2023最新文献

{"title":"Factors Influencing Underrepresented Minority Applicants’ Ranking of General Surgery Residency Programs","authors":"Rita R. Shehiriana, Caroline E. Richburg, Maya J. Smith, Sonia S. Iyengar, Jessica R. Santos-Parker, Grace F. Chao, G. Kwakye","doi":"10.3998/mjm.4814","DOIUrl":"https://doi.org/10.3998/mjm.4814","url":null,"abstract":"Background: Underrepresented minorities (URM) are disproportionately lacking in academic surgery, yet there is wide variation in URM in residency programs. This mixed methods study aims to describe factors that URM interns identified as important in their rank list of general surgery residency programs. These data will aid institutions in increasing URM representation and creating supportive training environments in academic surgery.\u0000Methods: We employed a mixed methods approach using an online survey and semi-structured interviews developed through focus group engagement and literature review. Interviews were audio recorded, transcribed, and coded for themes. We conducted narrative thematic analysis.\u0000Results: Sixty-four incoming general surgery interns completed the survey with median age 25 to 29. Of respondents, 67% identified as female and 34% as URM. URM general surgery interns were more likely to rate program benefits and finances, revisit opportunities (ie, organized post-interview revisit weekends), and post-graduate job opportunities higher than were non-URM participants (p<0.05). URM participants also ranked factors such as diversity of residents and faculty and diversity and inclusion statements by programs higher than did non-URM participants (p<0.05). Five URM interns completed semi-structured interviews. Qualitative themes influencing URM interns’ rank list decisions included (1) presence of URM in the program, (2) program support of resident-led goals, (3) active inclusivity initiatives, and (4) direct experiences of current URM residents. All interview participants relied heavily on interactions with current URM residents as a source of information. Detractors from programs included interns concerned with being the only person of color at their prospective program and no concrete initiatives or goals in place to support diversity and inclusion, raising concern for performative allyship.\u0000Conclusions: When evaluating residency programs, URM weighed current representation and support of URMs, active diversity and inclusion initiatives within a program, and lived experiences of URM residents. Surgery residency programs should take steps to not only intentionally recruit URM applicants but also create a supportive training environment that is diverse, inclusive, and empowering.","PeriodicalId":516820,"journal":{"name":"2023","volume":"121 17","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140378846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Peristaltic Pump to Improve Bladder Emptying and Irrigation in Patients Who Use Clean Intermittent Catheterization","authors":"Arjun Rajan, Jason W. Lo, Likitha Nimmagadda, Emily R. Bozich, Jason Qu, Julian Wan, B. Sack","doi":"10.3998/mjm.4816","DOIUrl":"https://doi.org/10.3998/mjm.4816","url":null,"abstract":"Background: Neurogenic bladder patients who intermittently catheterize may have systems that drain slowly and incompletely. These limitations can lead to urinary tract infections and bladder stone formation and be time consuming. We hypothesize that a catheter accessory device could improve drainage, reduce residual bladder volume, and save time.\u0000Methods: A yearlong collaboration between an undergraduate biomedical engineering student design team and client mentors from the pediatric urology department led to an evaluation of solutions to enhance emptying of bladders that require intermittent catheterization. Students performed market analysis, identified design requirements, generated design concepts, conducted usability testing, and constructed alpha and beta prototypes verified through benchtop experimentation during the yearlong project. Prototypes were verified using a phantom bladder model built from a compliant stress ball with an attached catheter and placed under an external pressure of 5 cm H 2 O. Tests were conducted to measure the diff erence between passive drainage and device-assisted drainage at various bladder volumes and catheter sizes. Eight student peers compared passive emptying, irrigating, and aspirating a phantom bladder model using the prototype or syringe to assess the usability of the device.\u0000Results: We developed a pump that interfaces with commercially available catheters. The pump housing was designed and 3D printed. Fluid can be moved bi-directionally with a battery-powered peristaltic pump and microcontroller. The pump has a built-in current sensing threshold with an automatic shutoff safety mechanism. Testing results showed that for all bladder volumes and catheter sizes, the pump emptied more completely and drained between 1.6 and 6.3 times faster when compared to passive drainage. Usability feedback showed that the pump required less time to irrigate the bladder and was preferred when compared to the manual syringe technique.\u0000Conclusions: This portable catheter pump improves phantom bladder emptying by increasing flow rate, decreasing residual volume, and making irrigation easier. Future design improvements will work to implement safety mechanisms and miniaturize the pump. This project demonstrates the feasibility of a catheter accessory device to improve patient quality of life and the ability for understudied clinical problems to be addressed through collaborations between capstone engineering design teams and physicians.","PeriodicalId":516820,"journal":{"name":"2023","volume":"122 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140381032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Introducing Mindfulness Practices to the Healer’s Art Course for Medical Students: A Feasibility Study","authors":"Kirin Saint, MD † C. Kenzie Corbin, M. M. ‡. Michael F. Barton, M. M. §. Julie Barrett, MD Heather L. Burrows","doi":"10.3998/mjm.4815","DOIUrl":"https://doi.org/10.3998/mjm.4815","url":null,"abstract":"Introduction: Burnout is common among medical students in the United States and can be debilitating. Mindfulness practices can reduce stress levels and burnout. Integrating mindfulness practices into pre-existing medical courses such as the Healer’s Art can potentially reduce burnout.\u0000Methods: We evaluated the impact of introducing meditation and yoga into the Healer’s Art course at a midwestern medical school. Half of the students were randomized into a meditation class (n=11) and the other half were randomized into a yoga class (n=12). Students were given pre- and post- session surveys to assess measures of mindfulness, burnout, and energy levels, adapted from validated survey instruments. Paired two-sample t tests were used to assess the relationship between each intervention and each pre-specified outcome.\u0000Results: Twenty-three medical students participated in a one-time yoga or meditation session. The yoga intervention resulted in a statistically significant increase in energy and breath awareness outcomes. The meditation intervention resulted in a significant increase in mindfulness. Both yoga and meditation were found to decrease burnout among participants in the immediate aftermath. Ninety-six percent of participants (22 of 23) expressed that mindfulness practices should be incorporated into future the Healer’s Art courses, with a mean recommendation score of 4.5 out of 5.\u0000Conclusion: Yoga and meditation classes might reduce medical student burnout. Randomized control trials are needed to assess longevity and generalizability of findings.","PeriodicalId":516820,"journal":{"name":"2023","volume":"2 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140378791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Missed Opportunity to Engage Students During a Crisis","authors":"S. Irani, Samuel Klein, K. Gondy, M. Waselewski, Tammy Chang","doi":"10.3998/mjm.4813","DOIUrl":"https://doi.org/10.3998/mjm.4813","url":null,"abstract":"","PeriodicalId":516820,"journal":{"name":"2023","volume":"116 44","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140379229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tale of Two Journeys","authors":"K. Strubchevska, Marko Kozyk","doi":"10.3998/mjm.4812","DOIUrl":"https://doi.org/10.3998/mjm.4812","url":null,"abstract":"Given the ongoing war in Ukraine, we hope our personal story will appeal to people. Our article aims to help readers understand the challenges medical professionals face coming to the United States. We escaped the horrors of the war and lost everything we had, except our hope. This year, only 10 Ukrainian physicians were selected as medical residents in US medical training programs, and we are honored to be two of them.","PeriodicalId":516820,"journal":{"name":"2023","volume":"68 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140378290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Student’s Perspective: Medical Education on Caring for Patients of All Abilities","authors":"Maxwell Sievers, Bryan Aaron, Kate Panzer, Rachel Gottlieb","doi":"10.3998/mjm.4817","DOIUrl":"https://doi.org/10.3998/mjm.4817","url":null,"abstract":"","PeriodicalId":516820,"journal":{"name":"2023","volume":"83 22","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140377863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Doula-Supported Births and Outcomes Among DONA International Doulas, 2000-2012","authors":"Nicole E. Trupiano, Kea Turner, Stacey L Klaman","doi":"10.3998/mjm.4819","DOIUrl":"https://doi.org/10.3998/mjm.4819","url":null,"abstract":"Introduction: Doula care has been shown to decrease maternal morbidity and mortality given the physical, emotional, and informational support that doulas provide during pregnancy and birth. Although usage of doulas and coverage of doula services have been increasing, several people are still unaware of the benefits doulas provide. In this study, we sought to describe characteristics related to doulas and doula-supported women on a national scale, including location, method of referral, childbirth settings and providers, and obstetric outcomes.\u0000Methods: We examined doula-supported births by year, state, urban/rural location, maternal age, and characteristics related to doulas, doula-supported birthing women, childbirth settings, providers, and obstetric outcomes. The sample population consisted of doula-assisted births (n=12,675) from 2000 to 2012 based on records from Doulas of North America (DONA) International. We used t tests or Pearson’s chi-squared test (X2) for continuous and categorical variables.\u0000Results: Doulas reported that the vast majority (73.2%) of all doula-supported women birthed by spontaneous vaginal birth and fewer than 1 in 5 (18.2%) women birthed by unplanned cesarean. Nearly 3 out of 4 (73.2%) women had some form of childbirth preparation instruction. Information regarding the source of referrals to doulas suggests that over half (52.9%) of birthing women found a DONA-member doula from a source other than a hospital system or DONA International. About half (49.7%) of birthing women supported by doulas were self-pay clients. Overall, few doulas (1.3%) received third-party reimbursements for their paraprofessional services. The vast majority (95.3%) of doula-supported births in the sample occurred in urban areas of the United States.\u0000Conclusions: This is the largest analysis of doula-supported births from the largest US doula certifying organization, which is critical for understanding how widespread access to doula services has the potential to significantly improve health outcomes for women and their infants during birth. Additionally, the data suggest there is a need for increased referrals and increased insurance coverage and potentially a heightened need for doula services in rural areas.","PeriodicalId":516820,"journal":{"name":"2023","volume":"28 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140378425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survey of Medical Student Debt Status, Financial Literacy, and Desires for Financial Education","authors":"Anderson Lee, Jamaal K Tarpeh, Emma C Manuel, Kristian M Black, B. McMichael, Jesse Wilson, Niki Matsuko, M. J. Englesbe, Brian Fallon, Gurjit Sandhu","doi":"10.3998/mjm.4818","DOIUrl":"https://doi.org/10.3998/mjm.4818","url":null,"abstract":"Objectives: The purpose of this study was to assess the financial literacy level of medical students, evaluate their perceptions about the importance of financial literacy, and determine the optimal timing and delivery for financial literacy education.\u0000Methods: From April to May 2019, a cross-sectional, anonymous, web-based survey was administered to a convenience sample of first-year (M1) to fourth-year (M4) medical students at the University of Michigan Medical School, with 216 of 680 (32%) students completing the survey. Respondents voluntarily answered 15 multiple choice questions on personal finance and 30 questions on their demographics, current financial situation, and opinions on financial literacy education. Individual financial proficiency was defined as answering 60% of the personal finance questions correctly.\u0000Results: Overall, respondents correctly answered 5.64 (38%) of the personal finance questions, with 41 (19%) students achieving financial proficiency. Lower performance on the financial literacy assessment was significantly associated with gender, age, and debt. Overall, 192 (89%) medical students believed that they should receive financial literacy training in medical school.\u0000Conclusions: Medical students demonstrate low levels of financial literacy and have a strong desire to improve their financial literacy during their medical education. Medical schools are well positioned to harness this interest for financial literacy education and integrate self-directed learning opportunities.","PeriodicalId":516820,"journal":{"name":"2023","volume":"114 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140379421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leo Marker","authors":"Emily Marker","doi":"10.3998/wsfh.5361","DOIUrl":"https://doi.org/10.3998/wsfh.5361","url":null,"abstract":"","PeriodicalId":516820,"journal":{"name":"2023","volume":"28 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140510556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter from the President of the Western Society for French History","authors":"Andrew Ross","doi":"10.3998/wsfh.5363","DOIUrl":"https://doi.org/10.3998/wsfh.5363","url":null,"abstract":"","PeriodicalId":516820,"journal":{"name":"2023","volume":" 47","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139640375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}