2023 IUSM Education Day

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https://hdl.handle.net/1805/32056

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U.S. Pediatric Residents’ Preparedness, Attitudes, and Knowledge in LGBTQ+ Healthcare
(2023) Menez, Olwen; Dauterman, Jonathan; Dauterman, Leah; Nowaskie, Dustin
Introduction: The objective of this study was to evaluate how comfortable, knowledgeable, and prepared pediatric residents are within LGBTQ+ care. Method: In June 2022, U.S. pediatric residents completed an anonymous, online survey including the three domain LGBT-DOCSS. Results: Pediatric residents (N = 78) reported low to moderate annual amounts of LGBT curricular hours (M = 3.32, SD = 3.17) and LGBT patients (M = 13.84, SD = 15.11) as well as low to moderate Clinical Preparedness and Basic Knowledge and high Attitudinal Awareness. They were significantly less likely to report receiving adequate training and supervision, having experience, and feeling competent in transgender care compared to LGB care. In general, pediatric residents who reported more LGBT education and LGBT patients also reported higher LGBT-DOCSS scores. Discussion: Pediatric providers currently have substantial shortcomings in LGBTQ+ care. Pediatric programs must increase LGBTQ+ education and LGBTQ+ patient exposure.
Knowledge of current exercise guidelines and perceived utilization in rural Indiana
(2023) Nettleton, Rachel; Danek, Robin; Ireland, Ellen; Reyes, Eric
Purpose: The aim of this research is to determine the understanding of current exercise guidelines in rural Indiana. A comparison of current exercise practices, barriers, and benefits of exercise were also briefly addressed. Methods: A survey was distributed to individuals (ages 18+) at a small family medicine clinic in a midwestern state (n=23). Findings: The sample size was 23, which comprised of mostly older females. Most participants responded that they do less than the recommended duration and intensity of exercise (Table 1). CDC recommendations were not well understood by 68% of participants. Conclusions: Results demonstrated that participants in rural Indiana underestimated the current CDC guidelines for exercise. They also fail to meet the CDC recommendations, as well as what they perceived the recommendations to be. Lack of motivation, energy and time were the most cited barriers. Increased energy and increased physical abilities were the most cited benefits.
An Analysis of Indiana Youth Group Demographics
(Proceedings of IMPRS, 2023-01-26) Gross, Rachel; Abraham, Olivia; Messmore, Niki
This study examines the demographics of the youth attending Indiana Youth Group (IYG) programs and how the demographics of the IYG attendees compare to youth in Marion County, Indiana at large. Indiana Youth Group is a center based in Indianapolis that serves LGBTQ+ youth ages 12-24 that creates safer spaces to build community and offers harm-reduction programs that empower youth to build confidence, explore their identities, and foster friendships. IYG provides a wide array of programs free of charge, including basic needs, support groups, arts and crafts, sexual health education, STI/HIV testing, case management, mental health counseling, and affinity groups to lessen the impact of stressors most faced by LGBTQ+ youth and increase self-efficacy. Based on our analysis of demographic data from the 2020 IYG Annual Report and the 2020 Indiana Youth Institute (IYI) County Snapshots, we found that IYG attendees are less diverse than the greater Marion County youth population in terms of race in 2020. IYG serves a higher proportion of white youth and a lower proportion of Black and Hispanic/Latinx compared to the Marion County population. Our study proposes the following strategies to broaden outreach to racially minoritized populations: identify and build relationships with trusted community-based organizations (CBOs) within Black, Indigenous, and People of Color (BIPOC) communities, invest in health education and health literacy, and increase language access by conveying program information through trusted community messengers. Organizational changes could include cultural competency and social justice training for staff that specifically focuses on the intersection between systemic racism and LGBTQ+ oppression.
Use of SGLT2 Inhibitors Reduces Heart Failures and Hospitalization: A Multicenter, Real-World Evidence Study
(2023-04-28) Blanco, Christopher; Garcia, Kara; Singson, Adrian; Smith, William
BACKGROUND: New research has produced evidence to support the use of diabetic drugs to prevent heart failure (HF). However, evidence of their effect in real-world clinical practice is limited. OBJECTIVE: The objective of this study is to establish whether real-world evidence supports clinical trial findings that use of sodium-glucose cotransporter-2 inhibitor (SGLT2i) reduces rate of hospitalization and incidence of HF for patients with cardiovascular disease and type 2 diabetes. METHODS: This retrospective study used electronic medical records to compare rate of hospitalization and incidence of HF among 37,231 patients with cardiovascular disease and type 2 diabetes under treatment with SGLT2i, glucagon-like peptide-1 receptor agonist (GLP1-RA), both, or neither. RESULTS: Significant differences were found between medication class prescribed and number of hospitalizations (p < 0.0001) and incidence of HF (p < 0.0001). Post-hoc tests revealed reduced incidence of HF in the group treated with SGLT2i relative to GLP1-RA alone (p = 0.004) or neither of these key drugs (p < 0.001). No significant differences were observed between the group receiving both drug classes compared to SGLT2i alone. DISCUSSION: Results of this real-world analysis are consistent with clinical trial findings that SGLT2i therapy reduces incidence of HF. The findings also suggest the need for further points of research in demographic and socioeconomic status differences. CONCLUSION: Real-world evidence supports clinical trial findings of SGLT2i reducing both incidence of HF and rate of hospitalization.
Innovations in Medical Education: 4th Annual Indiana University School of Medicine Education Day Program
(2023-04-28) Indiana University School of Medicine
Program for the 4th annual Indiana University School of Medicine Education Day held at Hine Hall Conference Center on the IUPUI campus on April 28, 2023. The IUSM Education Day is an event for faculty, staff, students, residents, and fellows from all departments and campuses to showcase their medical education research through oral presentations, workshops, poster sessions, and small group discussions.
Slemenda Scholars: The Impact of Early Experiential Learning in Global Health Education
(2023-04-28) Gaviola, Micaela; Resner, Destiny; Vander Missen, Marissa; Baenziger, Jenny
BACKGROUND: Global health electives, and other international experiences in medical education, typically expose medical students in their clinical years to the practice of medicine in a resource-limited setting. These experiences have been shown to improve medical knowledge and clinical skills, promote personal and professional development, and influence the trajectory of trainees’ careers. The Slemenda Scholars (SS) program at Indiana University School of Medicine offers preclinical students early exposure to the field of global health through a summer research program in collaboration with the Academic Model Providing Access to Healthcare (AMPATH), a 30-year partnership between Indiana University and Moi University that seeks to provide and expand sustainable access to high quality care through education and research. HYPOTHESIS: In this study, we analyze didactic and experiential learning opportunities described in publicly available articles written by students participating in the program, as well as responses to a survey. We hypothesize this analysis will demonstrate the influence of the SS program on students’ choosing a global health career, publishing scholarly work in the field of global health, and fostering personal and professional growth. We aim to identify unique aspects of the SS program relative to other global health programs. METHODS: This mixed methods study qualitatively assessed Internet articles written about the SS program and quantitatively analyzed a cross-sectional survey administered to past participants of the program via electronic mail in January 2023. Key phrases used to find Internet articles were “Slemenda Scholars,” “Slemenda Scholars Program,” “Slemenda,” and “IUSM Slemenda.” Themes were generated based on grounded theory and constant comparative model and finalized after three consensus meetings. The eight-question survey measured previous global health experience and personal and professional outcomes related to the program. Survey data collection is ongoing and will be analyzed via descriptive statistics. RESULTS: Thirty-one articles underwent full review and 25 were included in final analysis. Final themes were grouped into “Educational experience,” with 16 themes, and “Impact of Educational Experience,” with 14 themes. Salient examples included Cross-cultural Interactions and Motivation for a Service-Oriented Career, respectively. In themes of educational experience, 56% of all articles mentioned learning about AMPATH, research, personal and professional cross-cultural interactions, and 60% described network-building. In themes of “Impact,” 48% of articles reflected on ethical/sustainable global health, impactful patient experiences, and motivation for a career in global health. The survey was distributed to 70 former Slemenda Scholars. Results including demographics, rates of continuation in and publication of global health work, and measures of difference will be reported. CONCLUSIONS: The results of article analysis reveal the value of experiential global health learning early in the undergraduate medical career. Key program outcomes of expanding perspectives, developing relational skills with diverse colleagues, and building adaptability prepare medical students for success beyond undergraduate medical studies and fuel a future work force of global health leaders. Few schools offer engagement with long-term global health initiatives like AMPATH. This study highlights a need for the growth of long-term partnerships, with reciprocal benefits for care and education, as well as expanded access to such opportunities.
Prehospital Lung Ultrasound in Acute Heart Failure: Impact on Diagnosis and Treatment
(2023-04-28) Tamhankar, Omkar; Russell, Frances; Supples, Michael; Liao, Mark; Finnegan, Patrick
Background and Objectives Patients with acute heart failure (AHF) are commonly misdiagnosed and undertreated in the prehospital setting. These delays in diagnosis and treatment have a direct negative impact on patient outcomes. The goal of this study was to determine the diagnostic accuracy of AHF by paramedics with and without lung ultrasound (LUS). We also assessed LUS impact on rate of initiation and time to initiation of HF therapies in AHF patients with and without LUS performed. Methods This was a prospective, nonrandomized, interventional study on a consecutive sample of patients transported to the hospital by one emergency medical services agency. Adult patients (>18) with a chief complaint of dyspnea and at least one of the following: bilateral lower extremity edema, orthopnea, wheezing or rales on auscultation, respiratory rate >20 or oxygen saturation < 92% were included. LUS was performed when a paramedic trained in LUS was present and an US was available on the ambulance. LUS was defined as positive for AHF if both anterior-superior lung zones had >2 B-lines or bilateral B-lines were visualized on a 4-view protocol. Paramedic diagnosis with and without the use of LUS was compared to hospital discharge diagnosis using Fishers exact analysis. Kappa was used to determine LUS interpretation interrater reliability between paramedic and expert. HF therapy was defined as nitroglycerin prehospital and furosemide in the emergency department. Time to treatment was defined as paramedic initial patient contact time to the time treatment was administered. Results A total of 353 patients were enrolled from March to September 2022; 89 did not meet inclusion criteria. Of the 264 included patients 94 (35%) had AHF. Forty patients had a LUS performed. Sensitivity and specificity for AHF by paramedics was 23% (95% CI 0.14-0.34) and 97% (CI 0.92-0.99) without LUS and 71% (95% CI 0.44-0.88) and 96% (95% CI 0.76-0.99) with the use of LUS. In the 94 patients with AHF, 14% (11/77) received HF therapy prehospital without the use of LUS and 53% (9/17) with the use of LUS. LUS improved frequency of treatment by 39%. Median time to treatment was 19 minutes with LUS and 149 minutes without. Kappa for LUS interpretation was 0.79 (CI 0.6-0.98). Conclusion LUS improved paramedic sensitivity and accuracy for diagnosing AHF in the prehospital setting. LUS use led to higher rates of prehospital HF therapy initiation and significantly decreased time to treatment.
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.
Systems Modeling of Gut Microbiome Regulation of Estrogen Receptor Beta Signaling in Ulcerative Colitis
(2023-04-28) Trinh, Alan; Munoz, Javier; Cross, Tzu-Wen; Brubaker, Doug
Introduction: The pathogenesis of ulcerative colitis (UC), a chronic inflammatory disorder, involves interactions between gut microbiome dysbiosis, epithelial cell barrier disruption, and immune hyperactivity. Men are 20% more likely to develop UC and 60% more likely to progress to colitis-associated cancer than women. A possible explanation for this may be the anti-inflammatory and epithelial-protective role of estrogen via estrogen receptor beta (ESR2) in the gut. However, extracting insights into how microbiomes regulate host cell signaling is challenged by high-dimensional data integrations across kingdoms and the need to extract interpretable biological information from complex models. To address these challenges and understand microbiome regulation of ESR2 signaling, we developed a partial least squares path modeling (PLS-PM)-inspired microbiome multi-omic modeling framework. Materials and Methods: Gut metabolomic, colorectal transcriptomic, and stool 16S rRNA-seq data from unique UC or non-IBD controls subjects (n=35) were obtained from the Inflammatory Bowel Disease Multi-Omics Database. Single sample gene set enrichment analysis was used to calculate pathway scores for genes up or down-regulated by ESR2 (ESR2UP/ESR2DN respectively).Latent variables (LV) obtained via regularized sparse partial least square regression (sPLSR) mdoels were extracted and used as predictors in two linear regression meta-models with dependent variables of ESR2UP or ESR2DN scores, and independent variables in each model consisting of patient LV scores on metabolites and 16S LVs along with sex and UC status. Significance testing on regression coefficients identified LV interactions synergistically predictive of ER Beta pathway activity. Results and Discussion: The first two LVs from each single-omic sPLSR models were extracted to create terms in the multi-omic meta-model accounting for sex and disease status. The meta-model was predictive of ESR2UP pathway score, implicating UC status (p=0.046), microbiota LV1 (p=0.0006), metabolites LV2 (p=0.045), and interactions of metabolite LV1:microbiota LV1 (p=0.003), microbiota LV1:UC (p=0.0008), and microbiota LV2:sex (p=0.019) in predicting ESR2UP pathway status. For ESR2DN, the 16S model clustered by ESR2DN activity while the metabolomic model clustering was best illustrated by disease status. The ESR2DN meta-model was predictive of ESR2DN pathway activity, implicating main effects of microbiota LV1 (p =0.004), metabolites LV2 (p=0.004), and diagnosis and the interaction effects of metabolites LV1:microbiota LV1 (p=0.005), microbiota LV1:UC (p=0.014), microbiota LV2:sex (p=0.017), and metabolites LV2:UC (p=0.035) in predicting ESR2DN pathway status. Acesulfame, an artificial sweetener, and oxymetazoline, a nasal decongestant, were some of the metabolites predicted by our model to have a differential effect on ESR2 activity based on patient sex. The metabolites predicted in our models are tested in cancer cell lines to understand estrogen regulatory effects on inflammation observed in UC. Method developed in this study can be applied to gain insight regarding regulation of signaling pathways in pathologies not limited to UC. Conclusions: We demonstrate the effectiveness of a PLS-PM based method for modeling relationships between host signaling and microbiome multi-omics data via this investigation of ER Beta activity in UC patients. We quantified significant multi-omic microbiome interactions with disease status and sex that impact ER Beta signaling which may aid in identifying new microbiome-targeted UC therapeutics stratified by sex-specific disease characteristics.
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?

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