Growth and Experiences of a Student-Led Patient Navigation Program Serving Individuals Experiencing Homelessness

Please find below the third article featured in our Winter 2024 Issue, enjoy!

Background: Those experiencing homelessness face disproportionately large barriers in access to healthcare. Patient Navigation is a service that provides disadvantaged populations with guidance through healthcare systems. Acting as a patient navigator is found to help enhance learning in the pre-clinical years of medical school. Developed by medical students, the Patient Navigator Program (PNP) pairs medical students trained as patient navigators with individuals experiencing homelessness. The uniqueness of this program lies in its fully student-run format, simultaneously providing individuals experiencing homelessness with longitudinal navigation services toward self-defined goals and medical students with exposure to a disadvantaged and underserved population in their early years of medical school. The purpose of this study is to evaluate the growth and student experiences of PNP from its inception and inform those who aim to develop similar student-run patient navigation programs.

Methods: Participation metrics in the program were extracted from volunteer records, and five 30-min student leader semi-structured interviews were conducted using open-ended questions to investigate the experiences of those who developed the program. Interviews were transcribed, and responses were categorized by themes.

Results: Enduring involvement in PNP over years was demonstrated quantitatively through participation metrics and qualitatively through interviews. Positive aspects of participation in PNP were meeting and working with other students, utilizing their creative vision in developing the program, learning about those experiencing homelessness and the local resources available to them, shaping career goals and academic interests, and learning the soft skills necessary for medical clerkships. Negative experiences primarily revolved around time constraints of the program in addition to their academic responsibilities. Commonly stated advice included identifying an appropriate faculty mentor and building strong relationships with community partners.

Conclusions: Participation in PNP was felt to be beneficial both personally and professionally. Reporting these perspectives and experiences will provide insight to future student-led programs at other institutions.

Uncommon Presentation of Benign Dermatofibroma of Thigh: A Case Report

Here’s the second article featured in our Winter 2024 Issue, enjoy!

Abstract: Dermatofibromas (DF) are small, noncancerous skin lesions typically found in the dermis layer of the skin and are often composed of a variable combination of inflammatory cells, which classically present as a firm, nonpainful, skin-colored nodule on the extremities or trunk. We present a case of a 53-year-old woman with a medical history of psoriasis who had bilateral leg swelling, erythema, and dry skin for which she underwent a punch biopsy of the left thigh. The punch biopsy sample was found to be a dermatofibroma, which was negative for malignancy or atypia. The skin rash and associated symptoms were due to Candida intertrigo, which was treated with broad-spectrum antibiotics and fluconazole. Following this, she was discharged and prescribed a course of fluconazole and linezolid for continued treatment of Candida intertrigo. This case report describes a rare presentation of benign dermatofibroma.

Medical Students’ Perspectives on Pregnant or Parenting Peers: A Cross-Sectional Survey

We’re back after some technical difficulties! Big thanks to everyone for their patience. Please find below the first addition to our Winter 2024 Issue, enjoy!

Purpose: Limited institutional resources exist for pregnant and parenting medical students; however, students’ opinions regarding pregnancy in medical school have not been reported. The authors assessed medical students’ perspectives regarding pregnant or parenting peers and underlying bias or resource gaps.

Methods: An online, cross-sectional survey was distributed in October 2022 to medical students at Michigan State University College of Human Medicine (n = 806) to explore demographics, bias, family planning, and available resources. Descriptive analyses, a two- tailed t-test comparing female and male responses, and a one-way analysis of variance test comparing medical school classes were used.

Results: The survey response rate was 13.2% (n = 106). Few respondents (n = 4, 3.8%) had been pregnant during medical school. The majority (n = 67, 71.3%) indicated family plans influence specialty choice. Furthermore, 78.0% (n = 42) cited career and education as their reason for choosing to delay pregnancy. Other descriptive analyses identified that 80.0% (n = 75) of respondents were not aware of resources available for pregnant or parenting classmates. Also, 13.0% (n = 12) of respondents had witnessed bias toward a pregnant medical student. Differences in opinions between males and females were present regarding bias and support available. Differences between medical student classes also exist regarding opinions indicating pregnancy as a barrier during school. The statements with the strongest overall agreement were: Pregnant medical students are resilient, face additional challenges, and parental leave should be available in medical school.

Conclusion: This study provides new information regarding pregnancy opinions in medical school and highlights pregnant medical students’ challenges and biases. We revealed common delays in pregnancy due to career or educational choices and uncovered the strong consensus among students that parental leave should be an option. Support efforts are warranted to decrease biases and offer parental leave to promote equity and inclusion.

Physiopathology of Extrapulmonary Tuberculosis: A Literature Review

Please enjoy this new addition to our Fall Issue!

Introduction: Extrapulmonary tuberculosis (EPTB) is an infection by mycobacteria in any part of the body other than the lungs. There is information on tuberculosis infection from more than 3,000 years ago, and despite the knowledge that there is about the disease, nowadays, it is estimated that a quarter of the world population is infected and 15% of the cases are extrapulmonary.

Aims: This literature review aims to present the physiopathology of the most common EPTB, update and summarize the current diagnostic and therapeutic advances for the EPTB reviewed, as well as describe the physiopathological implications of coinfection with human immunodeficiency virus (HIV).

Methods: A literature review was performed for which PubMed, Cochrane Library, and Google Scholar databases were consulted using the following keywords: Tuberculosis, Epidemiology, Physiopathology, Diagnosis, and Therapy. Only articles published from 2016 to 2022, evaluated with a score ≥ 10 based on the Scale for the Assessment of Narrative Review Articles (SANRA) score were included, obtaining a total of 38 bibliographic sources.

Discussion: Depending on the system or organ affected, it is how the physiopathological process is carried through as well as how the clinical features manifest and the diagnostic approach is made. The diagnostic and therapeutic strategies of each type of EPTB have been widely studied; however, although technological innovation has contributed to the development of new diagnostic techniques, the treatment of almost all EPTB has remained the same over time, which consists of the same 6-month regimen of therapy as in pulmonary tuberculosis. Furthermore, tuberculosis treatment has been severely affected by rifampicin resistance and concomitant HIV infection.

Conclusion: The physiopathology of the different EPTBs is well described; nevertheless, a better understanding of how the disease spreads and develops will allow us to create new diagnostic resources and improve therapeutic targets for this disease, which still has a substantial presence worldwide.

Impact of Imposter Phenomenon on Medical Learners and Clinicians: A Scoping Review

Please enjoy this new addition to our Fall Issue!

Objective: The imposter phenomenon (IP) is the belief that one does not deserve success. Medical students, residents, and physicians experience IP at significant rates, often due to the stress of mastering the extensive diagnostic information and treatment modalities as well as the competitive nature of medicine. We aimed to identify the main factors of IP in medical students, residents, and physicians in the available literature to increase awareness of IP in medical education.

Methods: In this scoping review, PubMed, PsycINFO, Cochrane Library, Embase, Scopus, Web of Science, Google Scholar, Northern Lights Conference Abstracts, and Dissertations & Theses databases were systematically searched for relevant studies published before June 2020. Articles that examined IP in medical students, residents, and attending physicians were retained. References were hand- searched following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach. Extracted data were tabulated to summarize characteristics and main findings from each study. Content analysis of this table identified major themes in the available literature.

Results: Twenty-four journal articles published between 1978 and 2020 were included. Three main themes were identified, including specific demographic characteristics of IP (n = 14), the professional impact (n = 10), and the psychological impact (n = 17) of IP. For demographic characteristics, IP was higher in older individuals (n = 3), racial and/or ethnic minorities (n = 2), and women (n = 12). Married individuals experienced less IP (n = 2). For professional impact, IP increased during career transitions or professional challenges (n = 8). For psychological impact, IP was associated with reduced self-esteem (n = 7), a negative self-concept (n = 2), increased self-doubt (n = 3), and perfectionism (n = 3). Depression, anxiety (n = 3), and burnout (n = 6) were also heightened with IP.

Conclusion: Results revealed a multitude of factors influencing IP. Increased awareness of the presence, impact, and severity of IP assists medical educators to combat its negative effects. Further research is needed to improve treatments for IP in this population and to better understand the impact of IP on diversity, career trajectory, and career satisfaction in medicine.

Use of telehealth for cancer screening in primary care during COVID-19: an analysis of the Council of Academic Family Medicine Educational Research Alliance Survey 2022

Please enjoy this new addition to our Fall Issue!

Background: The COVID-19 pandemic caused rapid uptake of telemedicine in primary care settings affecting cancer screening.

Objective: This study aimed to understand provider perception of future cancer incidence and telehealth feasibility in cancer screening.

Methods: Data were gathered and analyzed as part of the 2020 Council of Academic Family Medicine’s (CAFM) Educational Research Alliance (CERA) survey for primary analysis. The 2020 General Member COVID Survey examined demographics, the impact of faculty isolation, E-learning experience, cancer screening during COVID-19, and outpatient prenatal care. Survey participants were practicing family medicine physicians who were members of one of the CAFM organizations, with a response rate of 14.5%. Descriptive statistics were calculated. Analysis of Variance (ANOVA) was used to evaluate the relationship between telehealth sufficiency and provider age or year they earned their highest degree. Logistic regression evaluated the relationship between telehealth sufficiency and institution type.

Results: 54% of respondents believe that there will be an increase in late-stage cancer. Respondents whose practice settings were not affiliated with medical schools were 1.94 times more likely to feel that telehealth would not be sufficient for cancer screenings in the future (odds ratio [OR] = 1.94, 95% confidence interval [CI]: 1.28, 2.93).

Conclusion: While our study shows that in light of the COVID-19 pandemic, primary care physicians believe there will be an increase in later stage cancer; they can also use telehealth to adequately maintain cancer screening practices. This research serves as a starting point to understanding where, in cancer screening, telehealth can be useful and how practitioners can provide high-quality hybrid care.

When Cannabis Use Goes Wrong: An Epidemiologic Study of Cardiopulmonary Symptoms in Patients That Present to Emergency Departments

Please enjoy this new addition to our Fall Issue!

Background: Increased availability and use of cannabis in Michigan have led to a marked increase in emergency department (ED) visits associated with the drug’s adverse cardiopulmonary effects. However, few people are aware of these potential cardiopulmonary side effects. Recognition of these presenting symptoms is critical for emergency clinicians to provide timely and effective care, make accurate diagnoses, and safeguard the health of patients who may be experiencing toxic effects from cannabis use.

Study objective: To describe the prevalence, clinical features, and disposition of cannabis cardiopulmonary toxicity in a community- based study.

Methods: This was a retrospective cohort analysis of all patients diagnosed with toxicity related to cannabis use. Patients were seen at eight EDs over a 26-month study period (November 2018–December 2020). Affiliated institutions included three university-affiliated hospitals, a children’s tertiary care facility, and four rural medical centers. Data collected included demographics, clinical features, and treatment outcomes in patients presenting to the ED with cardiopulmonary symptoms (CPS) versus those experiencing other forms of cannabis toxicity.

Results: During the study period, 1,174 patients were evaluated for cannabis toxicity. A total of 318 patients (27.1%) had a cardiopulmonary chief complaint (CPS group) and 856 (72.9%) experienced other forms of cannabis toxicity, predominantly symptoms of intoxication, cannabis hyperemesis syndrome, or neuropsychiatric complaints. The CPS group presented with tachycardia (36.5%), dyspnea (34.3%), chest tightness (28.6%), palpitations (17.9%), and hypertension (8.2%). CPS patients were more likely to be older (32.6 vs. 24.3 years, p < 0.001), ingested edible cannabis (36.8% vs. 9.2%, p < 0.001), and have a history of polysubstance abuse (17.6 vs. 12.0%, p = 0.013). These patients also had a longer ED length of stay (4.9 vs. 3.8 h, p < 0.001) and significantly more hospital admissions (10.1% vs. 6.3%, p = 0.027).

Conclusions: Cardiopulmonary toxicity is common after acute or chronic cannabis exposures, occurring in over one-quarter of ED patients in this community-based study. These troublesome findings highlight the risks associated with using cannabis for recreational or therapeutic purposes.

Do Probiotics Prevent Gestational Diabetes in Obese/Overweight patients? A Systematic Review

The final article to be included in our Spring 2023 issue is linked below. Enjoy!

Introduction: While some studies suggest probiotic supplements may prevent Gestational Diabetes Mellitus (GDM), it is unclear if probiotics effectively prevent GDM among overweight and obese patients. This systematic review synthesizes recommendations for clinical practice and future research by evaluating the quality of evidence regarding Lactobacillus and Bifidobacterium containing probiotics to prevent GDM among obese and overweight patients. 

Methods: PubMed, Embase, CINAHL, and Web of Science were searched using appropriate MeSH terms. Results were limited to randomized controlled trials published between 2011-2021. Titles and abstracts were screened for relevance after duplicates were removed. Included studies diagnosed GDM according to by International Association of Diabetes and Pregnancy Study Group criteria, suspended probiotic use prior to intervention, excluded participants with altered glucose metabolism, included participants with a BMI ≥25kg/m2, and provided a specified dose of probiotic supplements. Articles without statistical analysis were excluded. Resulting articles were critically appraised using Version 2 of the Cochrane Risk of Bias tool.

Results: This search strategy resulted in 24 articles after duplicates were removed. Five double- blind randomized controlled trials found the incidence of GDM during the third trimester was not significantly different between probiotic and control groups. There was wide variation in the bacterial species, dose and duration of probiotic treatments used. All studies have a high risk of bias due to non-adherence to the treatment.

Discussion: This review used a highly sensitive criteria for GDM diagnosis that may mask a preventative effect of probiotics. Non-compliance may bias results towards the null given insufficient analysis of the effect of adhering to the intervention. No patterns between length of probiotic intervention or probiotic species and improved glucose tolerance were noted.

Conclusions: Current evidence is not sufficient to recommend probiotic supplements to prevent GDM in overweight and obese patients. Future evidence should address the effect of adhering to probiotic interventions and develop consistent probiotic intervention protocols.