scholarly journals Implementation of a medical student-run telemedicine program for medications for opioid use disorder during the COVID-19 pandemic

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Marcus Castillo ◽  
Brianna Conte ◽  
Sam Hinkes ◽  
Megan Mathew ◽  
C. J. Na ◽  
...  
Keyword(s):  
Medical Student ◽  
People Who Inject Drugs ◽  
Medical Center ◽  
Academic Medical Center ◽  
Opioid Use Disorder ◽  
Health Issues ◽  
Opioid Use ◽  
Academic Medical ◽  
Life Saving ◽  
Attending Physicians

Abstract Objectives The COVID-19 pandemic led to the closure of the IDEA syringe services program medical student-run free clinic in Miami, Florida. In an effort to continue to serve the community of people who inject drugs and practice compassionate and non-judgmental care, the students transitioned the clinic to a model of TeleMOUD (medications for opioid use disorder). We describe development and implementation of a medical student-run telemedicine clinic through an academic medical center-operated syringe services program. Methods Students advertised TeleMOUD services at the syringe service program on social media and created an online sign-up form. They coordinated appointments and interviewed patients by phone or videoconference where they assessed patients for opioid use disorder. Supervising attending physicians also interviewed patients and prescribed buprenorphine when appropriate. Students assisted patients in obtaining medication from the pharmacy and provided support and guidance during home buprenorphine induction. Results Over the first 9 weeks in operation, 31 appointments were requested, and 22 initial telehealth appointments were completed by a team of students and attending physicians. Fifteen appointments were for MOUD and 7 for other health issues. All patients seeking MOUD were prescribed buprenorphine and 12/15 successfully picked up medications from the pharmacy. The mean time between appointment request and prescription pick-up was 9.5 days. Conclusions TeleMOUD is feasible and successful in providing people who inject drugs with low barrier access to life-saving MOUD during the COVID-19 pandemic. This model also provided medical students with experience treating addiction during a time when they were restricted from most clinical activities.

Clinicians Are From Mars and Pathologists Are From Venus

2000 ◽  
Vol 124 (7) ◽  
pp. 1040-1046 ◽  
Author(s):  
Seth M. Powsner ◽  
José Costa ◽  
Robert J. Homer
Keyword(s):  
Medical Errors ◽  
Medical Information ◽  
Potential Problem ◽  
Medical Center ◽  
Academic Medical Center ◽  
Open Book ◽  
Surgical Experience ◽  
Academic Medical ◽  
Pathology Reports ◽  
Attending Physicians

Abstract Context.—Text reports convey critical medical information from pathologists, radiologists, and subspecialty consultants. These reports must be clear and comprehensible to avoid medical errors. Pathologists have paid much attention to report completeness but have ignored the corresponding issue of report comprehension. This situation presents an increasingly serious potential problem. As laboratories are consolidated and as reports are disseminated in new ways (eg, via the World Wide Web), the target audience becomes more diverse and less likely to have any contact with pathologists beyond the written reports themselves. Objective.—To compare clinician comprehension with pathologist intent in written pathology reports. Methods.—Typical surgical pathology reports relevant to surgeons and covering a range of specimen complexity were taken from our hospital files. Questionnaires based on these cases were administered open-book-examination style to surgical attending physicians and trainees during surgical conferences at an academic medical center. Main Outcome Measures.—Scores from questionnaires. Results.—Surgeons misunderstood pathologists' reports 30% of the time. Surgical experience reduced but did not eliminate the problem. Streamlined report formatting exacerbated the problem. Conclusions.—A communication gap exists between pathologists and surgeons. Familiarity with report format and clinical experience help reduce this gap. Paradoxically, stylistic improvements to report formatting can interfere with comprehension and increase the number of misunderstandings. Further investigation is required to reduce the number of misunderstandings and, thus, medical errors.

scholarly journals The Procedure Coordinator: A Resident-Driven Initiative to Increase Opportunity for Inpatient Procedures

2018 ◽  
Vol 10 (5) ◽  
pp. 583-586 ◽  
Author(s):  
Matthew Gorgone ◽  
Brian McNichols ◽  
Valerie J. Lang ◽  
William Novak ◽  
Alec B. O'Connor
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Medical Providers ◽  
Procedural Training ◽  
Academic Medical ◽  
Attending Physician ◽  
Attending Physicians ◽  
The Impact ◽  
Training Opportunities

ABSTRACT Background  Training residents to become competent in common bedside procedures can be challenging. Some hospitals have attending physician–led procedure teams with oversight of all procedures to improve procedural training, but these teams require significant resources to establish and maintain. Objective  We sought to improve resident procedural training by implementing a resident-run procedure team without routine attending involvement. Methods  We created the role of a resident procedure coordinator (RPC). Interested residents on less time-intensive rotations voluntarily served as RPC. Medical providers in the hospital contacted the RPC through a designated pager when a bedside procedure was needed. A structured credentialing process, using direct observation and a procedure-specific checklist, was developed to determine residents' competence for completing procedures independently. Checklists were developed by the residency program and approved by institutional subspecialists. The service was implemented in June 2016 at an 850-bed academic medical center with 70 internal medicine and 32 medicine-pediatrics residents. The procedure service functioned without routine attending involvement. The impact was evaluated through resident procedure logs and surveys of residents and attending physicians. Results  Compared with preimplementation procedure logs, there were substantial increases postimplementation in resident-performed procedures and the number of residents credentialed in paracenteses, thoracenteses, and lumbar punctures. Fifty-nine of 102 (58%) residents responded to the survey, with 42 (71%) reporting the initiative increased their ability to obtain procedural experience. Thirty-one of 36 (86%) attending respondents reported preferentially using the service. Conclusions  The RPC model increased resident procedural training opportunities using a structured sign-off process and an operationalized service.

The Nonphysician “Medical Student Educator”: A Formal Addition to the Clerkships and Key Programs at an Academic Medical Center

2007 ◽  
Vol 19 (2) ◽  
pp. 154-161 ◽  
Author(s):  
Donna Elliott ◽  
Sarah Ingersoll ◽  
Maura Sullivan ◽  
Madeleine Bruning ◽  
Moreen Logan ◽  
...  
Keyword(s):  
Medical Student ◽  
Medical Center ◽  
Academic Medical Center ◽  
Academic Medical

Opioid use in the acute setting: A survey of providers at an academic medical center

2018 ◽  
Vol 14 (3) ◽  
pp. 203-210 ◽  
Author(s):  
Douglas R. Oyler, PharmD ◽  
Kristy S. Deep, MD ◽  
Phillip K. Chang, MD
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Healthcare Providers ◽  
High Risk Patient ◽  
Opioid Analgesics ◽  
Opioid Use ◽  
Cross Sectional ◽  
Academic Medical ◽  
Clinical Scenarios ◽  
Nonopioid Analgesics

Objective: To examine attitudes, beliefs, and influencing factors of inpatient healthcare providers regarding prescription of opioid analgesics.Design: Electronic cross-sectional survey.Setting: Academic medical center.Participants: Physicians, advanced practice providers, and pharmacists from a single academic medical center in the southeast United States.Main Outcome Measures: Respondents completed survey items addressing: (1) their practice demographics, (2) their opinions regarding overall use, safety, and efficacy of opioids compared to other analgesics, (3) specific clinical scenarios, (4) main pressures to prescribe opioids, and (5) confidence/comfort prescribing opioids or nonopioids in select situations.Results: The majority of the sample (n = 363) were physicians (60.4 percent), with 69.4 percent of physicians being attendings. Most respondents believed that opioids were overused at our institution (61.7 percent); nearly half thought opioids had similar efficacy to other analgesics (44.1 percent), and almost all believed opioids were more dangerous than other analgesics (88.1 percent). Many respondents indicated that they would modify a chronic regimen for a high-risk patient, and use of nonopioids in specific scenarios was high. However, this use was often in combination with opioids. Respondents identified patients (64 percent) and staff (43.1 percent) as the most significant sources of pressure to prescribe opioids during an admission; the most common sources of pressure to prescribe opioidson discharge were to facilitate discharge (44.8 percent) and to reduce follow-up requests, calls, or visits (36.3 percent). Resident physicians appear to experience more pressure to prescribe opioids than other providers. Managing pain in patients with substance use disorders and effectively using nonopioid analgesics were the most common educational needs identified by respondents.Conclusion: Most individuals believe opioid analgesics are overused in our specific setting, commonly to satisfy patient requests. In general, providers feel uncomfortable prescribing nonopioid analgesics to patients.

scholarly journals Two Data-Driven Approaches to Identifying the Spectrum of Problematic Opioid Use: A Pilot Study within a Chronic Pain Cohort

2021 ◽  
Author(s):  
Lori Schirle ◽  
Alvin D Jeffery ◽  
Ali Yaqoob ◽  
Sandra Sanchez-Roige ◽  
David C. Samuels
Keyword(s):  
Language Processing ◽  
Medical Center ◽  
Academic Medical Center ◽  
Correlation Coefficients ◽  
Pilot Project ◽  
Data Driven ◽  
Risk Scores ◽  
Opioid Use ◽  
Academic Medical ◽  
Manual Review

Background: Although electronic health records (EHR) have significant potential for the study of opioid use disorders (OUD), detecting OUD in clinical data is challenging. Models using EHR data to predict OUD often rely on case/control classifications focused on extreme opioid use. There is a need to expand this work to characterize the spectrum of problematic opioid use. Methods: Using a large academic medical center database, we developed 2 data-driven methods of OUD detection: (1) a Comorbidity Score developed from a Phenome-Wide Association Study of phenotypes associated with OUD and (2) a Text-based Score using natural language processing to identify OUD-related concepts in clinical notes. We evaluated the performance of both scores against a manual review with correlation coefficients, Wilcoxon rank sum tests, and area-under the receiver operating characteristic curves. Records with the highest Comorbidity and Text-based scores were re-evaluated by manual review to explore discrepancies. Results: Both the Comorbidity and Text-based OUD risk scores were significantly elevated in the patients judged as High Evidence for OUD in the manual review compared to those with No Evidence (p = 1.3E-5 and 1.3E-6, respectively). The risk scores were positively correlated with each other (rho = 0.52, p < 0.001). AUCs for the Comorbidity and Text-based scores were high (0.79 and 0.76, respectively). Follow-up manual review of discrepant findings revealed strengths of data-driven methods over manual review, and opportunities for improvement in risk assessment. Conclusion: Risk scores comprising comorbidities and text offer differing but synergistic insights into characterizing problematic opioid use. This pilot project establishes a foundation for more robust work in the future.

scholarly journals Interns' Experiences of Disruptive Behavior in an Academic Medical Center

2013 ◽  
Vol 5 (1) ◽  
pp. 25-30 ◽  
Author(s):  
Charles P. Mullan ◽  
Jo Shapiro ◽  
Graham T. McMahon
Keyword(s):  
Disruptive Behavior ◽  
Medical Center ◽  
Academic Medical Center ◽  
Hospital Environment ◽  
First Year ◽  
Convenience Sample ◽  
Team Members ◽  
Academic Medical ◽  
And Gender ◽  
Attending Physicians

Abstract Background The first year of graduate medical education is an important period in the professional development of physicians. Disruptive behavior interferes with safe and effective clinical practice. Objective To determine the frequency and nature of disruptive behavior perceived by interns and attending physicians in a teaching hospital environment. Method All 516 interns at Partners HealthCare (Boston, MA) during the 2010 and 2011 academic years were eligible to complete an anonymous questionnaire. A convenience nonrandom sample of 40 attending physicians also participated. Results A total of 394 of 516 eligible interns (76.4%) participated. Attendings and interns each reported that their team members generally behaved professionally (87.5% versus 80.4%, respectively). A significantly greater proportion of attendings than interns felt respected at work (90.0% versus 71.5% respectively; P  =  .01). Disruptive behavior was experienced by 93% of interns; 54% reported that they experienced it once a month or more. Interns reported disruptive behavior significantly more frequently than attending physicians, including increased reports of condescending behavior (odds ratio [OR], 5.46 for interns compared with attendings; P &lt; .001), exclusion from decision making (OR, 6.97; P &lt; .001), and berating (OR, 4.84; P  =  .02). Inappropriate jokes, abusive language, and gender bias were also reported, and they were not significantly more frequent among interns than attending physicians. Interns most frequently identified nurses as the source of disruption, and were significantly more likely than faculty to identify nurses as the source of disruptive behavior (OR, 10.40; P &lt; .001). Attendings reported other physicians as the most frequent source of disruption. Conclusions Although interns generally feel respected at work, they frequently experience disruptive behavior. Interns described more disruptive behaviors than a convenience sample of attending physicians at our institution.

Communication about opioid versus nonopioid analgesics in the emergency department

2015 ◽  
Vol 11 (3) ◽  
pp. 229 ◽  
Author(s):  
Danielle M. McCarthy, MD, MS ◽  
Kenzie A. Cameron, PhD, MPH ◽  
D. Mark Courtney, MD, MS ◽  
James G. Adams, MD ◽  
Kirsten G. Engel, MD
Keyword(s):  
Emergency Department ◽  
Adverse Effects ◽  
Medical Center ◽  
Academic Medical Center ◽  
Multivariable Analysis ◽  
Secondary Analysis ◽  
Academic Medical ◽  
Frequency Of Use ◽  
Nonopioid Analgesics ◽  
Attending Physicians

Objective: The Medication Communication Index (MCI) was used to compare counseling about opioids to nonopioid analgesics in the Emergency Department (ED) setting.Design: Secondary analysis of prospectively collected audio recordings of ED patient visits.Setting: Urban, academic medical center (>85,000 annual patient visits). Participants: Patient participants aged >18 years with one of four low acuity diagnoses: ankle sprain, back pain, head injury, and laceration. ED clinician participants included resident and attending physicians, nursing staff, and ED technicians.Main outcome measures: The MCI is a five-point index that assigns points for communicating the following: medication name (1), purpose (1), duration (1), adverse effects (1), number of tablets (0.5), and frequency of use (0.5). Recording transcripts were scored with the MCI, and total scores were compared between drug classes.Results: The 41 patients received 56 prescriptions (27 nonopioids, 29 opioids). Nonopioid median MCI score was 3 and opioid score was 4.5 (p = 0.0008). Patients were counseled equally about name (nonopioid 100 percent, opioid 96.6 percent, p = 0.34) and purpose (88.9 percent, 89.7 percent, p = 0.93). However, patients receiving opioids were counseled more frequently about duration of use (nonopioid 40.7 percent, opioid 69.0 percent, p = 0.03) and adverse effects (18.5 percent, 93.1 percent, p < 0.001). In multivariable analysis, opioids (β = 0.54, p = 0.04), number of medications prescribed (β = −0.49, p = 0.05), and time spent in the ED (β = 0.007, p = 0.006) were all predictors of total MCI score.Conclusions: The extent of counseling about analgesic medications in the ED differs by drug class. When counseling patients about all analgesic medications, providers should address not only medication name and purpose but also the less frequently covered topics of medication dosing, timing, and adverse effects.

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