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Item Student and Faculty Collaboration in Student Affairs(2023-04-28) Crowley, Evelyn; Salmon, Chase; Walvoord, Emily; Dafoe, ErinHow does an institution increase student engagement when delivering co-curricular content that students sometimes view as unnecessary? Over the years, co-curricular topics such as, professional identity formation, policy awareness, academic success, awareness of institutional resources, cultivating a sense of well-being, etc. have become increasingly important. Indiana University School of Medicine (IUSM) has developed a novel approach to delivering co-curricular content that incorporates students into the creation and delivery of this content. In this session, we will discuss ways that students partner with Student Affairs in co-curricular educational programming, with a focus on personal & professional development (PPD) sessions and first-year orientation. These collaborations have fostered a greater degree of student engagement, higher levels of satisfaction with programs, and the ability to deliver content better connected to the student experience. Intentional personal and professional development education is just as vital on the path to becoming a physician as is traditional coursework. Collaborations begin during our first-year orientation, where rising M2s serve as content creators and are responsible for executing orientation in tandem with student affairs and regional campus faculty and staff. Throughout the academic year, students serve on the PPD planning committee to crowdsource topics from peers, listen to class chatter and concerns, and then work with student affairs to develop just in time sessions. These sessions focus heavily on M1 and M2 students who are in the very beginning stages of forming their professional identity. Examples include panels with upper-class students and residents, sessions with Mental Health Services, information about summer opportunities following the M1 year, creating a Step 1 study routine, and determining the right specialty. For our upper-class students, the focus shifts towards career development, residency application and Match preparation, financial security, and more. During this presentation, IUSM’s Associate Dean for Student Affairs and student panelists will discuss the evolution of these student-led initiatives at their nine-campus institution, review topics built in the curriculum, lessons learned and lead attendees in activities to develop and/or refine their own models. The session will include an interactive PowerPoint presentation, table discussions augmented with worksheets and a pair & share activity. We will conclude with an open Q & A with student panelists.Item Investigating Leadership Beliefs Among Medical Students Before and After Women's Physician Panel(2023-04-28) Jeffries, Alison; Ayub, Jinan; Jauregui, Alexa; Kendrick, Sara; Stout, JulianneBACKGROUND While the number of female medical student graduates and residents continues to rise, women still hold a minority of visible leadership positions in medicine. Many factors are at play such as personal values, time commitment, and experience, which influence applying for and obtaining such positions. STUDY OBJECTIVE Our goal was to investigate the ways students can serve as leaders and learn from women physician role models who have held a variety of formal and informal positions. This study was designed to understand medical students’ perspectives of leadership and how beliefs may change after attending a women’s physician panel. METHODS Phase 1 medical students completed anonymous surveys before and after attending a one-hour “Women in Leadership” panel featuring three women physicians at different career stages. During the event, two audience participation activities were performed. The first involved students generating a digital word cloud using words they selected to describe characteristics of good leaders, and the second was ranking values they deemed important based on results from Barrett's Personal Value Assessment. The pre-survey collected demographic information and asked participants to define leadership. The post-survey asked them to define leadership again, questioned how the panel altered their views on women in leadership, and for one main takeaway from the panel. Both surveys asked participants to indicate the extent to which they agreed with seven statements regarding their opinions about leadership positions, their own leadership abilities, leadership opportunities, and how their values affect their career goals. RESULTS There were 15 attendees at the panel, and thirteen individuals completed both the pre- and post-surveys with 85% identifying as female and 15% identifying as male. In both surveys, all respondents agreed or strongly agreed that it is important for women to be in visible leadership roles. When defining leadership after the panel, there was greater emphasis on confidence, active listening, and integrity. Five out of 13 participants reported feeling more confident in being in a leadership role after the panel, while eight reported no increase or no change in confidence. Additionally, when comparing post-survey to pre-survey results, six out of 13 respondents reported an increase in how often they think about how their values impact their career goals, while six respondents reported no change, and one respondent reported a decrease. Key takeaways from the panel included giving oneself more grace, how leadership is a skill that can be developed, advocating for oneself and others, and “I can be a leader.” These results aligned with common themes shared by the panelists, including maintaining a growth mindset, becoming comfortable with managing conflicts, and manifesting leadership qualities without an official title. CONCLUSION This study emphasizes the importance of women physicians serving as leaders and sharing their experiences with medical students. Discussing qualities of leadership, reflecting on one’s personal values, and listening to women physicians share their stories can help students develop a better understanding of how they can serve as leaders, with or without a title, throughout all stages of their medical training.Item Impact of Gabapentin and Pregabalin on Neurological Outcome After Ischemic Stroke(2023-04-28) Weber, Michael; Morton, Caleb; Chang, Fen-LeiBackground: The purpose of this study is to determine whether patients taking either gabapentin or pregabalin at the time of their stroke injury tend to have better outcomes than patients with similar injuries who were not taking one of the two medications. Prior studies have shown potential neuro-protective effects of these two medications. Methods: A retrospective chart review of 115 ischemic stroke patients from 2016-2021 were assessed for patient outcomes using two tools, the NIH Stroke Scale (NIHSS) and the modified Rankin Scale (mRS), in addition to their hospital length of stay. The outcomes of patients taking either gabapentin or pregabalin with stroke diagnoses are compared to patients with stroke diagnoses who were not taking either medication. Kruskal-Wallis and X2 were used for statistical analysis. Results: There was a significantly larger proportion of gabapentin patients that improved compared to patients in the control group when using the mRS tool for patient outcomes (X2; p=0.015). The gabapentin group showed a significantly larger improvement in the NIHSS scores from admission to discharge (Kruskal-Wallis; p=0.0005). Patients on gabapentin had a longer hospital stay than those not taking the medication by 1.7 days (t-test; p=0.041). Discussion: Our data support the potential neuro-protective effect of gabapentin/pregabalin with improved outcomes after an ischemic stroke using two parallel outcome measures of NIHSS and mRS scores. Of interest, patient hospital stays were longer on gabapentin/pregabalin, which may contribute to the improved outcomes. We need larger patient groups to confirm and further study our findings. This often can be facilitated by studies involving larger medical practices, insurance, or payer databases. In addition, further investigation of potential confounders, other pharmaceuticals, other nervous system injury mechanisms, and impact of associated cost and care quality issues should occur.Item 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, DougIntroduction: 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.Item Slemenda Scholars: The Impact of Early Experiential Learning in Global Health Education(2023-04-28) Gaviola, Micaela; Resner, Destiny; Vander Missen, Marissa; Baenziger, JennyBACKGROUND: 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.Item Prehospital Lung Ultrasound in Acute Heart Failure: Impact on Diagnosis and Treatment(2023-04-28) Tamhankar, Omkar; Russell, Frances; Supples, Michael; Liao, Mark; Finnegan, PatrickBackground 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.Item Examining Visiting Student Evaluation Forms(2023-04-28) Rigueiro, Gabriel; Dammann, Erin; Guillaud, Daniel; Packiasabapathy, Senthil; Mitchell, Sally; Yu, CorinnaBackground: 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.Item Why Not Medicine? Perceived Barriers to Pursuing Medical Degrees in Junior College Students(2023-04-28) Blais, Austin; Yu, Corinna; Mitchell, SallyMany 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? Item Evaluating the Medical Leadership Reading Elective(2023-04-28) Weller, Robert; Mitchell, Sally; Tsai, Mitchell; Yu, CorinnaEducation 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.Item Policy impact of COVID-19 research published by the IU School of Medicine: An exploratory bibliometric analysis, 2020-2021(2023-04-28) Ramirez, Mirian; Whipple, Elizabeth C.Introduction/Background: Policy documents serve as an essential reference point in the process of developing and implementing policies that have an impact on various aspects of society, including healthcare. This is especially evident in the way that governments around the world have responded to the COVID-19 pandemic by implementing measures to control the spread of the virus and to protect public health. Policies outline actions and provide guidance for policy implementation to inform decision-making at all levels of government and society. Regulations, guidelines, white papers, and reports are just a few examples of the different types of policy documents that can be issued by governmental agencies and institutions, intergovermental organizations, research institutes, think tanks, and other groups. These written statements are the outcome of the research and evidence analysis that has been conducted. Regarding research impact, the citations of publications used in policy documents provide evidence that the policies are based on reliable and authoritative sources of information. They also reflect the utility and quality of research output. In this exploratory bibliometric analysis, we present an overview of altmetrics (or alternative metrics) data, specifically for citations in policy documents, for IU School of Medicine (IUSM) publications. Study objective: This study aims to identify and analyze the policy documents that mention research published by the IU School of Medicine from 2020-2021. We analyzed the overall characteristics of policy documents, including type, geography, institution of origin, language, year of publication, and time-lag. We also analyzed the overall publication patterns of the articles cited in policy documents, including the availability of preprint versions of the publications cited in policy documents and funding support information. This approach aims to contribute to a better understanding of the characteristics of policy document sources that disseminate COVID-19 publications generated by the IUSM, and the types of research mentioned most often in the policy documents. Methods We used the PubMed database to search and find accurate citations of research articles published by IUSM authors during 2020-2021 related to COVID-19. Articles were searched using a combination of keywords and MeSH Terms related to “COVID-19” OR “Sars-Cov-2 ”, combined with our in-house developed affiliation name search. To identify mentions in policy documents the Overton.io platform, bibliometric database of policy documents citations, was used. Excel was used to aggregate, clean up and analyze the data and to generate the analysis and network visualizations. Results and Conclusions Overall, 71 (14.5%) of the 564 publications have been cited 192 times in 161 policy sources (1.2 average citations per document) by time of data collection (January 10, 2023). The cited articles identified were published in 57 journals; the journal with the most cited articles (2 articles, ≥ 31 citations) was JAMA. Most of the citations associated with these articles come from sources generated by the Centers for Disease Control and Prevention (CDC) (33 citations). The findings provide relevant insight to the IUSM research community concerning policy documents mentioned and may support researchers when making decisions for developing a publication and research strategy.
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