Efforts to Enhance Health Care Access Reach Milestone with NYIT Medical School’s First Graduates – ASU News

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05/20/2020

JONESBORO Arkansas State Universitys effort to expand and enhance medical care throughout Arkansas and the Delta reaches a historic milestone Thursday as its partner, New York Institute of Technology College of Osteopathic Medicine, holds a virtual commencement ceremony at 2 p.m. for its inaugural class of medical school graduates.

In 2013, A-State announced its plans to conduct a feasibility study for the opening of an osteopathic medical school in Jonesboro. NYITCOM in Old Westbury, N.Y., was selected as a partner school for the effort and approved by the ASU System Board of Trustees in February 2014. NYIT received approval from the AOA Commission on Osteopathic College Accreditation in December 2015 to open an additional accredited site in Jonesboro, and the states first osteopathic medical school and only the second medical school opened for classes with 120 students in August 2016.

Nationally renowned medical education leader Dr. Barbara Ross-Lee, who was serving as vice president for health sciences and medical affairs of NYITCOM and previously was the nations first African-American woman to serve as a medical school dean, was the driving force for the project. She ultimately served as the first dean at the Jonesboro site, while Dr. Shane Speights was a key member of the organizational team in Jonesboro and serves as dean of the school today. Ross-Lee described the development as a new model of medical education for Arkansas.

Our partnership with NYIT has been remarkable and transformative, and its almost surreal that we have reached this milestone event, said Dr. Charles L. Welch, president of the ASU System. The vision and determination of Barbara Ross-Lee led an incredible team that brought the medical school to fruition, and we couldnt be happier to see the work of Shane and NYIT both with the students and with all the clinical partnerships developed throughout the region. We are also forever grateful to the leadership of Jonesboros medical centers for their extraordinary efforts to make this happen.

We had many naysayers who said another medical school wasnt needed or wouldnt work or couldnt secure clinical rotations and residencies, Welch said. NYITCOM at Arkansas State had an amazing 95 percent match rate for residencies in March with 72 percent in primary care and 47 percent within the Delta. Hundreds of qualified applicants seek to attend the school, and dozens of new residencies have been developed throughout Arkansas and the region as a result of this partnership. These were all goals we had in the beginning of the process, and NYITCOM has met every expectation.

As part of the partnership, A-State and NYITCOM worked together to renovate the historic, 86,000-square foot Wilson Hall in the heart of campus as the high-tech site for NYITCOM at Arkansas State. The $12.6 million project contributed to an economic impact of $88 million on Jonesboro and Northeast Arkansas, according to the feasibility study conducted by Tripp Umbach. The medical school brought 480 students and 78 faculty and staff members to Jonesboro. A-State has generated $5.2 million in new revenue from the medical school partnership and expects another $10 million over the next decade.

The impact of NYITCOM on Jonesboro and A-State has been extraordinary, said Dr. Kelly Damphousse, chancellor of A-State. Our partnership with NYIT aligned perfectly with our educational mission and existing academic programs in science and medical professions while giving the Jonesboro economy a substantial influx of jobs and nearly 600 residents. Im particularly pleased with the number of A-State graduates who have been able to stay on campus for their medical school studies.

NYITCOM faculty are conducting research at the Arkansas Biosciences Institute on the A-State campus, and the school is collaborating with the A-State College of Nursing and Health Professions and other programs on campus.

"We've reached this milestone because of the tremendous work of so many individuals and organizations, and I can't begin to express my gratitude for all of those involved who have contributed to our success," Speights said. "We set out to impact health care and health education in this state in a way that would have a generational affect, and as we celebrate our first commencement, I'm just so thankful to our partners, to our faculty, to our staff, and to this remarkable group of students who have made it all possible."

The NYITCOM virtual ceremony may be seen live on Facebook on the NYIT College of Osteopathic Medicine at Arkansas State page, http://www.facebook.com/NYITCOMAR, as well as the colleges website, https://www.nyit.edu/arkansas/virtual_commencement.

The virtual commencement will include remarks from Dr. Hank Foley, president of New York Institute of Technology; Dr. Jerry Balentine, vice president of medical affairs and global health at NYIT; Dr. Barbara Ross-Lee, founding dean of NYITCOM at Arkansas State; Arkansas Governor Asa Hutchinson; and Dr. Shane Speights, who has served as dean of NYITCOM at Arkansas State since January 2017.

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For more information:Jeff HankinsVice President for Strategic Communications & Economic DevelopmentArkansas State University System

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Efforts to Enhance Health Care Access Reach Milestone with NYIT Medical School's First Graduates - ASU News

VTC Medical School Moves Small-group, Problem-based Learning Online to Help Stop Spread of COVID-19 – The Roanoke Star

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As Virginia Tech took measures to help stop the spread of COVID-19, instruction moved online. For the Virginia Tech Carilion School of Medicine, that meant moving some types of high-interaction curriculum into new formats, including one of the signature components of the medical schools unique curriculum itssmall-group, problem-based learning method.

Known as PBL to the students and faculty members, the method is used in the first and second years of the curriculum as a way for students tolearn the basic science they need to know as physicianswithin the frame work of real patient cases. Instead of sitting through lectures to learn the science, students work in small groups of seven to eight students. A faculty facilitator is in each group as a guide, but, for the most part, the students teach each other.

With concerns about COVID-19, our faculty had only a few days to figure out how to transition the highly interactive curricular component online, said Lee Learman, dean of the Virginia Tech Carilion School of Medicine. Our faculty worked quickly to move it into a virtual space, while striving to preserve the special features of PBL.

Faculty set up separate Zoom rooms for each small group. They meet three times a week for a few hours in each small group. Then, the entire class joins a Zoom together at the end of the week to meet the physician who worked on the case they studied that week. If a patient is able to join virtually, they can be added to the Zoom meeting as well.

What Im most surprised about over the PBL experience in the virtual environment is that the interactions remained very organic and very positive between the facilitator and the peers and the peers themselves, said Renee LeClair, chair of the Department of Basic Science Education.

I was initially nervous about having to move to an online platform so quickly without much time for training. But with Dr. LeClairs we can do this attitude and the help the IT team, its gone much more smoothly than I had anticipated, said Joanne Greenawald, director of the problem-based learning curriculum. I think the online PBL platform is meeting our educational objectives, and its great to still have some connection with the students during this very disconnected time.

So far, student feedback has indicated that the transition has gone as well as it can, given the circumstances.

Personally, I have always used PBL to synthesize what weve been learning in basic science and clinical science and combine those to help me better understand and better learn the material, said Rebekah Sayre, a first-year medical student. When I found out we were transitioning, I was nervous that it wouldnt be the same and I wouldnt have the same opportunities for learning. However, PBL has been one of our most successful transitions as far as staying true to what I would expect to see in an in-person PBL session.

Some challenges have included occasional issues with internet connectivity for students or faculty. Some students returned to their family to quarantine, leading to some being in different time zones for their virtual meetings. It is also more difficult to share some content, like writing on a white board in a physical space, but faculty and students are getting creative to overcome the challenges.

Im realizing now how much of my teaching depends on knowing where the students are from nuanced body language, whether theyre getting frustrated, who needs help and who doesnt, said Andrew Binks, associate professor and director of professional development in the Department of Basic Science Education. All of that is much more difficult on online, but its something that Im going to learn as we use this environment.

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VTC Medical School Moves Small-group, Problem-based Learning Online to Help Stop Spread of COVID-19 - The Roanoke Star

These medical workers are tackling the coronavirus. They’re also saddled with student debt. – NBC News

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Many medical workers toiling during the coronavirus pandemic remain burdened by another crisis that emerged long before the outbreak: crushing amounts of student debt.

Now is the time, those beleaguered health care professionals say, for Congress to provide meaningful relief, such as total loan forgiveness, in the vein of other legislation crafted following a national tragedy as with first responders who were financially compensated after falling ill in the wake of the Sept. 11, 2001, terrorist attacks.

"They say we're at war, and we are putting our lives on the line," said Dr. Andrew Tisser, an emergency room physician in upstate New York who has treated patients with COVID-19, the disease caused by the coronavirus.

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Tisser began repaying his medical school debt five years ago, with the loans refinanced from federal to private lenders. "If I were to die from COVID right now," he added, "my family would be stuck with $433,000" in student debt.

With 45 million Americans owing about $1.7 trillion of student debt, a figure that more than doubled over the last decade, health care professionals are often on the hook for some of the largest loan amounts. The average debt of a graduating medical student is nearly $201,500, according to 2019 data from the Association of American Medical Colleges, a nonprofit that administers the Medical College Admission Test, or MCAT.

Tisser is part of a grassroots network of physicians who drafted an online petition aimed at Washington lawmakers. It asks Congress to ensure that all front-line medical workers, including physicians, nurses and emergency medical services professionals, get the personal protective equipment they need, as well as health care and tax credits; in addition, the petition seeks total loan forgiveness or at least a zero percent interest rate on their student loans. They also want all medical school debt federal or private to be discharged if a medical worker dies from COVID-19.

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Tisser, who hosts a podcast about the health care system, said medical workers, in particular doctors, are "shackled" by the high costs of education. After four years of undergrad and four years of medical school, physicians are required to practice at least three years as part of a residency program at salaries of $40,000 to $60,000 a year.

Although full-time doctors do get a bump in their salaries and physicians are among the top income earners in the country, "you're in the highest tax bracket," Tisser said, "so it's like a double hit."

He added that the assumption that all doctors are rich is a myth.

"I know myself and my wife, we are physicians in our mid-30s, and we have a combined $1 million-plus student debt between the two of us," Tisser said. "We want to go out and take care of people. Nobody becomes a doctor for the money."

Similar petitions have been gaining momentum in recent weeks as the coronavirus' spread shows no signs of abating, with the numbers of cases and deaths in the U.S. surpassing those in all other countries last week.

A petition on MoveOn.org that has garnered nearly 500,000 signatures asks Congress in the next stimulus bill to forgive loans for doctors, nurses and other health care professionals, a nod to the GI Bill of Rights, which created a comprehensive education benefit for veterans during World War II.

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The campaign's creator wrote that "without the debt burden, more would work in lower-paying specialties like family practice, or in underserved rural and urban areas."

In March, President Donald Trump signed the Coronavirus Aid, Relief, and Economic Security (CARES) Act, part of which provided temporary financial relief to student borrowers with federal loans. The legislation, a $2 trillion aid package, allows borrowers to hold off on student loan payments until Sept. 30; during that time, interest won't accrue. If borrowers enter into default, their tax refunds won't be withheld and their wages won't be garnished.

Democratic lawmakers led by Sens. Elizabeth Warren of Massachusetts and Sherrod Brown of Ohio have sent letters urging student loan servicers to provide similar relief to borrowers with private loans.

Even before the pandemic, student borrowers could apply for income-driven repayment plans in which monthly loan payments are based on income and family size.

In addition, doctors and nurses working full time for government agencies and nonprofits are eligible for the Public Service Loan Forgiveness Program, which was launched in 2007. If they make 120 loan payments typically over 10 years the federal government can forgive the rest of their federal loans.

The program, however, has been criticized for having onerous payment and paperwork requirements. After Congress created a temporary fund in 2018 to help more borrowers qualify, a Government Accountability Office report found that 99 percent of applicants were rejected.

Joanne DeCastro, a registered nurse at a nonprofit acute care hospital in Seattle, determined that she's eligible to have part of her student loans forgiven through the program, but she still has about eight years to go with payments.

After she attended a private school and obtained a master's degree in nursing, her student debt is at more than $100,000. A 2017 study by the American Association of Colleges of Nursing found that the median range of graduate nursing debt was around $40,000 to $55,000.

"Nursing programs are getting ridiculously expensive these days, and monthly loan payments can be a huge inhibitor of obtaining things we work our tails off for, like a house or car," said DeCastro, whose hospital was in the thick of the early days of the region's outbreak. "And right now, we're risking our own lives and health and that of our families and loved ones to serve those who need us the most. So wiping off our financial debt would be a great show of appreciation."

In a more recent movement, some prominent medical schools are empowering students financially by agreeing to give those who qualify a free ride.

New York University announced in 2018 that it was offering free tuition to all of its medical school students to encourage more of them to choose lower-paying specialties.

In September, Cornell University's Weill Cornell Medicine in New York City announced that it would cover tuition and other expenses for all medical students who qualify for financial aid.

Dr. Augustine M.K. Choi, the dean of Weill Cornell Medicine, said the response has been "overwhelmingly positive," especially because it goes beyond tuition relief and replaces student loans with scholarships that cover living expenses, including housing, groceries, books and commuting costs.

"I believe relieving this financial burden has the potential to improve the well-being of our future physicians and, ultimately, patient care," Choi said.

He added that Congress could help future doctors by suspending the taxability of their scholarships.

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These medical workers are tackling the coronavirus. They're also saddled with student debt. - NBC News

New Jersey OKs Outdoor Graduations Starting in July – NBC New York

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The coronavirus pandemic has canceled milestone events and rites of passage: weddings, reunions, parties, proms and even graduations came to a halt as states focused on containing the spread of the virus.

Those who have worked for years to obtain their degree and looked forward to donning that cap and gown while walking up on stage to obtain their diploma had their dreams crushed as social distancing and other necessary safety measures, including prohibiting gatherings, were implemented. However, the 2020 graduating class in New Jersey received good news Tuesday.

Gov. Phil Murphy announced via Twitter that schools will be allowed to hold outdoor, socially-distant compliant graduation ceremonies starting July 6 to "ensure the health and safety of all in attendance." The announcement relates to graduations "of any sort," including for high schools and colleges, Murphy said during his daily briefing Tuesday.

Previously, when asked if students should hold on to the hope that they would be able to celebrate graduations at some point this year, Murphy said they had every right to hold on to that hope, even mentioning he shared that same hope. However, he always stopped short of mentioning when graduations would resume.

The state's commissioner of education and the secretary of higher education will come out with guidance Wednesday, Murphy said.

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When it comes to other education related activities, Murphy said Sunday he thinksdaycares and camps will reopen sooner rather than later, telling CNN the economy can't successfully reopen without giving working parents an opportunity to have their kids properly looked after. He also still hopes to have schools reopen for in-person learning in September.

The Garden State has lagged New York a bit on the curve. It is seeing higher daily death tolls than New York almost daily now, though those numbers are also slowly coming down. To date, New Jersey has lost 11,191 people to the virus.

Meanwhile, as for New York City, the Big Apple is planning a virtual graduation celebration for its students, as other districts in the state have also opted for virtual commencement ceremonies and even drive-thru graduations.

Instead of a virtual ceremony, one Long Island high school has come up with a creative solution to allow for an in-person graduation, while still maintaining social distancing, Greg Cergol reports

Colleges and universities in the tri-state area have also opted for virtual commencement ceremonies over the past few weeks. Medical universities, including Rutgers Medical School, held an early virtual ceremony allowing for graduating medical students to get a head start working on the field as frontline medical workers were needed to treat the rising number of COVID-19 patients at the time.

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Coronavirus and the Heart – Harvard Medical School

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This article is part of Harvard Medical Schoolscontinuing coverageof medicine, biomedical research, medical education and policy related to the SARS-CoV-2 pandemic and the disease COVID-19.

Lung injury and acute respiratory distress syndrome have taken center stage as the most dreaded complications of COVID-19, the disease caused by the new coronavirus, SARS-CoV-2. But heart damage has recently emerged as yet another grim outcome in the virus'srepertoire of possible complications.

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COVID-19 is a spectrum disease, spanning the gamut from barely symptomatic infection to critical illness. Reassuringly, for the large majority of individuals infected with the new coronavirus, the ailment remains in the mild-to-moderate range.

Yet, a number of those infected develop heart-related problems either out of the blue or as a complication of preexisting cardiac disease. A report from the early days of the epidemic described the extent of cardiac injury among 41 patients hospitalized with COVID-19 in Wuhan, China: Five, or 12 percent, had signs of cardiovascular damage. These patients had both elevated levels of cardiac troponina protein released in the blood by the injured heart muscleand abnormalities on electrocardiograms and heart ultrasounds. Since then, other reports have affirmed that cardiac injury can be part of coronavirus-induced harm. Moreover, some reports detail clinical scenarios in which patients initial symptoms were cardiovascular rather than respiratory in nature.

How does the new coronavirus stoke cardiac damage?

The ways in which the new coronavirus provokes cardiac injury are neither that new nor that surprising, according to Harvard Medical School physician-scientists Peter Libby and Paul Ridker. The part that remains unclear is whether SARS-CoV-2 is somehow more virulent toward the heart than other viruses.

Libby and Ridker, who are practicing cardiologists at Brigham and Womens, say COVID-19-related heart injury could occur in any several ways.

First, people with preexisting heart disease are at a greater risk for severe cardiovascular and respiratory complications from COVID-19. This is hardly a surprise. Research has shown that infection with the influenza virus poses a more severe threat for people with heart disease than those without cardiac problems. Research also shows that heart attacks can actually be brought on by respiratory infections such as the flu.

Second, people with previously undiagnosed heart disease may be presenting with previously silent cardiac symptoms unmasked by the viral infection. In people with existing heart-vessel blockages, infection, fever and inflammation can destabilize previously asymptomatic fatty plaques inside the heart vessels. Fever and inflammation also render the blood more prone to clotting, while also interfering with the bodys ability to dissolve clotsa one-two punch akin to throwing gasoline on smoldering embers.

Its like one big stress test for the heart, said Ridker, who is the Eugene Braunwald Professor of Medicine at Brigham and Womens Hospital.

Third, some people may experience heart damage that mimics heart attack injury even if their arteries lack the fatty, calcified flow-limiting blockages known to cause classic heart attacks. This scenario, called myocardial infarction type 2, can occur when the heart muscle is starved for oxygen, which in the case of COVID-19 may be triggered by a mismatch between oxygen supply and oxygen demand. Fever and inflammation accelerate heart rate and increase metabolic demands on many organs, including the heart. That stress is compounded if the lungs are infected and incapable of exchanging oxygen and carbon dioxide optimally. This impaired gas exchange can further diminish oxygen supply to the heart muscle.

Finally, there is a subset of people with COVID-19some of them previously healthy and with no underlying cardiac problemswho develop fulminant inflammation of the heart muscle as a result of the virus directly infecting the heart. This type of inflammation could lead to heart rhythm disturbances and cardiac muscle damage as well as interfere with the hearts ability to pump blood optimally.

The propensity of certain viruses to attack the heart muscle and cause viral myocarditis is well known, Libby said, adding that the most notorious viral offender has been the Coxsackie B virus. Nonetheless, a recent case report from Italy underscores the notion that the new coronavirus could also infect the heart and affect heart muscle function in healthy adults even after the acute phase of the infection has resolved and even in the absence of lung damage.

There are definitely some people who develop acute fulminant myocarditisin which the virus infects the heart muscle itself or the cells within the heartand causes a horrible inflammatory reaction, said Libby, who is also the Mallinckrodt Professor of Medicine at Brigham and Womens Hospital. This can be life threatening, and it can happen in people who don't have any preexisting risk factors.

Libby and Ridker, however, say this out-of-the-blue scenario in otherwise healthy individuals is likely rare relative to the overall number of people with COVID-19 who experience heart problems.

The frenemy within

For Ridker and Libby, who have studied the immune pathways of cardiovascular disease for decades, the cardiac involvement in COVID-19 is yet another striking example of the widespread effects of inflammation on multiple organs and systems.

Inflammation is a critical defense response during infection, but it has a dark side. Infections can set off a cascade of immune signals that affect various organs.

Libby and Ridker hypothesize that any infection in the bodya festering boil, an injured joint, a viruscan become a source of inflammation that activates the release of inflammatory proteins known as cytokines and calls up armies of white blood cells and other messenger molecules that, in an effort to fight the infection, disrupt normal processes. When these inflammatory molecules reach the welcoming soil of a fatty deposit in the blood vessel wallone that is already studded with resident inflammatory white blood cellsthe cytokines can boost the local inflammatory response and trigger a heart attack.

Our work has shown that cytokines can impinge on these cells in the plaque and push it through a round of further activation, Libby said.

The inflammatory chemicals released during infection can also induce the liver to ramp up the production of important proteins that defend the body from infection. These proteins, however, make the blood more prone to clotting, while also reducing the secretion of natural clot-dissolving substances. The tiny clots that may form can clog the small blood vessels in the heart and other organs, such as the kidneys, depriving them of oxygen and nutrients and setting the stage for the multisystem failure that can occur in acute infection.

Thus, immune-mediated injury to the heart and other organs could be collateral damage because of the bodys overwhelming systemic immune responsea condition known as cytokine storm, which is marked by the widespread release of cytokines that can cause cellular demise, tissue injury and organ damage.

COVID-19 and blood pressure medications

SARS-CoV-2 invades human cells by latching its spike protein onto the ACE2 receptor found on the surface of cells in the airways, lungs, heart, kidneys and blood vessels. The ACE2 protein is an important player in the renin-angiotensin-aldosterone system, which regulates blood vessel dilation and blood pressure. Two classes of drugs widely used to treat high blood pressure and heart diseaseACE inhibitors and angiotensin receptor blockersinteract with the ACE2 receptor. A possible concern related to COVID-19 stems from the notion that these blood pressure medications could increase the number of ACE2 receptors expressed on cells, possibly creating more molecular gates for the virus to enter. Some experts have wondered whether the use of such drugs could render people who take them more susceptible to infection. Conversely, others have postulated that the abundance of ACE2 receptors may enhance cardiovascular function, exercising a protective effect during infection.

The answer is far from clear, but a recent review suggests these medicines may play a dual role in COVID-19on the one hand, enhancing susceptibility to infection and, on the other, protecting the heart and ameliorating lung damage from the disease.

Libby and Ridker cautioned that patients who take such life-saving medications should stay on them or at least have a careful discussion with their cardiologists. This is because these drugs have clear and well-established benefits in hypertension and certain forms of heart disease, while their propensity to make humans more susceptible to SARS-CoV-2 remains speculative for the time being.

But what remains speculative today will crystalize in the weeks and months to come, Ridker and Libby said, because the science is moving forward rapidly, with new papers coming out daily and a growing pool of patients to draw observations from.

In 12 to 18 months we're going to have a great deal of information, but right now our job is to, number one, keep people from getting COVID-19 by strict adherence to now-familiar containment measures, Libby said. Then, we need to get people who get the disease through this acute phase.

The need for rigorous randomized trials done quickly and effectively is acute, they said. Until the evidence from these trials begins to coalesce, clinicians will have to navigate the uncharted territory of delivering cardiac care in the time of pandemic with caution but also with resolve.

We don't have the comfort of our usual databases, so we have to rely on our clinical skills and judgment. But we have to do so in all humility because often data dont bear out our logical preconceptions, Libby said. Yet, we must act.

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‘On the front lines of a medical disaster’ – Eagle-Tribune

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Under normal circumstances, Dr. Demetri Rizos would be treating patients with kidney problems in the relative quiet of hospitals in Methuen and Newburyport. These days, however, he is in a besieged community hospital in the Bronx at the epicenter of the coronavirus outbreak.

Rizos, 50, has been volunteering at North Central Bronx Hospital in New York City since April 6. He is working 14 hours a day in a converted 14-bed intensive care unit, where he leads a team of 20 medical professionals caring for critically ill COVID-19 patients and making life-and-death decisions.

Ive never been on a battlefield before, but this is very much like being involved on the front lines of a medical disaster, said Rizos, who practices at Holy Family Hospital in Methuen and lives in Danvers, during a telephone interview.

Rizos volunteered to go to the Bronx after former medical school classmates reached out to him. The state of New York has more confirmed cases of COVID-19 than any country in the world besides the United States and Rizos said the densely packed Bronx has been particularly hard hit. He is one of more than 100 doctors from around the country who are volunteering at the hospital.

Rizos said most of the patients are dependent on breathing machines. They cannot be visited by family. Many have relatives who have the virus. Most are Spanish speaking. Those who are awake, he said, are often inconsolable.

Due to the scarcity of resources, Rizos said doctors are faced with decisions about who gets what type of care and who doesnt. A committee meets daily to make those excruciating choices.

If we have an elderly patient who is critically ill, we sometimes have to make a decision that even with all the therapies we have available that this patient will not get better, he said. This can be devastating to hear as a family member.

When a bed opens up in the intensive care unit through a patient either dying or getting better it is filled within an hour.

We dont have time to be anxious, Rizos said. Were simply too busy.

While Rizos is serving on the front lines in New York, his wife, Susan, is doing the same back home as a critical care nurse at Beverly Hospital. Incredibly, they first met on the USNS Comfort, the Navy medical ship that is now docked in New York harbor treating COVID-19 patients.

Rizos said his volunteer work in the Bronx has given him a productive outlet for his emotions after his father died March 2 as a result of a motor vehicle accident. The Rev. Peter Rizos, 82, was a Greek Orthodox priest and lifelong Lowell resident who served as a pastor and director of religious education.

My dad was the first individual to help out those in need, Rizos said. It gives me a great amount of satisfaction to do the same. Hes with me every day, and I know that even though I cant talk to him I know that hes guiding me through this difficult situation.

Rizos is staying in a hotel near Yankee Stadium, which he said only amplifies how much he misses baseball. He drives to work through empty streets, the hustle and bustle of the city replaced by an eerie solemnity.

But New Yorkers are very resilient, he said. Im not a Yankee fan, but were all fans of New York right now.

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'On the front lines of a medical disaster' - Eagle-Tribune

A Major Medical Licensing Exam Is Going Pass/Fail, and it’s About Time – Scientific American

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The number 210. Its meaningless to most individuals. Is it an area code for a phone number (for San Antonio, to be exact)? A number on the side of a house? But if you are a medical student or physician, even decades out from your medical training, you know exactly what that number means. It is a score on the United States Medical Licensing Exam (USMLE) Step 1 examination. A score that is below average. A score that destines young doctors-to-be to a life of ennui in a job they do not enjoy, because they could not match into the competitive specialty of their dreams. If they are able to match into post-graduate medical training at all.

Two hundred and ten. I am now on medical faculty at a highly regarded academic medical center; double board certified in internal medicine and geriatric medicine. Im in a job I love, that challenges me and excites meand 210 was my score on the USMLE Step 1. I felt emboldened to out my less-than-stellar performance, on a daylong examination I took nearly 10 years ago, with the recent announcement by the National Board of Medical Examiners (NBME) that the USMLE Step 1 will only be reported as pass/fail, with no numerical score, starting as early as 2022.

This is a seismic shift in the medical education community, and one that has numerous downstream effects in training doctors. It was a move that was sudden and unexpected, though there had been rumblings of discontent amongst much of the medical community about the USMLE Step 1 examination for years. The two most recent presidents of the NBME, Donald Melnick and Peter Katsufrakis, are white men in their 60sa demographic not particularly associated with radical change. The decision, announced on February 12, 2020, has engendered much praiseand a significant amount of criticismin the medical community on social media.

Why is this transition so earth-shattering? The USMLE Step 1 is a one-day test, taken at the end of the second year of medical school, that caps the preclinical medical school experiencethe culmination of all the knowledge doctors-in-training should know before they can safely set foot in a hospital, learning to care for real live patients. Step 1 is designed as a criterion-referenced testthat is, one that measures performance against predetermined learning standards. However, it has morphed and been universally misused as a norm-referenced test, which compares test-takers to one another, even though the test was never designed this way and not built on the standard bell curve.

The USMLE Step 1 long been used as a screening criterion for graduate medical education (residency) training programs. Highly competitive medical specialties, such as dermatology and various surgical subspecialties (neurosurgery, orthopedic surgery, otolaryngology) have required very high scores. Even highly regarded programs in less competitive specialties, like internal medicine or pediatrics, have required students to answer many questions correctly on a multiple-choice test to be granted the privilege of walking through the hallowed wings of their hospitals. In the nonmedical lay community, it is assumed this examination determines how smart or qualified a doctor is to be practicing medicine. It is assumed a poor performance on this test indicates the doctor is incompetent.

That would be well and goodif it were true. In reality, like many other multiple-choice examinations physicians take over the years, this test has next to nothing to do with practicing medicine. The discontent over the content and misuse of USMLE Step 1 was initially brought to the fore by J Bryan Carmody, a pediatric nephrologist at Eastern Virginia Medical School in Norfolk, Va. Carmody, preparing lectures for preclinical medical students, perused retired Step 1 questions to make his lectures relevant. He soon found that some Step 1 questions were testing analysis of Southern blot, a molecular biology testing mechanism, or the biochemical pathways that influence the position of a cell within an organ.

I am an academic physician, but my research interests lay in how to implement a universal health care system akin to other high-income countries, in an era of unprecedented congressional gridlocknot in pipetting. Is knowing about somatic hypermutation in a Southern blot really making me a better physician and health policy researcher and advocate? Carmody did not think so either. Therefore, he and his colleagues initiated a yearslong effort to investigate the adverse effects of Step 1, culminating in a scathing commentary recently accepted to the premier medical journal Academic Medicine.

There has been evidence that Step 1 mania, as Carmody calls it, has implications far beyond tests and residency selection. The first is psychological. The high stakes placed on a one-day exam, with little room for life events, can create inordinate stress and anxiety. In a 2016 paper in the Journal of the American Medical Association, researchers found that 27 percent of medical students have depression symptoms, and 11 percent have suicidal ideation, versus 9.6 percent and 3.7 percent in similar age groups in the general population.

A further consideration is financial. The cost of medical school has skyrocketed in recent years. The annual median tuition at a public in-state medical school has increased from $26,700 in 2009, the year I entered medical school, to $39,000 in 2019. Its even worse for public out-of-state and private medical schools, with median tuition increasing from about $46,000 in 2009 (already an exorbitant amount) to about $63,000/year in 2019.

This is pricing out many students from nonprivileged backgrounds. The median parental income of the matriculating U.S. medical student is $130,000 per year. Only 20 percent of medical students come from families in the bottom 60 percent of parental income (currently less than $75,000/year), and a mere 5 percent of students come from families in the bottom 20 percent of income (less than $25,000/year).

Where is this tuition money going? A recent paper from the University of North Carolina at Chapel Hill showed that $495,000 was spent aligning the preclinical curriculum to test preparation, for example through subscriptions to popular study resources. Furthermore, separate studies have shown that the USMLE Step 1 demonstrates biases in favor of men and traditional age students versus women and non-traditional (older) students and against African American medical students, who were rejected from an internal medicine program at higher rates as a result of Step 1 scores.

What about a physicians future career? There was no relationship between USMLE Step 1 scores and the odds of receiving disciplinary action in clinical practice [though interestingly, there is a correlation with the USMLE Step 2 CK, an exam taken in the fourth year of medical school that has significantly more clinical relevance]. Finally, the board certification examinations taken at the end of residency/fellowship training, the criteria often used by patients and medical boards to assess physician knowledge within their specialty, have always been criterion-referenced and pass/fail.

The demise of the scored USMLE Step 1 will not in itself solve many of the problems outlined with medical education; however, it could provide the impetus for innovation. Some ideas include significantly reducing the preclinical curriculum, now that professors do not have to teach to the test. This will allow doctors-in-training to get closer to the patients they will spend their entire career with earlier in their training.

Another idea, which is starting to gain traction, is shortening medical school to three years for physicians pursuing primary care specialties. This will significantly reduce financial costs, making a physician career achievable for those from lower-income backgrounds who want to return to serve their communities. As many Americans demand a more equitable health care system through calls for a universal health care system, physicians should demand the same of medical education.

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A Major Medical Licensing Exam Is Going Pass/Fail, and it's About Time - Scientific American

Letter: Increase the number of U.S. medical schools – Lincoln Courier

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SaturdayApr11,2020at8:25PMApr11,2020at8:25PM

I read with interest Sen. Durbins op-ed piece in the April 3 edition of the SJ-R, Lessons learned so far on coronavirus. The first of his lessons learned was our country has a critical shortage of doctors. His solution was to create a national policy to increase the number of medical professionals in our nation. He focused the blame on the financial burden necessary to becoming a doctor. He states a doctor, on average, will assume $240,000 of student loan debt. I agree that the cost of education may be a factor but I believe the senator also needs to consider another aspect of this problem: a shortage of medical schools.

Consider that a typical medical school in our country has more than 10,000 applicants for only 50-200 spots. Based on those numbers, an applicant has a 0.5% to 2% chance of acceptance in each school they apply to. If lucky enough to be granted an interview at a school, the prospective student then incurs travel expenses that can amount to thousands of dollars. Many highly qualified and motivated students are willing to incur the incredible amount of debt necessary to realize their dreams of becoming a doctor. This is a problem our country cannot afford to ignore. Our crisis has brought this to the attention of our own state senator. So Im asking you, Sen. Durbin, to move forward with your national policy to increase the number of medical professionals, but do this by increasing the number of our medical schools.

Linda Curtis, Springfield

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Letter: Increase the number of U.S. medical schools - Lincoln Courier

How COVID-19 is affecting medical school admissions – American Medical Association

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In a time of year when most medical schools are finalizing their classes and students are making choices on where they will begin their medical careers, the COVID-19 global pandemic has added a curveball to the admissions process.

For the 2020 application cycle, schools with rolling admissions have filled most of their spots. From the student vantage point, the American Medical College Application Service sets a deadline for students to narrow their acceptances down to a single medical school by the end of April.

Yet the COVID-19 pandemics limiting of physical contact has changed the final recruitment weeks for both students and institutions weighing options. For instance, second-look daysa chance for admitted students to visit schools in the spring and compare their finalistshave largely been moved online.

A Second Look Day is primarily a celebration to get the students very excited for medical school, said Benjamin R. Chan, MD, associate dean for admissions at the University of Utah School of Medicine, one of 37 member schools of theAMAs Accelerating Change in Medical Education Consortium. For a significant number of students who have multiple offers, its a chance to shop around. Those being canceled nationwide forced us to adopt a virtual second-look day. I dont know that it can fully replace what a live event looks like.

In terms of making that final decision, Dr. Chan said students shouldnt change their mind about a medical school based on the pandemic.

At times of crisis, it makes sense to go with your gut instinct. If you originally liked a med school [before the pandemic], its still going to be the same medical school, even if we are all going to be a little different after this, Dr. Chan said. Dont make decisions strictly based on the crisis. The same instincts of the decision being a combination of programming strengths, connection to the local community, finances, where you see yourself, those still stand.

Medical schools that are still extending offers to new candidates continue to conduct interviews with 2020 applicants.

John D. Schriner, PhD, is associate dean for admissions and student affairs at Ohio University Heritage College of Osteopathic Medicine (OU), also a member of the AMA consortium. OU plans to complete interviewing prospective students in the coming weeks. To do that, the school has moved interviews online, conducting them in part on Zoom and in part on GoToMeeting.

We have still been able to get what we want out of the process [while conducting interviews online], Schriner said. I dont feel like were compromised, but it was just a bit different. This is kind of the new reality for everyone, and we have just established our new process.

For prospective students who are readying for remote interviews, Schriner advised to treat the experience like any other interview.

Prepare as if it were in person, which means dress for success, he said. If you can find a comfortable space that is going to be quiet, go to it. Make sure that you minimize any distractions that could take away from the focus of your interview. You still want to maintain virtual eye contact and good posture and continue to make sure that youre a really active listener.

For those planning on applying as part of the 2021 application cycle, the spring prior to applying to medical school is a common time to take the Medical College Admission Test (MCAT), one of the primary criteria used to evaluate prospective applicants.

According to an FAQ prepared by the Association of American Medical Colleges, administrations of the exam have been canceled globally through May 21. For those who had already registered for the test, all rescheduling fees will be automatically waived.

Applications are typically submitted in the early fall of the year prior to admissions. MCAT scores are part of that, and many schools require applicants to have taken the exam before October of their application year. The AAMC is working with the schools as they begin to prepare for later test score availability for the upcoming application cycle.

Other areas of a medical school applications that could be affected by the pandemic include students ability to work as volunteers or shadow physicians, which are limited by mandates on social distancing and a shortage of personal protective equipment. There also will likely be some leeway given on how medical schools view transcripts. Most medical schools do not accept undergrad pass-fail credits, but with undergraduate schools going to remote learning, that has become a common practice.

Everyone is in the same boat, Dr. Chan said. This pandemic is an international crisis. We are all going to through it together. So future students, your application is going to be impacted like everyone elses. No one can go out and do any of those premed activities right now. That might be the case for the next few months or longer, so it doesnt make sense for people to feel like they are at some sort of competitive disadvantage.

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

Have peace of mind andget everything you need to start med school off strongwith the AMA.

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Collaboration ‘call to duty’ to battle a deadly global threat – Harvard Gazette

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Researchers from around Boston are opening a new front against the deadly coronavirus by rallying the regions biomedical science talent to develop better diagnostics, effective therapeutics, and potentially a vaccine.

The effort, announced Monday, will be mounted in collaboration with scientists at Chinas Guangzhou Institute for Respiratory Health, and in particular the lab of Zhong Nanshan, head of the Chinese task force fighting the disease. Those involved said an important aspect of the new international collaboration is not only its work with Chinese colleagues but also its coordination of local labs: Boston-area researchers at Harvard, its affiliated hospitals, the Massachusetts Institute of Technology, Boston University, area biotech companies, and others.

Were approaching this in a very different way than business-as-usual and trying to leverage the phenomenal biotech community here in Boston to work collaboratively and have an impact on this epidemic, said Bruce Walker, director of the Ragon Institute of MGH, MIT and Harvard, and the Phillip T. and Susan M. Ragon Professor of Medicine at Harvard Medical School.

Alarm over the disease has risen sharply over the past week as the death toll has risen to more than 2,700, and confirmed cases top 80,000 and have spread to nearly three dozen nations, according to the World Health Organization. Global financial markets plummeted in the early part of the week on fears that the virus could result in an economic downturn.

Walker said the Boston region is unparalleled in its biomedical prowess and, in a case like the global spread of the new coronavirus SARS-CoV-2 and the disease it causes, called COVID-19 ought to leverage the efforts of different labs working to better understand viral structure, how it spreads, how it sickens and kills those it infects, whether existing drugs and vaccines might be effective against it, and to develop new diagnostic tests, therapeutics to treat those in its grip, and vaccine candidates to one day stop its spread.

The novel coronavirus and the disease that it causes have already resulted in a global health crisis, the repercussions of which are already reverberating across fields outside of health care. A crisis like this calls for scientific and humanitarian collaborations that transcend borders. For us, as scientists, this is nothing less than a call to duty, saidHarvard Medical School Dean George Q. Daley, who is heading the effort. Harvard, its affiliated institutions, and our colleagues from academia and industry in Greater Boston have unique expertise. Our Chinese colleagues have dealt with the virus on the frontlines; they have unique access to samples, clinical and epidemiologic data, and first-hand observations. We each hold critical pieces to the puzzle.

A key step in building the collaboration, funded over five years by $115 million from the China-based Evergrande Group, will occur Monday during a meeting of area researchers at Harvard Medical School. Walker said he expects about 80 researchers to attend. Theyll break into groups focused on different aspects of the problem to discuss whats known and unknown, and what priorities should be adopted in the struggle to stop the contagion.

We have to attack this with a sense of urgency and unprecedented collaboration, Walker said, adding that the virus could one day have significant impacts in the Boston area. Some of us in the room that day may die of this.

Officials at the U.S. Centers for Disease Control and Prevention said they fully expect that the virus will spread in communities across the nation. Its not so much of a question of if this will happen in this country anymore but a question of when this will happen, Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases, told The New York Times.

A crisis like this calls for scientific and humanitarian collaborations that transcend borders.

George Q. Daley, Harvard Medical School

The new virus initially spread rapidly in China and has infected 77,780 people, with 2,666 dead as of Feb. 25, WHO reported. The number of new cases has been declining in China even as the relative handful of isolated cases internationally have grown into new outbreaks in South Korea, Italy, and Iran. Outside of China, there have been more than 2,400 cases and 34 deaths in 33 countries.

Epidemiologists, such as Marc Lipsitch, director of the Harvard T.H. Chan School of Public Healths Center for Communicable Disease Dynamics, say they expect the virus to eventually be widespread globally, driven in part by the large number of mild or asymptomatic cases that make it hard to detect.

Dan Barouch, professor of medicine at Harvard Medical School, Beth Israel Deaconess Medical Center, and the Ragon Institute of MGH, MIT, and Harvard, said his group began work on a vaccine as soon as the virus DNA sequence was released publicly on Jan. 10 and has been pushing toward the development and testing of candidate vaccines.

Collaboration is critical for the development of a coronavirus vaccine, because no single group has all the necessary expertise, and open sharing of data and reagents will greatly accelerate the field, said Barouch, who has also worked on HIV and Zika vaccines. It is important for multiple vaccine efforts to go forward in parallel, because it is not yet known which vaccine candidates will be safest and most effective and also can be manufactured and deployed at the scale to end a global epidemic.

In addition to sharing knowledge with colleagues in China, Boston-area scientists hope to access samples from Chinese patients, an important scientific resource currently in short supply, according to David Knipe, Higgins Professor and head of the program in virology at HMS Department of Microbiology.

Knipe, who has conducted work on the replication and latency of the herpes simplex virus and has a candidate vaccine for genital herpes in clinical trials, said although knowledge is lacking on many characteristics of the virus, efforts will focus immediately on steps that can help patients as soon as possible. Those efforts will likely include new and better diagnostic tests, screening existing antiviral drugs to see whether any can be an effective therapy against the virus, and finding a vaccine as quickly as possible.

Knipe said his own lab will probably focus on exploring the host immune response at a cellular level and the role inflammation plays in severe illness.

Mark Namchuk, director of HMS newly formed Therapeutics Initiative, said a thorough understanding of the virus, its fundamental biology, and its effect on patients is needed to guide efforts to understand which treatments may be effective.

This is something that we have to take very seriously and do what can be done medically, scientifically, Namchuk said, adding that though the coronavirus impact so far has largely been in China, its important to prepare for its broader spread. Morally, we have to prepare to respond to this wherever it is.

Jonathan Abraham, assistant professor of microbiology in HMS Department of Microbiology, said even though the need for rapid progress remains urgent, the pace of the response has already been unprecedented. His lab studies how viruses bind to cells to infect them and the antibodies generated by patients who have survived infection.

Unfortunately, Abraham said, antibodies against SARS wont necessarily be effective against the new virus, so researchers are looking for strategies to not only address the new virus, but also related viruses that may emerge in the future.

I think its critical thats being learned here is that its important to carry out this sort of highly collaborative research on these important pathogens before they emerge, Abraham said, because we can use the information we learn from related viruses to help fight off infection by the new viruses when they emerge.

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Flattening the Curve for COVID-19: What Does It Mean and How Can You Help? – Michigan Medicine

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The flatter, lower curve is a much better one but it will take working together to make it happen, says Markel, whos the director of the Center for the History of Medicine at the U-M Medical School.

He and his colleagues have studied the effects of efforts to stop the spread of the 1918 flu pandemic and the 2009 H1N1 flu epidemic.

If individuals and communities take steps to slow the viruss spread, that means the number of cases of COVID-19 will stretch out across a longer period of time. As the curve shows, the number of cases at any given time doesnt cross the dotted line of the capacity of our nations health care system to help everyone whos very sick.

If you dont have as many cases coming to the hospitals and clinics at once, it can actually lower the number of total deaths from the virus and from other causes, he says. And, importantly, it buys us time for university and government scientists, and industry, to create new therapies, medications and potentially a vaccine.

Another key factor to consider: the doctors, nurses, pharmacists, technicians and many other staff who actually work in healthcare. The more cases of COVID-19 there are at any given time, the more likely some of them are to catch it, whether in the community or at work. Once theyre sick, they need to stay away from patients for weeks. Which means fewer people to take care of the patients who need care.

Canceling, postponing or moving online for our work, education and recreation may be inconvenient, annoying and disappointing.

But hospitals need to have enough room, supplies and staff to care for those who need hospital-level care -- whether its for coronavirus, a heart attack, car crash, broken bone or birth. Thats why its important to listen to public health authorities and leaders if and when they say its time to change how we live our lives temporarily.

Coronavirus is a socially transmitted disease, and we all have a social contract to stop it, says Markel. What binds us is a microbe but it also has the power to separate us. Were a very small community, whether we acknowledge it or not, and this proves it. The time to act like a community is now.

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Flattening the Curve for COVID-19: What Does It Mean and How Can You Help? - Michigan Medicine

A bridge too far? A Medical Campus footbridge is still on the drawing board – Buffalo News

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Buffalo Niagara Medical Campus officials are still planning to build a long-delayed skybridge connector between the Conventus building and the new medical school building.

Patrick Kilcullen, the chief financial officer of the nonprofit organization that runs the campus, said planning is underway for the long-delayed project, which would connect the second floors of the research and medical building with the University at Buffalo's new Jacobs School of Medicine and Biomedical Sciences.

The cost is estimated at about $1.5 million, based on the price of similar connectors on the campus. Officials are working on both the design and funding sources, he said, following a presentation to the Western New York Commercial Association of Realtors on Thursday.

The lack of a connector had been a subject of discussion among some doctors, patients and others since the medical school opened last year. Officials had always intended for such a footbridge connector, and had publicly discussed it in the past.

But Kilcullen said it hadn't been formally factored into the construction plans for either of the two buildings, which were completed and opened at different times.

"They both were designed to accommodate it, but neither one actually had it as part of their project," he said.

Conventus was built in 2015 by Ciminelli Real Estate Corp., which sold the seven-story building to Hong Kong-based Chevalier International in March 2018 for $122 million. Ciminelli continues to manage the facility for Chevalier.

The $375 million medical school was completed in 2017, with the formal opening of the eight-story, 628,000-square-foot facility taking place in early 2018.

Kilcullen said officials are hoping to have the bridge designs, financing and permits in place by spring or early summer. He acknowledged that "there are some challenges associated with it," such as opening up the two buildings, but "its not significant from a construction standpoint."

"Weve done it before, and the contractors know how to handle these things. But especially when youre working with multiple parties, accommodating those things makes it a little more difficult," Kilcullen said.

The bridge is one of only two significant pending projects on the Medical Campus, after several years of rapid growth and new construction totaling more than $800 million. Roswell Park Comprehensive Cancer Center is also planning to erect a new parking ramp on the campus to help with its parking crunch.

"Parking is a continuing issue that we deal with on an ongoing basis," he said.

UB has previously talked about a long-term goal to relocate all of its health care-related schools from the South Campus to the Medical Campus. That's even part of the school's UB2020 comprehensive plan. But there's been no recent movement toward that goal, Kilcullen said.

Meanwhile, private developers continue to undertake a series of residential apartment and retail projects around the Medical Campus, including in Allentown, in the downtown core, just to the north along Main Street, and now even just to the east in the Fruit Belt.

Kilcullen said Medical Campus officials are hoping the continued redevelopment and growth will spur the city to repair and even reshape Main Street, which "has seen various sections in states of disrepair" as a result of all the work.

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A bridge too far? A Medical Campus footbridge is still on the drawing board - Buffalo News

Mini Medical School to Put Observation in Perspective – The Roanoke Star

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Virginia Tech Carilion School of Medicinesnext Mini Medical School will be an interactive odyssey into how we, as humans, observe. The series, titled, The Art of Observation: From Gallery to Clinic, is presented in partnership with theTaubman Museum of Art.The program will take place over three consecutive Wednesdays in January. Activities will be held Jan. 15 and 29 at the medical school and Jan. 22 at the art museum. The program begins at 5:30 each evening and runs until 7.

From the information doctors gather through patient observations to the way artists portray the world around them, this Mini Medical School is sure to make you pay closer attention to what and how you observe, said Dave Trinkle, associate dean for community and culture at the medical school. We are delighted to partner with the Taubman Museum of Art on this, especially since scientific and artistic observation are so similar. Truly the only difference is what we are observing.

The act of observing requires careful consideration and the inclusion of several points of view. It is, in a sense, an art.

Participants will be challenged to try observing using different approaches, said Cindy Petersen, executive director of the Taubman Museum of Art. This flexes our observation muscles and strengthens this skill. It also teaches us how others observe, which leads to better observations as individuals and teams.

In week one, participants will learn more about observation and will listen to a panel of physicians who will review cases with both good and bad observation outcomes and share personal anecdotes.

Week two will be held at the Taubman where participants will have a chance to visit the galleries and participate in structured activities that are designed to strengthen observation skills as well as bring attention to team building, communication, and empathy.

On the final night, participants will learn more about clinical observation and will take part in a mock clinical encounter demonstrating the concept of implicit bias and the fact that attitudes or stereotypes can affect our understanding in an unconscious manner.

The cost for the Mini Medical School is $15.Registration is required.

For more information, contact Courtney Powell at 540-526-2588 oremail her.

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Mini Medical School to Put Observation in Perspective - The Roanoke Star

Medical school rotations: What to expect from the hardest years of medical school – Dailyuw

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Editor's Note: The second quarter of Penicillin For Your Thoughts continues to explore the transition from pre-med to medical student to practicing doctor, not only in terms of schooling and physical obstacles, but also how ones identity and relationship with their passion is constantly being redefined.

The third and fourth years of medical school are not some Greys Anatomy prequel, the race to residency. Yes, you have dramatic things like surgery, impressing attendings, and 24-hour shifts, but this time, there are real people going through it. For those who have never spoken to medical students (me before sophomore year), you cant help that fiction dictates your reality, and thats okay. Just listen up.

Third and fourth years move the student out of the classroom into clinical rotations through the various specialties. The School of Medicine holds clerkship rotations in all five WWAMI states, sending its students all around the region to study under professionals. Sometimes, youre the only one in your rural Idaho town, stripped of the support of school.

Third year was jarring, and youre not really prepared for it until you do it, fourth-year student Liz Reed said. When your time is limited, you have to figure out how to soak up all that knowledge when you dont get the chance to see it over and over again.

The vast majority of students are accustomed to textbooks and lectures, to sitting down and having time to process. Labs and field experience have always been an elective. Once you get to rotations, though, youre learning from your hands.

You have those moments, Oh shoot I didnt ask that question, I didn't think of that, Reed said. I struggled a lot. I hated being wrong and I was wrong a lot.

The physical demands of rotations are about as crazy as youd expect. Reed commented that she got an average of three hours of sleep during her internal medicine rotation, which was apparently pretty good.

Youre adjusting to a new sleep schedule every six weeks, Reed said. My first was OB-GYN. The first two weeks was getting up at 4:30 to get to the hospital, then I had nights, then a regular 9-5 schedule I dont know if you ever get used to it, its just something you do.

Its always in retrospect that you realize you werent prepared for a big life adjustment. Reed advises not to beat yourself up and be gentle.

Fourth years been a huge relief, Reed said. Being able to talk to your classmates, your mentors, your partner, your friends [it is] that little piece of solidarity of We know, were there too.

For all the ways it grinds your soul to bits, rotations give you the first opportunity to see the same patient over and over again. During her internal medicine rotation, Reed got to tell a woman she had been moved to number one on the priority list for liver transplants. Saying goodbye to this patient after six weeks was one of the moments that validated Reeds decision to do medicine.

When I got up there, she was having a rough day, Reed said. When she realized it was me, she let me into the room and kind of broke down. Im feeling overwhelmed, all these doctors, I need a break. Shed kicked out every doctor, resident, person, but she let me in. It was really special.

What we can get out of medical school rotations as pre-meds is the attitude to just take things as they come without being bitter. If people can emerge from rotations with a positive attitude and a reinvigorated love for their passion, its probably the course to take.

What makes all the studying worth it, all that hard work worth it, is those relationships with patients, Reed said. Its been my absolute favorite part of school.

Reach columnist Theresa Li at science@dailyuw.com. Twitter: @lithere_sa

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Medical school rotations: What to expect from the hardest years of medical school - Dailyuw

Video: Department of Health finance director Neelia Lloyd confirms Derry medical school will cost 25m a year to run – Derry Journal

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The figure was revealed by Department of Health Finance Director Neelia Lloyd at the Stormont Health Committee.

She confirmed the expenditure was included in the additional 169m the Health Minister Robin Swann has said he needs to fulfil the ambitions of the New Decade, New Approach deal.

Ms. Lloyd was asked about the medical school by Sinn Fin MLA Colm Gildernew.

I noticed the Minister said that an additional 169m is required to deliver the NDNA commitments. Does that figure include the money for the development of the north-west medical school, and how much of it is within the 169m? she asked.

Ms. Lloyd replied: There is a resource element to it...yes, it does include revenue funding within the 169m. It is a very small amount for 2020/21, but, notwithstanding that, it is likely to have a lifespan of something like I think it ramps up to 25m by year 10 in terms of a resource requirement, but for 2020/21, the figure is very, very small.

Brigitte Worth, DoH Director of the Investment Directorate, said the cost of building the facility would be met by other departments.

On the capital side, because it is a further education project, we expect the capital spend to be factored in by the Department for the Economy on the further education side. There is no capital factored into the figures for that, she said.

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Video: Department of Health finance director Neelia Lloyd confirms Derry medical school will cost 25m a year to run - Derry Journal

The Top 10 Hospitals In the World – Newsweek

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The best hospitals in the world must deal with a plethora of challenges facing the health care field today, including tight regulations, rapid advancements in medical science, new health risks and ever-rising costs. And they must do so while also delivering on what must be a medical facility's No. 1 priority: providing top-notch patient care.

What is critical for health care consumers to figure out: Where can you find these industry leaders todaythe ones that meet the economic, political and medical challenges they face with speed and skill, while also providing the very best health care to the people they treat?

To help answer that question, Newsweek partnered with Statista Inc., a global market research and consumer data company, to develop a groundbreaking ranking of the world's best hospitals. The result is our second annual ranking of the best hospitals in the world, the top 10 of which you'll find here.

You find the full ranking, which includes separate lists of top hospitals from 21 countries including the U.S., as well as exceptional specialty hospitals in cardiology, oncology, orthopedics and pediatrics, here.

The largestand originalMayo Clinic has been in Rochester, Minnesota, since 1889. Every year, approximately 1.3 million people from 138 countries come to the Mayo Clinic's 19 hospitals in five states for their specialized team approach. With over 4,800 staff physicians and scientists and over 4,000 full-time research personnel, it is committed to finding answers to the toughest medical cases. Always on the cutting edge, the clinic recently announced several new cancer initiatives. In a counterintuitive move, researchers in Rochester found that by encouraging cancers to mutate, the cancers can be targeted by immunotherapy, and clinical trials for pediatric patients with brain tumors will put this into practice shortly. It also recently announced an agreement to build the first carbon ion therapy treatment center in North America to treat challenging cancers at its Jacksonville, Florida, campus. Patients who seek out the Mayo Clinic appreciate the convenience of its rapid, same-day test results and free concierge services to assist with logistics and travel advice. MayoClinic.org

Cleveland Clinic has always made patient care its centerpiece, and it takes to heart its motto: "Care for the patient as if they are your own family." Historically, Cleveland has also been known for medical breakthroughs and organ transplants, including the first face transplant in the United States. In 2019, it broke its own organ transplant records897, up 3 percent from the year beforeincluding the world's first single-port robotic kidney transplant, which allows for a single small incision and limits the need for postoperative opioids for pain relief. Cleveland's health system encompasses 18 full-service locations systemwide. In 2018, there were 7.9 million outpatient visits, from 185 countries, across all of its campuses. My.ClevelandClinic.org

Over 200 years old and the original and largest teaching hospital of Harvard Medical School, Massachusetts General Hospital is known for its cutting-edge research. Mass General doctors put the insights they gather from that research to good use when diagnosing and treating the nearly 1.6 million patients who walk through its doors annually. With an annual budget of more than $850 million for research and more than 1,200 clinical trials taking place at any time, it is no wonder that Mass General publishes more research articles in prestigious medical journals and receives more federal funding than any other independent hospital in the country. Its researchers' findings range from linking sleep timing and teen obesity to tagging cells using laser particles so as to better understand the growth ofand treattumors. MassGeneral.org

Since 1819, Toronto General Hospital has been a leader in cardiac care, organ transplants and the treatment of complex patient needs. TGH has focused on novel therapies to treat endocrine and autoimmune disorders ever since insulin was developed, and its first clinical use in the treatment of diabetes at the hospital was in 1922. This past year, TGH doctors performed the first robot-assisted brain surgery on a live patient, which they hope will bridge even more frontiers and eventually allow patients in remote communities to get this kind of life-saving care. Its five-year strategic plan focuses on patient well-being and provides regular, transparent performance reviews of health outcomes and patient experience. Uhn.ca

Given that Charit was founded in 1710 when bubonic plague threatened Berlin, it is fitting that, in what is now one of the largest university hospitals in Europe, Charit researchers are taking the lead on identifying and treating infectious diseases such as Zika, SARS and MERS. Charit researchers developed the first diagnostic test to identify the COVID-19 coronavirus, which originated in Wuhan, China. More than half of all German Nobel Prize winners in physiology or medicine can be claimed by Charit as one of its own, and the hospital is internationally renowned for its excellence in teaching and training. In a new partnership announced in July 2019, Charit is integrating the Berlin Institute of Health under its umbrella; according to a statement from the BIH, it "is to becomealongside patient care and the medical facultythe third pillar of Charit." Charite.de

The Johns Hopkins Hospital, founded in 1889 in Baltimore, is not only a leading teaching and research hospital, but it is also central to the history and development of American medical education. William Osler, one of the hospital's founding physicians, invented the idea of medical residency, taking students out of the lecture halls and onto the wards to examine patients. Today Johns Hopkins has 1,162 beds and more than 2,400 full-time attending physicians. Among other firsts, Johns Hopkins was the first hospital in the U.S. to perform male-to-female sex-reassignment surgery. HopkinsMedicine.org

The lineage of this hospital, the first in Zurich, dates back to 1204. It is one of five university hospitals in Switzerland. Currently, it has 43 departments and institutes, ranging from a center on aging and mobility to a department of surgery and transplantation. The hospital has 980 beds, and 1,500 physicians and scientists. It treats over 42,000 inpatients and has over 500,000 outpatient visits every year. In 1977, a physician here successfully restored normal blood flow to constricted coronary arteries using a balloon catheter. Today, the procedure is widely used all over the world. En.Usz.ch

The oldest and largest hospital in this city-state, Singapore General Hospital, a teaching hospital, was founded 1821. Now, it employs more than 10,000 people and sees more than 1 million patients every year. It is home to Southeast Asia's only full multidisciplinary center for cancer and is an acute tertiary referral hospital with over 40 clinical disciplines. In 2010, it was the first hospital in Asia to receive the Magnet designation for nursing excellence from the American Nurses Credentialing Center. Sgh.com.sg

The Sheba Medical Center at Tel Hashomer, near Tel Aviv, serves as Israel's national research and university-affiliated training hospital. It was founded in 1948 as the country's first military hospital. Today, it collaborates with biotech and pharmaceutical companies around the world to develop new drugs and treatments. Serving more than 1.6 million patients a year, its facilities include an acute care hospital, a rehabilitation hospital, a women's hospital, a children's hospital, an eating disorders clinic, a post-traumatic stress disorder clinic forsoldiers and an outpatient clinic. Its research specialties include cardiology, cancer, brain diseases, obstetrics and gynecology, genetics and medical education. https://eng.sheba.co.il/

This hospital, with about 15,000 employees and 1,340 beds, is affiliated with the Karolinska Institute, which was founded in 1810 by King Karl XIII as a school for military surgeons, given the alarm about death rates in army field hospitals. Today it is one of the largest and most prestigious medical schools in the world. The facility incorporates two children's hospitals and is known for its specialties in reproductive medicine, fetal medicine, surgery, urology and neurosurgery. It is a member of 18 referral networks across Europe concentrating on rare diseases. Karolinska.se

Visit http://www.newsweek.com/best-hospitals-2020 for the remaining Top Best Hospitals in the World.

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Scientists find way to supercharge protein production – Washington University School of Medicine in St. Louis

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Discovery promises to aid production of protein-based drugs, vaccines, other biomaterials

Tubes of green fluorescent protein glow more brightly when they contain more of the protein. Researchers at Washington University School of Medicine have found a way to increase protein production up to a thousandfold, a discovery that could aid production of proteins used in the medical, food, agriculture, chemical and other industries.

Medicines such as insulin for diabetes and clotting factors for hemophilia are hard to synthesize in the lab. Such drugs are based on therapeutic proteins, so scientists have engineered bacteria into tiny protein-making factories. But even with the help of bacteria or other cells, the process of producing proteins for medical or commercial applications is laborious and costly.

Now, researchers at Washington University School of Medicine in St. Louis have discovered a way to supercharge protein production up to a thousandfold. The findings, published Dec. 18 in Nature Communications, could help increase production and drive down costs of making certain protein-based drugs, vaccines and diagnostics, as well as proteins used in the food, agriculture, biomaterials, bioenergy and chemical industries.

The process of producing proteins for medical or commercial applications can be complex, expensive and time-consuming, said Sergej Djuranovic, PhD, an associate professor of cell biology and physiology and the studys senior author. If you can make each bacterium produce 10 times as much protein, you only need one-tenth the volume of bacteria to get the job done, which would cut costs tremendously. This technique works with all kinds of proteins because its a basic feature of the universal protein-synthesizing machinery.

Proteins are built from chains of amino acids hundreds of links long. Djuranovic and first author Manasvi Verma, an undergraduate researcher in Djuranovics lab, stumbled on the importance of the first few amino acids when an experiment for a different study failed to work as expected. The researchers were looking for ways to control the amount of protein produced from a specific gene.

We changed the sequence of the first few amino acids, and we thought it would have no effect on protein expression, but instead, it increased protein expression by 300%, Djuranovic said. So then we started digging in to why that happened.

The researchers turned to green fluorescent protein, a tool used in biomedical research to estimate the amount of protein in a sample by measuring the amount of fluorescent light produced. Djuranovic and colleagues randomly changed the sequence of the first few amino acids in green fluorescent protein, generating 9,261 distinct versions, identical except for the very beginning.

The brilliance of the different versions of green fluorescent protein varied a thousandfold from the dimmest to the brightest, the researchers found, indicating a thousandfold difference in the amount of protein produced. With careful analysis and further experiments, Djuranovic, Verma and their collaborators from Washington University and Stanford University identified certain combinations of amino acids at the third, fourth and fifth positions in the protein chain that gave rise to sky-high amounts of protein.

Moreover, the same amino-acid triplets not only ramped up production of green fluorescent protein, which originally comes from jellyfish, but also production of proteins from distantly related species like coral and humans.

The findings could help increase production of proteins not only for medical applications, but in food, agriculture, chemical and other industries.

There are so many ways we could benefit from ramping up protein production, Djuranovic said. In the biomedical space, there are many proteins used in drugs, vaccines, diagnostics and biomaterials for medical devices that might become less expensive if we could improve production. And thats not to mention proteins produced for use in the food industry theres one called chymosin that is very important in cheese-making, for example the chemical industry, bioenergy, scientific research and others. Optimizing protein production could have a broad range of commercial benefits.

Verma M, Choi J, Cottrell KA, Lavagnino Z, Thomas EN, Pavlovic-Djuranovic S, Szczesny P, Piston DW, Zaher HS, Puglisi JD, Djuranovic S. A short translational ramp determines the efficiency of protein synthesis. Nature Communications. Dec. 18, 2019. DOI: 10.1038/s41467-019-13810-1

This work is supported by the National Institutes of Health (NIH), grant numbers R01 R01GM112824, R01GM51266, R01GM113078, R01DK115972 and T32GM007067; the Skandalaris Center LEAP Award; JDRF, award number 3-APF-2018-573-A-N; and Stanford University Bio-X Fellowship.

SD holds US Provisional Patent #62/540,897 Methods to modulate protein translation efficiency. This patent is owned by Washington University and managed by the Washington University Office of Technology Management (reference numberT061889)

Washington University School of Medicines 1,500 faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Childrens hospitals. The School of Medicine is a leader in medical research, teaching and patient care, ranking among the top 10 medical schools in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Childrens hospitals, the School of Medicine is linked to BJC HealthCare.

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More high school students than ever are coming out, but their despair remains acute – TribLIVE

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PHILADELPHIA The proportion of high school students who identify as a sexual minority lesbian, gay, bisexual or questioning doubled in the past several years, according to a new study published Monday.

Yet those greater numbers have not necessarily meant they have found greater acceptance or peace. The study, based on data from a federal survey, found that those teens attempted suicide at a rate nearly four times higher than their heterosexual peers.

The research, published in the journal Pediatrics, was based on data from the Youth Risk Behavioral Surveillance Survey from 2009 to 2017. The findings were based on survey information from Delaware, Illinois, Massachusetts, Maine, North Dakota, and Rhode Island, the only six states that continuously collected sexual orientation data for all those years.

These new findings, particularly the disproportionate rate of suicide attempts, dramatically point out the need for increased efforts to assist and support these young people, according to the researchers.

Large disparities in suicide attempts persisted even as the percent of students identifying as LGBQ increased. In 2017, more than 20% of LGBQ teens reported attempting suicide in the past year, said lead study author Julia Raifman, an assistant professor with Boston Universitys School of Public Health.

Its 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 health curricula that are inclusive of sexual minority health, Raifman said.

According to the study, 14.3% of U.S. teens identified as a sexual minority in 2017, compared with 7.3% in 2009. Adolescent girls in 2017 were twice as likely as boys to identify as a sexual minority.

The research also found that many more high schoolers are engaging in or at least experimenting with same-sex sexual contact. Their numbers increased from 7.7% of teens in 2009 to a little over 13% in 2017.

The sexual contact numbers were based on data from Delaware, Connecticut, Illinois and Rhode Island, the four states that continuously collected that information from 2009 to 2017.

As troubling as the high rate of suicide attempts for sexual minority teenagers compared to heterosexual kids is, the rate at the beginning of the study period was even worse.

In 2017, a little over 20% of the high schoolers who identified as sexual minorities reported attempting suicide, compared to 26.7% in 2009. The reported suicide attempt rate for heterosexual kids was about 6% for both those years.

Our 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, Raifman said.

Raifman said previous research she was involved in show a correlation between public policies and LGBQ suicide attempts and mental health.

In one 2017 study, Raifman and colleagues found a 7% reduction in suicide attempts in high school students, particularly those identified as sexual minorities, in states that allowed same-sex marriage. A 2018 study led by Raifman found increased mental health distress among sexual minority individuals in states where there had been publicized cases of anti-gay discrimination.

Suicide is the second leading cause of death for young people ages 10 to 24.

In addition to Boston University, the study authors include researchers from Boston Childrens Hospital, Harvard Medical School and the School of Public Health, Johns Hopkins School of Medicine, Brown Universitys School of Public Health and medical school, along with other hospitals.

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IMGs: Heed these 4 tips to pursue academic medicine career – American Medical Association

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If you are looking to enter the U.S. physician workforce as an international medical graduate (IMG), following residency or fellowship, you are likely examining pros and cons of each potential practice setting.

One option that may offer some appeal is working in academic medicine.

Academic institutions offer opportunities for research and being at the cutting edge of knowledge and skills, including taking on the patients who are toughest to diagnose and treat. You also can work to shape the future of medicine by teaching the next generation of students and residents.

Based on insight from an IMG who has excelled in the field, there is a path for IMGs to land faculty positions and succeed in academic medicine. These four tips can help IMG residents make a smooth transition to the academic setting.

Learn more with the AMA about what to consider before you choose a practice setting.

Sabesan Saby Karuppiah, MD, MPH

Having completed medical school in India and residency in the U.K., Sabesan Saby Karuppiah, MD, MPH, was frustrated when he moved to the U.S. and had to go through residency training a second time.

By the time I was doing my second residency, I was kind of bored, said Dr. Karuppiah, division vice president of graduate medical education at HCA MidAmerica in Overland Park, Kansas. I was looking at other things I could get myself interested in. I took on leadership roles and tracks and became a chief resident.

Because I had so much time, I began to teach more, and I began to understand that I liked teaching.

Dr. Karuppiah, an AMA member, went on to do a post-residency fellowship in the field of faculty development. The experience gave him the tools to succeed as an academic physician.

Success in academic medicine is largely based on ones clinical and teaching ability, but the third pillar to the field is research.

In this arena, IMGs may have a leg up in that they tend to come into residency with extensive publishing experience.

According to the National Resident Matching Program, the average non-U.S. citizen IMG who matched in 2018 had 5.9 abstracts, presentations and publications as part of their application. Thats higher than the 5.7 figure for allopathic medical school seniors who matched in 2018.

If you are an IMG now and get into residency, you need to be top notch, you have to have [test] great scores and research papers, Dr. Karuppiah said. So, what that means is IMGs have more research which puts them in a good spot to be a faculty. They have already been looking at research and grants even prior to residency.

As residents, IMGs may find challenges in transitioning to the U.S. system of training. They also may need additional guidance in getting into the academic track and help networking.

If you want to get more involved in a field, you might need mentorship from people who were already in the position, Dr. Karuppiah said.

Communication is the key. Sometimes IMGs can be shy or their confidence might be lacking. You need to let your guard down and seek out mentors. That will help you go a long way.

Read about five AMA member IMGs who speak up for patients and fellow doctors.

Dr. Karuppiah credits his involvement in organized medicine and the AMA as a big part of his ability to advance in academic medicine. He is a member of the AMA-IMG Section governing council, which gives voice to and advocates for issues that affect IMG physicians.

You need many tools to be faculty, he said. You need basic teaching skills, communication skills, feedback, evaluation, those are the skills you have to have as a faculty. Those skills might be what IMGs are lacking.

I got that training personally from being involved in organized medicine, going to meetings, writing resolutions. You get to work with people and be on conference calls. It boosts your confidence, develops your communications skills.

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UMass Medical School and GE Healthcare establishing manufacturing facility in Worcester – MassLive.com

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UMass Medical School and GE Healthcare Life Sciences have announced the companies plan to establish a new large-scale viral vector manufacturing facility that will be housed on the Worcester campus of the medical school.

The facility will be able to provide large quantities of high-quality recombinant adeno-associated virus vectors for preclinical research, according to a news release from the medical school.

The potential of gene therapy to treat human disease has finally become a reality, said Terence R. Flotte, the Celia and Isaac Haidak Professor of Medical Education, executive deputy chancellor, provost and dean of the School of Medicine and professor of pediatrics. However, the ability to move the field forward to treat additional serious diseases remains limited by the efficiency and flexibility of producing gene therapy vectors suitable for testing in new disease models."

A lack of large-scale vector manufacturing facilities has limited preclinical research capabilities, according to the news release.

Researchers often wait 12 to 24 months to secure enough vector for their research. With this facility, researchers will have access to GE Healthcares processing equipment, helping get research to the clinic faster, the medical school said.

Accelerating research that brings novel cell and gene therapies to patients is the mission of our business, said Catarina Flyborg, the general manager of cell and gene therapy at GE Healthcare Life Sciences. By partnering with UMass Medical School to create this large scale AAV manufacturing facility, we will provide researchers with the tools and AAV needed for pre-clinical research that will advance the cell and gene therapy industry and get therapies to patients faster.

The facility will be 3,220 square feet and will be fully operational in 2020. Four to six professional staff members will manage day-to-day operations, with Sylvain Cecchini, an associate professor of microbiology and physiological systems, as the core director, the statement said.

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UMass Medical School and GE Healthcare establishing manufacturing facility in Worcester - MassLive.com