Fellowship program directors and trainees across the United States find parental leave policies to be inconsistent, inaccessible, and inadequate

Introduction Determine the consistency, accessibility, and adequacy of parental leave policies for adult and pediatric medicine fellowship programs. Methods We administered a 40-question survey to fellowship program directors (PDs) and trainees in adult and pediatric cardiology, hematology/oncology, gastroenterology, and pulmonology/critical care fellowship programs in the United States. We used Chi-square tests to compare proportions for categorical variables and t-tests to compare means for continuous variables. Results A total of 190 PDs from 500 programs (38.0%) and 236 trainees from 142 programs (28.4%) responded. Most respondents did not believe that parental leave policies were accessible publicly (322/426; 75.6%), on password-protected intranet (343/426; 80.5%), or upon request (240/426; 56.3%). The PDs and trainees broadly felt that parental leave for fellows should be 5–10 weeks (156/426; 36.6%) or 11–15 weeks (165/426; 38.7%). A majority of PDs felt that there was no increased burden upon other fellows (122/190; 64.2%) or change in overall well-being (110/190; 57.9%). When asked about the biggest barrier to parental leave support, most PDs noted time constrains of fellowship (101/190; 53.1%) and the limited number of fellows (43/190; 22.6%). Trainees similarly selected the time constraints of training (88/236; 37.3%), but nearly one-fifth chose the culture in medicine (44/236; 18.6%). There were no statistically significant differences in answers based on the respondents’ sex, specialty, or subspecialty. Discussion Parental leave policies are broadly in place, but did not feel these were readily accessible, standardized, or of optimum length. PDs and trainees noted several barriers that undermine support for better parental leave policies, including time constraints of fellowship, the limited number of fellows for coverage, and workplace culture. Standardization of parental leave policies is advisable to allow trainees to pursue fellowship training and care for their newborns without undermining their educational experiences.

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Medical cannabis use in the United States: a retrospective database study

Journal of Cannabis Research ◽

10.1186/s42238-020-00038-w ◽

2020 ◽

Vol 2 (1) ◽

Author(s):

V. Kishan Mahabir ◽

Jamil J. Merchant ◽

Christopher Smith ◽

Alisha Garibaldi

Keyword(s):

United States ◽

Medical Condition ◽

Statistical Tests ◽

The United States ◽

Categorical Variables ◽

Continuous Variables ◽

Medical Conditions ◽

Comorbid Conditions ◽

Medical Cannabis ◽

Number Of Patients

Abstract Introduction Growing interest in the medicinal properties of cannabis has led to an increase in its use to treat medical conditions, and the establishment of state-specific medical cannabis programs. Despite medical cannabis being legal in 33 states and the District of Colombia, there remains a paucity of data characterizing the patients accessing medical cannabis programs. Methods We retrospectively reviewed a registry with data from 33 medical cannabis evaluation clinics in the United States, owned and operated by CB2 Insights. Data were collected primarily by face-to-face interviews for patients seeking medical cannabis certification between November 18, 2018 and March 18, 2020. Patients were removed from the analysis if they did not have a valid date of birth, were less than 18, or did not have a primary medical condition reported; a total of 61,379 patients were included in the analysis. Data were summarized using descriptive statistics expressed as a mean (standard deviation (SD)) or median (interquartile range (IQR)) as appropriate for continuous variables, and number (percent) for categorical variables. Statistical tests performed across groups included t-tests, chi-squared tests and regression. Results The average age of patients was 45.5, 54.8% were male and the majority were Caucasian (87.5%). Female patients were significantly older than males (47.0 compared to 44.6). Most patients reported cannabis experience prior to seeking medical certification (66.9%). The top three mutually exclusive primary medical conditions reported were unspecified chronic pain (38.8%), anxiety (13.5%) and post-traumatic stress disorder (PTSD) (8.4%). The average number of comorbid conditions reported was 2.7, of which anxiety was the most common (28.3%). Females reported significantly more comorbid conditions than males (3.1 compared to 2.3). Conclusion This retrospective study highlighted the range and number of conditions for which patients in the US seek medical cannabis. Rigorous clinical trials investigating the use of medical cannabis to treat pain conditions, anxiety, insomnia, depression and PTSD would benefit a large number of patients, many of whom use medical cannabis to treat multiple conditions.

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Dana-Farber Cancer Institute/Mass General Brigham Fellowship Response to the COVID-19 Pandemic

JCO Oncology Practice ◽

10.1200/op.20.00894 ◽

2021 ◽

pp. OP.20.00894

Author(s):

Robert M. Stern ◽

M. Dror Michaelson ◽

Erica L. Mayer ◽

Aric D. Parnes ◽

Annemarie E. Fogerty ◽

...

Keyword(s):

Medical Education ◽

Training Programs ◽

Well Being ◽

The United States ◽

First Year ◽

Fellowship Program ◽

Dana Farber Cancer Institute ◽

Fellowship Programs ◽

Direct Feedback ◽

Research Structure

The coronavirus disease (COVID)-19 pandemic has affected graduate medical education training programs, including hematology-oncology fellowship programs, both across the United States and abroad. Within the Dana-Farber Cancer Institute/Mass General Brigham hematology-oncology fellowship program, fellowship leadership had to quickly reorganize the program's clinical, educational, and research structure to minimize the risk of COVID-19 spread to our patients and staff, allow fellows to assist in the care of patients with COVID-19, maintain formal didactics despite physical distancing, and ensure the mental and physical well-being of fellows. Following the first wave of patients with COVID-19, we anonymously surveyed the Dana-Farber Cancer Institute/Mass General Brigham first-year fellows to explore their perceptions regarding what the program did well and what could have been improved in the COVID-19 response. In this article, we present the feedback from our fellows and the lessons we learned as a program from this feedback. To our knowledge, this represents the first effort in the hematology-oncology literature to directly assess a hematology-oncology program's overall response to COVID-19 through direct feedback from fellows.

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Education Research: Multiple sclerosis and neuroimmunology fellowship training status in the United States

Neurology ◽

10.1212/wnl.0000000000009096 ◽

2020 ◽

Vol 94 (11) ◽

pp. 495-500 ◽

Cited By ~ 1

Author(s):

Ahmed Z. Obeidat ◽

Yasir N. Jassam ◽

Le H. Hua ◽

Gary Cutter ◽

Corey C. Ford ◽

...

Keyword(s):

United States ◽

Multiple Sclerosis ◽

Program Directors ◽

The United States ◽

Fellowship Training ◽

Current Status ◽

Application Process ◽

Shared Resources ◽

Fellowship Programs ◽

Internal Funding

ObjectiveTo investigate the current status of postgraduate training in neuroimmunology and multiple sclerosis (NI/MS) in the United States.MethodsWe developed a questionnaire to collect information on fellowship training focus, duration of training, number of fellows, funding application process, rotations, visa sponsorship, and an open-ended question about challenges facing training in NI/MS. We identified target programs and sent the questionnaires electronically to fellowship program directors.ResultsWe identified and sent the questionnaire to 69 NI/MS fellowship programs. We successfully obtained data from 64 programs. Most programs were small, matriculating 1–2 fellows per year, and incorporated both NI and MS training into the curriculum. Most programs were flexible in their duration, typically lasting 1–2 years, and offered opportunities for research during training. Only 56% reported the ability to sponsor nonimmigrant visas. Most institutions reported having some internal funding, although the availability of these funds varied from year to year. Several program directors identified funding availability and the current absence of national subspecialty certification as major challenges facing NI/MS training.ConclusionOur study is the first to describe the current status of NI/MS training in the United States. We found many similarities across programs. We anticipate that these data will serve as a first step towards developing a standard NI/MS curriculum and help identify areas where shared resources could enhance trainee education despite differences in training environments. We identified funding availability, certification status, and nonimmigrant visa sponsorship as potential barriers to future growth in the field.

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Representation of Women in Pain Medicine Fellowships in the United States, 2017–2018

Pain Medicine ◽

10.1093/pm/pnz274 ◽

2019 ◽

Cited By ~ 1

Author(s):

Tina L Doshi ◽

Hira C Richter ◽

Mariam Salisu ◽

Christelle Samen

Keyword(s):

United States ◽

Role Models ◽

The United States ◽

Women In Leadership ◽

Leadership Roles ◽

Pain Medicine ◽

Fellowship Program ◽

Representation Of Women ◽

Fellowship Programs ◽

And Gender

AbstractObjectiveTo quantify the representation of women trainees and faculty and to explore associations between them at Pain Medicine (PM) fellowship programs in the United States.SettingPM fellowship programs accredited by the Accreditation Council for Graduate Medical Education.MethodsAll PM programs approved for at least four fellows as of December 2017 were identified. Websites of these programs were reviewed to determine the number and gender of current fellows and faculty, and programs were contacted to verify the information.ResultsA total of 56 PM programs were eligible; of these, 48 PM programs (86%) provided information about the gender distribution of fellows. Women comprised ∼25% of PM fellows. PM programs with a female rather than male fellowship program director (PD) had 2.40 times increased odds of a female trainee. Proportion of female faculty and division chief gender were not significantly associated with trainee gender composition. The adjusted odds of a faculty member being female was 1.99 times greater for PM programs with a female vs male PD and 3.13 times greater for programs with a female vs male division chief.ConclusionsWomen are underrepresented throughout all levels of academic pain medicine. The presence of women in leadership roles is associated with higher proportions of female trainees and faculty, highlighting the need for more female role models in academic pain medicine.

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How are residents trained in neuropathology? A survey of neurology program directors in the United States

10.1101/2020.08.16.20176222 ◽

2020 ◽

Author(s):

Appaji Rayi ◽

Kiran Rajneesh ◽

Vineet Punia ◽

Amanda Start

Keyword(s):

United States ◽

Residency Training ◽

Assessment Tool ◽

Descriptive Analysis ◽

Program Directors ◽

The United States ◽

Categorical Variables ◽

Child Neurology ◽

Service Training ◽

Program Characteristics

To understand the current state of neuropathology education during neurology residency training in the United States, we electronically distributed a 16-item survey to 150 adult and 70 child neurology program directors (PDs). The survey inquired about their residency program characteristics, neuropathology curriculum and assessment methods, trainee performance in the subject and attitude about neuropathology education. Descriptive analysis was used to summarize categorical variables as frequencies and percentages and continuous as means and standard deviations. We conducted a series of Mann-Whitney U and Fishers exact tests to evaluate differences between various program characteristics. Sixty-four (29%) PDs responded to the survey, including 45 (30%) adult and 19 (27%) child neurology PDs. Thirty-one programs required a dedicated neuropathology rotation typically during the latter years of the program. Residency in-service training exam (RITE) was the main assessment tool (92%) for assessing the trainees knowledge in neuropathology. Overall, 87% of the PDs agreed that neuropathology is essential and 85% agreed that there is a clear need for a defined neuropathology curriculum during residency training. There was no difference in the RITE scores between programs with and without a dedicated neuropathology rotation. We conclude that a neuropathology rotation was felt to be essential even though the RITE scores did not differ between programs with and without a dedicated rotation. Alternative evaluation methods and neuropathology training techniques such as web modules, virtual reality may be helpful tools to optimize training and need consideration.

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Cardiac Arrests and Deaths Associated with Malignant Hyperthermia in North America from 1987 to 2006

Anesthesiology ◽

10.1097/aln.0b013e318167aee2 ◽

2008 ◽

Vol 108 (4) ◽

pp. 603-611 ◽

Cited By ~ 88

Author(s):

Marilyn Green Larach ◽

Barbara W. Brandom ◽

Gregory C. Allen ◽

Gerald A. Gronert ◽

Erik B. Lehman

Keyword(s):

United States ◽

Cardiac Arrest ◽

Malignant Hyperthermia ◽

Odds Ratio ◽

Anesthetic Management ◽

The United States ◽

Exclusion Criterion ◽

Categorical Variables ◽

Continuous Variables ◽

Increased Risk

Background The authors determined associated cardiac arrest and death rates in cases from Canada and the United States as reported to The North American Malignant Hyperthermia (MH) Registry and analyzed factors associated with a higher risk of poor outcomes. Methods The authors searched the database for AMRA (adverse metabolic/musculoskeletal reaction to anesthesia) reports with inclusion criteria as follows: event date between January 1, 1987, and December 31, 2006; "very likely" or "almost certain" MH as ranked by MH Clinical Grading Scale; location in Canada or the United States; and one or more anesthetic agents given. The exclusion criterion was a pathologic condition other than MH independently judged by the authors. Severe MH outcomes were analyzed as regards clinical history and presentation, using Wilcoxon rank sum tests for continuous variables and Pearson exact chi-square tests for categorical variables. A Bonferroni correction adjusted for multiple comparisons. Results Of 291 events, 8 (2.7%) resulted in cardiac arrests and 4 (1.4%) resulted in death. The median age in cases of cardiac arrest/death was 20 yr (range, 2-31 yr). Associated factors were muscular build (odds ratio, 18.7; P = 0.0016) and disseminated intravascular coagulation (odds ratio, 49.7; P < 0.0001). Increased risk of cardiac arrest/death was related to a longer time period between anesthetic induction and maximum end-tidal carbon dioxide (216 vs. 87 min; P = 0.003). Unrelated factors included patient or family history, anesthetic management, and the MH episode. Conclusions Modern US anesthetic practice did not prevent MH-associated cardiac arrest and death in predominantly young, healthy patients undergoing low- to intermediate-risk surgical procedures.

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750. Retrospective Evaluation of the Three-Step EIA/PCR Algorithm as a Cost-Effective Method for Detection and Treatment of Clostridium Difficile Infection

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.947 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S472-S473

Author(s):

Bakri Kulla ◽

patrick Haggerty

Keyword(s):

United States ◽

Clostridium Difficile ◽

Clostridium Difficile Infection ◽

The United States ◽

Hospital Length Of Stay ◽

Categorical Variables ◽

Continuous Variables ◽

True Positive ◽

Positive Rate ◽

Step Algorithm

Abstract Background Clostridium difficile infection (CDI) is the primary cause of infectious diarrhea in the United States. With an estimated 453,000-500,000 burden cases that are associated with 15,000-30,000 deaths annually in the United States. Because of its prevalence, there is a projected 3.2-4.8 billion dollar annual cost for inpatient care related to CDI. For these reasons, accurate and timely detection of CDI is crucial to reduce the morbidity, mortality, and medical costs. Methods This is a retrospective cohort study. Adult patients, aged 18 through 80 years, admitted between 9/1/2016 and 9/30/2017, who presented with diarrhea and received a CDI algorithm test. To assess bivariate associations between true positive and indeterminate positive groups, categorical variables were compared using Chi-Square or Fisher’s exact tests when appropriate, and continuous variables were analyzed using independent samples t-tests. Results The study included 1031 stool samples, of which 853 (82.7%) were CDI negative and 178 (17.3%) were CDI positive. Of the full sample, 265 (25.7%) were GDH (+), 94 (9.1%) were toxin (+), and 84 (8.1%) were PCR (+). In order to examine patient-level variables, the first positive from each patient was included to ensure independence of data points, resulting in 830 unique tests and patients. The true positive rate of this sub-sample was 9.4% (n = 78) and indeterminate positive rate was 8.7% (n = 72). An important findings of the study is that of the patients who were GDH (+)/toxin (-), 87 (50.9%) were PCR (-) and 84 (49.1%) were PCR (+).Table 1 Conclusion The study found that of the patients who are GDH (+) and Toxin (-), the PCR test serves as a proxy for the CDI test. In addition, we demonstrated that whether the patient was true positive by the GDH/Toxin test or indeterminate positive, the outcomes were the same. The only difference was the antibiotic selections for treatment. Performing PCR tests as a part of three-step algorithm prevented nearly half of discrepant patients from being unnecessarily treated with antibiotics and placed on enteric precaution, thereby extending their hospital stay. Finally, by preventing unnecessary antibiotic use, isolation and hospital length of stay, it is proposed that the three-step algorithm effectively reduces hospital cost. Disclosures All Authors: No reported disclosures

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