2025 IUSM Education Day

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Leveraging Advanced Cardiac POCUS in the Diagnosis of Infective Endocarditis with Negative Conventional Imaging: A Case Report
(2025-04) Sanjuan, Adriano; Andrade, Heather; Bundy, Alyson; Clapham, Philip; Markus, Nathan; Brenner, Daniel; Hariri, Irina; Jackson, Edwin
Introduction. Infective endocarditis (IE) is a life-threatening condition that includes bacteremia and echocardiographic findings. However, many cases yield inconclusive results with transthoracic (TTE) or transesophageal echocardiography (TEE), creating diagnostic challenges. This report highlights the role of advanced cardiac point-of-care ultrasound (POCUS) in addressing these limitations, using daily POCUS exams to address these limitations. Case report. A 68-year-old male with methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia and recurrent fevers underwent multiple conventional TTEs and a TEE, that failed to detect valvular vegetations. Advanced cardiac POCUS, including parasternal long-axis (PLAX), parasternal short-axis (PSAX), right ventricular (RV) inflow/outflow, and apical four-chamber views, was performed daily at the bedside. The PLAX view enabled visualization of new onset of aortic regurgitation, and Color Doppler imaging was applied to assess the severity of the valve disfunction. A vegetation in the aortic valve was identified, later confirmed by a consultative TTE and TEE, leading to a change in management. Discussion. This case highlights the utility of advanced cardiac POCUS in diagnosing IE when conventional imaging is inconclusive. Advanced cardiac POCUS offers immediate, bedside diagnostic insights, making it a valuable tool for critically ill patients. Compared to basic cardiac POCUS, the advanced cardiac POCUS includes the RV inflow/outflow (that can be achieved through tilting or fanning of the probe), and use of color Doppler. A study by Hellmann et al. demonstrated that medical residents could achieve significant proficiency with color Doppler, with minimal formal training, aligning with our experience. Despite limitations such as operator dependency and patient characteristics, the integration of advanced cardiac POCUS into diagnostic workflows has the potential to improve diagnostic accuracy and outcomes. Additionally, the case emphasizes the need for advanced cardiac POCUS education among trainees, expanding their ability to address complex clinical scenarios.
Effects of Functional Movement-Based Myofascial Release Therapy on Shoulder Range of Motion in a Collegiate Pitcher: A Case Report
(2025-04-25) Heumann, Ryan; Waltz, Matt; Garcia-Hosokawa, Marcel; Chlebowski, Arthur
Strong, repetitive forces sustained by the shoulder joint during overhead throwing sports can cause alterations in range of motion (ROM) of the joint itself, which can lead to risk of injury. Currently, there are several established therapies to increase ROM and decrease injury risk. This case report investigates the use of combinational functional myofascial release and chiropractic therapies, and its effect on throwing shoulder ROM and pain in a collegiate baseball player. After twelve sessions of therapy, external rotation increased by 20.64° (16.98%) and internal rotation increased by 18.51° (61.30%). This increase in ROM provides evidence for a less common therapeutic technique and its possible effect on decreasing risk of injury in overhead throwing athletes.
Structured Pediatric Endoscopy Training: Lessons from Curriculum Innovation
(2025-04-25) Hoskins, Brett J.
Background: Traditional pediatric endoscopy training often follows an informal apprentice-based model, leading to variability in skill acquisition—especially for therapeutic procedures. Simulation and competency-based frameworks have gained recognition but remain underutilized in many pediatric programs. A need existed for a formalized curriculum to standardize training and enhance technical proficiency. Objective: To evaluate the impact of a structured, multimodal endoscopy curriculum on fellows’ perceptions of training adequacy and procedural comfort. Methods: A structured endoscopy curriculum was implemented for six pediatric gastroenterology fellows over one academic year. The intervention included: - A restructured first-year introductory endoscopy month with didactics, simulation using the Thompson Endoscopic Skills Trainer®, consistent faculty educators, and an “endoscopy passport” to track progress. - A second-year curriculum focused on advanced therapeutic techniques, including stricture dilation, polypectomy, endoscopic mucosal resection, deep enteroscopy, exposure to ERCP and third space endoscopy, and others. - Quarterly simulation sessions for all fellows. - On-demand educational endoscopy video tutorials and peer-reviewed journal opportunities. Pre- and post-intervention surveys assessed fellows’ perceived training adequacy and procedural comfort using a five-point Likert scale. Results: The curriculum significantly improved fellows’ perceptions of formal endoscopy training adequacy(mean score: 2.2 pre- vs. 4.2 post-intervention; p = 0.003). Perceptions of informal training remained unchanged (3.3 vs. 3.7; p > 0.05). Comfort with therapeutic endoscopy improved, though skill-specific gains did not reach statistical significance. Conclusions: A structured endoscopy curriculum enhances fellows’ confidence and perceived adequacy of training, particularly in formal endoscopy training. Simulation-based learning, a clear tracking system, and faculty standardization may contribute meaningfully to skill development. Future work should include objective competency assessments, larger cohorts, and integration of emerging technologies like virtual reality to further improve pediatric endoscopy training.
Acute compartment syndrome: A case report for pre-clinical students’ learning & associated small group worksheet
(2025-04-25) Callahan, Kyle; Mast, Aaron
Introduction: Acute compartment syndrome is a limb-threatening, orthopedic surgical emergency that is often a result of trauma with associated edema and increased pressure that has limited room for expansion due to the compartments of a limb. During pre-clinical years of medical school, the emphasis on musculoskeletal (MSK) ailments, including acute compartment syndrome, can be limited. It is therefore important to provide case reports that highlight even routine cases of traumatic MSK problems to the learning mind, as repetition is the key to learning. Small group worksheets were utilized during pre-clinical learning sessions, which further play a role in the learning process by forcing students to brainstorm solutions before answers are revealed, and can thus also be utilized to better understand MSK disease. Case Description: A male patient in their teens presented to the emergency department following an open fracture of his tibia and fibula after getting his leg stuck between a lawn mower and tree. On the day of injury, surgery was done for intramedullary fixation and distal tibia nailing. Post-op day one, early in the morning, the patient began complaining of mild pain and paresthesia of his toes and plantar foot, however had preserved motor function and brisk capillary refill. Compartments of the lower leg were swollen but not tense. A few hours later, the patient had increased pain with passive stretch, paresthesia up to his knee, and tense anterior compartment. The decision was made to do an emergent fasciotomy. The surgery was uncomplicated, but the post-op course was complicated by incision site infection. The patient has been progressing well and undergoing physical therapy with no gross motor or sensory deficits. Discussion: Acute compartment syndrome can be a rapidly progressing injury, and it is therefore vital to keep it high on the differential in patients complaining of pain with passive stretch and paresthesia. Serial physical exams with this patient ensured the fasciotomy was not delayed. While this report is a classic example of acute compartment syndrome, it can aid in the education of preclinical students. Next steps include incorporating this case and worksheet into MSK curriculum to determine if it leads to improved scores on standardized MSK exams.
Regional Disparities in the Social Determinants of Stroke Severity
(2025-04-25) Barnard, Jacobus; Lin, David; Armstrong, Grace; Calumpang, Neon; Cash, Miranda; Han, Amy
Social determinants of health (SDOH) are known factors of stroke risk and outcomes. We aim to gain a comprehensive understanding of the impact of stroke risk-specific SDOH on stroke severity by investigating the patient population served by a regional healthcare system. We conducted a retrospective bivariate analysis of data from patients’ American Heart Association Get With The Guidelines–Stroke (AHA GWTG-S) Case Record Forms collected at three stroke centers between January 2022 and May 2024. We compared the patient ordinal modified Rankin Scale (mRS) and the National Institutes of Health Stroke Scale (NIHSS) scores to the predictor variables of age, sex, race, Hispanic ethnicity, ZIP code, payment sources, and mode of arrival. When age-adjusted, Black or African American patients had higher mean NIHSS scores and higher rates of Minor Stroke Symptoms than White patients (p<0.01, p<0.01). ZIP Codes with higher mean NIHSS stroke scale scores correlated significantly with ZIP Codes defined by lower median household income (r=-0.61, p<0.01), lower education attainment (r=-0.71, p<0.001), and higher percentages of minority group populations (r=0.50, p<0.02). Patients with higher mean scores across all measures were those associated with using Medicare versus private insurance (p<0.0001) and those arriving at the hospital via EMS versus private transport (p<0.01). This research addresses the significance of surveying region-specific social determinants of health for insight into targeted interventions. Initiatives such as expanding stroke awareness education and increasing preventative screenings in the community may reduce disparities in stroke severity and improve outcomes in underserved areas.
Gender Bias in Artificial Intelligence-Written Letters of Reference for Otolaryngology Residency Candidates
(2025-04-25) Young, Grace; Abouyared, Marianne; Kejner, Alexandra; Patel, Rusha; Edwards, Heather; Yin, Linda; Farlow, Janice
Introduction/Background: Written letters of reference (LORs) are an important component of the residency application process, and human-written LORs have been shown to contain gender-bias. Given that AI tools such as ChatGPT are increasingly utilized to draft LORs, it is important to understand how bias may be perpetuated in these tools. Study objective/Hypothesis: In a previous study, we identified gender bias in AI-written LORs when using prompts with randomly-generated resume variables. We sought to investigate whether this bias persisted using real applicant experiences, and how this compared to the LORs written by otolaryngology faculty. Methods: We obtained 46 LORs for otolaryngology residency applicants written by faculty from 5 different institutions who regularly compose LORs. Prompts describing the candidate’s experiences using the exact phrasing as the letter writers were provided to ChatGPT4.0 in individual sessions. The writer-generated and AI-generated letters were compared using a gender-bias calculator (https://slowe.github.io/genderbias/) which reports the ratio of male-associated ‘ability’ words to female-associated ‘grindstone’ words. Results: Both the writer-generated and AI-generated letters exhibited male bias on average (18.7% and 37.2% respectively). We used a paired t-test to determine that the AI-generated letters exhibited significantly higher male bias (t-statistic: -4.27, p-value: 0.0001). Independent t-tests did not reveal a significant difference for male versus female applicants for either writer-generated (t-statistic: 1.54, p-value 0.131) or AI-generated letters (t-statistic: 0.14, p-value: 0.892). However, Levene’s test comparing variation in scores indicated AI had significantly lower variability than for writers (Levene’s statistic: 11.38, p-value: 0.0011), and notably, every single AI-generated letter was male biased. 54.3% of the LORs were written for male candidates. Conclusions: While the use of AI for letter drafting resulted in overall male-bias, there was not a significant difference between letters using male versus female names, and the results did not vary as much as human-written letters. This suggests that AI-drafts could help reduce gender discrepancies. Further research is necessary to explore the broader implications of AI-assisted letter writing in residency selection, particularly in non-technical contexts.
Patient Care Ownership in Radiology Residency: Insights from Structured Interviews of Residents and Faculty
(2025-04-25) Fromke, Molli; Ahmadi, Tina; Gunderman, Peter
Introduction/Background: In radiology residency and education globally, fostering a sense of ownership can be an undervalued metric of program success. Ownership drives individual achievement, enhances organizational outcomes, and contributes to improved patient care in medicine. Objective: To explore radiology residents' perceptions of ownership at the start of their postgraduate training, alongside faculty members’ perspectives, identify barriers and facilitators, and use these insights to develop targeted professional development activities. Methods: First-year radiology residents and faculty from the same department participated in 45-minute, semi-structured interviews focusing on participants' views of roles, ownership, and conflict responses. Five residents and five faculty were interviewed. Interviews were transcribed and coded using software. Analysis included three phases: open coding for initial perspectives, axial coding to condense codes into themes, and selective coding to identify theme frequency. Results: Residents' main conception of ownership was taking responsibility. Key factors promoting ownership included: 1) intrinsic motivation, 2) responsibility for patient outcomes, 3) integrity, and 4) patient relationships. Barriers included: 1) others assuming responsibility, 2) report criticism, 3) lack of program support, and 4) lack of confidence. Faculty viewed residents as primarily trainees, with a secondary role in supporting the service, while their own primary responsibility was managing the list and patient care. Faculty noted that residents develop ownership most significantly when challenged and uncomfortable, with a supportive environment enhancing this process. Faculty emphasized the importance of culture and attitudes in fostering the willingness to grow through discomfort. Conclusions: Residents shared similar definitions of ownership but varied in its role during training. External environment was their most significant barrier to ownership. Faculty agreed that the best way to develop ownership is to form a culture that normalizes discomfort and emphasizes its importance. These perspectives offer opportunities for programs to improve professional development and foster ownership.
Objective Assessment and Scoring of Parkinsonian Tremors using Wrist Sensor Technology
(2025-04-25) Sullivan, Megan E.; Shanghavi, Aditya A.; Rentley, Oliwia; Zauber, Sarah Elizabeth; Sereno, Anne B.
Background: Parkinson’s Disease (PD) is the second leading cause of neurodegenerative disease in humans. The gold standard for assessing disease progression is the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS). Neurologists score motor symptoms from 0-4 and determine medication adjustments based on score variation between the OFF and ON medication states. Numerous studies have noted inter-rater variability due to the subjectivity of the visual-based MDS-UPDRS rating scale complicating treatment plans. Objective: This clinical study evaluated the use of wrist-worn inertial sensors as a more objective and reliable method for measuring the severity of Parkinsonian rest and postural tremors, in comparison to the current gold standard, the MDS-UPDRS. Methods: 30 PD patients and 30 age-matched healthy controls performed the rest and postural tasks. Shimmer3 IMU sensors, sampling at 100Hz, were attached to both wrists to record angular velocity and linear acceleration. Tremor Severity Score (TSS), a novel objective tremor scoring algorithm based on sensor signals, was developed to measure tremor severity. Results: In a subset of controls and PD patients tested only ON medication, the mean scores for rest and postural tremor showed significant differences using both MDS-UPDRS (0.53 vs 0.46) and TSS (0.53 vs 0.39) rating scales, with TSS showing a marginally greater effect size (0.07 vs 0.06). When comparing OFF/ON states in a subset of 7 PD patients, the MDS-UPDRS showed no significant difference between scores, while the TSS showed significantly lower scores in the ON vs OFF state for both postural (0.44 vs 1.1) and rest tremor (0.91 vs 1.97). Conclusion: Results suggest TSS is more sensitive to changes in tasks (rest, postural) and medication effects (OFF vs ON). The ability to more objectively assess tremor severity and progression has implications for early diagnosis, medication dose adjustments, and more accurate assessment of patients in the telehealth setting.
Reanalysis and Reclassification of UBA2 Variants in Patient with Syndactyly, Polydactyly, Aplasia Cutis Congenita and Other Anomalies Reveals Diagnosis
(2025-04-25) Liaqat, Khurram; Felipe, Kimberly; Treat, Kayla; McPheron, Molly; Conboy, Erin; Vetrini, Francesco
Aplasia cutis congenita and ectrodactyly skeletal syndrome (ACCES) is known to cause by heterozygous mutation in the UBA2 gene. In this report we present the case of 7-year-old male with cutis aplasia, syndactyly, pre-axial polydactyly, and severe complex hypospadias. The exome sequencing identified a heterozygous frameshift variant [c.52_58dupGGCCGGG p.(Val20Gfs*31)] in UBA2 gene. This variant is absent in gnomAD and has been predicted to be pathogenic by various as insilico tools. Following enrollment of the patient at Undiagnosed Rare Disease Clinic (URDC) this frameshift variant [c.52_58dupGGCCGGG p.(Val20Gfs*31)] was reclassified as a pathogenic from Variant of unknown significance (VUS) according to ACMG guidelines. The variant classification affects the patient diagnosis, precision therapy and family screening. In this study, we highlighted the importance of reanalysis of genetic data for reclassification of variant from VUS to pathogenic in unsolved cases.
Impact of Indiana University School of Medicine’s Service Learning Experience in the Dominican Republic on Medical Students
(2025-04-25) Goins, Ethan; Messmore, Niki; Munguia-Vasquez, Ray; Baker, Elizabeth
Service learning experiences are used at the high school, undergraduate, and graduate levels of educational spaces as opportunities for academic and professional development in the context of community service. Over the past few years, Indiana University School of Medicine has led a weeklong service learning trip in December to the Dominican Republic in partnership with the 7 Elements organization. The trip includes medical brigades to rural communities, educational activities, and reflection. This project seeks to examine the impact that this service experience has on medical students including their personal and professional development. Participants of the 2023 cohort were surveyed anonymously roughly a year after their experience. Participants of the 2024 trip were surveyed before and after their trip. For the 2024 cohort, our study found that participants felt better prepared to work with migrant patients, Spanish-speaking patients, and underserved communities after the trip. The majority of participants also reported having a greater desire to work with underserved communities and engage with other service learning opportunities in the future. Overall, the trip has been of some benefit to medical students when it comes to their professional development and increasing their desire to work with underserved and global populations.

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