Southern Medical Journal最新文献

{"title":"Impact of School-Enforced Step 1 Deadlines on Medical Student Well-Being and Failure Rates: Two Medical Students' Perspective.","authors":"Joseph A Lanese, Forrest Bohler","doi":"10.14423/SMJ.0000000000001805","DOIUrl":"10.14423/SMJ.0000000000001805","url":null,"abstract":"<p><p>The US Medical Licensing Examination Step 1 is a milestone assessment that evaluates a medical student's mastery of foundational medical sciences. Traditionally taken at the end of the preclinical curriculum, it now serves as a pass/fail examination before students begin clinical rotations. This transition, coupled with the enforcement of strict deadlines by various medical schools, has introduced significant challenges for students, including increased stress, potential academic delays, and financial hardship. This perspective explores the implications of these enforced deadlines to complete the US Medical Licensing Examination and how they may exacerbate the physician shortage, and it provides solutions that promote student well-being and maximize Step 1 pass rates.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 4","pages":"240-241"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When Suicidality Is Suspected.","authors":"Raymond Pary, Steven Lippmann","doi":"10.14423/SMJ.0000000000001810","DOIUrl":"10.14423/SMJ.0000000000001810","url":null,"abstract":"<p><p>Physicians have the potential to detect a person in danger of suicide. A history of self-injury, abuse of illegal substances or alcohol, mood disorders, and schizophrenia may contribute to the risk of suicide. There are four recognized screening tools that can assist in identifying individuals at risk to commit suicide. A safety plan provides coping strategies that may alleviate suicidal behavior or a suicidal crisis. A written, mutually agreed upon safety plan can be helpful for those suspected of being in danger of suicide. Family members or friends should assist the patient with safety plans as well as closely observe the patient and ensure timely professional attention. Emergency medical services may be necessary, and firearms must either be removed from the home or locked to prevent access. The medications that have had a preventive effect against suicide include antidepressant drugs, lithium, clozapine, ketamine, and esketamine. Lithium has historical evidence in combating suicide.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 4","pages":"242-245"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation and Assessment of a Resident-Preceptor Curriculum for Internal Medicine Residents in Outpatient Continuity Clinics.","authors":"Dylan D Fortman, Rongrong Wang, Scott Rothenberger, Matthew Metzinger, Tanya Nikiforova, Deborah DiNardo","doi":"10.14423/SMJ.0000000000001811","DOIUrl":"10.14423/SMJ.0000000000001811","url":null,"abstract":"<p><strong>Objective: </strong>Opportunities for senior residents to precept junior trainees in continuity clinics have previously been explored. Faculty or junior resident perceptions of the resident-preceptor model remain understudied, however. We describe a resident-preceptor curriculum implemented with third-year Internal Medicine residents at a single institution with a multipronged evaluation. The objective was to assess the feasibility of and perceptions about a resident-preceptor curriculum for third-year Internal Medicine residents.</p><p><strong>Methods: </strong>Postgraduate year 3 (PGY-3) residents on ambulatory rotations between January and May 2023 attended a 1-hour educational workshop and then participated in up to four half-day resident-preceptor sessions. Pre- and postcurriculum surveys using Likert scales assessed the perceptions of ambulatory training among PGY-3 residents. Faculty members and junior residents completed postcurriculum surveys to assess feasibility and impact on the clinic learning environment. Survey responses were summarized using means, standard deviations, and one-sided Wilcoxon signed rank tests.</p><p><strong>Results: </strong>Fourteen PGY-3 residents participated, and 10/14 (71.4%) completed both pre- and postcurriculum surveys. PGY-3s precepted a median of two half-day sessions and five patients per session. No additional faculty, space, or clinic resources were necessary. Postcurriculum, PGY-3s were significantly more likely to view their faculty as using evidence-based practice (<i>P =</i> 0.02). Among faculty and junior residents, 15/23 (65.2%) and 13/44 (29.5%) completed the postcurriculum surveys, respectively. Faculty and junior residents provided positive ratings on the impact of the curriculum across multiple aspects of clinical training.</p><p><strong>Conclusions: </strong>Implementing a resident-preceptor curriculum in outpatient continuity clinics is feasible without additional resources and is perceived as a valuable addition to ambulatory training by faculty, resident preceptors, and junior residents.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 4","pages":"225-228"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neural Tube Defects in South Carolina 1992-2019: A Review of Risk Factors.","authors":"Lucy Pulliam, Stephanie Trammel, Jane H Dean, Natallia Sianko","doi":"10.14423/SMJ.0000000000001812","DOIUrl":"10.14423/SMJ.0000000000001812","url":null,"abstract":"<p><strong>Objectives: </strong>Neural tube defects (NTDs) are one of the most common major birth defects, yet the reasons for occurrence of many NTDs are still not well understood. This study sought to determine the presence of seven specific NTD risk factors in a sample of 515 isolated NTD cases that occurred in South Carolina between 1992 and 2019.</p><p><strong>Methods: </strong>A total of 1351 NTD cases were ascertained in the state between 1992 and 2019 using data from the South Carolina NTD Surveillance and Prevention Program. Medical and pregnancy data were available for 723 of the children, whose mothers chose to enroll in the prevention portion of the program. This study focused on examining the presence of seven NTD risk factors in 515 (71.2%) of these 723 cases in which the NTDs were isolated birth defects and had no identified probable cause, such as a chromosome abnormality.</p><p><strong>Results: </strong>Of the 515 isolated NTD cases examined in this study, 26.3% had mothers with maternal obesity, 24.0% had exposure to maternal hyperthermia, 7.6% had Hispanic race/ethnicity, 4.7% were the product of a twin or multiple pregnancy, 4.1% had mothers with pregestational diabetes mellitus, and 1.4% had maternal exposure to drugs that affect folate metabolism. In addition, 12.2% of the mothers and 12.1% of the infants were homozygous for the <i>MTHFR C677T</i> variant allele. Of the NTD cases under review, 57.0% had one or more of the risk factors and 15.2% had two or more risk factors.</p><p><strong>Conclusions: </strong>These findings on NTD risk factors may provide focus areas for continued efforts to reduce preventable NTDs.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 4","pages":"201-205"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Know Your Guidelines: EULAR Management of Fatigue in Patients with Inflammatory Rheumatic and MSK Diseases Guideline Synopsis and Review.","authors":"Malvika Lall, Iman Abutineh, Christopher D Jackson","doi":"10.14423/SMJ.0000000000001793","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001793","url":null,"abstract":"","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 3","pages":"174-176"},"PeriodicalIF":1.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors and Surgical Outcomes of Older Adult Patients Undergoing a Whipple Procedure.","authors":"Daniel Hakakian, Allison J Bellaire, Jana K Elsawwah, Lawrence E Harrison, Rolando H Rolandelli, Zoltan H Nemeth","doi":"10.14423/SMJ.0000000000001800","DOIUrl":"10.14423/SMJ.0000000000001800","url":null,"abstract":"<p><strong>Objectives: </strong>The Whipple procedure, or pancreatoduodenectomy with pancreatojejunostomy, can result in adverse outcomes among older adult patients with lower physiological reserves. As such, we studied the differences in comorbidities and postoperative outcomes between older adult and younger (nonolder adult) populations following Whipple procedures.</p><p><strong>Methods: </strong>We compared clinical factors of 1553 older adult (70 years and older) and 2171 younger adult patients (18-69 years) who underwent a Whipple procedure using the 2021 American College of Surgeons National Surgical Quality Improvement Program databases.</p><p><strong>Results: </strong>The older adult cohort had higher rates of cancer diagnosis (58.02% vs 50.99%), diabetes mellitus (31.49% vs 26.07%), congestive heart failure (2.38% vs 1.29%), hypertension (67.80% vs 44.13%), and American Society of Anesthesiologists class ≥3 (89.83% vs 80.01%). The older adult cohort also had higher rates of postoperative mortality (1.35% vs 0.69), pneumonia (3.73% vs 2.12%), transfusions (20.15% vs 17.00%), and delayed gastric emptying (16.61% vs 14.19%) than the younger cohort. The older adult cohort had fewer postoperative pancreatic fistulas (11.33% vs 13.73%), however. Multivariate logistic regression revealed that older adult age (odds ratio 3.316) and hypertension (odds ratio 5.813) were significantly associated with increased odds of postoperative myocardial infarction.</p><p><strong>Conclusions: </strong>We found higher rates of mortality and postoperative myocardial infarction among older adults after Whipple procedures. Regardless of this elevated risk, a higher proportion of older adult patients presented with pancreatic cancer and required the procedure.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 3","pages":"184-188"},"PeriodicalIF":1.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ten Tips for Navigating Difficult Patient Encounters.","authors":"Amber Thacker, Anna McQueen, Emily Mai","doi":"10.14423/SMJ.0000000000001794","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001794","url":null,"abstract":"","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 3","pages":"171-173"},"PeriodicalIF":1.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Where Are Future Doctors Who Southern Rural African Americans Will Trust? A Look Back into Rural Medical Scholars Data.","authors":"John R Wheat, Antonio J Gardner, Cynthia E Moore","doi":"10.14423/SMJ.0000000000001803","DOIUrl":"10.14423/SMJ.0000000000001803","url":null,"abstract":"<p><strong>Objectives: </strong>African Americans' distrust of institutions extends to southern US rural communities, limiting their use of healthcare resources. Local physicians are scarce, and treatable diseases accumulate. These communities want local doctors they can trust, consistent with research promoting culturally concordant doctor-patient relationships. African American student inclusion was a priority of the Rural Health Leaders Pipeline, which included precollege pipeline programs and a professional track (Rural Medical Scholars Program) of a master's degree program and medical education. The purpose of the present study was to review African American students' experience in the professional track to inform future efforts to produce rural African American physicians.</p><p><strong>Methods: </strong>We retrospectively tracked African Americans in the Rural Medical Scholars Program from 1996 to 2017. Data from pipeline and professional programs supplied racial identity, recruitment mechanism (from pipeline or general admissions), completion of a master's degree program, medical school matriculation, medical school attended, and medical school progression. We counted students for visual analysis with a table for students' distribution and graph for student progression.</p><p><strong>Results: </strong>In 21 years, 1045 students participated in the Rural Health Leaders Pipeline-380 (36%) were African American, including 195 high school, 169 posthigh school, and 16 professional track students. Ten (63%) of these African American Rural Medical Scholars had been earlier pipeline students compared with 15% of non-African American peers. All 16 African American Rural Medical Scholars completed the master's program, 12 entered medical school, and 10 progressed successfully, producing one rural African American physician every 2 years. These numbers were too small for statistical analysis.</p><p><strong>Conclusions: </strong>Enthusiasm among preprofessional students and academic success through the master's degree program but so few accessing medical education was the major finding, matching Association of American Medical Colleges' data showing fewer than 0.01% of US medical students are rural African Americans. Interventions beyond recruitment are needed to involve African American students in rural medicine programs to produce culturally concordant physicians whom their communities can trust.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 3","pages":"155-160"},"PeriodicalIF":1.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11913229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Prophylactic Policy-Driven Tranexamic Acid Administration during Cesarean Delivery in a Rural Healthcare Setting.","authors":"Manuel C Vallejo, Anna L Zukowski, Jamie M Long, Christa L Lilly, Linda S Nield, Mark I Zakowski","doi":"10.14423/SMJ.0000000000001796","DOIUrl":"10.14423/SMJ.0000000000001796","url":null,"abstract":"<p><strong>Objectives: </strong>Postpartum hemorrhage (PPH) is a major contributor to maternal mortality worldwide and is a leading cause of pregnancy-related mortality in the United States. The American College of Obstetricians and Gynecologists, the Royal College of Obstetricians and Gynecologists, and the World Health Organization advocate for the early use of tranexamic acid (TXA) in the prevention of PPH. The purpose of this study was to determine the efficacy and patient characteristics of the use of prophylactic TXA administration during cesarean delivery (CD) as part of a newly instituted policy to reduce blood loss and PPH rates in a tertiary care regional rural and underserved maternal care center.</p><p><strong>Methods: </strong>An electronic quality assurance chart review from February 2020 through October 2021 of more than 2705 patients was conducted, comparing two groups after implementation of a TXA protocol for all CDs. In total, four CD groups were analyzed (control group without TXA before policy, PPH group without TXA before policy, TXA control group after policy, and PPH group with TXA after policy).</p><p><strong>Results: </strong>PPH rates decreased with TXA use (9.7% vs 1.5%). TXA use was more likely to be given to patients with one or more of the following characteristics: commercial insurance, self-identified Asian race, admission from a doctor's office, urgent CD delivery, fetal distress, abruptio placenta/placenta previa, and extended hospital length of stay with increased hospitalization cost. Subset analysis of 720 patients revealed decreased blood loss (896.4 ± 521.0 mL vs 771.1 ± 405.6 mL, <i>P</i> = 0.0004) and fewer blood transfusions with TXA use (6.7% vs 1.1%, <i>P</i> = 0.0001).</p><p><strong>Conclusions: </strong>Prophylactic policy-driven TXA administration during CD protocol-driven TXA administration decreases PPH.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 3","pages":"196-200"},"PeriodicalIF":1.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Affecting Gastroenterologists' Fear When Performing Endoscopies during the COVID Pandemic: Results of a US National Survey.","authors":"Reem Q Al Shabeeb, Esther Lee, Muhammad El Shatanofy, Erika Pashai, Ivy Benjenk, Marian Sherman, Eric Heinz, David Yamane, Marie L Borum","doi":"10.14423/SMJ.0000000000001795","DOIUrl":"10.14423/SMJ.0000000000001795","url":null,"abstract":"<p><strong>Objectives: </strong>The coronavirus disease 2019 (COVID-19) pandemic affected the practice of gastroenterology. Endoscopic procedures are aerosolizing procedures that carry the risk of COVID-19 transmission. Our national survey examined factors affecting gastroenterologists' fear of contracting COVID-19 during endoscopy.</p><p><strong>Methods: </strong>An institutional review board-approved multicenter cross-sectional study used a snowball sample approach to disseminate a 42-question survey to gastroenterologists during a 3-month period in 2021, during the height of the pandemic. Physician demographics, information about personal protective equipment (PPE), negative pressure rooms, and COVID-19 vaccination status was collected. Likert scales were used to evaluate gastroenterologists' fear when performing endoscopy. Analysis was performed using Pearson's χ², Mann-Whitney <i>U</i>, and Wilcoxon rank tests, with significance set at <i>P</i> < 0.05.</p><p><strong>Results: </strong>Results from 69 respondents showed that 91.3% believed that PPE was adequate, 52.2% had PPE education and training, and 47.8% reported that PPE education decreased their fear of contracting COVID-19 during endoscopy. Fear decreased from first to subsequent endoscopies (<i>P</i> < 0.0005) and after COVID-19 vaccination (<i>P</i> < 0.0005). Higher levels of fear were associated with having comorbid conditions (<i>P</i> = 0.048), being the primary caregiver for or living with a person 65 years old or older (<i>P</i> = 0.041), having had to quarantine during the pandemic (<i>P</i> = 0.017), having not performed a procedure because of infectious risks (<i>P</i> = 0.005), and living with someone with comorbid conditions (<i>P</i> = 0.001).</p><p><strong>Conclusions: </strong>Multiple factors affect gastroenterologists' fear of contracting COVID-19 during endoscopic procedures. Lessons learned during the COVID-19 pandemic about mitigating gastroenterologists' fear are potentially applicable to future circumstances that may be associated with significant infectious concerns.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"118 3","pages":"181-183"},"PeriodicalIF":1.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}