Pimping: Valuable Teaching Tool or Mistreatment? Perceptions of Medical Students and Faculty Differ.

ImportanceThe AAMC Graduate Questionnaire has drawn attention to medical student mistreatment. Pimping, a form of Socratic teaching often used in medical education where students are singled out by faculty for questioning, may be considered by some students and faculty as mistreatment. To date, minimal research has been performed on the viewpoints of students and faculty regarding pimping and its relation to mistreatment. ObjectiveThis study aims to formally define pimping and determine if there is a difference in the perception of students and faculty on its role in medical education.Design: Medical students and faculty of Michigan medical schools were surveyed via electronic questionnaire. Chi-squared and Fisher’s exact tests were performed.SettingMedical schools within the state of Michigan ParticipantsStudents who had completed their core clerkships and faculty with experience educating medical students in a clinical setting ResultsThe student response rate was 42%; the faculty response rate could not be determined. The majority of students agreed with our operational definition of pimping and 100% had experienced pimping. 54% of students reported a positive experience with pimping, 26% neutral, and 20% reported a negative experience. The majority of students reported it was challenging and educational and should be used regularly. Several differences were found between students and faculty as to why faculty use pimping. Students’ perception of their role on the clinical care team influenced their perception of pimping as mistreatment, and students reported pimping made them feel more a part of the team.Conclusion and relevanceThis study helps to define pimping and sheds more light on the perceptions of pimping from students and faculty and their differences. Most medical students report a benefit from pimping, even though it may be stressful, and suggest it should be used regularly, which is in contrast to faculty opinion. Pimping may make students feel more a part of the clinical care team, but their role on the team may not influence whether they perceive it as mistreatment.  Our data suggest medical schools should educate students and faculty on pimping and not move toward discouraging or banning it.

Phleboliths mistaken for intraperitoneal copper-containing intrauterine device in the presence of missing strings

Although rare, pelvic phleboliths may confound the diagnosis of an intraperitoneal or malpositioned intrauterine device (IUD). Pelvic phleboliths are focal calcifications in pelvic veins, often in multiples near the ureters, occurring in about 40% of adult patients. We treated a 35-year-old woman requesting removal of her copper-containing IUD (TCu380A IUD). She had missing IUD strings on clinical examination. A clinic-based transvaginal ultrasound and anteroposterior abdominal radiograph that followed suggested prior TCu380A IUD expulsion. A radiologist later interpreted several ambiguous radiodensities in the abdominal radiograph as a possible intraperitoneal or malpositioned IUD. In collaboration with radiologists and family planning specialists, it was suggested that the patient further undergo a three-dimensional ultrasonography and a CT of the pelvis. The radiodensities first noted on the radiograph were revealed to be phleboliths, a diagnostic possibility not initially considered by any of the primary clinical care team, radiologists or family planning specialists.

A guide for pre-procedural imaging for transcatheter aortic valve replacement patients

Safe and accurate pre-procedural assessment of cardiovascular anatomy, physiology, and pathophysiology prior to TAVR procedures can mean the difference between success and catastrophic failure. It is imperative that clinical care team members share a basic understanding of the preprocedural imaging technologies available for optimizing the care of TAVR patients. Herein, we review current imaging technology for assessing the anatomy, physiology, and pathophysiology of the aortic valvular complex, ventricular function, and peripheral vasculature, including echocardiography, cardiac catheterization, cardiac computed tomography, and cardiac magnetic resonance prior to a TAVR procedure. The authorship includes cardiac-trained anesthesiologists, anesthesiologists with expertise in pre-procedural cardiac assessment and optimization, and interventional cardiologists with expertise in cardiovascular imaging prior to TAVRs. Improving the understanding of all team members will undoubtedly translate into safer, more coordinated patient care.

Patient-reported pain and pain medication impact in patients with HR+ Her2-neg advanced breast cancer: A U.S. FDA pooled analysis.

e13027 Background: Despite the ubiquitous prescribing of pain medications (PMs) in cancer clinical trials, the impact of such prescribing patterns and reporting on the experience of pain is not often investigated. We examined patient-reported pain before initiation of PM reporting and at the next available pain assessment. Our aim was to understand change in patient-reported pain. Methods: We pooled data from 7 phase 3 randomized, controlled, registration trials of CDKI with endocrine therapy in patients with hormone receptor positive, human epidermal growth factor receptor-2 negative MBC. We restricted our analyses to patients who started therapy with no PM reported and looked at patients who had NSAID or opioid medication documented. We calculated change between 2 assessments in patient-reported pain before and after PM using the pain occurrence item (Q9) on the EORTC Quality of Life questionnaire (QLQ-C30). Results: Of the 4200 patients who received at least 1 dose of CDKI/placebo, 1488 started with no documented PM, with 48% reporting none at all when asked about pain at baseline. Subsequently, 185 patients had documented NSAID and 43 an opioid and had a pain PRO assessment before and after. NSAIDs documentation occurred on average 11 weeks into trial and opioids 5. Before documentation of NSAIDs, 45% of patients reported no pain compared to 23% of patients with an opioid. Patients who had documented NSAIDs, 29% experienced an improvement in their self-reported pain, whereas 32% of patients with documented opioids improved. On average the time between the 2 pain assessments was around 58 days for both PMs. Conclusions: In this analysis in patients who had a pain assessment before and after documentation of a PM, there is a small group whose pain improved. It is important to note that patients’ response to the pain item was not provided to the clinical care team, which may explain why there may have been suboptimal pain control. Further study is needed to examine how pain management can be achieved in patients with advanced breast cancer. Future analysis should be performed with patients whose PRO pain results are communicated with the clinical care team in real-time. [Table: see text]

Clinical Practice Informs Secure Messaging Benefits and Best Practices

Background Clinical care team members in Department of Veterans' Affairs (VA) facilities nationwide are working to integrate the use of Secure Messaging (SM) into care delivery and identify innovative uses. Identifying best practices for proactive use of SM is a key factor in its successful implementation and sustained use by VA clinical care team members and veterans. Objectives A collaborative project solicited input from VA clinical care teams about their local practices using SM to provide access to proactive patient-centered care for veterans and enhance workflow. Methods This project implemented a single-item cross-sectional qualitative electronic survey via internal e-mail to local coordinators in all 23 Veterans Integrated Service Networks (VISNs). Content analysis was used to manage descriptive data responses. Descriptive statistics described sample characteristics. Results VA clinical care team members across 15 of 23 VISNs responded to the questionnaire. Content analysis of 171 responses produced two global domains: (1) benefits of SM and (2) SM best practices. Benefits of SM use emphasize enhanced and efficient communication and increased access to care. Care team members incorporate SM into their daily clinical practices, using it to provide services before, during, and after clinical encounters as a best practice. SM users suggest improvements in veteran care, clinical team workflow, and efficient use of health resources. Clinical team members invested in the successful implementation of SM integrate SM into their daily practices to provide meaningful and useful veteran-centered care and improve workflow. Conclusion VA clinical care team members can use SM proactively to create an integrated SM culture. With adequate knowledge and motivation to proactively use this technology, all clinical team members within the VA system can replicate best practices shared by other clinical care teams to generate meaningful and useful interactions with SM to enrich veterans' health care experience.