Rapid Mobilization of Medical Student Volunteers to Administer Vaccines During the COVID-19 Pandemic

In December 2020, the first COVID-19 vaccines were approved for emergency use by the U.S. Food and Drug Administration, and vaccination efforts rapidly launched across the country. Concurrently, New York City experienced an increase in COVID-19 hospitalizations. This created an immediate need to inoculate frontline workers in a strained health system that lacked sufficient personnel to meet the demand. In response, New York State permitted medical students with appropriate clinical experience to administer vaccinations. Albert Einstein College of Medicine students rapidly stepped in to administer vaccines and serve as clinic navigators. Student leaders at Einstein collaborated with Montefiore Medical Center to rapidly implement a student vaccination initiative. Medical students underwent virtual and on-site training regarding COVID-19 vaccines and their administration. In January 2021, students began to staff vaccine clinics across the Bronx. By July 2021, 291 out of 830 eligible medical and Medical Scientist Training Program (MSTP) students (35.1%) had volunteered >2400 h. Of the 291 volunteers, 77 (26.5%) worked as vaccinators and administered approximately 2929 COVID-19 vaccines from January to May 2021. We demonstrate success using the concept of Entrustable Professional Activities (EPAs) in the context of training medical students in a specific clinical skill. Our framework resulted in the administration of approximately 2929 COVID-19 vaccines from January to May 2021. The authors believe that this framework can be implemented at peer institutions to alleviate the burden on hospital systems and outpatient clinics vaccinating their communities against COVID-19, or to meet future clinical needs.

Reducing time to differentiated service delivery for newly diagnosed people living with HIV in Kigali, Rwanda: study protocol for a pilot, unblinded, randomised controlled study

IntroductionCurrent HIV guidelines recommend differentiated service delivery (DSD) models that allow for fewer health centre visits for clinically stable people living with HIV (PLHIV). Newly diagnosed PLHIV may require more intensive care early in their treatment course, yet frequent appointments can be burdensome to patients and health systems. Determining the optimal parameters for defining clinical stability and transitioning to less frequent appointments could decrease patient burden and health system costs. The objectives of this pilot study are to explore the feasibility and acceptability of (1) reducing the time to DSD from 12 to 6 months after antiretroviral therapy (ART) initiation,and (2) reducing the number of suppressed viral loads required to enter DSD from two to one.Methods and analysesThe present study is a pilot, unblinded trial taking place in three health facilities in Kigali, Rwanda. Current Rwandan guidelines require PLHIV to be on ART for ≥12 months with two consecutive suppressed viral loads in order to transition to less frequent appointments. We will randomise 90 participants to one of three arms: entry into DSD at 6 months after one suppressed viral load (n=30), entry into DSD at 6 months after two suppressed viral loads (n=30) or current standard of care (n=30). We will measure feasibility and acceptability of this intervention; clinical outcomes include viral suppression at 12 months (primary outcome) and appointment attendance (secondary outcome).Ethics and disseminationThis clinical trial was approved by the institutional review board of Albert Einstein College of Medicine and by the Rwanda National Ethics Committee. Findings will be disseminated through conferences and peer-reviewed publications, as well as meetings with stakeholders.Trial registration numberNCT04567693.

First person – Pragya Chandrakar

ABSTRACTFirst Person is a series of interviews with the first authors of a selection of papers published in Journal of Cell Science, helping early-career researchers promote themselves alongside their papers. Pragya Chandrakar is first author on ‘Jagged–Notch-mediated divergence of immune cell crosstalk maintains the anti-inflammatory response in visceral leishmaniasis’, published in JCS. Pragya conducted the research described in this article while a Senior Research Fellow in Dr Susanta Kar's lab at the CSIR Central Drug Research Institute, Lucknow, India. She is now a Postdoctoral Research Fellow in the lab of Dr John Chan at Albert Einstein College of Medicine, New York, USA, investigating the different possible mechanisms by which foreign pathogens breach the immune system.

First person – Juan Flores and Peter M. Takvorian

ABSTRACT First Person is a series of interviews with the first authors of a selection of papers published in Journal of Cell Science, helping early-career researchers promote themselves alongside their papers. Juan Flores and Peter M. Takvorian are co-first authors on ‘Human microsporidian pathogen Encephalitozoon intestinalis impinges on enterocyte membrane trafficking and signaling’, published in JCS. Juan is a PhD student in the lab of Nan Gao, at Newark, New Jersey, USA, investigating the role of the underappreciated intestinal microbiome and pathogens by profiling their metabolic and transcriptional impacts on host cells. Peter is a Visiting Research Associate Professor (Rutgers) and Visiting Assistant Professor of Pathology (Albert Einstein College of Medicine) in the lab of Ann Cali (Rutgers, Newark, USA) and Louis M. Weiss (Albert Einstein College of Medicine, New York, USA) investigating ultrastructural studies of the host cell interaction and pathological effects of intracellular parasites and viruses.

Knowledge Mapping of Migraine: a Bibliometric Analysis (2000-2019)

Background: There has been rapid development of migraine research in the past 20 years in China and around the world. We analyzed the development trend of migraine research, and made a bibliometric analysis on the growth trend of the total number of publications, countries, institutions, authors, cited references and keywords from 2000 to 2009 and 2010 to 2019 by applying visualization software, and constructed the relevant knowledge map, and found the trends and hot spots in the field through comparison. Methods: Retrieved the literature on migraine in the Web of Science database from 2000-2009 and 2010-2019 respectively, and then utilized CiteSpace to conduct bibliometric analysis to acquire the knowledge mapping. Results: The total number of publications each year has increased year by year, and the average annual growth rate from 2000 to 2009 was 7.999%, while from 2010 to 2019 was 5.348%, with a faster growth rate from 2000 to 2009. According to the cluster analysis of institutions, authors, cited references, and keywords, 10/11, 12/11, 12/11, and 8/9 categories were obtained from 2000 to 2009 and 2010 to 2019 respectively. The most productive countries, institutions, and authors are the USA, Albert Einstein College of Medicine, and Lipton RB from 2000 to 2009 and 2010 to 2019, whose frequency is 4274/7107, 322/592, and 279/472 respectively. However, the most important of them are Belgium/ Pakistan, Houston Headache Clin/ Amgen Inc, and Lipton RB/ Klatt J, owing to their highest centrality, they are 1.20/1.08, 1.13/1.32, and 1.22/0.89 separately. Moreover, Cited references that contributed to the most co-citations are Silberstein SD (2004)/ Bes A (2013) from 2000 to 2009 and 2010 to 2019, however, the most vital cited reference is Welch KMA (2001)/ Goadsby PJ (2017). Keywords such as migraine, headache, prevalence, and the double blind are the most frequently used. But prevalence is the crucial keyword. In the cluster analysis of institutions, authors, cited references, and keywords from 2000 to 2009 and 2010 to 2019, the more convincing research categories are potential anti-migraine agent/ chronic migration prevention, reducing headache recurrence/ following symptomatic treatment, to-left shunt/ placebo controlled phase, spectrum study/ family study hemiplegic migraine, with S values of 0.952/0.956, 0.985/0/986, 0.981/0.970 and 0.985/0.982 respectively. Furthermore, the hotspots in this field are “stimulation”, “triptan” from 2000 to 2009 and 2010 to 2019. Conclusion: Based on the bibliometric analysis in the past 20 years, the knowledge mapping of the country, institution, author, cited reference, and the keyword is gained, which has an important guiding significance for quickly and accurately positioning the trend in this field.

The Effect of COVID-19 on Training and Case Volume of Vascular Surgery Trainees

Background: In many facilities, the coronavirus disease (COVID-19) pandemic caused suspension of elective surgery. We therefore sought to determine the impact of this on the surgical experience of vascular trainees. Methods: Surgical case volume, breadth, and the participating trainee post-graduate level from 3 large New York City Hospitals with integrated residency and fellowship programs (Mount Sinai, Montefiore Medical Center/Albert Einstein College of Medicine, and New York University) were reviewed. Procedures performed between February 26 to March 25, 2020 (pre-pandemic month) and March 26 to April 25, 2020 (peak pandemic period) were compared to those performed during the same time period in 2019. The trainees from these programs were also sent surveys to evaluate their subjective experience during this time. Results: The total number of cases during the month leading into the peak pandemic period was 635 cases in 2019 and 560 cases in 2020 (12% decrease). During the peak pandemic period, case volume decreased from 445 in 2019 to 114 in 2020 (74% reduction). The highest volume procedures during the peak pandemic month in 2020 were amputations and peripheral cases for acute limb ischemia; during the 2019 period, the most common cases were therapeutic endovascular procedures. There was a decrease in case volume for vascular senior residents of 77% and vascular junior and midlevel residents of 75%. There was a 77% survey response rate with 50% of respondents in the senior years of training. Overall, 20% of respondents expressed concern about completing ACGME requirements due to the COVID-19 pandemic. Conclusions: Vascular surgery-specific clinical educational and operative experiences during redeployment efforts have been limited. Further efforts should be directed to quantify the impact on training and to evaluate the efficacy of training supplements such as teleconferences and simulation.

Development of a Positive Psychology Program (LAVENDER) for Preserving Medical Student Well-being: A Single-Arm Pilot Study

Background Mental health tends to worsen over the course of medical school, with steep declines in well-being in students’ clerkship year (M3). Positive emotion promotes adaptive coping to stress and may help preserve medical student well-being. Objective This study describes the development of LAVENDER (Leveraging Affect and Valuing Empathy for Nurturing Doctors’ Emotional Resilience), a program aimed at increasing positive emotion to preserve well-being in medical students. Methods We conducted a single-arm pilot of LAVENDER, a positive psychology intervention developed for medical students delivered in an interactive classroom format to a cohort of 157 third-year medical students at the Albert Einstein College of Medicine. Our primary outcome was the acceptability of LAVENDER. We also examined preliminary efficacy using measures of emotion, stress and burnout collected at each intervention session. Results LAVENDER showed good acceptability: 76% of participants agreed that the LAVENDER skills were useful and 72% agreed that they would recommend the LAVENDER program to others. Qualitative feedback suggested that medical students enjoyed the program and found the skills to be useful for coping with stress, but also reported the following barriers to engagement: lack of time to practice the skills, resistance to the mandatory nature of the wellness sessions, and difficulty integrating the skills in daily life. We did not find support for the preliminary efficacy of LAVENDER for improving medical student well-being in students’ clerkship year. Participants showed decreases in positive emotion and increases in symptoms of burnout over the intervention period ( ps < .01). Conclusion The current paper describes the development and a single-arm pilot test of LAVENDER, a positive psychology program tailored for medical students. Although we found preliminary evidence for the acceptability of LAVENDER, we did not find support for the preliminary efficacy. Lessons learned and next steps for the program are discussed.

Mater Artium Necessitas: The Birth of a COVID-19 Command Center

In February of 2020, New York City was unprepared for the COVID-19 pandemic. Cases of SARS-CoV-2 infection appeared and spread rapidly. Hospitals had to repurpose staff and establish diagnostic testing for this new viral infection. In the background of the usual respiratory pathogen testing performed in the clinical laboratory, SARS-CoV-2 testing at the Montefiore Medical System grew exponentially, from none to hundreds per day within the first week of testing. The job of appropriately routing SARS-CoV-2 viral specimens became overwhelming. Additional staff was required to triage these specimens to multiple in-house testing platforms as well as external reference laboratories. Since medical school classes and many research laboratories shut down at the Albert Einstein College of Medicine and students were eager to help fight the pandemic, we seized the opportunity to engage and train senior MD-PhD students to assist in triaging specimens. This volunteer force enabled us to establish the “Pathology Command Center,” staffed by these students as well as residents and furloughed dental associates. The Pathology Command Center staff were tasked with the accessioning and routing of specimens, answering questions from clinical teams, and updating ever evolving protocols developed in collaboration with a team of Infectious Disease clinicians. Many lessons were learned during this process, including how best to restructure an accessioning department and how to properly onboard students and repurpose staff while establishing safeguards for their well-being during these unprecedented times. In this article, we share some of our challenges, successes, and what we ultimately learned as an organization.

Moving Medical Students into Shared Housing During the COVID-19 Pandemic

A new academic year began in the midst of the COVID-19 pandemic. In order to allow for in-person learning, a fundamental part of medical education, some medical schools grappled with how to safely move students into shared on-campus housing. The authors describe a behavior-based strategy to safely move students from all parts of the United States to the Albert Einstein College of Medicine in the Bronx, New York. This strategy included a school-organized phased move-in that included 14-day quarantines for students coming from states with high COVID prevalence; requiring students to sign a COVID-agreement; the use of a phone-based daily COVID risk assessment; and facilitation of safe in-person social activities with peer monitoring of adherence to behavior guidelines. This strategy resulted in no known transmission of SARS-CoV-2 in student housing between July and October of the 2020 to 2021 academic year. The authors share this strategy in the hope that colleagues at other medical schools will find it useful in utilizing similar behavior-based strategies to keep students safe in shared housing.