical schools prerequisites and navigating the application process can be a challenge unto itself. TheAMA premed glossary guidehas the answers to frequently asked questions about medical school, the application process, the MCAT and more.

There are fewer MD-PhD programs, and they accept fewer students than traditional MD programs. According to a recent survey conducted by the Association of American Medical Colleges (AAMC)"The National MD-PhD Program Outcomes Studyin 2016 there were 1,936 MD-PhD program applicants, 649 matriculants and 602 graduates.

Looking over the past few years of medical school matriculation data, roughly 20,000 new students matriculate each year. Considering that there are significantly fewer spots, MD-PhD program applicants are likely going to need to apply to more programs.

Now in the first year of his PhD researchafter completing two years of medical schoolat the University of Southern California Keck School of Medicine, Drayton Harvey applied to 30 MD-PhD programs.

Its not just hard to get in, its hard to survive and thrive during the process to fulfill the requirements of both becoming a medical doctor and a PhD, said Harvey, an AMA member. If you dont have the passion, it could be very daunting.

Learn the pros and cons of pursuing a dual degree.

Most MD-PhD programs grant entrants tuition-free training. In addition, most students in those tracks earn a stipend, which according to the AAMC report, can be as high as $38,000 annually. Harvey believes that the potential savings on education shouldnt be your top motivation for entering an MD-PhD program.

[The lack of tuition] is a very attractive aspect, especially with the cost of medical education being what it is, Harvey said. But it is an incredibly competitive process to get in and during that process it is really easy for interviewers to pick up on that you are doing this for the wrong reasons.

The average MD-PhD program length, according to the AAMC report, is eight years. So, in attending an MD-PhD program, youre doubling your time in medical school. When factoring in residency training and, for those who have aims on fellowship, an MD-PhD students training can extend well beyond a decade.

The best advice I got was once you are accepted into a program and you show up on day one, you have started your career, Harvey said. You are at your job working every single day. You are not waiting to get to a career point. That is helpful for students, instead of focusing on how long-term the training process is, you can center yourself on the fact that [getting in] is an amazing accomplishment. You are in your career. Its called professional school for a reason.

Learn how research experience can strengthen your medical school application.

Of MD-PhD program alumni, according to the AAMC report, the vast majority either work as faculty members at U.S. medical schools or work for the for the National Institutes of Health, research institutes, industry and federal agenciesin the COVID-19 pandemic the value of these rules has been reinforced.

As far as specialty, a survey conducted by the AAMC of more than 4,600 MD-PhD physicians found that the most popular specialties among that group were:

It is worth noting that the list above excludes other, a specialty designation selected by 7.1% of respondents.

Within specialties, MD-PhD degrees were most common among physicians in:

Have peace of mind andget everything you need to start medical school off strong.

Continued here:
Considering an MD-PhD program? Here's what you should know - American Medical Association

Its a really weird time for us because I feel like we've worked so hard to get here, and we were really excited to celebrate this accomplishment, and it just kind of has fizzled out, said Ariane Lemieux, 27, who will be completing her internal medicine residency in Dallas. The worst part, I would say, is not being able to say goodbye and thank you to all my mentors and friends that I've made through med school that I would consider my family now. It's not being able to close the book.

Edwards said graduating during a pandemic feels anticlimactic.

The saddest part is that all of this happens so fast that I haven't been able to see my classmates in person in two months, and we're not all going to be in the same place at the same time again, maybe ever, Edwards said. It's not the way that I pictured med school ending, especially being the first class. When we came in, we were the only students in the building, and so we really felt like it was ours, and we really bonded like a family.

This year, Match Day when graduating medical students across the country simultaneously open their match letters to discover where they will be completing their residencies for the next three to seven years fell at 11:00amMarch 20. But instead of ripping apart envelopes at their planned brunch with classmates and family, Dell Medical students had to settle for clicking open emails together over Zoom.

People could raise their hand when they wanted to announce, said Lemieux, who organized the virtual celebration with a classmate. They would tell everybody on Zoom ... I'm going to Portland, and we all cheer. Except you actually can't hear everybody because everyone's on mute.

Clinical rotations for Dell Medical students were also canceled in March. Instead of caring for patients face to face, Lemieux finished the requirement from home, compiling and sharing resources on how to talk to patients with COVID-19 and their families. Similarly, she completed her intensive care unit requirement via online modules and virtual simulations.

But Lemieux and other students were still able to contribute from home through Dell Medicals newly created global pandemic elective. They performed screenings and contract tracing, worked on models and helped shape Austins policy response, among other tasks, Johnston said.

I think it was, oddly, a really good way to redirect them, Johnston said, because now they've got all of that knowledge and experience, which they're going to absolutely need in their new jobs after graduation.

For now, Lemieuxs hospital in Dallas isnt allowing residents to treat COVID-19 patients in an attempt to limit the number of people exposed to the virus. But graduates like Edwards, who is heading to Detroit to complete his residency in emergency medicine at Henry Ford Hospital, will be thrust onto the front lines almost immediately.

He and his wife, Kate Spitz, who also graduated from Dell Medical this week and matched at the same hospital, recently returned from a house-hunting trip to Michigan. Last month, they canceled their wedding and got married over Zoom. Later, they nixed their honeymoon.

But as much as they had to give up, Edwards said hes more eager than ever to get to work. His biggest fear is giving coronavirus to somebody else. Edwards and Spitz are already plotting out logistics toprevent that from happening, like keeping the COVID laundry from the regular laundry and driving a COVID car and a non-COVID car.

We just want to take every precaution because we believe this is real, Edwards said. We know this is real.

For Edwards, the COVID-19 crisis has only reinforced why he left engineering to go into health care. But he said the pandemic has also spurred in him another feeling of responsibility.

I think the medical field as a whole is kind of disappointed in the public to see how much misinformation has been really touted and trotted out as the truth, Edwards said. And I think it's incumbent on my generation and my classmates to really gain the trust of the public back.

Disclosure: The University of Texas at Austin and Austin Mayor Steve Adler, a former Texas Tribune board chairman, have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of themhere.

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After an 'Anticlimactic' Virtual Goodbye, Dell Medical School's Inaugural Class Heads to the Front Lines of the Pandemic - Pulitzer Center on Crisis...

Because of the COVID-19 pandemic,Harvard University and Harvard Medical School held virtualgraduation ceremonies this year to ensure the health and safety of the Harvard communities. In-person celebrations will take place at a later date.

For the more than 100 Harvard Medical School masters and MD-PhD students this year, the global coronavirus pandemic did not get in the way of their formal passage into a changing world of medicine and biomedical research.

It's a worldthat, perhaps now more than ever, will need their intellect and dedication, master's studentswere told during their online graduation ceremony on May 28.

Read more about HMS/HSDM Commencement and Class Day

For thousands of years, humanity has been plagued by outbreaks that ravaged societies, like todays pandemic. Smallpox, measles, mumps, rubella and others stayed with us for centuries until scientists and medical professionals persevered and found cures and treatments to make our world healthier and safer, said keynote speaker Laurie Glimcher,Dana-Farber Cancer Institute president and CEO, HMS alumna,andthe Richard and Susan Smith Professor of Medicine at HMS.

This is now your time, she added. You are being called to do your part to be agents of health and use the power of science, combined with your own curiosity, talent and training to solve the problems that plague humanity today, from Alzheimers to heart disease to cancer and more. And yes, to rid the world of the novel coronavirus and prevent the next epidemic.

The 126 masters graduates were told that their skills will be needed as they enter hospitals and labs.By being agents of health, Glimcher said, they will also be agents of hope for humanity, adding that people all over the world are putting their hope and faith in science like never before.

Yes, the challenges weve faced for the last several months are unprecedented, Glimcher said. But when you are tested, you must respond by harnessing all of your determination, creativity and innovationand those special traits of hard work, dedication and commitmentto continue making progress for all the patients and their loved ones who are counting on you.

The masters graduates received degrees from eight HMS masters programs: bioethics, biomedical informatics, clinical investigation, global health delivery, health care quality and safety, immunology and medical education as well as the Schools first masters degrees in clinical service operations. The grads hailed from every continent except Antarctica, said HMS Dean George Q. Daley, in his congratulatory remarks.

Weve all had to rapidly adapt to a new normal, and that has not been easy, Daley said. Many of you have had to endure even longer separations from your families than you had planned. Many of you have confronted unexpected health care burdens from the COVID-19 pandemic, both in your own lives and in your service in medical, scientific, policy and related spheres.

The current health crisis has impacted every one of us, and yet you persevered.

But, Daley added, Although the pandemic adds a bittersweet tinge to what should be a joyous occasion, I will say this to you as solace: If you can get through this, you can get through anything.

Dean for Graduate Education Rosalind Segal told the graduates, many of whom already hold advanced degrees or work as practicing physicians or health care professionals, that all of the HMS masters degree programs share a goal of further training future leaders who can advance the worlds understanding of disease and improve care for patients everywhere.

This pandemic this year highlights why this goal is so critical, Segal said. The graduates of each program are well prepared to deal with repercussions of the new coronaviruswhether it is the immunologists deciphering the immune response to SARS-COV-2, the biomedical informaticians who can rapidly identify the novel sequences and determine which have been infected by virus, the clinical investigators who can test new therapies, or the leaders in clinical service operations who can rearrange clinical care to deal with a crisis, she said.

In a separate online ceremony on May 26, the 18 graduates of the Schools MD-PhD program gathered with faculty and loved ones to celebrate what for some has been a five-to-nine-year academic journey.

Their celebration opened with a video montage featuring candid photos of the gradssix women and 12 menthrough their years at HMS and MIT, at poster sessions, picnics, retreats, beach outings and on the HMS Quad. Dean Daley, himself an MD-PhD graduate, toasted their achievement and told them you will be the ambassadors of the best that HMS has to offer.

Loren Walensky, director of the Harvard/MIT MD-PhD program and an HMS professor of pediatrics, served as master of ceremonies, telling the grads that earning their dual degrees has prepared them well for the many different kinds of careers they will be pursuing,adding that the coronavirus pandemic has made them soldiers on the frontlines, running toward the fire.

COVID-19 is the crisis that came without a fire drill, but you are uniquely ready to make a difference, he said. In the hospitals, in the laboratory, in the public health sector or in the government.

He told them that their graduation would be more memorable than most due to a once in a hundred years global pandemic, and thatupon graduation they will no longer be students and everything will change. From now on, he said, they will be responsible for the medical judgments and decisions they make.

"Did the intervention you made that day help the patient? Did it neither help nor hurt? Was your decision wrong or even harmful?These are the questions that come with being ultimately responsible for the well-being of another human being.You will now have influence over the healing process and as much of an enormous responsibility as it is, the more responsibility you take on, the more deeply fulfilling your doctoring will be," he said.

He told those who will be pursuing research that they will assume responsibility for creating solutions in the lab that will improve human health.

I promise you that there will always be an army of people sitting there, waiting to tell you that your idea stinks and that your plan isnt doable, he said. Part of assuming the responsibilities you assume today is to harness the confidence and the fortitude to stay focused on what you believe in. This is not a 100-meter dash. Its a marathon. So, you have to stay laser-focused on what you believe in, so that you, yourself, can go the distance.

Three student speakers, David Cox, Amy Li and Sana Raoof, addressed their classmates to discuss what their years in the program have meant to them, recalling how awestruck they were by the talent and intellect of their classmates.

In this program, excellence is the standard, not the exception, said Cox, who spoke lovingly of his mentor, Feng Zhang,an accomplished CRISPR scientist who believed in me.

Li, the new mother of a six-month-old, thanked her parents for helping her get to the finish line to earn her degree. She said she learned the most from the many shots that I missed, and she said her classmates were the best part of her nine-year journey.

We felt each others losses and we also celebrated together, Li said.

Raoof also thanked faculty and leadership, and she also recognized her classmates.

"I thank the graduates of the MD-PhDprogram. We have all, in some ways, provided great inspiration for each other. We helped each other writing our F30s, helped each other get fellowships, warned each other about weird things happening on the wards, and also created memories together year after year," she said. "We have all taken slightly different paths, but Ihope we all got to the same place by the end to be proud of ourselves and excited for the next chapter."

The HMS masters program has grown rapidly, and Segal said 110 students will continue with their training this year while 184 new students will begin their programs in the fall. This years graduates specialized in the following areas:

Excerpt from:
Agents of Health and Hope - Harvard Medical School

The first graduates of New Jersey Medical Schools global health distinction program talk about what theyre thinking and feeling as they careen into the medical profession during the COVID-19 pandemic.

When Asmi Panigrahi was accepted to New Jersey Medical School, she was eager to become a doctor who would help patients in ways that extend beyond medicine. She applied and was accepted to the schools Distinction Program in Global Health, joining its inaugural cohort and embarking upon a curriculum that would enrich her medical worldview to incorporate social determinants of health and principles of health equity.

She knew it would be tough to balance the medical school requirements with the global health program, which includes field experiences, didactic learning, leadership expectations, and a capstone project. And she would embrace the schools host city of Newark, learning how its most vulnerable residents need more than access to quality health care in order to lead productive lives.

But she never could have imagined what the world would be like during her final term at NJMS, when she made the hard-earned transition from medical student to M.D.

The COVID Class

Panigrahi and her NJMS classmates, including three other students in the global health distinction programs Class of 2020, graduated in April, during the peak of the COVID-19 pandemic. And Newark is within an epicenter of activity: 34 percent of the nations 1.6 million COVID-19 cases are within the tristate area of New Jersey, New York, and Connecticut, and 35 percent of those cases have been in New York City, which is Newarks neighbor to the east.

This twist of fate has prompted the first-ever graduates of the medical schools global health distinction program to reflect upon their time at Rutgers and what lies ahead. Two of these new doctors, Panigrahi and classmate Nemesis Y. Hazim-Liriano, talk about what theyre thinking and feeling as they careen into the medical profession at a time when everyone is concerned about global health.

Asmi Panigrahi, M.D.

This is a major milestone in your life, and youre experiencing it through the filter of an infectious disease pandemic. Whats on your mind?

Panigrahi: As one of the 30,000 newest physicians entering our nations workforce during the coronavirus pandemic, I am reminded of the privilege it is to be joining a profession that is, in its essence, wholly dedicated to healing.

Has your understanding of global health changed since you started medical school?

Panigrahi: Yes, definitely. Ive realized that there are innumerable roles that physicians ultimately take on in the global health space, from drafting international policy to conducting biomedical research to leading short-term medical missions to practicing long-term overseas, just to name a few. Attending medical school in the incredibly diverse Newark community revealed to me, time and again, how global health also encompasses local and community health, especially in todays increasingly globalized world.

Nemesis Y. Hazim-Liriano, M.D.

How has the pandemic influenced your outlook for this next chapter of your medical education and career?

Hazim-Liriano: Ive been a commissioned officer in the U.S. Army since 2016. When the military match for residency training took place last December, I was so excited to start work as an orthopaedic surgery intern. Given the current circumstances, Ive had to mentally prepare myself to work in whatever area we may be needed. As medical students, though, weve always had to find ways to integrate ourselves wherever we can help. I found my niche helping the COVID team at University Hospital in Newark with interpreting in Spanish and doing follow-up calls for patients that have been tested and discharged.

Looking back on your medical school experience at NJMS, what lessons will you draw upon as you begin your residency?

Panigrahi: I am so deeply grateful tothe entire Newark community andall of my patients throughout medical school who have taught me the most important aspects of my medical education. Though social determinants of health has increasingly become a buzzword in health care, the reality of caring for patients in Newark instills far more than any textbook or journal article could attempt to impart when it comes to issues ranging from access to health care to housing stability to immigration status. Advocating for patients was a daily act that I witnessed my peers, seniors, and attending physicians engage in, and advocacy is viewed as an essential component of patient care. That has deeply influenced me and will always be a part of my own practice of medicine.

How will your global health mindset influence your medical practice?

Hazim-Liriano: Ive learned that sustainable global health can work in many ways, and that includes working with global populations right at home. For instance, providing language support to all non-English-speaking patients, hosting health screenings and workshops within local immigrant communities, and mentoring younger students from underrepresented minority groups so that they, too, can help bridge the gaps that lend to these populations being disproportionately affectedby not just COVID, but by many of the chronic illnesses we commonly see. This pandemic has brought some of those concerns to a brighter light, and I hope that it drives change in insurance policies and access to care.

Case Study of the Century

Nearly 200 NJMS medical students graduated in Aprilvirtually and a month early.

We were looking forward to being at graduation to congratulate this first cohort as they received their diplomas with the Distinction Program in Global Health notation on it, says Harsh Sule, associate professor of emergency medicine and, along with associate professor of surgery Ziad Sifri, a founding director of the distinction program. Sule and Sifri also are core faculty members of Rutgers Global Health Institute.

In the shadow of this pandemic, it is essential that all health workers have a basic understanding of global health and its very real impact on their own immediate surroundings, Sule says. Global health is not just about helping people in other countries, a common misconception. It has security implications for the U.S. and the world, and it is intertwined with many other factors, such as food insecurity, poverty, unemployment, and mental health.

Both Sule and Sifri have been juggling their academic responsibilities with their clinical roles as physicians at University Hospital. At the height of the outbreak, Sule was working with emergency department teams to manage a large volume of COVID-19 patients, including several in critical condition. As director of the emergency medicine residency program at NJMS, he makes sure there is adequate clinical coverage by resident physicians in the emergency department while also ensuring their safety. Sifri, part of the hospitals frontline trauma team, assesses and manages patients presenting with acute trauma and unknown COVID-19 status. He also was part of a surge team that managed critically ill patients in a flexible intensive care unit space. (Read more about University Hospitals transformation during the pandemic.)

If there is one thing the pandemic has shown us, Sule says, its something those of us in global health have discussed for a long time: the world is interconnected, and health issues, especially infectious diseases, do not respect borders.

Congratulations to the four medical students who graduated from New Jersey Medical School with a Distinction in Global Health. They graduated on April 13, and their medical degrees will be conferred officially on May 31 as part of the Rutgers University Commencement virtual celebration.

Nemesis Y. Hazim-Liriano

Capstone project: Distribution of Aedes aegypti Arboviral Infections in the Dominican Republic

Residency: orthopaedic surgery, Tripler Army Medical Center

Thobekile Ndlovu

Capstone project: Medical Students and Pre-Departure Orientations: Are Medical Students Adequately Prepared for Global Health Experiences?

Residency: global child health pediatrics, Baylor College of Medicine

Asmi Panigrahi

Capstone project: Incorporation and Implementation of WHO Medical Donation Guidelines Within the International Relief Community

Residency: internal medicine and preventive medicine, Kaiser Permanente San Francisco and University of CaliforniaSan Francisco

Nicole Silva

Capstone project: Portuguese-Speaking Populations: Local and International Outreach

Residency: neurosurgery, University of North Carolina School of Medicine

COVID-19 data sources: CDC.gov, NYC.gov

Link:
The Real World of Global Health - Rutgers Today

States that have adopted gender-minority nondiscrimination rules for private health insurance policies slowed an epidemic of mental illness, suicide attempts and suicidal thoughts among transgender and gender-diverse people, compared with states that do not offer such protections, according to new research from Harvard Medical School.

The study findings, published May 6 in JAMA Psychiatry, reveal that in states that enacted such protections between 2014 and 2016, the rate of suicide attempts and suicidal ideation, collectively known as suicidality, dropped by as much as 50 percent among gender-minority individuals in the year following the adoption of the rules, compared to states that did not have nondiscrimination policies.

While overall rates of suicide attempts among transgender people increased over the eight years of the study, they did so to a markedly lesser degree in states where the policies were enacted, the study found.

Get more HMS news here

The study results underscore the potent effect of policies that prevent discrimination in health care, the researchers said.

Science tells us that the stress people experience from discrimination can cause serious health problems, including mental health conditions and suicidality said Alex McDowell, astudent in the PhD Program in Health Policy at Harvard University and lead author of the study. Interactions with the health care system should improve the health of transgender and gender-diverse individuals, rather than be an additional source of stress.

Additionally, the study authors say, nondiscrimination rules may boost peoples sense of safety and trust in their health care providers, a known predictor of better health outcomes.

The study compared changes in rates of suicidality and rates of mental health hospitalizations among privately insured gender-minority individuals, before and after the policies were put in place. Suicidality for gender-minority individuals decreased or stayed the same for individuals living in states that adopted antidiscrimination policies compared with those living in states that did not, the analysis showed.

Multiple studies have shown that across the United States, Canada and Europe, more than 20 percent of gender-minority people report that they have attempted suicide in their lifetime. This includes people who identify as transgender, nonbinary and other gender-diverse identities. More than 10 percent report attempting suicide within the last year. Researchers estimate that suicidality among transgender people is as much as five times higher than among the overall population. Past research shows that this epidemic of suicidality is associated with stress related to various forms of discrimination.

These findings are consistent with evidence showing that when it comes to mental health, gender-minority people fare better if they have access to gender-affirming hormone therapy and surgery, receive care from knowledgeable health care professionals, and are protected by nondiscrimination laws.

The nondiscrimination policies may also be easier to implement than expected, the researchers said. Many states that have already enacted these policies have done so in the form of a bulletin or memo released by the state insurance division that amends an existing insurance nondiscrimination policy. For example, some states that had an existing policy prohibiting discrimination by private insurers on the basis of sex simply added gender identity to the policy, which avoided potentially controversial negotiations that might otherwise be needed to enact the new rules.

Also, because these policies do not necessarily require private health insurers to cover gender-affirming hormone therapy and surgery but rather prohibit categorical exclusion of these services from their policies, the policies do not automatically mean increased health care spending.

For these reasons, the researchers said, health insurance nondiscrimination regulations may offer a mechanism for reducing barriers to care and mitigating discrimination for gender-minority individuals.

People are hurting, even dying because of discrimination, said Sherri Rose, senior author of the study and HMS associate professor of health care policy in the Blavatnik Institute. This study shows the potential for great health benefits that can come from relatively simple policy changes.

Co-authors include Julia Raifman of the Department of Health Law, Policy and Management, Boston University School of Public Health; Ana Progovac of the Health Equity Research Lab at Cambridge Health Alliance and the Department of Psychiatry at Harvard Medical School.

This work was supported by the Laura and John Arnold Foundation.

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Lifesaving Protections - Harvard Medical School

By DAVID J. HILL

There are probably other phrases that would do justice to the spring semester transition to distance learning. But this one seems most appropriate: zoom, zoom!

UB faculty, staff and students participated in 46 days of remote learning, a change necessitated by the COVID-19 pandemic. Over the course of those five weeks, 31,380 UB students took part in more than 5,580 courses in Blackboard.

And, heres the real whopper of a stat: 78,953 sessions using the Zoom videoconference platform accounting for 32,414,240 minutes. Thats over 540,000 hours, according to the computing prowess of Google. And if you keep going down that rabbit hole which UBNow of course did it amounts to 61 calendar years worth of Zoom sessions.

Shifting course content to distance learning was no easy task, and I applaud the efforts of UBs dedicated faculty and staff who made that happen without sacrificing the quality of education, says Graham Hammill, vice provost for academic affairs and dean of the Graduate School.

Here are some other amazing stats provided by UBIT:

To be sure, the technological undertaking of all this was no small feat.

I would like to extend my deepest appreciation to our 2,509 professors and other instructors. To UBIT, including our 400 staff and student workers, my heartfelt gratitude for your professionalism and commitment to UB. Without you, the spring semester might have been much different. Finally, to the 150 IT professionals across the schools, colleges and administrative units, thank you for your partnership, says Vice President and Chief Information Officer J. Brice Bible.

Bible attributes the smooth transition to these keys to success:

Dilpreet Kaur, a first-year student in the Jacobs School of Medicine and Biomedical Sciences, praised Jacobs School faculty members in a story that aired on Spectrum News Buffalo about how medical education changed this spring.

Its definitely a difficult transition watching patient interactions on YouTube. Its not how I thought Id be doing medical school for the first year. But I think UB has done a great job integrating the programs that they had available, Kaur said.

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Breaking down the stats on UB's spring of distance learning - UB Now: News and views for UB faculty and staff - University at Buffalo Reporter

Coronavirus Pandemic: The New Normal for Medical Communities and American Society (a virtual event)

Please join FRONTLINE for an important discussion about the present and future effects of the coronavirus on medical professionals, as well as an exploration of the public health considerations as states begin to re-open amidst various pandemic guidelines. The conversation will feature clips from FRONTLINE's film Inside Italy's COVID War which shows a behind-the-scenes look at the difficult decisions Italian ER physician Dr. Francesca Mangiatordi and her medical colleagues navigated on a daily basis, while Italy was at the epicenter of the outbreak.

Presented by FRONTLINE PBS, the Harvard T.H. Chan School of Public Health, and the Harvard Medical School Center for Bioethics.

FEATURED SPEAKERS:Dr. Michelle Williams: Dean, T.H. Chan School of Public Health, Harvard UniversityChristine Mitchell: Executive Director, Harvard Medical School Center for BioethicsSasha Joelle Achilli: Film Director/Producer of Inside Italy's COVID War, FRONTLINE PBSModerated by Raney Aronson-Rath, Executive Producer, FRONTLINE PBS

Photocredit: Courtesy of Sasha Achilli/FRONTLINE (PBS)

This virtual event will begin at 4pm Eastern Standard Time.

WGBH encourages you to use Zoom Webinar to watch for this event. Zoom is free to the public but you will need to download it to your computer first. You can download Zoom here. If you already have Zoom, you will not need to download the platform again.

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Coronavirus Pandemic: The New Normal for Medical Communities and American Society (a virtual event) - wgbh.org