Check out our latest article below.

https://msrj.chm.msu.edu/wp-content/uploads/2023/04/237-ePub-final.pdf

Background: Incoming emergency medicine residents may feel unsure of their ability to handle common emergency department scenarios, even if they are well educated on the proper steps to take in those scenarios. This may not stem from a lack of skill so much as a lack of confidence in their ability to perform with skills they have. 

Objective: We look to establish a link between completion of simulation- based training in common emergency medicine scenarios and learner self-reported confidence in their ability to perform competently in those scenarios. 

Methods: Fourth-year medical students who matched into an emergency medicine residency program participated in a Transitional Educational Program (TEP) at the Interprofessional Immersive Simulation Center at the University of Toledo in April 2021. Simulations of 16 procedural skills and clinical judgement cases were carried out using high-fidelity mannequins and real medical equipment in a hospital-based setting. Subjects were given pre- and post- TEP survey questionnaires assessing their self-reported confidence to competently perform in common emergency medicine clinical scenarios, using a 5-grade Likert scale. Data was analyzed using a one-tailed Wilcoxon signed-rank matched-pairs test. 

Results: Of 19 participating subjects, 16 (84.2%) consented and responded to the pre-survey. Of those 16 subjects, 10 (62.5%) completed the surveys at the correct time and order. The pre- and post- surveys consisted of the same 14 questions. In 11 of 14 survey questions, there was a significant increase in subject self-reported confidence (p<.05) between pre- and post-survey. 

Conclusions: Simulation-based training in the setting of high-fidelity equipment and faculty guidance improved the self-reported confidence of incoming emergency medicine residents to perform in common emergency medicine scenarios.

https://msrj.chm.msu.edu/wp-content/uploads/2023/04/239-ePub-final.pdf

Purpose: Patient positioning plays a crucial role in the field of radiology. Lateral knee x-rays are a type of image that often has incorrect positioning of the angle of knee flexion. The ideal range is between 20-30 degrees. The goal of this study was to assess the angle of knee flexion at two different locations in a single hospital system while determining if several variables influence the angle.

Methods: This study is a retrospective chart review that assessed the angle of knee flexion in patients 18 years or older that underwent a lateral-mediolateral knee x-ray taken at an urgent care center and a general diagnostic center of a hospital within the same system between March 1 and December 1, 2021. Variables including age, sex, BMI, technologist, and location were collected from these patients’ charts and evaluated. MRI information was gathered for patients who underwent an MRI within 30 days of a lateral knee x-ray. The research team assessed effusions reported on x-ray compared to effusions reported on MRI for these patients.

Results: Among patients included in the study (n=665) the average angle of knee flexion was 51.28 degrees. Age, sex, BMI, and location were not significantly associated with the mean angle of knee flexion with p-values of 0.63, 0.13, 0.55, and 0.15 respectively. The radiology technologist taking the image did have an association with the angle of knee flexion with a p- value of 0.001. Differences in the mean angle of knee flexion between the groups of x-rays with effusions reported compared to the groups of x-rays where effusions were not reported but found on MRI resulted in a p-value of 0.83.

Conclusions: The technologist taking the image was the only variable of this study that had a significant difference in mean angle of knee flexion. Additional studies are needed to determine what technologist factors are most important in determining the angle of knee flexion. Using MRI information to evaluate if effusions were not reported due to the angle of knee flexion was limited in this study due to small sample size.

Click the link below to view the full manuscript.

https://msrj.chm.msu.edu/wp-content/uploads/2023/04/230-ePub-final2.pdf

Background: Optic neuritis (ON) is inflammation of the optic nerve that can occur in both adults and children. This disease is marked by a heterogeneous presentation in children and has clinical and epidemiologic characteristics that differ greatly from those found in adults. The purpose of this report is to illustrate the clinical features of ON that occur during childhood and to highlight the differences of ON in children versus adults. In doing so, we aim to add to the sparse current literature on this topic and help prevent the future misdiagnosis of ON in pediatric patients.

Case Presentations: An 11-year-old female presented with bilateral decreased visual acuity and significant ocular pain. The ophthalmic presentation and diagnostic workup led to the diagnosis of acute disseminated encephalomyelitis with ON. A second patient, a 12-year-old male, presented with decreased visual acuity and bilateral papilledema. Alongside a diagnosis of bilateral ON, a muscle biopsy confirmed mitochondrial cytopathy as the etiology of his presenting symptoms.

Conclusions: ON in children may be related to specific infections, autoimmune disorders, diseases of adjacent anatomical structures, or demyelinating disorders. Attacks may be acute or subacute with signs of reduced visual acuity, abnormal pupillary response, loss of color vision, impaired contrast sensitivity, and decreased peripheral vision. Awareness of this complex disease allows the clinician to initiate specific treatment and follow-up care that may reduce subsequent morbidity and the rate of recurrence.

Check out this interesting article for our upcoming Fall 2022 issue!

https://msrj.chm.msu.edu/wp-content/uploads/2022/11/219-ePub-final.pdf

Abstract

Background: Little is known about the ethical issues confronting medical students during their first exposure to emergency medicine (EM). The aim of this study was to review student narratives to determine the type and frequency of ethical issues that beginning students confront in the ED.

Methods: This was a prospective, qualitative observational study of consecutive first- and second-year medical students electing to do a pre-clinical clerkship in Emergency Medicine (EM) at five university- affiliated hospitals. Students were asked to write a short description of three cases that had the greatest impact on them during the month-long clerkship. Each essay was independently analyzed by five members of the research team. Descriptive and kappa statistics were used to summarize the data.

Results: During the four-year study period, 292 consecutive student essays were evaluated from 103 medical students. A total of 194 specific incidents were coded across 15 categories of ethical standards. Overall, 71.1% (138/194) were depictions of exemplary instances of ethical issues, 13.9% (27/194) were considered normal interactions, and 14.9% (29/194) were categorized as unethical behavior. While generally impressed by the admirable behavior of faculty and staff, students were quick to describe instances of improper treatment of patients, such as poor communication, discrimination, improper pain management, or a perceived lack of empathy.

Conclusions: Narrative essays describe a wide variety of interesting ethical situations that beginning medical students confront during their clerkships. Many of these ethical interactions seem to be connected to the student’s role as an observer of the health care team and how that role can lead to ethical tension. As educators, we need to shine a light on the subtle ethical issues that clerkship students struggle with daily and give them practical tools to deal with moral decisions required of them in medical practice.

Check out this early release of the latest article for our Fall 2022 issue!

http://msrj.chm.msu.edu/wp-content/uploads/2022/11/222-epub-final.pdf

Abstract

Quadricuspid aortic valves (QAVs) are a rare congenital anomaly associated with increased risk of aortic insufficiency. This case presents the incidental finding of a quadricuspid aortic valve on intraoperative transesophageal echocardiography after going undetected on transthoracic echocardiography multiple times, suggesting that transesophageal echocardiography may be a superior imaging modality for the identification of this defect. This patient with a history of coronary artery disease presented with sudden onset moderate to severe aortic insufficiency and required subsequent aortic valve replacement (AVR).

Another new and interesting article! Click the link below to view the full case study.

https://msrj.chm.msu.edu/wp-content/uploads/2022/11/228-ePub-final.pdf

Abstract

We aim to add to the literature regarding Petit (inferior lumbar) hernias. The presence and location of lower back masses may have a deeper origin than initially apparent. We urge the surgical community to keep in mind the differential diagnosis of lumbar hernia, although rare, when evaluating subcutaneous masses and lipomata in this region. Simple excision may address the mass but not the cause and will lead to early recurrence of the presenting problem.

Check out the link below to view the full article.

http://msrj.chm.msu.edu/wp-content/uploads/2022/11/223-epub-final.pdf

Abstract

Case: We present a case of acute idiopathic four-compartment syndrome of the leg, treated by four-compartment fasciotomy, and wounds left to heal by secondary intention due to persistent edema following surgery.

Conclusion: This case highlights the importance of maintaining a high level of clinical suspicion for idiopathic spontaneous compartment syndrome presentation. This case also illustrates the variability of compartment syndrome treatment and recovery. The standard treatment for compartment syndrome is fasciotomy with delayed primary wound closure, but the patient elected to heal by secondary intention. The patient’s long term follow-up results showed positive outcomes.

Check out the link below to view the full article!

https://msrj.chm.msu.edu/wp-content/uploads/2022/11/226-ePub-final.pdf

Background: In addition to the purposeful teaching of knowledge and skills to medical students, the “hidden curriculum” refers to the inadvertent – and often unrecognized – transmission of implicit ideas, attitudes, and behaviors. One way to raise student and teacher understanding of the hidden curriculum (HC) is to provide them concrete examples of how and when it occurs during medical school. The goal of this study was to investigate how the HC is depicted popular medical television (TV) shows.

Methods: A systematic content analysis of successive episodes of eight prime-time TV shows was completed using a standardized classification scheme. A complete season of each TV program was analyzed to identify and classify depictions of the HC as it pertains to medical students. Our classification scheme used four dominant themes: what students discovered about medicine, what students learned about becoming a physician, what students experienced, and what students realized about themselves. After coding, all incidents were classified as “negative” if a rule or normal procedure was broken, or “positive” if they followed established professional values or provided patient-centered care.

Results: A total of 137 episodes were viewed with 1160 depictions of the HC portrayed. The TV shows with the most depictions were Code Black and Scrubs. Within the four dominant themes, 45 subthemes were identified. Most depictions (66.7%) were described as positive and included conflict resolution, sensitivity, respect, empathy, accountability and role-modeling. However, 33.3% (386/1160) were negative and included unrealistic patient expectations, working in a chaotic environment, haphazard learning interactions, emotional detachment, loss of idealism, complex social situations, and dealing with uncertainty.

Conclusions: Television dramas contain many positive and negative examples of the hidden curriculum during undergraduate medical training. Short snippets from these incidents could be used in an educational setting to teach related issues including professionalism, ethics, role modeling, communication skills, and coping techniques.

Author: Haleigh Prather, MHS, Oregon Health & Science University

Here’s a reflection from our Fall 2021 journal that most of us could relate to:
https://msrj.chm.msu.edu/wp-content/uploads/2022/10/227-ePub.pdf

Abstract: This piece is a conversation and reflection of my ongoing relationship with toxic professionalism in medical school. Students are often at the whim of their evaluators to give them outstanding feedback in the name of having a strong residency application, but a great deal of the criteria we are evaluated on is subjective. One piece of feedback I’ve gotten more than once that I take issue with is the idea that being extroverted, enthusiastic, and cheery in medicine is seen as “unprofessional” and that I need to change myself. I am pushing back on this idea and advocating for medical students to feel more comfortable being themselves during patient encounters and asking those in evaluative positions of power to consider how feedback such as this contributing to phenomena like physician burn out.

Key Phrases: Medical School, Medical Professionalism, Student Burnout