FORT SMITH, Ark. -- - The first medical school in Fort Smith opened its doors earlier this week to students to mark a milestone for medicine in the River Valley.

150 students started their journey today to become a doctor at the Arkansas College of Osteopathic Medicine.

The brand new medical school welcomes students from across the country to be a part of the class of 2021.

ARCOM hopes their brand new services and their initiative for better education will break the glass ceiling in medicine for the River Valley.

"I think the passion of the peope here really stood out to me," medical student Ryan Schultz said. "Then you start to look at Fort Smith and what it has to offer and the need that the community presents and the excitement of the community for the school. That is what becomes a very attractive option."

The school is also home to natives from the area. '

Missy Olcott is from Fort Smith and says she probably wouldn't have had the opportunity at 30 years old to attend medical school if it wasn't for one close to home.

"Staying close to Fort Smith is what made sense to me," Olcott said. "You never know what is going to come here or what the future holds, but being here in Forth Smith and being a part of the growing community is what is really important to me."

ARCOM says its biggest goal is to provide doctors who will build relationships and stay and serve the River Valley.

"People are coming from the wood works to welcome us and embrace us so it is important that we train physicians to give back and serve the community," Executive Director of Student Affairs said. "Since they have embraced us, we are need to embrace them and we are doing that."

In the next several years, ARCOM does plan on expanding to train and educate more future doctors.

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First Medical School in Fort Smith Welcomes Students Today - KNWA

Are you talking on your campus about the UVM Larner College of Medicines transition to an all active learning program?

You should be.

This change at UVM is a very big deal - and a big deal outside of the world of medical education.

Heres why:

Lesson 1 - Learning Research Is Filtering Into Teaching Practice:

UVM is redesigning the the pre-clinical years of medical school to move towards 100 percent flipped courses. Students will review lectures and readings before class, and then take low-stakes formative assessments to gauge areas of weakness. Class sessions will consist of hands-on group problem solving, with faculty serving as mentors and coaches.

Research has consistently demonstrated that active learning techniques yield great levels of student learning - and retention - as compared to traditional methods of lectures and high-stakes assessments. What research (as well as experience) has not demonstrated is that students prefer active learning. In many cases, students will give courses and faculty lower evaluations in active learning classes than in traditional lecture based classes.

It is remarkable that UVMs Larner College of Medicine is willing to remake its course design methodology to align with the learning research.

Lesson 2- Professional Schools May Be Leading Institutional Change:

As far as I know, the rest of UVM is not committing to design every class at the university around the research on learning. Across UVM there will still be in-class lectures and high stakes exams. My guess, however, is that this change at UVMs medical school will catalyze shifts throughout the institution.

It should not be surprising that a professional school is leading learning innovation at UVM. Professional schools have the advantage of being smaller, more focused, and better integrated than other parts of the academy. In my experience, deans of professional schools have a good deal of influence and power to drive change.

New online and low-residency masters degrees often emerge from professional schools, as the demand for these credentials has increased. These new programs can build experience and capabilities with new forms of course design and teaching, and can lower barriers to changes in face-to-face programs.

Lesson 3- Postsecondary Status (and Rankings) May Increasingly Align With Evidence of a Commitment to Active Learning:

The third reason that I think the news out of UVMs Larner College of Medicine is a big deal for all of higher education - not just medical education - is the impact I expect these changes to have on status. I fully expect that the relative rankings of UVMs medical school to improve. (The school is already highly regarded). More importantly, it is clear that this medical school is generating buzz in the medical educator community.

Those in positions of postsecondary leadership should be watching the UVM Larner College of Medicine example closely to see what impact these shifts have on the finances and reputation of the school. My hypothesis is that a willingness to commit to active learning will be a cost-effective method to drive institutional success - as measured by applications, yield and six-year graduation rates.

The challenge in moving towards an all active learning methodology are less about costs, and more about leadership and commitment. There is no doubt that UVMs transition is being made smoother by the generous $66 million dollar gift of Robert Larner. The impact that this gift will have across postsecondary education in catalyzing reform will extend far beyond UVM.

Have you been talking about this story with your colleagues?

What do you think the lessons are for the rest of higher ed from the news coming out of UVM?

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3 Lessons from the UVM Medical School Active Learning Pivot - Inside Higher Ed (blog)

The status of more than 4,200 foreign doctors who were chosen to do medical residencies in American teaching hospitals hospitals that will desperately need their help to cope with Covid-19 is in doubt because the State Department has temporarily stopped issuing the visas most of them would need to enter the country, according to a group that sponsors international medical graduates.

The Educational Commission for Foreign Medical Graduates said Monday that most of the international doctors would be relying on getting a J-1 visa to work in the United States, but processing of those visas has been put on hold by the State Department amid the coronavirus pandemic.

The doctors are scheduled to start working in the hospitals at the beginning of July. During a medical residency, medical school graduates actively work in hospitals under the supervision of senior staff.

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If these new residents are unable to get their visas, its going to really hamper the ability of the teaching hospitals to respond to the virus, William Pinsky, president and CEO of the Educational Commission for Foreign Medical Graduates, told STAT.

The doctors learned of their assignments last Friday so-called Match Day for medical residents.

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Dr. Sandro Galea, dean of Boston Universitys School of Public Health, suggested a work-around needs to be found.

With the Covid-19 pandemic unfolding, this is not the moment to risk creating a physician shortage, Galea said via email. We should take steps in the US to facilitate the training and retention of medical professionals at all times, but especially now.

Pinsky said it would not be easy to replace these 4,222 medical school graduates if they cannot make it to the United States to do their residencies. While every year some U.S. medical school graduates or U.S. citizens who graduate from medical schools outside the country are not selected for a residency program, going back to that pool is not necessarily the answer, he said.

Technically theyre eligible but theres probably a reason why they didnt match, Pinsky said. We do have to be careful from a quality perspective.

The ECFMG handles the process of getting visas for foreign medical graduates who apply to do their residencies in the U.S. The organization vets them thoroughly, including by checking their credentials and ensuring there are no incidents in their history that would preclude them from getting a visa.

It also registers all applicants it typically gets about 16,000 a year to take the same medical exams U.S. trained doctors take, only entering them into the residency match once they have passed those exams.

Most come to the United States on a J-1 visa, a cultural exchange visa program also used by entertainers and researchers.

But embassies and consulates around the world have stopped processing the visas. And last week the State Department sent out advice to program sponsors such as ECFMG urging them to either cancel the programs or defer the start dates.

Pinsky said his organization has approached the State Department to warn officials there about the unintended consequence of suspending the J-1 visa program and to ask for an exemption for the foreign medical graduates. He said they were told the department would take it under advisement.

The State Department did not immediately reply to a request for comment from STAT.

Pinsky said in normal times J-1 visas are not issued until 30 days before the start of a program. He also asked that that rule be waived in this case, because it may be difficult for the foreign doctors to secure flights into the United States at this point and because each would need to be quarantined for 14 days before they could start their residencies.

Correction: An earlier version of this story misstated the number of foreign doctors affected by the suspension of the visa program.

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Amid coronavirus, thousands of foreign doctors could be blocked from US - STAT

In the race to understand the new coronavirus and generate solutions, Duke research teams are well underway.

In fact, you could say theyve been working on it for decades. Everything Duke experts have learned over the years about the spread of new diseases, the biology of viruses, and the techniques of developing treatments and vaccines is now being applied to the new coronavirus, SARS-CoV-2, and the illness it causes, COVID-19.

These experts work across the medical school and campus as well as abroad. They work in the Duke Human Vaccine Institute (DHVI), the Duke Global Health Institute (DGHI), and the Duke-NUS Medical School in Singapore, among many other centers, institutes, and departments. And they are collaborating with other experts across the globe.

Duke also has state-of-the-art facilitiessome of which are uncommon on university campusesthat are speeding up the development of new treatments and vaccines.

Weve got years of experience working with viruses and other pathogens, says Colin Duckett, PhD, vice dean for basic science in the School of Medicine. Because we have the infrastructure and highly trained experts, weve been able to pivot rapidly to confront this new challenge.

Slowing the Spread

Epidemiologists and those who work in global health are hard at work learning more about how the virus spreads, with the immediate goal of slowing the spread.

If we string out cases over time, especially for those likely to have severe disease, our intensive care units wont be overrun and we can help them survive, says Gregory Gray, MD, MPH, FIDSA, professor of medicine in the Division of Infectious Diseases and member of the Duke Global Health Institute. He also has appointments at Duke-NUS Medical School in Singapore, Duke Kunshan University in China, and the Duke Nicholas School for the Environment.

Grays lab members are conducting investigations both in Durham and Singapore to discover how far the virus can travel in the air. The investigators are setting up bio-aerosol samplers at various distances from patient beds to collect and identify virus and virus particles. Current thinking suggests the virus doesnt typically travel beyond 2 meters (6 feet) from an infected person; Grays studies will help confirm or revise this.

Gray, an epidemiologist, is also working to collect and analyze data related to close contacts of infected people to learn more about the incubation period and what sorts of interactions are likely to result in transmission. Refining those two pieces of information will improve mathematical models of the spread.

In the lab, Grays team is starting work to identify animal reservoirs, which are animals in which a virus multiplies prolifically, often without causing symptoms. The etiology of SARS-CoV-2 hasnt been nailed down, but it may have started in bats as some other coronaviruses have, and then become amplified in animals that have more contact with humans, perhaps wild animals in markets or domesticated livestock. In any case, if animal reservoirs can be identified, limiting or modifying contact with those animals can slow the spread.

Diagnosis

Faced with rapid spread of disease and a limited supply of test kits available to the state, a variety of private labs and universities, including Dukeand UNC Chapel Hill, quickly developed their own tests for SARS-CoV-2. These tests provide a yes-or-no response to quickly identify patients who have been infected.

Other types of tests will be needed to facilitate treatment and research. For example, knowing how much virus is present could be useful. These kinds of assays are often used for HIV, where viral load guides treatment decisions.

The lab of Thomas Denny, chief operating officer of DHVI, develops these kinds of assays and assay validations in support of HIV clinical trials. Denny says the National Institute of Allergy and Infectious Diseases (NIAID) asked his lab and other labs it funds focusing on HIV assays to shift to the new coronavirus.

We have expertise that can flip over and develop assays for other viruses, he says. Its a frame shift. Weve been doing things similar to this for HIV, for H1N1 and other flu viruses, and now were working to do that for this virus.

Denny and others in DHVI work with partners in African countries, which have the potential to be hit hard by the combination of SARS-CoV-2 and high rates of HIV. Denny and others are anxious to share assays with those labs to help them respond to the new disease.

Dennys lab is also helping to validate assays created by others, including the University of Texas Medical Branch in Galveston. Speed was of the essence to help respond to the shortage of tests kits from the CDC. Our work with the UT team was to get that done quickly so there would be an approved test kit that other institutions or labs could [use], he says.

Treatments and Countermeasures

Duke has been approved to participate in a nationwide clinical trial sponsored by NIAID evaluating remdesivir in patients hospitalized at Duke University Hospital with COVID-19.

Remdesivir is a broad-spectrum antiviral drug that was developed for use with Ebola and has since shown some effectiveness against severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), which are both coronaviruses.

Cameron Wolfe, MD, associate professor of Medicine, is the Duke lead on the trial. The fact that our teams operationalized this substantive study in the space of a week or a week and a half is astonishingly fast-paced, Wolfe says. It is a credit to folks in multiple departments. There hasnt been a single person who hasnt rolled up their sleeves and said, Lets make this happen.

In addition to getting the studies off the ground quickly, Wolfe expects data will also be available quicker than usual. Because of the incredible efforts of individual people trying to make it happen, and the adaptive nature of the trial,we would anticipate getting nationwide, actionable data in a matter of months, not the usual extended length of time, he says.

Remdesivir is a so-called small molecule drug, as are most pharmaceuticals. A newer class of therapies are monoclonal antibodies, also called large-molecule drugs or biologics. These typically have the suffix mab, such as denosumab (Prolia) and pembrolizumab (Keytruda), and are given as injections or infusions rather than pills. Monoclonal antibodies may also prove to be a powerful tool in the fight against SARS-CoV-2.

Developing such a treatment is underway in the Duke Human Vaccine Institute (DHVI) in the lab of Greg Sempowski, PhD, professor of Medicine and Pathology. My research program focuses on developing antibody treatments for viral pandemic pathogens, he says. This is a temporary treatment, or medical countermeasure, to help blunt or stop a pandemic in its tracks.

An antibody treatment doesnt confer lasting immunity as a vaccine does, but would help infected patients beat the disease. It also could be used as a temporary preventative for groups being exposed to the disease, such as healthcare providers or people in the military. Its something that would be a short-term measure while the vaccines are being developed, optimized and tested, Sempowski says.

Sempowskis lab is one of four nationwide thats been funded for several years by the Defense Advanced Research Projects Agency (DARPA) to develop rapid responses to pandemics. That means, for any unknown virus, being able to isolate the virus and antibodies from humans that are infected, select the antibodies that can neutralize the virus, and engineer delivery methods for these antibodies.

DHVI has a state-of-the-art laboratory where highly trained specialized personnel work with potentially dangerous pathogens. The National Institutes of Health (NIH) funded the construction of 14 of these facilities about 15 years ago, including the one at Duke. Its a highly secure facility with redundant safety mechanisms so we can safely work with these materials to develop drugs, diagnostics, and therapeutics, Sempowski says. Its an amazing resource for our region.

The DHVI also has its own in-house Good Manufacturing Practices (GMP) facility, which makes small batches of vaccines and medical countermeasures for initial phase 1 clinical testing. This rapid and cost-effective in-house manufacturing saves precious time. The Duke University School of Medicine and DHVI also have robust clinical trials units, including the Duke Vaccine Trial Unit (DVTU), led by Emmanuel (Chip) Walter, MD.

At DHVI, were able to use in-house resources to rapidly go from bench to bedside, Sempowski says.

Sempowski is pursuing a new technique thats faster than engineering the antibodies themselves: creating genetic blueprints for the antibodies, in the form of messenger RNA (mRNA). When the mRNA is injected, the body follows the encoded instructions to make the antibodies itself.

Switching to RNA-based manufacturing and delivery could help accelerate manufacturing and delivery of both vaccines and countermeasures, Sempowski says.

Vaccines

Vaccines are designed to prevent rather than treat an infection or disease. Used in a vaccine, mRNA would tell the body how to make fragments of the SARS-CoV-2 virus called spike proteins. These would spur the body to produce antibodies and memory cells that could respond if confronted with the actual virus later.

The vaccine effort at Duke is led by the director of DHVI, Barton Haynes, MD, the Frederic M. Hanes Professor of Medicine. Haynes has long worked to develop a vaccine for HIV, a notoriously sneaky and frequently mutating virus. He leads a multi-institution consortia that has received hundreds of millions of dollars in funding from NIAID and the Bill and Melinda Gates Foundation since 2005.

NIAID Director Anthony Fauci, who was an early mentor of Haynes, recently told Duke Magazine, Youre dealing with a superstar who is leading a very impressive group of people. If were going to get a vaccine for HIV, it almost certainly is going to be all or in part by this group.

Haynes is now turning his focus to SARS-CoV-2 in an attempt to develop a mRNA-based vaccine, using all the combined expertise of his team and the DHVI in-house production facility and clinical trials unit. In this effort, Haynes is collaborating closely with Drew Weissman, MD, PhD, professor of Medicine at the University of Pennsylvania.

All of the past 15 years worth of work on the HIV vaccine has led to the development of the technologies that are now being used to rapidly respond to the COVID-19 pandemic, Haynes said. This includes the antibody-isolation technology we are using to isolate neutralizing antibodies and the rapid movement to vaccine and antibody production for clinical trials in our own vaccine production facility. Coupling these technologies with the state-of-the-art Regional Biocontainment Facility provides a powerful approach for rapid development of solutions to pandemics.

Vice Dean Duckett says, Bart Haynes is truly a pioneer in vaccine development, especially with his experience in HIV. His group is poised to make seminal contributions to the development of a vaccine for SARS-CoV-2.

Preventing Future Pandemics

As an epidemiologist, Gray wants to be able to identify the next pandemic-causing virus before it causes a pandemic.

He is leading an effort to conduct a study at eight sites in six Asian countries to identify and keep tabs on zoonotic pathogens present in people who work in animal markets or who process meats. Benjamin Anderson, PhD, assistant professor of Global Health at Duke Kunshan University, will be leading the effort for three sites in China.

The immune systems of people who work closely with animals are repeatedly attacked or insulted by animal pathogens, but they usually are able to shrug it off. Sometimes, however, an animal pathogen adapts to life in a human host and gets better at multiplying in its new home. The real problem occurs when the pathogen begins moving from one human to another. Its a progression, Gray says: Insult, adaptation, effective replication, and then human-to-human transmission.

The new project will harness genomic sequencing and big data tools to identify new pathogens that have adapted to the human respiratory tract and show transmission potential.

That puts us ahead of the curve before the virus becomes highly effective at causing disease and human to human transmission, Gray says. If we can show that this works, it will be a novel tool that would help us get ahead of these outbreaks.

Developing an Antibody Test

On the other side of the world, in Singapore, researchers at the Duke-NUS Medical School were among the first in the world to isolate the new virus, after China and Australia. They were also among the first, if not the first, to develop a blood test for antibodies to the virus, which makes it possible to identify people who have had COVID-19 even after they have recovered and cleared the virus.

The Duke-NUS Medical School was established in 2005 to provide graduate-level medical education in Singapore, which at the time had only medical schools that were designed for undergraduate-entry.

We were brought by explicit invitation of the Singapore government to establish a research-intensive school that would train students to become clinician-scientists, says Thomas Coffman, dean of the school. The school is organized around interdisciplinary public health issues, one of which is emerging infectious diseases, which are a particular concern for Singapore. This region has been a fountain of new viruses, Coffman says.

The schools Programme in Emerging Infectious Diseases is directed by Linfa Wang, PhD. Wang is an expert in zoonotic virusesthose that jump from animals to humans, as SARS-CoV-2 did.

I have been in this business for last 25 years, Wang says. This is my fifth emerging zoonotic disease outbreak and they all look like bat-borne viruses. We were ready [for the current outbreak] in many ways.

Several years ago, Duke-NUS established a biocontainment facility (an animal biosafety level 3 laboratory) in Singapore, which has been a critical resource for work during the current outbreak. And Wang explicitly trains his lab members, doctoral students, postdocs, and junior faculty to be prepared for outbreaks.

As a basic scientist, I think this concept of peace time and war time is so important, he says. I always tell my junior scientists: during peace time, publishing and working on your CV and grants are important, but during an outbreak, its about having an impact on the ground.

Researchers at Duke-NUS, including Danielle Anderson, PhD, scientific director of the Duke-NUS biocontainment lab, isolated the live virus just days after receiving a sample from an infected patient at the end of January. Once the researchers had the virus and could grow it in the lab, they could begin developing a blood-based test to detect antibodies, called a serological test.

With that test in hand, the research team was able to use it to describe how a coronavirus outbreak in one church in Singapore led to an outbreak in another. A couple from one church, unknowingly infected, spent time with a man from the other church. Using the antibody test, researchers could determine that both members of the couple had indeed been infected with COVID-19 even though they were no longer symptomatic. One of them no longer had any virus in the bloodstream, so a standard SARS-CoV-2 test would have been negative.

Wang is setting up collaborations with research teams around the world on studies using the antibody test. In particular, it could be used to understand whether children are less likely to acquire COVID-19, or whether they simply dont show symptoms. If its the latter, Wang says, you can prove that by serology because even if the infection is mild, it still produces antibodies.

Researchers at Duke-NUS will also be collaborating with others to test vaccines in clinical trials. Duke-NUS, in collaboration with the SingHealth team, has extensive clinical trials capacity, and Singapore, with its multi-ethnic population, is an ideal site. Wang is in conversations with the World Health Organization (WHO) and the Coalition for Epidemic Preparedness Innovations (CEPI) about potential vaccine trials.

Mary-Russell Roberson is a freelance writer in Durham. She covers the geriatrics and aging beat for the Department of Medicine in the Duke University School of Medicine.

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Duke Researchers Pivot to Attack the New Coronavirus - Duke Today

At times struggling to find adequate personal protective equipment, working multiple shifts and even succumbing to COVID-19 themselves, physicians around the globe exhibit hard work, sacrifice, and compassion. Many are applauding them for it.

At a time that has rapidly changed how physicians live and practice medicine, it is urgent to consider if current medical education is preparing new doctors for the changes ahead in the health care system. And to propose how to fill that preparation gap.

In this country, competition among the 50,000 medical school applicants is difficult for barely 22,000 spots to begin nearly a decade of grueling training and residency before graduation. Only 800,000 physicians care for a U.S. population of 328 million.

But in this country, medical schools looks very different now than it did 10 or 15 years ago. Then students crowded lecture halls for hours each day during much of the first two years of a guided curriculum.

Due to COVID-19 shutting down in-person learning, lectures and cases are readily available to students online, on-demand, anywhere. Most medical students have the freedom and flexibility to create personalized learning schedules that work for them, choosing when and where to study, listening to lectures in double time via podcast.

While the paradigm of flexible, distance learning has allowed medical students to continue their studies while sheltering in place, on-demand, modular learning and curricula of todays medical education creates an unreasonable expectation of flexibility and convenience for students.

But this method of learning fails to translate to the rigidity and rigor of actual medical practice.

To be sure, the current state of medical education is in stark contrast to the medical school life these students imagined for themselves and the values that drew them to medicine in the first place. And the stress of isolation and the uncertainty ahead pose new challenges for students.

This disconnect between todays education and the reality of the disrupted profession possibly sets up new physicians early on for failure, creating unreasonable expectations and worsening professional dissonance. This tension can contribute to the rapid rise in resident and physician burnout.

Now, more than ever, students and medical schools need to find ways of learning and instructing that better approximate the realities of medical practice.

Certainly, the ability to reinvent methodology for learning speaks to a certain resilience that is required of physicians. But it is just one trait and by itself often not enough for success.

The recent news that the United States Medical Licensing Examination Step I licensing exam will transition to pass/fail grading in January 2022, further underscores the disconnect between the perception of medical schools intensity and the rigor of actual practice.

Dr. Susan Skochelak, a chief academic officer of the American Medical Association, recently explained, Current residency selection is causing distress for our students.

As doctors, we understand daily distress. We are responsible for making decisions that affect, and perhaps determine our patients lives. The importance of this responsibility to society has never been as clear as it is right now as physicians and health care workers around the globe place patients wellbeing and care above their own.

More than 320 physicians around the world so far have died from COVID 19. Many continued to work as physicians until their deaths. Physicians continue to separate themselves from their families over fears of spreading the disease to loved ones. Others are writing wills and making plans for who will raise their children in the event they cannot.

Medical education administrators and policymakers needs to address the discrepancy between this newly disrupted medical education and medical practice.

Although learning can be done virtually, it is not the ideal choice to teach the nuances of a successful patient-physician relationship which is central to good patient outcomes.

As medical schools purpose is to prepare future doctors for practice, students need to adapt from a virtual practice to hands-on practice. Medicine is based on observation, examination, and the relentless critical assessment of patient presentation translated into facts, data, and relevant evidence.

Even before COVID-19 added new challenges to practicing medicine, physicians were leaving the field at alarming rates. A mounting shortage of doctors threatens to further burden an already challenged system.

The top three contributors to burnout for Millennial and Gen X doctors include a glut of bureaucratic tasks such as charting and paperwork; the number of hours spent at work; and lack of respect from administrators and staff.

And yes, many medical schools have increased early intervention and access to mental health care, wellness resources, career planning, and mentorship for students. There has been a shift in helping students find ways to maintain physical health and wellbeing despite long hours.

These are positives.

But with the sudden changes to how medical students learn, there must be a shift to accommodate what they experience and lessons they have lost in real life in order for them to be effective physicians.

With a likely second coronavirus surge in the fall, medical schools need to prepare for long term changes to medical education.

With adequate personal protective equipment and hands-on learning and mentorship from clinical instructors, medical students have a vital role to play in the clinical setting. They can learn how to take a history and the challenges of a physical exam via telemedicine. They can and should be included.

Working alongside physicians during this pandemic offers invaluable education to prepare these medical students for an evolving future career.

Dr. Inna Husain, M.D. is an otolaryngologist and assistant professor at Rush University Medical Center in Chicago where she also serves as Associate Residency Program Director and Director of the Voice, Airway, Swallowing Disorders Program.

Dr. Rebecca Van Horn, M.D., M.A., is a psychiatrist and assistant professor at Rush University Medical Center in Chicago and the Medical Director of the Road Home Program: The National Center of Excellence for Veterans and Their Families at Rush.

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Transform medical education for a new world | TheHill - The Hill

Sumi Sexton, MD, grew up with two parents who were physicians, so her interest in the health field did not come as a big surprise. It was not until her third year of medical school, though, that she discovered her passion for family medicine.

Up until that point, she had thought her specialty would be psychiatry, but she realized she wanted to practice a primary care specialty that would allow her to pursue a wide range of clinical interests. Dr. Sexton also wanted to be in a position that forced her to constantly learn new things.

Today, she is doing just that.

Dr. Sexton is a family physician with Premier Primary Care Physicians in Arlington, Virginia, and her practice is a proud member of Privia Medical Groupan AMA Health System Program partner. She also serves as the editor-in-chief of American Family Physician, wrote Pacifiers Anonymous: How to Kick the Pacifier or Thumb Sucking Habit, and is an associate professor at the Georgetown University School of Medicine. Her particular interest areas include adolescent medicine, newborn and infant care, and womens health.

Sometimes family medicine is undervalued in terms of caring for the person as a whole and being able to treat and help with many different things, Dr. Sexton says. Were not just a gatekeeper and referral center. Were about caring for the whole person and, when possible, knowing their family, which really makes a difference.

When a doctor is able to learn and understand a patients family history, it can impact recommended treatment or care. When patients separate out symptoms from one anotheroften unintentionallyhaving insight into the family can sometimes serve as the bond that brings those symptoms together.

Psychosocially, it makes a huge impact, Dr. Sexton says. It makes it more interesting for me because Im able to form genuine connections with my patients, and they feel they can trust me because theyve been coming to me for a while and they know I have their best interest at heart.

Many of the patients Dr. Sexton sees are teenagers, and over the course of her 20-plus-year career, shes seen this patient population evolve. Children and teenagers today are far more accepting with regards to sexuality and gender identification, she says, and overall there is more of an openness in their attitudes. As they have evolved, though, so too have their risk factors.

Today Dr. Sexton spends much of her time talking with kids about social media and screen time.

A 2018 Pew Research Center report found that 95% of teenagers have access to a smartphone, and 45% said they are online almost constantly. While Dr. Sexton readily acknowledges there are some benefits to social media, she also warned that, as with anything in life, too much of one thing can lead to problems.

Spending a lot of time on social media and not actually having enough human interactions can lead to lingering feelings of inadequacy because of what others are posting, Dr. Sexton says.

Vaping is another major topic Dr. Sexton finds herself frequently addressing. The 2019 National Youth Tobacco Survey from the Centers for Disease Control and Prevention found that one in four U.S. high school students and one in 10 middle school students used e-cigarettes in the past 30 days. These statistics are particularly alarming since people younger than 25 are at more of a risk from nicotine because of how it impacts a developing brain.

Few teenage patients who talk with Dr. Sexton openly admit to vaping or trouble with social mediabe it overuse or online bullying. To get information, she frequently relies on asking open-ended questions and reassuring confidentiality, the longstanding relationship shes been able to build with the patient and family, comments from parents, or a detail she notices on an exam.

Dr. Sextons varied responsibilities could easily lead many in a similar position to burnout, and she confessed that juggling her roles is not easy.

I realized long ago that there are only 24 hours in a day, and it matters what I choose to do with those hours, she says. In the end, all of us are faced with the same time constraints. Im a good multitasker, and when I get overwhelmed, I take a deep breath and say, Just do what I can do.

Learn more with the AMA about how teamwork, tech help this Privia physician rediscover joy in his practice.

A recent online survey by the Medscape news site found a burnout rate of 46% among family physicians. Dr. Sexton said administrative burdens are driving that sobering statistic. The sense of being overwhelmed by paperwork detracts from time in the exam room.

If the time needed to take care of families and getting to know people is slowly chipped away because youre focused on how am I going to get this chart done so I get paid, thats not a happy situation, she says.

For Dr. Sexton, one of the most effective ways to prevent burnout is through her editorial role with American Family Physician. Shes been involved with the twice-a-month journal since she was a medical student and took on the editor-in-chief role in 2018.

Being a part of Privia has also helped. Since her practice joined in 2014, Dr. Sexton and her team have benefitted from a more robust EHR system and other technological upgrades such as virtual visits and virtual assistantsthe latter is an upcoming pilot project to help cut documentation overload. Having a national network of doctors to connect and collaborate with has been valuable, as has the autonomy Privia provides.

We intentionally made the decision to partner with other groups under an umbrella but we did not want to be absorbed, Dr. Sexton said. We work together to make changes in medicine and hopefully improve quality care for our patients, but we make our own decisions on a day-to-day basis.

Read how Privia internist Shishir Kumar Khetan, MD, is improving workflow in the office.

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How this family doctor finds satisfaction in juggling roles - American Medical Association

Medical school students are being mistreated by fellow students, medical faculty, and supervising residents based on their race, gender, and sexual orientation, according to a new study led by Yale University researchers.

The study, which examined 27,504 student surveys representing all 140 accredited medical schools in the United States., found that women, under-represented minority (URM), Asian, multiracial, and lesbian, gay, or bisexual (LGB) students reported more frequent incidents of mistreatment and discrimination than their male, white, and heterosexual medical school counterparts.

The findings appear in the Feb. 24 online edition of JAMA Internal Medicine.

The Yale team analyzed data from an annual survey administered to graduating medical students by the Association of American Medical Colleges (AAMC). The study is one of the first of its kind to look at how mistreatment of medical students relates to demographic characteristics.

There is a lot of data showing that although medical schools are slowly becoming more diverse, they are still not yet inclusive, said co-author and emergency medicine assistant professor Dowin Boatright, M.D.

The study is unique in that it involves a large nationally representative sample, includes a wide breadth of mistreatment types, and focuses on the connection between membership in a marginalized group and the experience of mistreatment, the authors write.

The most common mistreatment reported was public humiliation, followed by denial of opportunities, offensive remarks or names, and lower grades or evaluations.

In the 2017 AAMC survey that provided the raw data for the new study, graduating students were asked questions about how often they were publicly humiliated or physically harmed during medical school; how often they had been denied opportunities based on their gender, race, or sexual identity; or been subject to offensive remarks.

Key findings included that 40.9% of female students, compared to 25.2% of male students, reported at least one episode of mistreatment. And 28.2% of female students reported gender-based discrimination, compared to 9.4% of male students.

Multiracial students reported higher rates of mistreatment compared to white students, and underrepresented minority female students reported the highest levels of racial and ethnic discrimination (26.5%).

For non-URM male students, just 6.8% reported racial and ethnic discrimination.

Students identifying as lesbian, gay, or bisexual reported the highest rates of mistreatment, with 43.5% reporting at least one episode of mistreatment, compared to 23.6% for heterosexual students. Nearly 22% reported that they were subjected to offensive remarks or names related to their sexual orientation, compared to 0.8% for heterosexual students.

Women and people of color are under-represented in academic medicine, and they, along with LGB physicians, all face discrimination in the workplace, said lead author Katherine A. Hill, a second-year medical student at Yale School of Medicine. When you are denied opportunities based on racism or sexism, these can accumulate over the years and hinder careers or cause burnout.

The researchers said the findings suggest that more must be done to move beyond simply diversifying medical school student bodies to ensure all students feel supported throughout their academic experience.

There are measures that can help to safeguard vulnerable students, Hill said, including implicit bias training for faculty; better protections for students to shield them from retaliation; and greater transparency about the policies that already exist to support students facing mistreatment.

Theres not enough focus on these issues, she said. Medical schools put almost all their attention on diversity of overall numbers; its important to think about diversity in terms of the student experience.

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Medical school mistreatment tied to race, gender, and sexual orientation - Yale News

By Ivanka Perez 1/28/20 9:56pm

When shes not shooting hoops on the basketball court, you can find Rice forward Erica Ogwumike shooting YouTube videos in her room. Although she graduated with her bachelors degree from Rice in December, finishing one semester early, Ogwumike continues to play for the Rice womens basketball team. Having already been accepted into medical school, Ogwumike has decided to share the lessons shes learned and capture her experiences in a memorable way through YouTube.

Since December, Ogwumike has been documenting the pivotal moments of her life on her YouTube channel, vlogging about her medical school interviews and showing viewers a day in the life of a Division 1 athlete.

People asked me for the longest [time] to start something just to share what Im doing, how I got to where Im at and [give] advice because there arent a lot of pre-med student-athletes out there, Ogwumike said.

Ogwumike first joined a basketball team in fifth grade, after tagging along to her three older sisters basketball practices after school. Ogwumike said it wasnt until her sophomore year of high school that she realized she wanted to follow her sisters footsteps again by pursuing college basketball.

My older sisters were playing basketball in college, so I saw how you could use basketball as an awesome opportunity to get a great education and [use it] as a platform for change, Ogwumike said.

After high school, Ogwumike headed off to Malibu, California to attend Pepperdine University, and played on the womens basketball team with her older sister, Olivia. After one year, both sisters decided to transfer to Rice and continue playing college basketball.

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But even with the support of her sister, Ogwumike said she still found herself needing to adjust to Rice.

The amount of time studying and trying to improve your craft, which is your sport, is increased to another level as well as your academic load, so it took a while to get adjusted to, Ogwumike said.

After two years of playing on the team, Ogwumike said shes grateful for the opportunity to witness the teams trajectory.

The growth that Ive witnessed in our program over the past [two] years surpassed any of my dreams and goals, and I am just happy to be one small part in that, Ogwumike said. This program is truly amazing [and head coach Tina] Langley is truly amazing.

Being part of a college basketball team allowed her to grow in more ways than one. Throughout the years, Ogwumike said she learned time management, resilience, communication and teamwork.

I just love the teamwork aspect of working together to achieve a collective goal, Ogwumike said.

According to Ogwumike, the physical aspect of college athletics has also been important to her.

You have to be in shape in every aspect of fitness it involves running, jumping, changing directions, strength, et cetera, Ogwumike said. I like the versatility of [fitness].

Ogwumike said she appreciates versatility in all aspects of her life, which influenced her choice of a future career. She said she loves how flexible a doctors role is, and how doctors can impact patients in all aspects of their lives.

Medicine is interwoven into many aspects such as academia, policy, law, media and more, Ogwumike said. I have so many interests that I know I can cater to all while being a physician and working towards something so altruistic each day: helping people reach their optimal level of health.

As she describes in her video How I Got Into Med School, Ogwumikes decision to pursue medicine was gradual.

I never had this [a-ha] moment it was just over time, I became more exposed to medicine, physicians [and] health care and I began to see myself in this profession, Ogwumike said. No one in my family is in medicine, so it has been a shot in the dark, but I gradually learned through the great resources at Rice and the Texas Medical Center that its what I want to pursue.

Ogwumike talks about her experiences as a pre-med on YouTube to help other users find answers to their questions. On her channel, Ogwumike has posted two videos dedicated to her medical school interviews, hoping her experiences will help students applying to medical school.

At some point, I decided that it would be cool to share the knowledge and info Ive gotten along my journey, Ogwumike said. If my channel could help someone like me in the past, it would be worth it.

Although Ogwumike began her channel to provide resources for high school students hoping to balance pre-med and college athlete commitments, it soon developed into a way for her to capture special moments in her life.

This channel has made [me] aware of living in the moment, Ogwumike said. As I go back and watch a video, I realize that there are so many great moments in my life that I easily forget about it. This channel has been a great way for me to [cherish] those memories.

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Erica Ogwumike: Shooting baskets and video - The Rice Thresher

Though more teenagers are identifying as sexual minorities, their rate of attempted suicide remains much higher than teens who are straight.

That disparity, the key finding of a study published Monday in the journalPediatrics, suggests that many LGBTQ teens are highly distressed.

Between 2009 and 2017, the percentage of high school students identifying as lesbian, gay, bisexual or questioning doubled from 7.3% to 14.3%, Boston University researchers found. Their data source, the Youth Risk Surveillance Behavioral Survey, did not consistently include data on the number of teens identifying as transgender.

During the same time frame, consensual, same-sex sexual contact jumped from 7.7% to 13.1%. Teen girls were twice as likely as boys to identify as a sexual minority.

And while the rate of LGBQ teens attempting suicide decreased from 26.7% in 2009 to 20.1% in 2017, it is still more than three times that of straight teens.

To lower this disparity, researchers say more support is needed for LGBTQ teens.

"It's critical that health and educational institutions have policies and programs in place to protect and improve LGBQ health such as medical school curricula and high school curricula that is inclusive of sexual minority health,"saidJulia Raifman, a health law professor at Boston University.

"Our new paper indicates that an increasing number of teenagers are identifying as LGBQ and will be affected by anti-LGBQ policies that may elevate these already very high rates of suicide attempts," she said.

Previous studies have shown that anti-LGBTQ policies are having a negative effect on the mental health of both LGBTQ teens and adults.

In a 2017 study, Raifman found a 7% decrease in all high school student suicide attempts in states that had legalized same-sex marriage. She also led a 2018 study that linked publicized cases of anti-gay discrimination to increased mental health distress among LGBTQ adults living in the states where the incidents occurred.

Her latest study was based on data from the Youth Risk Behavioral Surveillance Survey, a national school-based survey conducted by the U.S. Centers for Disease Control andPrevention and state health agencies.

Only six states Delaware, Illinois, Massachusetts, Maine, North Dakota and Rhode Island included information on sexual orientation. Just three Connecticut, Delaware and Rhode Island included data on consensual sexual behaviors.

Overall, 110,243 high school students were included in the study, but consensual sexual behavior data could only be analyzed among 25,994 students.

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More teens are coming out as LGBTQ, but suicide attempts remain high - PhillyVoice.com

Sometimes, location is everything.

When Dr. Eric Bing started working at Dallas Southern Methodist University (SMU), the person in the office next to his would give him a new perspective on how virtual reality can be instrumental in teaching medical students.

SMU happens to have one of the worlds best graduate schools for video game design and Bings office neighbor, Professor Anthony Cuevas, helps create the curriculum for it. Surgery and first person shooters may seem worlds apart, but over the course of several months, the professors neighborly chitchat gave rise to a low-cost VR training system that can be implemented in locations where medical schools are limited, such as sub-saharan Africa.

In order to meet the basic need of surgical care in the developing world by 2030, the surgical workforce there would need to double, according to the Lancet Commission of Global Surgery. Shafi Ahmed, co-founder of the VR health training platform Medical Realities, has highlighted this problem as one he hopes his companys content can address. Dr. Alex Young of the startup VR company Virti is developing a platform that gives students access to training programs for free, with an eye toward improving medical care in the third world.

Bing has spent much of his medical career working in impoverished communities in south central Los Angeles as well as overseas countries like Zambia, Haiti, Nigeria, and Belize. Throughout his decades of treating patients, one challenge has always been present: Numerous people suffer and die from easily preventable and curable diseases such as cervical cancer. That condition that ended the life of Bings mother.

Precancerous cervical growths are easy to diagnose with diluted household vinegar, explains Bing. They can be removed as simply as warts. However, such treatable diseases often end lives when they could be treated because the lack of local medical expertise means needy patients schedule exams too late. In the case of cervical cancer, the disease spreads and the resulting remedy may be more extensive, such as a hysterectomy, or untreatable.

There are just not enough surgeons in developing countries to provide the care that people need.

Weve always been trying to think through How do we scale up the number of surgeons who do these procedures or any surgical procedures? explains Bing. There are just not enough surgeons in developing countries to provide the care that people need. Many sub-saharan African countries, for example, have no medical schools or just one.

Bing and Cuevas brainstormed the potential for training students in virtual reality.. While diagnostic and surgical simulations are now a regular part of many American medical school programs, theyre much harder to find in the developing world given the associated costs, which can quickly rise into six figures.

When the doctor running the med program at the University of Zambia teaching hospital stopped by SMU to pick up an honorary degree, Bing got him together with Cuevas to figure how to create a VR program.

Along with doctors and professors from the University of North Carolina, Kings College London and SMU, the three created a study on teaching oncology with low-cost virtual reality headsets. Around that time, the price of Oculus Quest had recently dropped, making the budget for VR instruction feasible.

Using SMUs VR program, numerous medical students at the University of Zambia have practiced the steps for performing a radical abdominal hysterectomy, needing to complete it within a target time and accuracy rate. The simulations operating room is outfitted with equipment commonly found in Zambia. Studying the VR surgical program, the dev team found users need to reflect on what theyre learning to retain information. As a result, no student can attempt the virtual procedure more than six times in one day.

Trainees need to reflect on what theyve learned or missed for it to stick, explains Bing, who underscores that VR learning augments class lessons and book chapters and doesnt replace them.

In U.S. teaching hospitals, you have a lot of oversight and support, explains Bing. Med schools in developing countries dont always have those necessities. By using the simulations, [students] are able to identify potential gaps in knowledge.

Dr. Alex Young was snowed in on a weekend a few years ago when he started thinking about new ways to train med students. At the time, the British orthopedic surgeon was a resident at New Yorks Hospital for Special Surgery (HSS) and reflecting on the thing his experience wasnt teaching him: how to deal with the stress of emergency medicine.

When youve got people sent to the E.R. from car accidents, you never know whats going to come through the door, says Young. Doctors at HSS, one of the United States top hospitals for orthopedic surgery, regularly see worst-case scenarios.

After working through a few difficult cases, a new surgeon might get used to that surge of adrenalin, explains Young, but new doctors often make mistakes because they panic. Theres no real way in a clinical environment to test your skills under pressure, he says.

Youngs weekend brainstorm eventually led him to co-develop Virti, a medical training platform focused on building soft skills in augmented and virtual reality simulations. Users are transported into real world scenes, either by themselves or with a team of fellow students, to diagnose and treat patients, often ones suffering trauma.

Virtis system utilizes artificial intelligence and natural language processing to analyze decision making, leadership, communication and other capabilities that arent typically a focus of med school training.

We look at how well the team communicated. Did they empathize with the patient? Did they come to the correct diagnosis? explains Young. The VR headsets can also track where the students are looking during fast-moving situations and how quickly they identify relevant problems. The company has published research showing that students who work with the Virti system have reduced stress that transfers to real-life experiences.

As Young developed Virti, he also kept in mind the experience he had working in Tanzania soon after he graduated from med school. Not only were the doctors facing stress, they also had to deal with limited resources.

Seeing the potential for training medical professionals in the developing world, Young designed the Virti platform to function on any mobile phone as well as with a VR headset. The basic level of the platform, geared at teaching new medical professionals, is free.

In 2020, the Virti team will be launching simulations specifically for med students in Kenya and Ethiopia, in partnership with Oxford University and Torbay Hospital. To develop the new scenarios, the company needs teams on the ground capturing 360 video that includes appropriate imagery and protocol for attending to patients.

Both Young and Bing view the opportunity to offer affordable, accessible medical education in underserved communities as exciting and rewarding. For those people who do this, its a lot of hard work, says Bing. There has to be meaning behind it.

Bing, in particular, sees the potential to save the lives of people stricken with easily treated diseases, such as the one that took his mothers life.

When youre able to help other people survive from these things, it helps the work have more meaning for you.

Read more from the original source:
VR is making medical training cheaper, better, and more accessible than ever - Digital Trends

Image: Getty/LightFieldStudios

A new study published by The Journal of Pediatrics shows increased rates of implementation of hospital-based breastfeeding initiatives are associated with decreased rates of infant deaths in the first six days after birth, dispelling speculation that such practices might increase infant death.

The authors of the study examined trends in the percentage of births in baby-friendly hospitals between 2004-2016, as well as the implementation of skin-to-skin care in the first hour after birth in both the U.S. population and in Massachusetts. The authors looked at trends in Sudden Unexpected Infant Deaths (SUID), including deaths by asphyxia, in the first six days after birth during the same time period.

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Despite marked increases in both the percentage of newborns being delivered in baby-friendly facilities and in the percentage of newborns experiencing skin-to-skin care, there has been a significant decrease in deaths due to SUID within the first six days after birth.

These data come as welcome news and should reassure us that these initiatives are not resulting in any increase in infant deathsin fact, just the opposite is true, said study lead author Melissa Bartick, Harvard Medical School assistant professor of medicine and an internist at Cambridge Health Alliance.

Bartick noted that widespread speculation had arisen on whether such interventions could be deadly after an opinion piece citing Massachusetts infant mortality data was published in medical literature in 2016, followed by a national study in 2018.

Both of these publications were controversial, and the related mainstream media attention they garnered characterized such deaths as being relatively common. The new study by Bartick and colleagues found that fewer than 1 percent of sudden unexpected infant deaths during the first month of life actually occur during those first six days.

Bartick noted that the peak occurrence for SUID is in the first two to four months of life. Rates of skin-to-skin care rose to nearly 100 percent in Massachusetts, yet there were zero deaths from suffocation or asphyxia.

We now recognize that evidence-based maternity care practices to support breastfeeding are associated with a decreased risk of neonatal death, said study co-author Lori Feldman-Winter, professor of pediatrics at Cooper Medical School of Rowan University.

The authors noted that skin-to-skin care is now routine for all infants, regardless of feeding method.

An additional significant finding of the study was that deaths in the first six days of life occurred disproportionately among black infants, indicating that racial disparity in infant mortality begins as early as the first six days after birth.

Adapted from a Cambridge Health Alliance news release.

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Breastfeeding and Infant Mortality - Harvard Medical School

At the 200-year mark, some institutions would be content to rest on their laurels. But not Indiana University. As their bicentennial celebrations nears, the Hoosiers have dedicated themselves to a tackling what they are calling Grand Challenges, a suite of economic, social and environmental problems plaguing Indiana and the world. These challenges are marked by their impressive scale, immense impact, driven commitment to solutions, and a spirit of interdisciplinary collaboration.

One of the Grand Challenges is the Precision Health Initiative, which aims to match patients more closely and carefully with treatments that meet their individual needs. According to Anatha Shekhar, the executive associate dean of research affairs at the Indiana University School of Medicine, the initiative derives that precision by taking a decidedly holistic look at a patient's health.

"What we're trying to do here is to have a comprehensive approach to understanding a person's health, taking into account their genetics, their environment, their behavior, their culture, and to understand the diseases that are caused by these factors," Shekar explains. "We're particularly focusing on five major serious illnesses that currently have no good treatments and that are uniformly lethal or disabling."

Those five diseases include three types of cancer: triple-negative breast cancer, multiple myeloma, and pediatric sarcoma. They're also targeting diabetes, in particular gestational diabetes affecting pregnant women, as well as Alzheimer's disease.

The Precision Health Initiative was the first project to receive Grand Challenges funding. A truly transformative undertaking, Indiana is pulling together researchers and physicians from across the university ecosystem to create new approaches to prevention, treatment and health care delivery.

"The Precision Health Initiative is trying to just marshal the great resources we have here, all the scientific minds, all the technology, to attack big, bold problems," says Aaron Carroll, professor of pediatrics and associate dean for research mentoring at the IU School of Medicine.

The project is funneling $120 million into six different major scientific pillars: Genomic Medicine; Cell, Gene & Immune Therapy; Regenerative Medicine & Engineering; Psychosocial, Behavioral & Ethics; Data & Informatics; and Chemical Biology & Biotherapeutics.

Carroll likens it all to a moonshot. Where research is normally understood to move slowly, taking tiny steps towards a solution, Indiana seeks great strides founded in unfettered access to both real and mental capital. And, as the only medical school in the state, as well as a regional and national research leader, their charge is an imperative. "It's certainly very Hoosier. I think the idea that we're going to take our local expertise and really try to band together and cross boundaries to try to make a big difference, it's, it's very Indiana," Carroll says.

Clinically speaking, the Precision Health Initiative is not just seeking to draw down instances of the maladies their targeting. Rather, they seek wholesale cures for the cancers, and robust, workable preventative measures for diabetes and Alzheimer's disease.

Their patient-focused approach is already being taught to physicians-in-training at the IU School of Medicine. The importance of factors such as genetic and family medical history, sleep and eating habits, exercise levels and overall mental health is emphasized alongside traditional testing in making a diagnosis.

In the lab, Indiana researchers are matching that holistic approach to patient health with an equally vibrant understanding of how diseases operate. They're working towards a more-perfect model of exactly how cancers evolve and how they become resistant to certain treatments. Concurrently, pharmaceutical scientists are making gains in drug discovery for the treatment of Alzheimer's.

Shekhar says that the feeling among the Precision Health Initiative team is that the work being done now is serving as inspiration for others to "think big and to go for the fences rather than do incremental work."

There are, though, factors limiting the speed at which the team can make new discoveries. Key among them is the need for an expansion in data analysis and management as well as advances need in AI to help researchers make sense of extremely large data sets.

One such set derives from the All In project, which is under the Precision Health Initiative umbrella. Researchers are asking people from across the state and all walks of life to share with them a blood sample as well as specific, yet anonymous health data. This will aid immensely in their understanding of how and why diseases flourish and progress in various populations.

That particular project is indicative of the larger initiative, says Shekhar, echoing Carroll's sentiment that Indiana is uniquely positioned to helm such an audacious undertaking.

"I think Indiana is unique in that first of all, we have the largest medical school in the country, that is a state wide medical school with nine campuses," he says. "We have the largest health system in the state. We serve about two million people every year for their health needs. So, we have gone all the way from engaging large scientific teams, recruiting nearly 50 new scientists to Indiana University to work on this, to engaging nearly hundred thousand people from the community. It's an initiative that couldn't happen in very many places except in Indiana."

Originally posted here:
Inside Indiana's Precision Health Initiative: BTN LiveBIG - Big Ten Network

This transcript has been edited for clarity.

Stephen M. Strakowski, MD: Hello. I'm Dr Stephen M. Strakowski, acting senior associate dean for research at the Dell Medical School at the University of Texas at Austin. I'm speaking today with two of my expert colleagues here. Dr Elizabeth Lippard is an assistant professor in our department and has been here the longest of anybody else other than me. Dr Charles Nemeroff joined us about a year ago and is now acting as chair in the department of psychiatry, in addition to creating and directing the Institute for Early Life Adversity Research.

We're speaking with Drs Lippard and Nemeroff about a seminal paper they just published in the American Journal of Psychiatry, reviewing the impact of early life adversity on people, their lives, their medical history, and potentially what goes on in the brain. I want to talk with them today about how all of us who practice mental health care might apply their important work.

To begin, can you tell us about the field of early life adversity and how common such experiences are in patients?

Charles B. Nemeroff, MD, PhD: The entire field was really launched by the phenomenal Adverse Childhood Experiences (ACE) Study, which was funded by the Centers for Disease Control and Prevention (CDC). Investigators went to Kaiser Permanente in San Diego and sampled 17,000-plus individuals.

The results were just astounding. In this nonclinical general population, the rates of child abuse in the form of physical abuse, sexual abuse, emotional abuse, and neglect were remarkably high, rangingdepending on the categoryfrom about 8% to 25%. These results have since been confirmed in several subsequent studies from the CDC and others. This is really a public health tragedy.

Strakowski: It sounds like an epidemic. If we imagined a new virus suddenly affecting 1 in 4 kids, I assume that people would be quite upset and doing something about it.

Nemeroff: This is the single biggest contributor to the risk for psychiatric and medical disorders, more than any single gene or factor. It increases the risk for heart disease, stroke, depression, drug abuse, suicide. It's awful.

Strakowski: How should people be thinking about the potential impact of these risks?

Elizabeth Lippard, PhD: Piggybacking on what Charlie was saying, if you look at the prevalence of childhood maltreatment, early life stress, and mood disorders, you see rates as high as 50%-60%. If you look at individuals with mood disorders and comorbid addiction, rates are even higher.

We consistently see across studies that it's associated not only with increased risk for onset, but also increased risk for disease recurrence. In terms of mood disorders, this means more mood symptoms occurring over time with greater severity. You also see a relationship in terms of more complicated clinical cases: more comorbidities, with addiction and medical morbidities as well.

Considering the clinical impact that it's having on disease outcomes, and how prevalent child maltreatment is, this is a large percentage of disease burden that can be directly contributed to early life stress. It points to a very powerful target that we need to be thinking about when treating disease.

Strakowski: I think when a lot of us consider these kinds of abusive histories, we tend to then jump to post-traumatic stress disorder (PTSD) as the only consequence that we need to contemplate. But you're saying that it's much broader than that.

Lippard: Yes, definitely. Whenever you think about childhood maltreatment, it really crosses diagnostic boundaries. It increases the risk for mood disorders, addiction, PTSD, schizophrenia, etc., and you see it across the board.

Nemeroff: If you look at victims of child abuse and neglect when they are adults with psychiatric disorders, they are much more treatment resistant than patients with comparable disease severity without this history. We believe that the reason for that is that early life trauma results in brain and body changes that persist for the lifetime of the individual. These folks have a different biology, a different brain, and their treatment response for bipolar disorder, for depression, for PTSD is just terribly worse than it is for people without this history.

Strakowski: You perfectly anticipated my next question. Do we have some idea of what early life trauma is doing to the person's brain or body that is setting them up for these consequences?

Lippard: We do. There's a wealth of research out there pointing toward long-lasting neurobiological and immune mechanisms, as well as the hypothalamic pituitary adrenal stress response system, and changes within these systems that may be contributing to these outcomes.

In terms of the brain, we see long-lasting changes in structure and function within systems that regulate stress response and emotional, higher-order cognitive processes. It really is giving us an insight into the brain systems that may be so critical for developing psychopathology over time following childhood maltreatment.

One of the things that's really striking to me when you look at the literature is the more recent emergence of longitudinal studies, which suggest that changes in the brain really can predict future mood symptoms, recurrence, and severity. Traditionally, we started with a wealth of cross-sectional studies in this area, but now these longitudinal studies coming out have given us a lot of power to hone in on certain systems of the brain that can hopefully be targeted for intervention.

Strakowski: Clinicians and providers across many different specialties will be watching this. This applies to patients with psychiatric conditions but, as you implied, medical conditions as well. How do you recommend they ask their patients about this?

Nemeroff: First, for the clinicians out there, it's extremely important that you get this information from the patient. You need to know it.

There are several screening tools available to help you obtain this information. There's the ACE questionnaire, although I'm not particularly fond of it. I think the Childhood Trauma Questionnaire is somewhat better. There are others as well. These are self-rating scales, so they won't take any of your time. We have every patient fill out the scales, which gives you a good indication of their history, as patients will often put things down on paper that they don't want to tell you.

Second, it often takes several visits with a patient before they're comfortable enough to talk about their trauma. I've seen many patients with treatment-resistant depression who finally revealed to me that they had suffered a childhood rape or some other awful experience. If you're seeing a treatment-resistant patient, you should be thinking about child abuse and neglect.

Strakowski: In anticipating my talk with you both today, I gave some thought to my own clinical practice. On a given day in my clinic, I bet 80% of the young people I treat have these histories. It's hard to overexaggerate the risk.

Strakowski: From a treatment perspective, do you consider maybe doing something differently if you are aware that a patient has this history?

Nemeroff: We know that in every study that we looked at, when you parse out the patients with early life trauma and compare them to those who don't have that history, they have a poorer outcome. But part of the problem is that there are no treatment trials that have specifically asked this question. In terms of designing a treatment, my gut feeling, which is not science, is that they would do better with a combination of pharmacotherapy and psychotherapy.

One of my concerns is that, as pharmaceutical companies come to realize that these patients actually have poor treatment outcomes, they're starting to eliminate them from clinical trials.

Strakowski: Which is the exact opposite of what we wish would happen.

Nemeroff: It's sort of like what's happened with pregnancy; we don't know how to treat pregnant women because they're never allowed in trials.

Strakowski: To me, it sounds like we have an epidemic for which we're not aggressively trying to find a solution. Does it feel like the psychiatric or psychological professional associations and organizations are making this issue sufficiently visible to engender some response?

Nemeroff: I think that a number of the organizations you're referring to have done their best, but it's not enough. First, from a medical education point of view, there is very little training about child abuse and neglect in the curriculum.

Strakowski: I probably received none, roughly 200 years ago when I was in training, and I'm guessing the same is true for you.

Nemeroff: Absolutely. There's very little attention paid to this. Of all of the physicians, I think pediatricians have been the most sensitive to this. But as Beth alluded to, this a population with an increased risk for diabetes, certain forms of cancer, heart disease, and stroke, and specialists in those areas don't ask about child abuse and neglect.

Strakowski: There's a lot more detail to this very important topic in the paper, authored by Drs Lippard and Nemeroff, which is titled "The Devastating Clinical Consequences of Child Abuse and Neglect: Increased Disease Vulnerability and Poor Treatment Response in Mood Disorders." I hope you all will take a look at that, and I hope you found our conversation interesting. Thank you all for listening today.

Stephen Strakowski, MD, is the founding chair and professor of psychiatry at Dell Medical School, University of Texas. His research focuses on the brain changes that occur at the onset of bipolar disorder.

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Originally posted here:
The 'Single Biggest Contributor' to Medical and Mental Illness - Medscape

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Researcher Tom Cappola tells us about the latest clinical trials and medical breakthroughs to be announced during Scientific Sessions.

Chief of the cardiovascular medicine division in the Perelman School of Medicine at the University of Pennsylvania, Tom Cappola.

For the first time in its near 100-year history, the American Heart Association (AHA)will host its annual meeting in Philadelphia. AHAs Scientific Sessions is the largest cardiovascular meeting in the United States. On November 16-18, the meeting will attract nearly 18,000 attendees from more than 100 countries to the Pennsylvania Convention Center, and an additional two million medical professionals who will participate virtually in lectures and discussions about basic, translational, clinical and population science innovations aimed at reducing disability and deaths caused by cardiovascular disease and stroke.

The American Heart Association is excited to be in Philadelphia, said Michelle Kirkwood, director of National Science Media Relations for AHA. It has been on our wish list for some time, especially since the renovations at the Pennsylvania Convention Center and the citys landmark, robust nonsmoking laws that align directly with the American Heart Associations health and wellness goals. We are excited for our thousands of attendees to visit Philadelphia.

More than 610,000 people die of heart disease in the United States every year, according to the CDC. While heart disease is a leading cause of death for both men and women, it claims the lives of over 400,000 American women each year, or one death every 80 seconds. During the three-day meeting, more than 12,000 leading physicians, scientists, cardiologists and healthcare professionals in the global cardiovascular health community will host 850 educational sessions and more than 4,100 original research presentations to unveil the late-breaking science, clinical trials, and novel therapeutics and pathways that are shaping the future of cardiovascular care.

Its very fitting for Scientific Sessions to be here, chief of the cardiovascular medicine division in the Perelman School of Medicine at the University of Pennsylvania Tom Cappola said. We have the first medical school in the country and the first teaching hospital in the country. It makes sense that these new innovations would be presented in a place where theres already been so much innovation.

Cappola will be one of several Penn researchers leading the Cardiovascular Expert Theater, Innovations in Cardiovascular Therapies session during the meeting. Here are just a few big trends in heart care that Cappola says we can expect to learn more about during this weekends meeting:

Using artificial intelligence to monitor heart health

Artificial intelligence (AI) is having a big impact on cardiovascular care. Results from two preliminary studies to be presented this weekend will show AI can be used to accurately examine electrocardiogram (ECG) test results to possibly predict irregular heartbeat and risk of death. There will also be a presentation on the Apple Heart Study, which found that the Apple Watch and other wearable remote monitoring devices may be capable of detecting atrial fibrillation (aFib), an irregular and often rapid heartbeat that can lead to blood clots, stroke, heart failure and other complications.

Identifying new risk factors for aFib and stroke

George Mason University researchers will present results from two studies that found young people who smoke marijuana regularly have an increased risk of stroke. According to the study findings, young adults between the ages 18 and 44 who reported frequent use of marijuana, cigarettes and e-cigarettes were three times more likely to suffer stroke than young adults who did not smoke marijuana at all. The study also found that African-American males between the ages of 15 and 24 faced the highest risk of being hospitalized for arrhythmia.

In one Penn study to be presented this weekend, researchers found women who are diagnosed with peripartum cardiomyopathy (PPCM) during late pregnancy or within a month following delivery are more likely to experience restored cardiac function and improved outcomes compared to those who are diagnosed later in the postpartum period. The findings underscore the need for increased awareness and monitoring of heart failure symptoms, particularly among black women, who, on average, are diagnosed significantly later than white patients, according to study results.

Making advances in genetics and genomics

Another big trend at this years meeting will be the continued advancement in genetics and genomics, and how thats impacting cardiovascular care.

I think that genomic medicine has arrived and its arriving in waves, but it will ultimately affect all aspects of cardiovascular care, Cappola said. We have lots of people getting their 23andMe for sort of recreational purposes and they dont know what to do with it. But were starting to figure out what to do with that genetic information to improve care.

Another Penn Medicine study to be presented during the meeting will show why taller people may have an increased risk of developing atrial aFib. The research found a strong link between the genetic variants associated with height and ones risk for AFib, for the first time demonstrating that height may be a causal not correlated risk factor for the condition. Researchers hope insight from human genetics in large studies like this one will help them better understand causal risk factors for common disease.

It takes expertise to find links like this. Thats why researchers go to the American Heart Association meetings. You get all the experts together, they share their knowledge and this helps us to actually figure out what to do with this genetic information, Cappola said. Thats true across the board, but its particularly important for genomic medicine as it continues to advance.

Read more:
The American Heart Association's Annual Conference Comes to Philly This Weekend - Philadelphia magazine

Using Google to self-diagnose potential medical conditions often leads to stress and seriously inaccurate diagnoses, according to a new survey.

The survey, commissioned by a personal health testing company LetsGetChecked, polled 2,140 Americans and found that 65 percent had tried diagnosing themselves on Google. Of those respondents, 74 percent said these attempts had stressed them out. One reason: The diagnoses they found online were inaccurate more than half of the time, meaning many people falsely convince themselves they have serious illnesses.

Why not see a doctor? A majority of survey respondents said they'd avoided doctors because of factors like cost, lack of time and concerns that the doctor wouldn't take their symptoms seriously. Given these reasons, it's no wonder why many prefer the immediate consultation of "Dr. Google" or "Google University", as some health care professionals have dubbed the online self-diagnosis phenomenon. Self-diagnosing has become so common that there's even a word for people who do it too much: "cyberchondriacs".

But is there any value in using the internet to self-diagnose? David Kopp, chief executive officer of Healthline Media, argued that Googling symptoms often helps people better manage their health.

"Contrary to popular belief, consumers can typically trust what they find online," Kopp wrote in an opinion piece in Newsweek. "The three fastest growing online sources of medical information contain content written or curated by physicians. In addition, reputable government sites like the Centers for Disease Control and Prevention and the National Institutes of Health are among the most visited on the internet."

The keyword there is "reputable" there's of course no shortage of shoddy, unreliable and downright insane medical advice on the internet. Still, some sources do seem to help people self-diagnose with relative accuracy.

A 2015 study published by BMJ in 2015 examined 23 popular symptom checkers commonly used by insurance companies, medical schools and government agencies. Overall, these systems correctly diagnosed the condition on the first try 34 percent of the time, and the correct diagnosis appeared in the first three diagnoses about half of the time. (The symptom-checkers with the highest accuracy were Isabel, iTriage, Mayo Clinic and Symcat, all of which are free to use.)

Symptom-checkers often get it wrong, but they generally do a good job of telling people when to go to the hospital.

"It's not nearly as important for a patient with fever, headache, stiff neck, and confusion to know whether they have meningitis or encephalitis as it is for them to know that they should get to an ER quickly," Ateev Mehrotra, associate professor of health care policy and medicine at Harvard Medical School, told The Harvard Gazette. "These tools may be useful in patients who are trying to decide whether they should get to a doctor quickly, but in many cases, users should be cautious and not take the information they receive from online symptom checkers as gospel."

The main shortcoming of symptom-checkers is that they don't factor in your comprehensive medical history.

"Each person has a different family history, has experienced different risk factors, and has his own social history, all of which contribute to the decision-making process a physician goes through," board-certified internist Dana Corriel, MD, told Byrdie in an interview.

So, even though a symptom-search for "cough" might show "cold" next to "lung cancer", it's usually no reason to panic. But if you're unsure?

"A primary care doctor is always available for a quick visit or question on the phone," Corriel said. "They cover general internal medicine and can answer most questions about the body."

Related Articles Around the Web

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Cyberchondria: 40% of Americans have misdiagnosed themselves online - Big Think

Dr. Gabe Mirkin

Dr. Gregg L. Semenza of Johns Hopkins, Dr. William G. Kaelin Jr. of Harvard and Dr. Peter J. Ratcliffe at Oxford in London shared the 2019 Nobel Prize for discovering how your body responds when you cant meet your needs for oxygen. Their groundbreaking research is now being used to treat certain cancers, strokes, infections, anemia, heart attack risks, and some eye diseases that can cause blindness.

You need oxygen for your cells to convert food to energy. When you cant get enough oxygen, your body makes extra red blood cells to carry oxygen, makes new blood vessels to bring the oxygen to your cells, and switches to ways to convert food to energy without using oxygen. These researchers have shown how to turn genes on and off to increase or decrease oxygen levels. By decreasing available oxygen, you can: kill cancer cells, stimulate new growth of blood vessels for a person prone to heart attacks, stimulate the bone marrow to make new red cells to treat anemia.By increasing oxygen levels, you can treat kidney diseases.

Applications for Cancer TreatmentCancer cells need lots of oxygen to keep on growing, so researchers are now trying to stop cancer from spreading by blocking their supply of oxygen through blocking production of new blood vessels. Scientists have known for many years that low oxygen levels cause the kidneys and liver to make a hormone called erythropoietin (EPO), that causes the bone marrow to increase production of new red blood cells. Both Drs. Semenza and Ratcliffe showed that low oxygen levels cause all the cells in the body to make large amounts of a protein called HIF-1a that stimulates the body to increase production of blood vessels and red blood cells that increase a cancers chance of spreading.

Dr. Kaelin studied people who suffered from von Hippel-Lindau syndrome (VHL), an inherited disease in which patients have a very high risk of pancreatic and kidney cancers. The same gene that increases their cancer risk also increases the oxygen supply to cancer cells, so their cancers can grow and spread through the body. Since high levels of oxygen increase (and low levels decrease) the risk of cancer spreading through the body, blocking HIF-1a can treat cancer by preventing cancer cells from increasing oxygen supply by making new blood vessels. An angiogenesis blocker, Avastin (bevacizumab), treats brain, kidney, lung and colon cancers by blocking cancer cells from stimulating the growth of new blood vessels they need to obtain oxygen and nutrients. On the other hand, increasing HIF-1a production can increase production of red blood cells to treat anemia.

The RecipientsWilliam G. Kaelin Jr., is professor of medicine at Harvard Medical School. He earned his bachelors degree in math and chemistry at Duke University where his laboratory instructor wrote, Mr. Kaelin appears to be a bright young man whose future lies outside of the laboratory. He went to Duke Medical School and took his residency in internal medicine at Johns Hopkins. He then went to Harvard where he studied a genetic disorder, VHL, that is characterized by high risk for cancer. He found that the disease was characterized by high levels of a hormone called erythropoietin, and showed that these people have a gene that causes high oxygen levels that cause cancers to spread through the body.Gregg L. Semenzais professor of pediatrics, radiation oncology, biological chemistry, medicine, and oncology at the Johns Hopkins University. He credits his interest in science to his high school biology teacher, Rose Nelson, in Sleepy Hollow, N.Y. He went to college at Harvard and medical school at the University of Pennsylvania, where he also got a PhD. He took a pediatrics residency at Duke University Hospital and then went to Johns Hopkins where he did his breakthrough research that is now used to treat patients with cancers and heart attacks.Peter J. Ratcliffeis the director of the Target Discovery Institute at Oxford University in London, UK. In high school, he wanted to be an industrial chemist. The headmaster showed up in his chemistry classroom and told him, Peter, I think you should study medicine. The next day he changed his university application form to medical school at Cambridge University. He has specialized in kidney diseases with studies involving EPO, the hormone that is released when oxygen levels are low to cause the bone marrow to make more red blood cells.

Dr. Gabe Mirkin is a Villager. Learn more at http://www.drmirkin.com

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Breakthrough research from winners of the 2019 Nobel Prize in Medicine - Villages-News

Democratic presidential candidates former Vice President Joe Biden (left), Sen. Elizabeth Warren, D-Mass., and South Bend, Ind., Mayor Pete Buttigieg (right) debate different ways to expand health coverage in America. John Minchillo/AP hide caption

Democratic presidential candidates former Vice President Joe Biden (left), Sen. Elizabeth Warren, D-Mass., and South Bend, Ind., Mayor Pete Buttigieg (right) debate different ways to expand health coverage in America.

The Democratic debate is less than a week away, and it's likely that health care will once again take center stage. Once again, the candidates will spar over the best way to achieve universal coverage. Once again, the progressives will talk up the benefits of "Medicare For All" while the moderates attack it for its high cost and lack of choice. Just like the last debate. And the one before.

But it's not the repetitiveness of the health care debate that bothers me. As a medical student, what bothers me is that the current health care debate is myopically focused on health insurance.

Although health insurance coverage is important, it's only part of the picture. If the goal of our health care system is to keep Americans healthy, insurance will only get us so far. Health is about much more than access to health care.

Asthma triggers when you're homeless

Take the case of a patient I helped treat this past summer, a young man in his early 20s who came into the emergency department experiencing severe shortness of breath. I could hear him wheezing before I even walked into the room.

He was sitting on the stretcher, breathing rapidly, and leaning forward with his hands on his knees the classic "tripod" position signifying respiratory distress. After the resident physician and I determined he was having an asthma attack, we controlled his symptoms with steroids and inhalers and monitored him until he improved.

As I was preparing to discharge the patient, I briefed him on some of the asthma triggers he should avoid. When I advised him to keep the windows closed to minimize his exposure to pollen, he told me that the shelter where he was staying didn't have air conditioning. It was 83 degrees outside that day.

Health insurance couldn't prevent his next asthma attack. He needed a better and more stable housing situation.

Food deserts and no ride to the doctor

The same was true for a second patient of mine who was admitted to the hospital with diabetic ketoacidosis, a life-threatening complication of diabetes resulting from poor blood sugar control. After he recovered, we discharged him home to a food desert, a neighborhood where grocery stores and fresh-food markets are scarce and where following a low-carbohydrate diet is next to impossible. Health insurance cannot solve the food insecurity in his community.

Nor could health insurance enable a third patient of mine who'd had vascular surgery to re-open a blocked artery in his leg to return for his follow-up visit. Had he done so, we would have caught his post-operative infection early. As it happened, however, he had no way of traveling the 15 miles from his home to our clinic, and his infection worsened to the point that we had to amputate two of his toes. Health insurance didn't address his transportation barriers.

Fortunately, all three patients were insured. Indeed, I'm grateful to attend medical school in Massachusetts, which has achieved near universal health insurance coverage. But sometimes insurance isn't enough. I constantly see cases like these in which acute health problems arise due to factors seemingly unrelated to medicine. Universal coverage, while a worthy goal, does not translate into universal health.

Who will fix holes in the social safety net?

A recent study that rated U.S. counties based on health outcomes found that access to medical care accounted for only 20 percent of a county's score. The other 80 percent was more readily attributable to social and economic factors like the ones affecting my patients, including housing instability, food insecurity, and access to transportation.

The health care dialogue in this political race has been dominated by the notion that we need to cover everyone, a principle I fully support. But even if we achieve that, it will only get us a fraction of the way to our goal of better health for all Americans. The German health care system is widely praised for its universal coverage, robust primary care, and low out-of-pocket costs for medical care. But it is nonetheless plagued with health disparities. In some cities, life expectancies of neighboring communities differ by up to 13 years.

To neglect these social factors in our public discourse on health care would be a mistake, not only because they are important to public health but also because policymakers are often better equipped to tackle social factors than they are medical ones. Evidence suggests that providing stable housing to homeless populations in urban areas, for instance, contributes to significantly reduced mortality.

Insurance coverage is a critical determinant of health. We should discuss it. But candidates for president should also discuss their plans to strengthen communities by addressing homelessness, food insecurity, and the other social factors that underpin America's health gap.

Thus far, these issues have received scant attention in the Democratic primary race and in the larger political dialogue about health care. We need to broaden the conversation from a narrow discussion of health insurance to a holistic conversation about health.

Suhas Gondi is a third-year medical student at Harvard Medical School. A version of this essay originally appeared in Undark, the online science magazine.

Visit link:
Good Health Insurance Isn't Enough To Fix Holes In The Social Safety Net : Shots - Health News - NPR

The city of Wichita has an agreement with a development group to convert four downtown buildings into a medical school, student housing, a culinary school and a hotel.

The city council has approved an agreement with Douglas Market Development, which owns the four buildings. The former State Office Building will be converted into the Kansas Health Science Center, and the former Sutton Place building will be remodeled to have 119 units for student housing.

The former Henrys building at 124 South Broadway will be converted into a commercial kitchen and culinary school, and the former Broadway Plaza Building at 109 South Broadway will be remodeled into a 119-room hotel that will be operated as a Marriott hotel.

Assistant city manager Scot Rigby said construction on the medical school is expected to begin by March, 2020, and the first class will begin in August of 2022. Work on the other buildings will also begin by March and they would be ready for occupancy in 2022. The entire project is a $90 million investment.

Jason Gregory with the Downtown Wichita organization said the project will bring life back to four vacant buildings and it will strengthen the Douglas Avenue and Williams Street corridors.

(above image is a rendition of the State Office Building as the medical school)

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Construction to begin next year on medical school in downtown Wichita - KFDI

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Texas has an abundance of medical schools already, and there are only more to come! School is on the rise, which means pre-meds are hard at work on their MCAT studies and application preparations. If you are a Texas resident, you have more options than most! Here is the complete list of Texas medical schools, including the ones slated to open within the next few years. (These are in no way ranked by prestige.)

1. Baylor College of Medicine

Average GPA: 3.88

Average MCAT: 35 out of 45

Main Program: M.D.

There are currently 743 total medical students. Of the 6,618 people who applied in the last class, 732 were interviewed (452 of which were Texas residents), and of those interviewed and accepted, 186 enrolled this past year. Approximately 139 out of the 186 students in the first-year class are Texas residents. Located in the Texas Medical Center in the ever-so-humid and large city of Houston, Baylor is one of the most prestigious and competitive medical schools in the nation. However, it was voted the most affordable private medical school with in-state tuition set at $17,498 and out-of-state tuition at $30,598. Baylor College of Medicine is ranked 18th in the nation among medical schools by U.S. News and World Report.

2. UT Southwestern Medical School at Dallas

Average GPA: 3.88

Average MCAT: 34 out of 45

Main Program: M.D.

There are currently 939 medical students, with 226 in the first-year class. Of the 4,057 people who applied, 834 received an interview (750 of which were Texas residents). Of those interviewed and accepted, 226 enrolled. Eighty-five of the students that just enrolled are from Texas and an overwhelming 61 percent of first-year students are male (so all the single ladies put your hands up!). UT Southwestern is ranked 23rd in the nation by U.S. News and World Report.

3. University of Texas Health Science Center at San Antonio

Average GPA: 3.74

Average MCAT: 32 out of 45

Main Program: M.D

There are currently 880 medical students. Of the 4,133 people who applied, 974 received an interview (847 of which were Texas residents). Of those interviewed and accepted, 212 enrolled. Eighty-nine percent of the enrolled students are from Texas and 51 percent are female. UTHSC San Antonio is ranked 70th in the nation by U.S. News and World Report. Since it is located in San Antonio, you can definitely find some of the best Tex-Mex food to eat while cramming for your boards!

4. University of Texas Medical Branch at Galveston

Average GPA: 3.87

Average MCAT: 32 out of 45

Main Program: M.D.

There are currently 900 medical students. Of the 4,091 that applied for admission, 1,053 received an interview and 949 were Texas residents. Of those who were interviewed and accepted, 228 enrolled and 57 percent are male. Again, ladies, if you are looking for the perfect doctor husband, this is another great place to go. Located near the beach, UTMB at Galveston is ranked 111th in the nation by U.S. News and World Report.

5. University of North Texas Health Science Center

Average GPA: 3.59-3.6

Average MCAT: 28 out of 45

Main Program: D.O.

UNTHSC is the only Doctor of Osteopathic Medicine program in Texas. Of the 3,006 people that applied for admission, 837 received interviews. Of those who were interviewed, 454 were accepted and 228 enrolled (209 of which were Texas residents). There are only 30 medical schools in the U.S. which offer the D.O. degree. People with a D.O. degree can be physicians and surgeons just like those of the M.D. degree, however, the D.O. degree requires 300-500 hours of studying philosophically based techniques for hands-on manipulation of the human musculoskeletal system. D.O. schools are known to be slightly easier to gain admission into. UNTHSC is located in Fort Worth (which is the best city in the state of Texas), and is ranked 158th in the nation by U.S. News and World Report.

6. Texas A&M University Health Science Center

Average GPA: 3.74

Average MCAT: 30 out of 45

Main Program: M.D.

Of the 3,791 people who applied, 714 received an interview and 668 were Texas Residents. Of the people who were accepted, 199 enrolled, 95 percent of whom were Texas residents. Fifty-four percent of first-year students are female. The school is located, unfortunately, in College Station. It is ranked 101st in the nation by U.S. News and World Report. Aside from its location, it's a great medical school. Just keep in mind that you'll have to call yourself an Aggie for the rest of your life. Whoop...

7. Texas Tech Health Science Center

Average GPA: 3.78

Average MCAT: 32 out of 45

Main Program: M.D.

Of the 3,535 people who applied, 783 received an interview, 717 of whom were Texas Residents. Out of those interviewed and accepted, 150 enrolled, 90 percent of whom were Texas residents. Fifty-six percent of the students in the first-year class are male. TTHSC is located in Lubbock, where it smells like cow droppings and is almost worse than College Station because it's straight-up in the middle of nowhere. At least you won't be distracted from studying, because there's not much to do out there in the middle of the plains of Texas. The school is ranked 104th in the nation by U.S. News and World Report. However, it does snow there, which could be fun.

8. Texas Tech Paul L. Foster School of Medicine

Average GPA: 3.6

Average MCAT: 28 out of 45

Main Program: M.D.

Located in El Paso, the Texas Tech Paul L. Foster School of Medicine has 100 students in its first-year class, 99 percent of whom are Texas residents. The current first-year class is 65 percent male and 35 percent female. Learning Spanish is an additional requirement at this school. I was not able to find as much in-depth information about this school, but I can also guess there is very good, authentic Mexican food around. Learning Spanish truly gives you an edge in Texas medicine, so I think this would also be a very solid choice of medical school.

9. UT Health Science Center at Houston

Average GPA: 3.84

Average MCAT: 33 out of 45

Main Program: M.D.

There are currently 958 medical students, with 240 of them in the first-year class. Of the 4,393 who applied, 845 received interviews (791 of whom are Texas residents). The first-year class is 55 percent male. This school is neighbored with Baylor College of Medicine. It looks like this town is "big enough for the two of us." Houston is a great place for medicine, especially since it contains THE world-class M.D. Anderson Cancer Center.

UNDER CONSTRUCTION

10. Dell Medical School

We have yet to know the average GPAs or MCATs at this medical school, because it is BRAND NEW AND NOT EVEN FINISHED BEING BUILT YET! It has, however, received preliminary accreditation, which means it will begin recruiting its first class this year. Its first class will contain 50 students in June of 2016. Dell Medical School hopes to revolutionize medical education by creating educational flexibility for students to determine their own objectives for clinical cases, commitment to innovation of care in the Austin community, focus on leadership development, integrating more technology into medicine, and increasing student presence in the community. Dell Medical School will be located in Austin, home of the Texas Longhorns, great food, live music festivals, prime hiking and camping spots in the hill country, and hippies. While the first class may seem small, it is only because the school will not be fully licensed yet. Class sizes will increase over time.

11. University of Texas Rio Grande Valley School of Medicine

The school of medicine will welcome its first class in fall of 2016. The program already has already accepted 42 medical residents to begin clinical rotations in Valley Baptist Medical Center in Harlingen, McAllen Medical Center, and Doctors Hospital at Renaissance in Edinburg.

12. TCU & UNT Medical School

TCU recently announced its partnership with UNT to create the first M.D. program in Fort Worth, in addition to the D.O. program. The school will accept its first class of 60 students in 2018. To minimize costs, it will utilize both the UNTHSC and TCU campuses and existing faculty. People who graduate from this medical school will be alumni of both UNT and TCU.

13. University of the Incarnate World Medical School

Main Program: D.O.

The University of the Incarnate World is a Catholic institution located in San Antonio. It will be the only faith-based medical school in the state of Texas. It is currently applying for its accreditation by the American Osteopathic Association in the hope of welcoming its first class of 150 medical students in July of 2017.

With the addition of the four new medical schools, Texas will tie with California for having the second most medical schools in the U.S., leaving New York at the top with 16. The opening of new medical schools and increased enrollment has been a side effect of Obamacare. Obamacare will now emphasize an increase in demand for primary-care physicians, rather than specialties, to aim for more preventative care. There will be more scholarships and loans available to students who pursue primary care. In 2013, overall medical school enrollment increased by 6.1 percent. Today, people are becoming more aware of the Doctor of Osteopathic Medicine degree. D.O. schools will expect an increased enrollment of 162 percent by 2020, whereas M.D. schools will expect an increased enrollment of 29 percent because D.O. degrees emphasize more primary, preventative care.

Texas is a melting pot for medicine, and is only becoming more prominent. Just remember to maximize your options when applying for medical school!

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The Complete List Of Texas Medical Schools