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ABSTRACT: In recent years, pursuing a second degree during medical school has become an increasingly attractive option. Interested students choose to leave medical school for one or several years, and then return to finish their clinical rotations. However, they often have minimal clinical exposure while completing these degree programmes, and may have difficulty adapting to the clinical environment when returning for their third or fourth year of medical school.
Whereas MD and PhD students tend to have clinical re-entry courses at their medical schools, there are no formal reintegration programmes for medical students who choose to pursue 1- or 2-year degrees.
We designed a 5-day reintegration course based on a hospital service model, with physician assistants or nurse practitioners to aid in student transition to clinical rotations, and describe the experience of a dual-degree medical student participating in this re-entry model.
This model provides the student with both didactic and patient care training, as well as the experience of working with professionals from different backgrounds. As the demand for dual-degree opportunities increases, the implementation of formal re-entry programmes should be considered to ensure students returning to medical school are prepared to begin clinical rotations.
The Clinical Teacher 09/2011; 8(3):164-7.
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ABSTRACT: To evaluate the retrievability and safety of the G2 filter.
A retrospective study of all G2 filter retrievals at a single institution was conducted. Hospital records and imaging studies were reviewed for complications, and factors affecting retrieval were analyzed.
From 2005 to 2009, a total of 139 patients presented for retrieval of their G2 filter, and 131 pairs of pre- and post-placement cavagrams and 39 computed tomography scans were available for analysis. The following findings were recorded: limb penetration (n = 33), tilt greater than 15° (n = 22), local migration greater than 2 cm (n = 17), retained thrombus within the filter (n = 16), deformity (n = 10), inferior vena cava (IVC) occlusion (n = 3), fracture (n = 2), and pulmonary embolism breakthrough (n = 2). A total of 118 filters were removed, with a mean indwelling time of 131.8 days (range, 3-602 d). Indwell time (< 90, 90-180, or > 180 d) did not affect retrieval (P = .4). There were 21 filters (15.1%) left in situ as a result of severe tilt (n = 9), significant thrombus in the filter (n = 5), IVC occlusion (n = 3), filter incorporation into the caval wall (n = 3), or lack of central venous access (n = 1). There was a strong relationship between penetration and caudal migration (P < .0001). Severe tilt was associated with prolonged fluoroscopic times for retrieval (P = .003).
The majority of G2 filters can be removed without difficulty. The most common factor affecting retrieval was severe tilting. The indwelling time had no impact on retrieval. G2 filter-related complications were frequent but most, including fractures, were clinically insignificant.
Journal of vascular and interventional radiology: JVIR 06/2011; 22(6):806-12. · 1.81 Impact Factor
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ABSTRACT: Because medical students have many different learning styles, the authors, medical students at Mayo Clinic, College of Medicine researched the history of anatomical specimen procurement, reviewing topic-related film, academic literature, and novels, to write, direct, and perform a dramatization based on Robert Louis Stevenson's The Body-Snatcher. Into this performance, they incorporated dance, painting, instrumental and vocal performance, and creative writing. In preparation for the performance, each actor researched an aspect of the history of anatomy. These micro-research projects were presented in a lecture before the play. Not intended to be a research study, this descriptive article discusses how student research and ethics discussions became a theatrical production. This addition to classroom and laboratory learning addresses the deep emotional response experienced by some students and provides an avenue to understand and express these feelings. This enhanced multimodal approach to"holistic learning" could be applied to any topic in the medical school curriculum, thoroughly adding to the didactics with history, humanities, and team dynamics.
Anatomical Sciences Education 09/2010; 3(5):244-8. · 2.98 Impact Factor
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ABSTRACT: The transition from medical student to intern is inherently stressful, with potentially negative consequences for both interns and patients.
We describe Internship Boot Camp, an innovative course specifically designed to prepare fourth-year medical students for the transition from medical school to internship. An intensive 1-week course, Internship Boot Camp has simulated, longitudinal patient-care scenarios that use high-fidelity medical simulation, standardized patients, procedural task trainers, and problem-based learning to help students apply their knowledge and develop a framework for response to the challenges they will face as interns.
In March 2007, 12 students participated in the course as an elective in their final year of medical school, and the other 28 students in their class did not. After beginning internship and 5 to 7 months after the completion of Internship Boot Camp, all 40 former students were asked to complete a blinded survey about their preparation for internship. The overall response rate for the survey was 80%. Of responders to an open-ended question about the aspects of medical school training that best prepared them for internship, 89% (8 of 9) of course participants listed "Internship Boot Camp." The next highest response ("subinternship") was given by 45% (9 of 20) of nonparticipants and 33% (3 of 9) of course participants.
Internship Boot Camp is a unique learning environment that is recalled by participants as the most helpful, of all components of their medical school education, in preparation for internship.
Simulation in healthcare: journal of the Society for Simulation in Healthcare 06/2010; 5(3):127-32. · 1.83 Impact Factor
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ABSTRACT: Literature-centered medicine is a nontraditional learning method developed to supplement medical didactic curricula. With this method, a work of medically related fiction was used as a starting point in the exploration of various historical and contemporary topics. The project initially involved reading Morton Thompson’s The Cry and the Covenant, a fictionalized biography of the Hungarian obstetrician Ignac Semmelweis, known for promoting antisepsis in nineteenth-century Europe. Subsequently, a branching analysis of five major topics generated from this work was conducted. Multiple parallels were identified between nineteenth-century and twenty-first century medical communities. The group concluded that approaching medicine from this nontraditional angle was an intellectually stimulating way to learn and an excellent supplement to didactic education. Literature-centered medicine led to an exploration of issues that would have otherwise been overlooked in a standard learning environment, while also providing an opportunity to apply history to the understanding of modern medical practice.
Eä : Revista de Humanidades Médicas & Estudios Sociales de la Ciencia y la Tecnología. 01/2010;
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Mayo Clinic Proceedings 07/2009; 84(6):492. · 5.70 Impact Factor
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ABSTRACT: Sister Mary Joseph's nodule is referred to a metastatic lesion of the umbilicus originating from intra-abdominal or pelvic malignant disease. Metastases from other locations have been also reported. In 1949 the English surgeon Sir Hamilton Bailey coined this term after Sister Mary Joseph (1856-1939), a superintendent nurse at St. Mary's Hospital in Rochester, Minnesota, USA, who was the first to observe the association between the umbilical nodule and intra-abdominal malignancy. In this article, we discuss both the historical and clinical perspectives of Sister Mary Joseph's nodule.
The American Journal of the Medical Sciences 05/2009; 337(4):271-3. · 1.39 Impact Factor
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ABSTRACT: To determine whether the effectiveness of arterial embolization in patients with acute upper gastrointestinal hemorrhage is related to the visualization of contrast medium extravasation at angiography.
Transcatheter embolization was performed in 108 patients who experienced acute upper gastrointestinal hemorrhage during a 5-year period. Patient charts were retrospectively reviewed. Thirty-six patients who underwent embolization after angiography demonstrated active contrast medium extravasation from an involved artery. Seventy-two patients underwent embolization in the absence of contrast medium extravasation into a bowel lumen. Embolization technique, requirement for further blood products, need for further surgery, and 30-day mortality were recorded.
The gastroduodenal artery (GDA) was embolized in 26 of the 36 patients (72%) with extravasation, and the left gastric artery was embolized in 10 (28%). The GDA was embolized in 64 of the 72 patients (89%) without extravasation, and the left gastric artery was embolized in 13 (18%). After embolization, 23 of the 36 patients (64%) with extravasation and 44 of the 72 (61%) without extravasation required additional blood product transfusions. Seven of the 36 patients (19%) with extravasation and 16 of the 72 (22%) without extravasation required subsequent surgery secondary to bleeding. Thirty-day hemorrhage-related mortality was 17% (six of 36 patients) in the positive extravasation group and 22% (16 of 72 patients) in the negative extravasation group. The treatment success rate was 44% (16 of 36 patients) in the positive extravasation group and 44% (32 of 72 patients) in the negative extravasation group.
In patients with acute upper gastrointestinal hemorrhage, arterial embolization is equally effective in patients who demonstrate active contrast medium extravasation at angiography as in those who do not show contrast extravasation.
Journal of vascular and interventional radiology: JVIR 05/2009; 20(4):461-6. · 1.81 Impact Factor
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ABSTRACT: To determine the incidence and risk factors for surgical intervention after uterine artery embolization for symptomatic uterine fibroids.
Electronic medical records of all patients who underwent uterine artery embolization for symptomatic uterine leiomyomata were reviewed. Logistic regression was used to identify independent risk factors for any surgical intervention and for hysterectomy alone after uterine artery embolization.
Uterine artery embolization was performed in 454 patients during the study period, with a median follow-up time (range) of 14 (0-128) months. Overall, 99 patients (22%) underwent any surgical intervention after uterine artery embolization in the operating room. Risk factors for any surgical intervention included younger age (P < .003), bleeding as an indication for uterine artery embolization (P < .01), presence of significant collateral ovarian vessel contribution to the uterus (P < .01), or use of 355-500 mum particles (P < .008).
Patients undergoing uterine artery embolization have a 22% risk for requiring additional surgical intervention, but overall uterine artery embolization is an effective minimally invasive option.
American journal of obstetrics and gynecology 12/2008; 199(6):671.e1-6. · 3.28 Impact Factor
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ABSTRACT: In patients with acute lower gastrointestinal bleeding, colonoscopy is the initial test of choice. But when colonoscopy gives indeterminate results or cannot be performed, either radionuclide imaging or angiography is indicated.
Cleveland Clinic Journal of Medicine 07/2007; 74(6):417-20. · 3.77 Impact Factor
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ABSTRACT: Uterine leiomyomata are a frequent finding in a gynecologist’s practice. Until recently, options for management have been limited. A relatively new procedure is gaining popularity as another option for a select group of patients. The treatment of choice for definitive management remains hysterectomy. However, uterine artery embolization (UAE) can be considered in certain women. We discuss the indications, benefits, risks, and potential complications of UAE. We review recent literature including results and complication rates. A proposed protocol is introduced for patient selection, preoperative assessment, and postprocedural follow-up. A coordinated effort is recommended, including incorporating a multiteam approach with the interventional radiologist, pain management service, and gynecologist. A brief technical review of the procedure is included. (Primary Care Update Ob/Gyns 2001;8:232–239
Primary Care Update for OB/GYNS.
