IU Indianapolis ScholarWorks :: Browsing by Author "Mitchell, Sally"

Browsing by Author "Mitchell, Sally"

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Breast Pumping in the Healthcare Workplace
(2023-11-04) Yu, Corinna; Boyer, Tanna; Mitchell, Sally
Background: Reasons women do not breastfeed, or shorten their breastfeeding journey, include the lack of paid leave and the challenges of breast pumping in the healthcare workplace. Despite the health benefits of breastfeeding for mother and baby, health care workers returning to work often struggle to breast pump due to lack of access to lactation facilities and lack of time and support. The aim of this needs assessment was to determine the extent of these challenges. Methods: A survey was created and distributed through social media forums from 2020-2023 to determine the extent of these issues. IRB exemption was obtained (Protocol #2010273689). Responses were obtained from 222 health care workers across the United States. Data were analyzed and comments were sorted thematically. Results: Survey respondents were from the Midwest 30% (66), Southeast 25% (55), Northeast 18% (40), West 16% (35), and Southwest 10% (22) with 222 total responses. Physicians (n = 191) made up 86% of the responses across 11 specialties, with 15 of them being residents or fellows. There were 50% of respondents who did not have nearby access to a lactation room although 96% used a breast pump while at work. Pumping occurred every 2-3 hours for 48% and every 4-6 hours for 48% of respondents. Pumping duration was 11-20 minutes for 53% and 21-30 minutes for 32% of respondents, with transit time and other logistics taking an additional 1-5 minutes for 33%, 6-10 minutes for 47%, and 11-15 minutes for 12% of respondents. On a scale of 1-5, where 1 was “Pumping at work did not affect the duration of breastfeeding at all” and 5 was “I had to stop breastfeeding because I was not able to pump enough at work,” responses were 1 (19%), 2 (23%), 3 (20%), 4 (19%), 5 (19%). Respondents (n = 106; 48%) have used a wearable breast pump. On a scale from 1 to 10, where 1 is “No, I CAN NOT do my job equally well when wearing a breast pump” and 10 is “Yes, I CAN do my job equally well when wearing a breast pump,” 49% of those respondents chose 10. In the free text comments, multiple respondents discussed pumping while providing clinical care using wearable pumps. One person pumped while performing a vaginal delivery, another during an intraoperative code, and another while placing lines for a patient with a Type A aortic dissection. Discussion: Lack of access to lactation facilities, long transit times, frequent pumping, and long pumping sessions can be time prohibitive challenges for many health care workers. Lack of support from colleagues, administrators, and patients can influence breastfeeding duration. Wearable breast pumps have mixed reviews but have allowed many women to pump while doing normal work activities. Although only 107 respondents (48%) have used wearable breast pumps, 148 respondents (67%) answered “Does a wearable breast pump affect your ability to perform your job effectively?” suggesting opinions instead of personal experience. “Nearby access” of lactation facilities was not defined. The scope of work may differ from health care providers who do telemedicine, see patients in clinic, or perform codes in the operating room. Improvements on this survey include specifying the states for each US region and clarifying the year when respondents were breast pumping, as culture has evolved with a greater emphasis on wellness and increased numbers of women physicians. Expanding data on trainees would identify issues related to autonomy and educational practices. Conclusion: Accessible lactation rooms are lacking in the healthcare workplace. On average, respondents pumped every 2-6 hours with the majority taking 11-30 mins with 1-15 mins for logistics. Wearable breast pumps may be a viable option for some women to continue work activities while pumping. Workplace bias against breast pumping is still prevalent and more work needs to be done to support breast pumping women.
Career Mentors & 5-Year Data on the IUSM Anesthesiology Match
(2022-04-28) Yu, Corinna; Ye, Jian; Boyer, Tanna; Mitchell, Sally
Introduction: The IU Department of Anesthesia provides Anesthesiology Career Mentors to 3rd and 4th year medical students. We have approximately 47 requests per class year. In the past 5 years, we have matched 181 students into Anesthesiology, averaging 36 students per year (range 30-46). Where do these students match into Anesthesiology? How many of them use the Career Mentorship program? If they don’t choose Anesthesiology, which other specialties appeal to them? Objective: The purpose of this presentation is to examine the pipeline of students interested in anesthesiology who request a career mentor and match into anesthesiology. Methods: Match data from publicly obtained IUSM Graduation Booklets for the Class of 2017 through 2021 was filtered for those students matching into Anesthesiology Residency Programs. These programs were mapped and cross-referenced for medical school rankings based on the 2022 US News & World Report Medical School Rankings for Research. Anesthesiology career mentorship requests were tracked starting in 2019 for the class of 2020 onwards, so students who matched into Anesthesiology were cross-referenced with students who had formally requested Anesthesiology Career Mentors in 2020 and 2021. Students who had formally requested Anesthesiology Career Mentors in 2020 and 2021 were also cross-referenced with the IUSM Graduation Booklet data to see how many of these students matched into Anesthesiology or other fields. Results: Of the 181 students that have matched into Anesthesiology from 2017-2021, 63 students matched at IU (35%). The rest are distributed across the regions of the US, including residency programs at the top 25 medical schools including Harvard, NYU, Duke, Stanford, and UCSF. The majority of students matching into Anesthesiology request Anesthesiology Career Mentors, with 73% (48/66) of students assigned to mentors in the graduating class of 2020 and 2021. 96 mentors were requested in the class of 2020 and 2021, with 29 students (30%) not matching into Anesthesiology. These students may have changed careers and not applied to Anesthesiology. Many of these students choose to pursue other specialties, including Internal Medicine, Radiology, Pediatrics, Family Medicine, General Surgery, Obstetrics-Gynecology, Orthopedic Surgery, and Psychiatry. Some students were not listed in the IUSM Graduation Booklet or did not have a residency listed. Conclusion: Limitations of this analysis include students’ choice to publish their Match data in the IUSM Graduation Booklet and the possibility of some students being lost to follow up due to not graduating yet or changing their name. No direct link can be made between formally assigned Anesthesiology Career Mentors and the Match, especially since some students may have sought out informal mentorship. Anesthesiology continues to be a competitive field with high student interest. More research can be done to understand factors that influence student decisions for specialty and to track student alumni and follow their career progression into fellowship and the physician workforce. Additional data collection on the usefulness of the career mentorship program and ways to improve and further support student career choice and Match success will be especially helpful as Step 1 changes to pass/fail.
Evaluating the Medical Leadership Reading Elective
(2023-04-28) Weller, Robert; Mitchell, Sally; Tsai, Mitchell; Yu, Corinna
Education in leadership is an essential skill in the development of an effective physician.1 The Medical Leadership Reading Elective at Indiana University School of Medicine was created in partnership with Dr. Mitchell Tsai at University of Vermont2 to provide medical students with a mental framework on leadership and management, discuss physician burnout and resilience, and to create a vision statement as future physician leaders. The curriculum included 3 trade books and 4-8 articles weekly with a weekly 2-3 page essay assignment answering, “What does leadership mean?” and ”How will you create effective/Agile medical teams?” Although research has been done on medical student reading rate capabilities for medical textbooks,3 it is unknown how quickly medical students can read trade books and business articles. The goal of this project was to assess whether the elective reading and writing assignments were reasonable and evaluate the effectiveness of the curriculum in developing a greater understanding of medical leadership and providing tools to be an effective physician leader.
Examining Visiting Student Evaluation Forms
(2023-04-28) Rigueiro, Gabriel; Dammann, Erin; Guillaud, Daniel; Packiasabapathy, Senthil; Mitchell, Sally; Yu, Corinna
Background: Each medical school has clinical evaluation forms with competencies that align with their institutional and course learning objectives. The differences between evaluation forms and the items being assessed presents a challenge for elective course directors to evaluate and complete forms for visiting students. The aim of this project was to compare common characteristics of visiting student evaluation forms presented to an elective course director on Anesthesiology & Perioperative Medicine (APM) in 2022-2023. Materials & Methods: Each medical school has clinical evaluation forms with competencies that align with their institutional and course learning objectives. The differences between evaluation forms and the items being assessed presents a challenge for elective course directors to evaluate and complete forms for visiting students. The aim of this project was to compare common characteristics of visiting student evaluation forms presented to an elective course director on Anesthesiology & Perioperative Medicine (APM) in 2022-2023. Results: Schools (n=33) included ACGME competencies for communication (94%, 31), professionalism (91%, 30), medical knowledge (79%, 26), practice-based improvement (79%, 26), patient care (76%, 25), and systems-based practice (61%, 20) in their evaluation forms. Clinical reasoning skills included history & physical (82%, 27), assessment & plan (79%, 26), differential diagnosis (64%, 21), and charting/note-taking (61%, 20). Additional categories included inter-professionalism (85%, 28), osteopathic principles and practices (64%, 21), self- awareness/receptiveness to feedback (48%, 16), and procedural skills (42%, 14). Formative and summative comments were requested from 94% (31) of schools. Discussion: While many competencies for visiting medical student evaluation forms align with IU School of Medicine evaluations, some subcategories of ACGME core competencies like charting/note-taking are not assessed in the APM elective. Visiting students do not obtain electronic medical record access due to time-prohibitive training requirements, and thus, do not chart during their rotation. Mock paper records for the preanesthetic evaluation history and physical, intraoperative anesthesia record, and postoperative notes and orders could be created as additional assignments to assess students in this skill. Formative/summative comments may or may not comment on the delivery of patient care. Comments frequently discuss teamwork, work ethic, and medical knowledge which are easily evaluated. The time-pressured environment of the OR can limit student opportunity to perform the preoperative anesthetic evaluation. A differential diagnosis during a preoperative history and physical is challenging on the APM elective because patients present to surgery after diagnostic workup. However, differential diagnoses for perioperative symptoms like tachycardia and hypertension could be assessed through Canvas case log discussions. Students currently share an abbreviated written patient presentation with a learning point. They could include perioperative differential diagnoses and treatment plans and share an article from the literature to demonstrate evidence-based learning with more specific questions about systems-based practice. The perioperative environment provides an excellent opportunity to evaluate students in their interprofessional and communication skills working with surgeons, nurses, technicians, assistants, and other learners. Additional questions could be included in the APM evaluation to capture these relationships more fully. Conclusion: Analyzing visiting student evaluations for competencies and skills provides insight into areas for improvement in the APM elective curriculum and clinical evaluation form.
Medical Student Concerns for Respiratory Protection on Anesthesiology Elective
(2022-04-28) Yu, Corinna; Webb, Timothy; Guillaud, Daniel; Mitchell, Sally
Introduction: Anesthesiologists perform aerosolizing procedures including endotracheal intubation, necessitating the use of personal protective equipment (PPE) such as N95 masks during the Coronavirus Pandemic. Medical students rotating on anesthesiology electives are similarly exposed to potential viral transmission during these procedures. Objective: This study compares student responses to concerns about their respiratory protection in 2020 vs. 2021. Methods: Medical students rotating on the Adult Anesthesia Elective (2020) and the Anesthesiology & Perioperative Medicine Elective (2021) were assigned to read, “Respiratory Protection for Healthcare Workers” and answer “Do you have any concerns about your respiratory protection?” 61 students completed the assignment in 2020, and 74 students in 2021. These responses were analyzed and coded for themes. 10 themes emerged for students who were concerned with their respiratory protection, and 4 themes emerged for students who were not concerned. Basic percentages were calculated and the number of students expressing various themes in their responses was summed and compared between 2020 vs. 2021. Results: In 2020, 35% of students were concerned about their respiratory protection, decreasing to 28% in 2021. Reasons for students not being concerned include the availability of PPE, vaccination status, testing patients for COVID pre-operatively, and the option to avoid the risk. Reasons for concern included the aerosol-generating nature of intubation, N95 masks should be single use, patients not being tested for COVID properly and failed fit tests and mask seals (only in 2020), availability of PPE, fear of being a vector, and not doffing properly. Long-term COVID complications and ability to socially distance at work were also concerns in 2020. Conclusion: Student concern with respiratory protection decreased from 35% to 28% from 2020 to 2021. One of the primary differences is that students were vaccinated in 2021. Students not concerned displayed confidence in PPE availability and patients testing negative for COVID-19 prior to OR procedures. In addition, some students commented on their ability to avoid risk by not caring for COVID-positive patients, although one student commented this hindered their education. Student concerns included viral transmission during aerosolizing procedures and the observation of N95 mask reuse, which is not advised. Some students were not able to get a fit test due to PPE shortages or had failed their fit test in 2020. Facial hair and having a beard was a concern in both 2020 and 2021 for proper mask fit. Other students feared being an asymptomatic carrier and acting as a vector to their patients and loved ones. Similarly, they worried that the testing window for patients was too wide. Students in both 2020 and 2021 expressed concern about self-contamination from not doffing their PPE properly. A few students commented on the unknown long-term effects of COVID-19 and the inability to socially distance at work. Generally, students were not concerned with PPE availability and their personal safety in the clinical environment on their anesthesiology elective. As the pandemic continues to evolve, time will tell if we can continue to maintain PPE supplies, effective vaccines, and work to decrease student concerns.
Stunned Myocardium as a Sequela of Acute Severe Anemia: An Adult Simulation Case for Anesthesiology Residents
(Association of American Medical Colleges, 2024-09-06) Okano, David Ryusuke; Ko, Bryan; Giuliano, Marelle; Mitchell, Sally; Cartwright, Johnny; Moore, Christopher; Boyer, Tanna; Anesthesia, School of Medicine
Introduction: Anesthesiologists develop anesthetic plans according to the surgical procedure, patient's medical history, and physical exams. Patients with ischemic heart disease are predisposed to intraoperative cardiac complications from surgical blood loss. Unanticipated events can lead to intraoperative complications despite careful anesthesia planning. Methods: This anesthetic management simulation was developed for the anesthesiology residency curriculum during the first clinical anesthesia year (CA 1/PGY 2 residents). A total of 23 CA 1 residents participated. A 50-minute encounter focused on a 73-year-old male who presents for an elective total hip replacement and develops acute myocardial stunning in the setting of critical acute blood loss and a delay in the transportation of blood products. Results: One hundred percent of the residents felt the simulation was educationally valuable in the immediate postsimulation survey (Kirkpatrick level 1). The follow-up survey showed that 100% of residents felt the simulation increased their knowledge of managing acute cardiac ischemia (Kirkpatrick level 2), and 93% felt it increased awareness and confidence in similar real-life situations that positively affected patient outcomes (Kirkpatrick level 3). Discussion: Our simulation provides a psychologically safe environment for anesthesiology residents to develop management skills for acute critical anemia and cardiogenic shock and foster communication skills with a surgery team.
Why Not Medicine? Perceived Barriers to Pursuing Medical Degrees in Junior College Students
(2023-04-28) Blais, Austin; Yu, Corinna; Mitchell, Sally
Many academic institutions like Indiana University School of Medicine have created specific programs to increase diversity in admissions of underrepresented minorities. This is often achieved with a master's program designed to increase applicant "competitiveness". The issue that arises is that many of these programs are directed toward students at 4-year colleges or post-baccalaureate programs which excludes students pursuing education at 2-year community colleges without these programs. This is a missed opportunity to increase diversity as 2-year colleges often have higher proportions of underrepresented minorities (22% African American representation at this level of institution compared to 11.3% at 4 year or higher universities).4 A large share also come from low-income families (36.7% of students whose families make less than $20k/year attend 2-year institutions compared with 17.7% of students whose families make more than $100K/year).5,6 Sequela of this lack of resources for these students manifests as lower rates of application to medical school (only 28% of applicants in 2013 had a history of 2-year college attendance).2,3,5 This highlights the need for quality research on this particular subset of health science students not only from a system and access-based approach but also from a motivational standpoint. Junior colleges have some of the most diverse cohorts of students with profound interest in health science yet who often chose pathways other than medical school. So, why not medicine?

Browsing by Author "Mitchell, Sally"

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