Monthly Archives: March 2016

Time to Neurological Deterioration

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Time to Neurological Deterioration in Ischemic Stroke.

Author: James E. Siegler, MD1†, Karen C. Albright, DO, MPH2,3,4,5†, Alexander J. George, BS1, Amelia K. Boehme, MSPH2, Michael A. Gillette, MPH 1, Andre D. Kumar, MD1, Monica Aswani MSPH6, Sheryl Martin-Schild, MD, PhD1

Author Affiliations:

1 Stroke Program, Department of Neurology, Tulane University Hospital, New Orleans, LA 70112.

2 Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 35294.

3 Health Services and Outcomes Research Center for Outcome and Effectiveness Research and Education (COERE), University of Alabama at Birmingham, 35294.

4 Center of Excellence in Comparative Effectiveness Research for Eliminating Disparities (CERED) Minority Health & Health Disparities Research Center (MHRC), University of Alabama at Birmingham, 35294.

5 Department of Neurology, School of Medicine, University of Alabama at Birmingham, 35294.

6 Department of Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35249.

† Siegler and Albright contributed equally to this article as first authors.

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Corresponding Author: Sheryl Martin-Schild, smartin2@tulane.edu

Key Words: Acute ischemic stroke, neurological deterioration, latency, time to event analysis

 

Abstract:

Background: Neurological deterioration (ND) is common, with nearly one-half of ND patients deteriorating within the first 24 to 48 hours of stroke.  The timing of ND with respect to ND etiology and reversibility has not been investigated.

Methods: At our center, we define ND as an increase of 2 or more points in the National Institutes of Health Stroke Scale (NIHSS) score within 24 hours and categorize etiologies of ND according to clinical reversibility.  ND etiologies were considered non-reversible if such causes may have produced or extended any areas of ischemic neurologic injury due to temporary or permanent impairment in cerebral perfusion.

Results: Seventy-one of 350 ischemic stroke patients experienced ND.  Over half (54.9%) of the patients who experienced ND did so within the 48 hours of last seen normal.  The median time to ND for non-reversible causes was 1.5 days (IQR 0.9, 2.4 days) versus 2.6 days for reversible causes (IQR 1.4, 5.5 days, p=0.011).  After adjusting for NIHSS and hematocrit on admission, the log-normal survival model demonstrated that for each 1-year increase in a patient’s age, we expect a 3.9% shorter time to ND (p=0.0257).  In addition, adjusting for age and hematocrit on admission, we found that that for each 1-point increase in the admission NIHSS, we expect a 3.1% shorter time to ND (p=0.0034).

Conclusions: We found that despite having similar stroke severity and age, patients with nonreversible causes of ND had significantly shorter median time to ND when compared to patients with reversible causes of ND.

 

Published on date: March, 2016

 

DOI: 10.15404/msrj/03.2016.0005

Citation: Siegler J, Albright K, et al. Time to Neurological Deterioration in Ischemic Stroke. Medical Student Research Journal (2016). doi:10.15404/msrj/03.2016.0005

References:

  1. Davalos A, Toni D, Iweins F, Lesaffre E, Bastianello S, Castillo J. Neurological deterioration in acute ischemic stroke: potential predictors and associated factors in the European cooperative acute stroke study (ECASS) I. Stroke; a journal of cerebral circulation. 1999;30(12):2631-6.
  2. Siegler JE, Martin-Schild S. Early Neurological Deterioration (END) after stroke: the END depends on the definition. International journal of stroke : official journal of the International Stroke Society. 2011;6(3):211-2.
  3. Siegler JE, Boehme AK, Kumar AD, Gillette MA, Albright KC, Martin-Schild S. What change in the National Institutes of Health Stroke Scale should define neurologic deterioration in acute ischemic stroke? Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 2013;22(5):675-82.
  4. Kwan J, Hand P. Early neurological deterioration in acute stroke: clinical characteristics and impact on outcome. QJM : monthly journal of the Association of Physicians. 2006;99(9):625-33.
  5. DeGraba TJ, Hallenbeck JM, Pettigrew KD, Dutka AJ, Kelly BJ. Progression in acute stroke: value of the initial NIH stroke scale score on patient stratification in future trials. Stroke; a journal of cerebral circulation. 1999;30(6):1208-12.
  6. Siegler JE, Boehme AK, Kumar AD, Gillette MA, Albright KC, Beasley TM, et al. Identification of modifiable and nonmodifiable risk factors for neurologic deterioration after acute ischemic stroke. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 2013;22(7):e207-13.
  7. Miyamoto N, Tanaka Y, Ueno Y, Kawamura M, Shimada Y, Tanaka R, et al. Demographic, clinical, and radiologic predictors of neurologic deterioration in patients with acute ischemic stroke. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 2013;22(3):205-10.
  8. Tei H, Uchiyama S, Ohara K, Kobayashi M, Uchiyama Y, Fukuzawa M. Deteriorating ischemic stroke in 4 clinical categories classified by the Oxfordshire Community Stroke Project. Stroke; a journal of cerebral circulation. 2000;31(9):2049-54.
  9. Weimar C, Mieck T, Buchthal J, Ehrenfeld CE, Schmid E, Diener HC, et al. Neurologic worsening during the acute phase of ischemic stroke. Archives of neurology. 2005;62(3):393-7.
  10. Jorgensen HS, Nakayama H, Raaschou HO, Olsen TS. Effect of blood pressure and diabetes on stroke in progression. Lancet. 1994;344(8916):156-9.
  11. Grotta JC, Welch KM, Fagan SC, Lu M, Frankel MR, Brott T, et al. Clinical deterioration following improvement in the NINDS rt-PA Stroke Trial. Stroke; a journal of cerebral circulation. 2001;32(3):661-8.
  12. Leigh R, Zaidat OO, Suri MF, Lynch G, Sundararajan S, Sunshine JL, et al. Predictors of hyperacute clinical worsening in ischemic stroke patients receiving thrombolytic therapy. Stroke; a journal of cerebral circulation. 2004;35(8):1903-7.
  13. Ogata T, Yasaka M, Wakugawa Y, Ibayashi S, Okada Y. Predisposing factors for acute deterioration of minor ischemic stroke. Journal of the neurological sciences. 2009;287(1-2):147-50.
  14. Toyoda K, Fujimoto S, Kamouchi M, Iida M, Okada Y. Acute blood pressure levels and neurological deterioration in different subtypes of ischemic stroke. Stroke. 2009;40(7):2585-8.
  15. Awadh M, MacDougall N, Santosh C, Teasdale E, Baird T, Muir KW. Early recurrent ischemic stroke complicating intravenous thrombolysis for stroke: incidence and association with atrial fibrillation. Stroke. 2010;41(9):1990-5.
  16. Georgiadis D, Engelter S, Tettenborn B, Hungerbuhler H, Luethy R, Muller F, et al. Early recurrent ischemic stroke in stroke patients undergoing intravenous thrombolysis. Circulation. 2006;114(3):237-41.
  17. Britton M, Roden A. Progression of stroke after arrival at hospital. Stroke. 1985;16(4):629-32.
  18. Davalos A, Cendra E, Teruel J, Martinez M, Genis D. Deteriorating ischemic stroke: risk factors and prognosis. Neurology. 1990;40(12):1865-9.
  19. Toni D, Fiorelli M, Gentile M, Bastianello S, Sacchetti ML, Argentino C, et al. Progressing neurological deficit secondary to acute ischemic stroke. A study on predictability, pathogenesis, and prognosis. Arch Neurol. 1995;52(7):670-5.
  20. Siegler JE, Boehme AK, Dorsey AM, Monlezun D, George AJ, Bockholt HJ, et al. A Comprehensive Stroke Center Patient Registry: Advantages, Limitations, and Lessons Learned. Med Stud Res J. 2013;1(2):21-9.
  21. Siegler JE, Boehme AK, Albright KC, George AJ, Monlezun DJ, Beasley TM, et al. A proposal for the classification of etiologies of neurologic deterioration after acute ischemic stroke. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 2013;22(8):e549-56.
  22. Serena J, Rodriguez-Yanez M, Castellanos M. Deterioration in acute ischemic stroke as the target for neuroprotection. Cerebrovasc Dis. 2006;21 Suppl 2:80-8.
  23. Del Bene A, Palumbo V, Lamassa M, Saia V, Piccardi B, Inzitari D. Progressive lacunar stroke: review of mechanisms, prognostic features, and putative treatments. Int J Stroke. 2012;7(4):321-9.
  24. Adams HP, Jr., Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993;24(1):35-41.
  25. Albright KC, Martin-Schild S, Bockholt HJ, Howard G, Alexandrov A, Sline MR, et al. No consensus on definition criteria for stroke registry common data elements. Cerebrovasc Dis Extra. 2011;1(1):84-92.
  26. Bender R, Lange S. Adjusting for multiple testing–when and how? J Clin Epidemiol. 2001;54(4):343-9.

Does Traditional Chinese Medicine Matter?

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Does Traditional Chinese Medicine Matter? Medical Choices of Rural Diabetic Patients in Changsha, China

Author: Xiaoyue Mona Guo, B.A.1, Shuiyuan Xiao, M.D., Ph.D.2

Author Affiliations:

1Yale University School of Medicine, New Haven, CT USA

2Department of Social Medicine and Health Management, School of Public Health, Central South University, Changsha, Hunan, China

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Corresponding Author: Xiaoyue Mona Guo

Key Words: Traditional Chinese Medicine, Health-seeking behaviors, Rural China, Diabetes

 

Abstract:

Introduction: With an aging, urbanizing population, China is home to the world’s largest number of adult diabetics. Although more diabetic patients currently live in cities, the prevalence of pre-diabetes is greater in the rural population due to changing dietary and physical habits, as well as the relative poverty. This demographic is thus an important target for public health intervention. As Traditional Chinese Medicine (TCM) is viewed in China as useful for treating chronic diseases and widely accepted, we sought to explore its use for rural diabetic patients.

Methods: The study population included 63 diabetic patients and two village doctors from four rural villages near Changsha, China. An initial survey was orally conducted with all 63 participants to collect demographics, financial situation, health-seeking behaviors, treatment beliefs, and medical expenditure. Three focus groups of six rural patients each were subsequently held at village health centers. For analysis, questionnaire data was summarized using means and standard deviations or medians and quartiles. Focus group sessions were voice-recorded and transcripts were coded for thematic analysis.

Results/Conclusions: Questionnaire data revealed that for the majority of participants, seeing a doctor is costly in terms of time and money. Patients often do not have the luxury of choosing their medical provider. Despite the benefits of TCM, its slow speed and cumbersome preparation methods do not fit a need for immediate results. Furthermore, TCM doctors are not as available or accessible as Western medicine doctors. As such, although 20% of rural patients rated higher trust in TCM than WM, no patient solely used TCM for their treatment. Instead, almost 40% of patients try to use both TCM and WM. Village practitioners similarly believed that although diabetes treatment should go towards integrative treatment, TCM’s development is hindered by its slow onset and inconvenience coupled with a more systemic lack of TCM infrastructure and research in China. In summary, the continued trust that rural patients place in TCM supports further research for better understanding the true economic, social, and health benefits of having combined TCM-WM treatment be part of diabetes standard of care.

Published on date: March 2016

DOI: 10.15404/msrj/03.2016.0004

Citation: Guo X, Xiao S. Does Traditional Chinese Medicine Matter? Medical Choices of Rural Diabetic Patients in Changsha, China, Medical Student Research Journal (2016). doi:10.15404/msrj/03.2016.0004

References:

  1. Hesketh T, Zhu WX. Traditional Chinese medicine: One country, two systems. BMJ: British Medical Journal (International Edition). 1997;315(7100):3p.
  2. Covington MB. Traditional Chinese medicine in the treatment of diabetes. Diabetes Spectrum. 2001;14(3):154-159.
  3. Yu H, Wang S, Liu J, Lewith G. Why do cancer patients use Chinese Medicine?-A qualitative interview study in China. European Journal of Integrative Medicine. 2012;4:c197-c203.
  4. Lee GBW, Charn TC, Chew ZH, Ng TP. Complementary and alternative medicine use in patients with chronic diseases in primary care is associated with perceived quality of care and cultural beliefs. Fam Pract. Dec 2004;21(6):654-660.
  5. Yang WY, Lu JM, Weng JP, et al. Prevalence of Diabetes among Men and Women in China. New Engl J Med. Mar 25 2010;362(12):1090-1101.
  6. Wang WB, McGreevey WP, Fu CW, et al. Type 2 Diabetes Mellitus in China: A Preventable Economic Burden. Am J Manag Care. Sep 2009;15(9):593-601.
  7. Yeh GY, Eisenberg DM, Kaptchuk TJ, Phillips RS. Systematic Review of Herbs and Dietary Supplements for Glycemic Control in Diabetes. Diabetes Care. 2003;26(4):18p.
  8. Liu JP, Zhang M, Wang WY, Grimsgaard S. Chinese herbal medicines for type 2 diabetes mellitus. Cochrane Database Systemic Review. 2004;3:CD003642.
  9. Li WL, Zheng HC, Bukuru J, De Kimpe N. Natural medicines used in the traditional Chinese medical system for therapy of diabetes mellitus. J Ethnopharmacol. May 2004;92(1):1-21.
  10. Donnelly R, Wang B, Qu X. Type 2 diabetes in china: Partnerships in education and research to evaluate new antidiabetic treatments. British Journal of Clinical Pharmacology. 2006;61(6):702-705.
  11. He J, Gu D, Wu X, et al. Major Causes of Death among Men and Women in China. New Engl J Med. 2005;353(11):1124-1134.
  12. Weil A. The state of the integrative medicine in the U.S. and Western World. Chinese journal of integrative medicine. Jan 2011;17(1):6-10.
  13. Xu W, Towers AD, Li P, Collet JP. Traditional Chinese medicine in cancer care: perspectives and experiences of patients and professionals in China. European journal of cancer care. Sep 2006;15(4):397-403.
  14. Liu Y, Rao K, Hsiao WC. Medical expenditure and rural impoverishment in China. Journal of health, population, and nutrition. Sep 2003;21(3):216-222.
  15. Health in rural China worsening, costs rising-WHO. 2007. http://www.reuters.com/article/2007/11/01/idUSPEK281625. Accessed Feb 7, 2012.
  16. Hui J, Xiao S, Xu H. Community-based screening for type 2 diabetes mellitus. Chinese Journal of Social Medicine. 2011;28(6):415-417.
  17. Lei X, Lin W. The New Cooperative Medical Scheme in rural China: does more coverage mean more service and better health? Health economics. Jul 2009;18 Suppl 2:S25-46.
  18. Hung JC, CJ; Chang, HY. Relationships between medical beliefs of superiority of Chinese or western medicine, medical behaviours and glycaemic control in diabetic outpatients in Taiwan. Health and Social Care in the Community. 2012;20(1):80-86.

Combating Obstacles to Empathy

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Combating Obstacles to Empathy: A Replicable Small Group Discussion Series for Medical Students

Author: Francesca P. Kingery, M.S.1*, Alexander Bajorek, M.D. M.A.2, Amber Zimmer Deptola, M.D.3 Karen Hughes Miller, Ph.D.4, Craig Ziegler Ph.D.5, Pradip D. Patel M.D.6

Author Affiliations:

1School of Medicine, University of Louisville, Louisville, KY, USA.

2Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston MA, USA.

3Washington University School of Medicine, St. Louis, MO, USA.  

4Graduate Medical Education, University of Louisville School of Medicine, Louisville, KY, USA.

5Office of Medical Education, University of Louisville School of Medicine, Louisville, KY, USA.

6Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, USA.

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Corresponding Author: Francesca P. Kingery, fdprib01@louisville.edu

Key Words: Medical Humanities, Bioethics, Curriculum, Student-led, Empathy, Medical Education, Pre-Clinical

 

Abstract:

The expression of humanism in patient encounters is a core component of the medical profession and evolving national medical student curriculum. Growing evidence suggests that empathetic care improves patient outcomes and diagnostic accuracy while decreasing physician stress and rates of litigation. Unfortunately, multiple recent studies using different scales and survey tools have consistently shown empathy to decrease during the third and fourth years of medical school. We developed a replicable, case-based, student and expert-driven, small-group discussion series designed to address this decline. Over two years, the series included four separate discussions over controversial topics seldom addressed by formal courses (Chronic Pain Management vs. Prescription Drug Abuse, Balancing Business and Medicine, and Domestic Violence). We utilized pre- and post-session surveys to qualitatively and quantitatively evaluate the program. Our results demonstrated significant improvement in participants’ comfort with the subject matter and desire to approach faculty and peers regarding humanistic patient care. Future and more frequent interactions, combined with optimization of the format could further uncover the utility of this program. Ultimately, we believe our discussion series could be replicated on other medical campuses.

 

Published on date: March, 2016

 

DOI: 10.15404/msrj/03.2016.0001

Citation: Kingery et al. Combating Obstacles to Empathy: A Replicable Small Group Discussion Series for Medical Students Medical Student Research Journal (2016). doi: 10.15404/msrj/03.2016.0001

References:

  1. Chen D, Lew R, Hershman W, Orlander J. A cross-sectional measurement of medical student empathy. Journal of General Internal Medicine. October 2007;22(10):1434-8. http://dx.doi.org/10.1007/s11606-007-0298-x.
  2. Hojat M, Vergare MJ, Maxwell K, et al. The devil is in the third year: A longitudinal study of erosion of empathy in medical school. Academic Medicine. September 2009;84:1182–1191.
  3. Mangione S, Kane GC, Caruso JW, Gonella JS, Nasca TJ, Hojat M. Assessment of empathy in different years of internal medicine training. Medical Teacher. July 2002;24:370–3.
  4. Newton BW, Barber L, Clardy J, et al. Is there hardening of the heart during medical school? Academic Medicine. March 2008;83:244–249. http://dx.doi.org/10.1097/ACM.0b013e3181637837.
  5. Rosenthal S, Howard B, Schlussel YR, et al. Humanism at heart: preserving empathy in third-year medical students. Academic Medicine. March 2011;86(3):350-8. http://dx.doi.org/10.1097/ACM.0b013e318209897f.
  6. Rosen IM, Gimotty PA, Shea JA, Bellini LM. Evolution of sleep quantity, sleep deprivation, mood disturbances, empathy, and burnout among interns. Academic Medicine. January 2006; 81(1):82-5.
  7. Gold A, Gold S. Humanism in medicine from the perspective of the Arnold Gold Foundation: challenges to maintaining the care in health care. Journal of Child Neurology. June 2006;21(6): 546-9.
  8. Mueller PS. Incorporating professionalism into medical education: the Mayo Clinic experience. Keio Journal of Medicine. September 2009;58(3):133-43.
  9. Shiau S, Chen CH. Reflection and critical thinking of humanistic care in medical education. Kaohsiung Journal of Medical Science. July 2008;24(7):367-72. http://dx.doi.org/10.1016/S1607-551X(08)70134-7.
  10. Swick HM. Viewpoint: professionalism and humanism beyond the academic health center. Academic Medicine. November 2007;82(11):1022-8.
  11. Bikker AP, Mercer SW, Rielly D. A pilot prospective study on the consultation and relational empathy, patient enablement, and health changes over 12 months in patients going to the Glasgow Homoeopathic Hospital. J Altern Complement Med. August 2005;11(4):591-600.
  12. Di Blasi Z, Harkness E, Ernst E, Georgiou A, Kleijnen J. Influence of context effects on health outcomes: a systematic review. The Lancet. March 2001;357(9258):757-762.
  13. Kim SS, Kaplowitz S, Johnston MV. The effects of physician empathy on patient satisfaction and compliance. Eval Health Prof. September 2004;27(3):237-51.
  14. Wensing M, Jung HP, Mainz J, Olesen F, Grol R. A systematic review of the literature on patient priorities for general practice care, part 1: description of the research domain. Social Science & Medicine. November 1998;47(10):1573-1588.
  15. Schattner, A. The silent dimension: expressing humanism in each medical encounter. Archives of Internal Medicine. June 2009;169(12):1095-9. http://dx.doi.org/10.1001/archinternmed.2009.103.
  16. Beckman HB, Markakis KM, Suchman AL, Frankel RM. The doctor– patient relationship and malpractice: lessons from plaintiff depositions. Archives of Internal Medicine. June 1994; 154:1365–1370.
  17. Levinson W, Roter DL, Mullooly JP, Dull VT, Frankel RM. The relationship with malpractice claims among primary care physicians and surgeons. Journal of the American Medical Association. February 1997;277:553–9.
  18. Neumann M, Bensing J, Mercer S, Ernstmann N, Ommen O, Pfaff H. Analyzing the “nature” and “specific effectiveness” of clinical empathy: a theoretical overview and contribution towards a theory-based research agenda. Patient Education and Counseling. March 2009;74(3):339-46. http://dx.doi.org/10.1016/j.pec.2008.11.013
  19. Association of American Medical Colleges Medical School Objectives Project. Learning Objectives for Medical Student Education: Guidelines for Medical Schools. Washington, DC: Association of American Medical Colleges. Available from: https://members.aamc.org/eweb/ upload/Learning%20Objectives%20for %20Medica l%20Student%20Educ%20Report%20I.pdf. Accessed December 28, 2014.
  20. Accreditation Council for Graduate Medical Education. General Competency and Assessment: Common Program Requirements. June 9, 2013; Available from: http://www.acgme.org/acgmeweb/Portals/0/PFAssets/ProgramRequirements/CPRs2013.pdf. Accessed December 28, 2014.
  21. Medical professionalism in the new millennium: A physician’s charter. Project of the ABIM Foundation, ACP-ASIM Foundation and the European Federation of Internal Medicine. Annals of Internal Medicine. February 2002;136:243–246.
  22. Lehmann LS, Kasoff WS, Koch P, Federmann DD. A survey of medical ethics education at U.S. and Canadian medical schools. Academic Medicine. July 2004;79:682–689.
  23. Medical residency application to recognize student achievement in humanism in medicine [news release]. Englewood Cliffs, NJ: Arnold P. Gold Foundation; Nov 12, 2014. http://www.prnewswire.com/news-releases/medical-residency-application-to-recognize-student-achievement-in-humanism-in-medicine-282404131.html. Accessed January 10, 2015.
  24. Benbassat J, Baumal R, Borkan JM, Ber R. Overcoming barriers to teaching the behavioral and social sciences to medical students. Academic Medicine. April 2003;78(4):372-80.
  25. Wachtler C, Lundin S, Troein M. Humanities for medical students? A qualitative study of a medical humanities curriculum in a medical school program. BMC Medical Education. March 2006;6:16.
  26. Doukas DJ, McCullough LB, Wear S. Perspective: Medical education in medical ethics and humanities as the foundation for developing medical professionalism. Academic Medicine. March 2012;87(3):334-41. http://dx.doi.org/10.1097/ACM.0b013e318244728c.
  27. Patel PD, Kischnick DB, Bickel SG, Ziegler CH, Miller KH. Evaluating the Utility of Peer- Assisted Learning in Pediatrics. Medical Science Educator. December 2011;21(4):316-319.
  28. Pandit NR. The Creation of Theory: A recent application of the Grounded Theory Method. The Qualitative Report. December 1996;2(4):1-20.
  29. Moyer CA, Arnold L, Quaintance J, et al. What factors create a humanistic doctor? A nationwide survey of fourth-year medical students. Academic Medicine. November 2010; 85(11):1800-7. http://dx.doi.org/10.1097/ACM.0b013e3181f526af.
  30. Reichert J, Bognar S, Greenberg LW, Godoy M, Durgans KY. New educational modules offer tough case studies around humanistic issues. Journal of Cancer Education. February 2011; 26(2):386-7. http://dx.doi.org/10.1007/s13187-011-0195-1.
  31. Wen LS, Baca JT, O’Malley P, Bhatia K, Peak D, Takayesu JK. Implementation of small-group reflection rounds at an emergency medicine residency program. Canadian Journal of Emergency Medicine. May 2013; 5(3):175-7.
  32. Misch, DA. Evaluating physicians’ professionalism and humanism: the case for humanism “connoisseurs”. Academic Medicine. June 2002;77(6):489-95.
  33. Self, DJ, Olivarez M, Baldwin DC Jr. The amount of small-group case- study discussion needed to improve moral reasoning skills of medical students. Academic Medicine. May 1998;3(5):521-3.

Medals 4 Mettle

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Medals4Mettle: A Program to Enhance the Medical Student-Patient Bond

Author: McKenzie Vater MS31*, Pradip D. Patel MD2, Kanyalakshmi Ayyanar, MD3, Autumn Marks, RN BSN CPHON4, Craig Ziegler, PhD5, Karen Hughes Miller, PhD6

Author Affiliations:

1Medical Student, University of Louisville School of Medicine, Louisville, KY, USA.

2 Professor of Pediatrics, University of Louisville School of Medicine, Louisville, KY, USA.

3 Associate Professor, Division of Pediatric Hematology Oncology, University of Louisville, Louisville, KY, USA.

4Practice Manager, University of Louisville Physicians Pediatric Cancer and Blood Disorders, Louisville, KY, USA.

5 Biostatistician, University of Louisville School of Medicine, Louisville, KY, USA.

6 Associate Professor, University of Louisville School of Medicine, Louisville, KY, USA.

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Corresponding Author: McKenzie Vater, mrvate01@louisville.edu

Key Words: service learning, humanism, empathy, student/patient communication, extracurricular activity

 

Abstract:

Introduction: Humanism is a necessary component of patient care. Medical schools are implementing strategies to educate students about humanism in medicine. The University of Louisville School of Medicine (ULSOM) encourages such practices through collaboration with Medals4Mettle (M4M), a non-profit organization that gives marathon medals to patients battling debilitating illnesses. The ULSOM’s chapter matches students participating in the Kentucky Derby Half/Full Marathon with pediatric patients, allowing students to establish a relationship with their “running buddies” prior to gifting their medals on race day as an act of support and acknowledgement of their struggle. The goal of this study was to evaluate the ULSOM chapter and to create a replicable model for other institutions to employ.

Methods: We conducted a survey for current and previous student and patient/parent participants. Participants were asked to complete six 5-point Likert scaled questions anchored with “Strongly Disagree” to “Strongly Agree” and three open-ended questions. The surveys were analyzed using the Mann-Whitney U test for quantitative analysis and Pandit’s variation of Glaser and Straus’ constant comparison for qualitative analysis.

Results: Data was collected from 62 medical students and 21 patients or parents (49% and 33% response rate, respectively). Five of the scaled questions had mean scores above 4.0, revealing that the majority of participants would recommend the M4M program to others and that M4M helped students relate to their patient on a personal level. The qualitative analysis identified four themes among participants: M4M is a wonderful program, it provides a patient benefit, people want to re-participate, and it allows you to connect with others.

Discussion: Findings from the survey suggest the implementation of programs like M4M will promote the integration of humanistic practices into medical school curricula. In the future, we plan to pair medical students with the patients earlier to create a longer-lasting, more meaningful relationship prior to the race.

 

Published on date: March, 2016

 

DOI: 10.15404/msrj/03.2016.0002

Citation: McKenzie et al. Medals4Mettle: A Program to Enhance the Medical Student-Patient Bond, Medical Student Research Journal (2016). doi: 10.15404/msrj/03.2016.0002

References:

  1. Dossett ML, Kohatsu W, Nunley W, Mehta D, Davis RB, Phillips RS, Yeh G. A medical student elective promoting humanism, communication skills, complementary and alternative medicine and physician self care: an evaluation of the HEART program. Explore. 2013 Sep-Oct;9(5):292-8.
  2. Moyer CA, Arnold L, Quaintance J, Braddock C, Spickard A 3rd, Wilson D, Rominski S, Stern DT. What factors create a humanistic doctor? A nationwide survey of fourth-year medical students. Acad Med. 2010 Nov;85(11):1800-7.
  3. Chou CM, Kellom K, Shea JA. Attitudes and habits of highly humanistic physicians. Acad Med. 2014 Sep;89(9):1252-8.
  4. Magnezi R, Bergman LC, Urowitz S. Would your patient prefer to be considered your friend? Patient preferences in physician relationships. Health Educ Behav. 2014 Aug 25.
  5. Branch WT Jr. Treating the whole patient: passing time-honored skills for building doctor-patient relationships to generations of doctors. Med Educ. 2014;48:67-74.
  6. Duong DV. Caregiving as good doctoring. Acad Med. 2013 Nov;88(11):1678-9.
  7. Williams GC, Frankel RM, Campbell TL, Deci EL. Research on relationship-centered care and healthcare outcomes from the Rochester biopsychosocial program: a self-determination theory integration. Fam Syst Health. 2000;18(1):79-90.
  8. Schaechter, JL, Canning EH. ‘Pals’ a medical student public service program. West J Med. 1994 Oct;161(4):390-2.
  9. Burks DJ, Kobus AM. The legacy of altruism in health care: the promotion of empathy, prosociality and humanism. Med Educ. 2012; 46:317-25.
  10. Eckenfels, EJ. The purpose of service learning. Fam Med. 2009; 41(9):659-62.
  11. Isenberg SF. Physician founds charity to honor collective ‘mettle.’ IBJ. 2006 Feb 6;26(49):A38.
  12. Center for Disease Control (CDC) Handbook on program Evaluation Available online at http://www.cdc.gov/eval/guide/CDCEvalManual.pdf
  13. IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp. Systat Software, Released 2008 .
  14. Pandit, NR (1996) Creation of Theory: A Recent Application of the Grounded Theory Method. The Qual Repo 2(4). Available online at http://www.nova.edu/ssss/QR/QR2-4/pandit.html
  15. Cohen, Jacob. Statistical Power Analysis for the Behavioral Sciences. New Jersey: Lawrence Erlbaum Associates, 1988. Print

New Feature: MSRJ e-Publications

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MSRJ’s Exciting New Feature!

The staff of MSRJ is extremely pleased to announce the addition of an exciting new feature to our journal! Starting today, we will be launching MSRJ e-Publication, which will be our first ever early-access publication issue. MSRJ e-publication will enable us to publish articles “online before print” as many other journals do. This new feature has many advantages for our student contributors including:

  • Faster publishing time for accepted manuscripts
  • Increased ease of access
  • Greater longevity of published literature
  • Assignment of a unique Digital Object Identifier number

We want to express our appreciation and thanks to the authors who have been instrumental in getting this put together. We invite you to take a look at their articles in our first-ever e-Pub Early Access Issue:

 

Combating Obstacles to Empathy: A Replicable Small Group Discussion Series for Medical Students.

Authors: Francesca P. Kingery, M.S., Alexander Bajorek, M.D. M.A., Amber Zimmer Deptola, M.D. Karen Hughes Miller, Ph.D., Craig Ziegler Ph.D., Pradip D. Patel M.D.

Medals4Mettle: A Program to Enhance the Medical Student-Patient Bond

Authors: McKenzie Vater MS3, Pradip D. Patel MD, Kanyalakshmi Ayyanar, MD, Autumn Marks, RN BSN CPHON, Craig Ziegler, PhD, Karen Hughes Miller,PhD

Does Traditional Chinese Medicine Matter? Medical Choices of Rural Diabetic Patients in Changsha, China.

Authors: Xiaoyue Mona Guo, B.A., Shuiyuan Xiao, M.D., Ph.D.

Time to Neurological Deterioration in Ischemic Stroke.

Authors: James E. Siegler, MD; Karen C. Albright, DO, MPH; Alexander J. George, BS; Amelia K. Boehme, MSPH; Michael A. Gillette, MPH; Andre D. Kumar, MD; Monica Aswani MSPH; Sheryl Martin-Schild, MD, PhD

 

What is e-Publication?

With MSRJ ePubs, not only will student authors be able to see their manuscripts published earlier, but each article will be assigned an individual Digital Object Identifier (DOI) number. A DOI number is a unique alphanumeric string assigned to a digital object. The DOI number is then registered with CrossRef.org, which is an official DOI registration agency dedicated to providing reliable and efficient reference linking for online scholarly material.

Each DOI uniquely identifies the article and provides a permanent link that takes readers to that particular electronic document, even if the web address which originally hosted the article changes.

These DOI’s already exist in various online journals such as JAMA and NEJM. They also provide ease of citation since they provide a short, easy, and unchanging link to the original document as opposed to a lengthy web address.

 

What Does This Mean for Student Contributors?

The use of DOIs enables us to safely publish intellectual property on the internet, prior to print, and without fear of plagiarism. The fact that DOIs are registered with Crossref © makes them permanent, so our student authors will always be able to find their articles, even many years down the road, using just that unique identifier. Finally, it makes these articles easy to reference, for any future researchers.

At any point in the future, people can access an article just by typing doi.org/ followed by the DOI number. This will automatically take you to wherever the article is housed at that time. It’s that simple!

Starting from today onwards, accepted manuscripts which have been prepared for e-Publication will be available for viewing under the new tab “ePubs” under “Publications” on the MSRJ website. Once we are off the ground, our MSRJ Tech Team will continue to work with the Executive Editors to format and prepare accepted manuscripts for e-Publication, and will continue fine-tuning the process to ensure smooth and continuous e-Publishing.

 

Behind the Scenes Work:

We would like to extend a special thanks our wonderful MSRJ Tech Team for their endless energy and tireless work towards getting e-Publication launched and helping our journal continue to grow. This has been no small feat, and we could not have done it without them! Leading the charge are Danny Yau and Danielle Levy, second-year medical students at MSU-CHM. They have been instrumental in designing the MSRJ template for our e-Publications, getting the MSRJ set up to accept and publish e-Publications, andestablishing the procedure for assigning DOIs to our manuscripts for future online publication.

We would also like to thank our faculty advisors, Dr. Luz and Dr. Trottier, for their support in helping us coordinate this transition to e-Publication.

 

Final Words:

As the longest-running journal run by medical students for medical students, we at the MSRJ strive to provide the highest quality product and experience for our student contributors. We hope that the addition of e-Publication will provide medical students another platform to promote their scholarship and research. and would like to thank our authors for their great submissions, support, and patience as we transition into this new phase.