The Harvard Medical Student Review (HMSR) is a student-run open access medical journal. Its mission is to provide a platform for students to contribute to important issues facing health and medicine through scholarly articles, reviews, editorials, and original artwork. Contributions are invited from medical students and other professional graduate and health-related programs.
Neurological and Cerebrospinal Fluid Accumulation Effects of Non-Cobalt Metal Ions from Joint Implants: Cognition, Peripheral Neuropathy, and Movement Disorders
Background: Joint arthroplasty remains a cornerstone of orthopedic surgery, restoring mobility and alleviating pain for millions of patients worldwide. With advances in implant longevity and expanding use among younger, more active individuals, attention has turned toward the long-term systemic effects of implant wear and corrosion. While cobalt and chromium toxicity from metal-on-metal designs is well documented, emerging data suggest that non-cobalt metal ions—particularly titanium (Ti), niobium (Nb), zirconium (Zr), and vanadium (V)—may also accumulate in systemic circulation and cerebrospinal fluid (CSF), raising concern for potential neurologic sequelae. Purpose: This review synthesizes current mechanistic and clinical evidence linking non-cobalt metal ion exposure from joint implants to neurologic outcomes, with the goal of informing both orthopaedic and neurology practice. Methods: Recent mechanistic, cohort, and case-based literature was examined to characterize (1) pathways of ion release and systemic accumulation, (2) mechanisms of neural barrier penetration and neurotoxicity, (3) observed neurologic manifestations, and (4) clinical and surveillance implications. Key studies include cross-sectional analyses of blood and CSF metal levels, case reports of neurologic dysfunction, and translational work on metal-induced oxidative and inflammatory injury. Results: Non-cobalt metal ions are released through mechanical wear, fretting, and electrochemical corrosion, subsequently entering systemic circulation and crossing neural barriers. Elevated Ti, Nb, and Zr concentrations have been documented in CSF of arthroplasty patients compared with controls, confirming central nervous system exposure. Mechanistic data implicate oxidative stress, mitochondrial dysfunction, and glial activation in metal-related neurotoxicity. Clinical observations include cognitive decline, peripheral neuropathy, and movement disorders, although large-scale, longitudinal evidence remains limited. No randomized controlled trials have evaluated neurologic endpoints, and standardized surveillance protocols are lacking. Conclusions: While modern joint arthroplasty is highly effective, accumulating evidence supports the biologic plausibility and emerging reality of neurologic effects associated with systemic accumulation of non-cobalt metal ions. Patients with high activity levels, renal impairment, or pre-existing neurologic conditions may be particularly vulnerable. Future research should focus on prospective cohorts linking quantified metal exposure to validated neurologic outcomes, biomarker development, and implant innovations that minimize ion release. Integration of neurologic screening into long-term arthroplasty follow-up may be essential as implant lifespans continue to extend.
Copyright (c) 2026 Ryan Marra (Author) https://creativecommons.org/licenses/by-nc/4.0
Prolonged Seizure with Respiratory Arrest in a Resource-Limited Setting: A Case Managed During an Annual Project World Health Trip in the Dominican Republic
Seizure emergencies in low-resource settings present unique challenges due to limited access to diagnostics, antiepileptic medications, and emergency services. Global health literature emphasizes the importance of rapid, coordinated interventions when standard treatments are unavailable. During the 2025 Project World Health (PWH) service-learning trip in Jarabacoa, Dominican Republic, a male in his early-mid teens with a history of syncopal episodes presented to a temporary outreach clinic. While awaiting referral planning, he became emotionally distressed and developed a generalized tonic–clonic seizure, followed by recurrent seizures and apnea. A care team, including medical students, residents, nurses, pharmacists, and attending physicians, provided continuous monitoring and supportive management with airway protection, bag-valve-mask ventilation, intravenous access, and dextrose-containing fluids. No antiepileptic medications or diagnostic tools were available. The patient experienced prolonged seizure activity with recurrent respiratory arrest, suspected to represent ictal central apnea. Oxygen saturation dropped to 73% but stabilized above 92% with sustained ventilation. Emergency care continued for over 45 minutes until transfer by emergency medical services. He was later hospitalized and discharged without neurologic deficits. This case highlights the clinical and logistical challenges of managing seizure emergencies in resource-limited environments, underscoring the lifesaving potential of rapid, coordinated interdisciplinary action. Even without access to pharmacologic therapy or advanced diagnostics, effective teamwork and decisive supportive care proved critical. Furthermore, this experience illustrates the educational value of global health initiatives like PWH, which foster adaptability, critical thinking, and collaboration. Pre-trip training in emergency protocols, including seizure management, is essential for optimizing patient outcomes in similar contexts.
Copyright (c) 2026 Mónika Domenech Acevedo, Wid Alhassani, Blake DePaul, Michael Niederbrach, David Boughanem, Ava Bruner, Aiden Jaskolka Brown, Eduardo Gonzalez (Author) https://creativecommons.org/licenses/by-nc/4.0
Non-Inferiority Analysis of Levonorgestrel IUD Versus Oral Levonorgestrel for Emergency Contraception: A Systematic Review and Meta-Analysis
Introduction: Emergency contraception (EC) is a critical component of reproductive healthcare, with currently approved oral options including levonorgestrel (LNG) and ulipristal acetate. Although effective, oral EC methods demonstrate reduced efficacy with increasing time since intercourse and higher body mass index (BMI). In contrast, intrauterine devices (IUD), particularly the copper IUD, provide highly effective EC. Emerging evidence suggests that the levonorgestrel IUD may also be a non-inferior option. This systematic review and meta-analysis examined the comparative efficacy of the LNG-IUD versus oral LNG for EC. Methods: Following PRISMA guidelines, PubMed, Scopus, Medline, and ClinicalTrials.gov were searched through December 2024. Five studies (n = 920) met inclusion criteria and were evaluated for risk of bias using the Mixed Methods Appraisal Tool (MMAT). Using a random-effects meta-analysis, we estimated pooled pregnancy proportions with 95% confidence intervals, assessed heterogeneity and publication bias, and conducted a non-inferiority test with a 1% margin to compare the effectiveness of the levonorgestrel IUD versus oral levonorgestrel for EC. Results: This study found an overall pregnancy proportion ≤1%, with no significant differences among LNG-IUD, oral LNG, and copper IUD groups. Non-inferiority testing demonstrated that the LNG-IUD was non-inferior to oral LNG, as the upper bound of the pooled difference (0.008) remained below the 1% margin. Conclusion: Despite limited direct comparison studies requiring subgroup formation, these findings indicate that the LNG-IUD does not confer a clinically meaningful increase in pregnancy risk compared with oral LNG when used for EC. The findings suggest that LNG-IUD could be a promising alternative to oral LNG for EC, offering both immediate and long-term contraception. Further large-scale, direct comparative studies are warranted to expand EC options for women.
Copyright (c) 2026 Andie Blankenstein, Jenna Currier, Catherine Crow, Bhakthi Liyanage, Emily Hock, Erin Williams, Dr. Neli Ragina, Dr. Alexa Shepherd (Author) https://creativecommons.org/licenses/by-nc/4.0
When Medicine Meets Mortality: Rethinking Medical Futility Through a Cultural Lens
Medical futility, or treatment unlikely to produce meaningful benefit, generates some of healthcare’s most difficult ethical conflicts. Physicians assess benefit through evidence-based metrics, while families interpret these situations through frameworks shaped by culture, faith, and personal values. This disconnect fuels tension, especially around end-of-life care, where aggressive intervention may cause suffering even as families view withdrawal as abandonment. I examine how cultural attitudes influence these decisions and argue that current “cultural competency” training may inadvertently worsen conflicts by encouraging demographic stereotyping rather than genuine listening. Effective navigation requires early communication, institutional flexibility, and acknowledging medicine’s inability to answer questions about life’s meaning.
Copyright (c) 2026 Rida Ghani (Author) https://creativecommons.org/licenses/by-nc/4.0
We are pleased to present the newest issue of the Harvard Medical Student Review. The work collected here asks readers to pay closer attention: to the experiences that shape care, to the questions that emerge in clinical training, and to the evidence through which medicine examines and improves itself.
Copyright (c) 2026 Cameron Young, Keegan Mendez, Evan Dennis, Samuel Steuart, Lynn Bi, Seerat Chawla, Anna Wadhwa, Arya Rao (Author) https://creativecommons.org/licenses/by-nc/4.0
Investigating the Need for Prehospital Education to Include Sex Differences in the Clinical Presentation of Stroke
Copyright (c) 2026 Anna Slebonick, Kristen Ryczak, MD (Author) https://creativecommons.org/licenses/by-nc/4.0
Are medical students biased toward chronic pain patients?
Background: Little research has been done into exploring medical students' perspectives of chronic pain patients despite increasing media attention on the opioid epidemic and their encounters during medical school. Methods: To investigate, all medical students at Michigan State University College of Human Medicine were emailed an invitation to voluntarily participate in an online survey. Students were randomized between two identical patient vignettes, one was the control and the other was identical with the exception of a history of chronic back pain and opioid dependence. Students were then asked a series of questions regarding their perceptions, biases, and attitudes towards the patient in their vignette. Eleven questions were asked using a 0-10 scale. Results: Results between the control and pain patient were quantified using an unpaired t-test. Students rated the chronic pain patient worse than the control in 8 of the 11 questions. Discussion: Our survey showed that medical students had more negative perceptions of chronic pain patients in terms of their health, self-care, self-discipline, and compliance.
Copyright (c) 2020 Genevieve Pourzan, Alberto Tamayo, Muhammad Nabeel (Author) https://creativecommons.org/licenses/by-nc/4.0
Evidence-Based Policy Can Help Massachusetts Stay On Top Of Gun Violence
The following essay provides an argument for the implementation of evidence-based gun control policies in Massachusetts. This argument is based on the disturbing trauma witnessed in the emergency room at Brigham & Women's Hospital, as well as the stagnant gun control rate over the last decade in our state. The argument is further supported by Dr. Hemenway's gun policy research and international policies that highlight the effectiveness of laws that strengthen background checks and limit gun ownership.
Copyright (c) 2020 David E. Velasquez, Pooja U. Neiman, Bethany Strong (Author) https://creativecommons.org/licenses/by-nc/4.0
All that Glitters: A Perspective on Peer Reviewed Publications
As trainees and even as established clinicians, we are often gifted the following wisdom: pursue your passions, but make sure your passions are productive. The hidden meaning embedded in this term "productive" is that these passions should culminate in not just any form of scholarly material, but a peer reviewed paper. In an exploration of the origins and present state of peer review and its role for both the individual clinician and academic medicine at large, what follows is a discussion of the peer-reviewed publication as the "gold standard" of productivity, and what alternatives might be considered.
Copyright (c) 2020 Danielle Jameison, Sheila Lee (Author) https://creativecommons.org/licenses/by-nc/4.0
Large benign granular cell tumor with skin involvement: a case report
Granular cell tumors (GCT) are a rare soft tissue neoplasm of Schwann cell origin. This form of tumor is generally benign (0.5-2% malignant) and in these cases, involvement of the skin and deeper structures are not common, presenting usually as a solitary, slow-growing, painless mass. This case report presents a 43-year-old woman with multiple benign slow growing masses on the back for 15 years, later biopsied to reveal benign granular cell tumor. Wide local excision of 2 masses and placement of wound VAC was performed by plastic surgery team with primary specimen measuring 11.5 x 12.5 x 2.5cm with skin and deep structure involvement, and a smaller mass measuring 6 x 3.1 & 5 x 2.1cm. Split-thickness skin graft was performed a week after confirmation from pathology on its benign nature. This case highlights an abnormal presentation of benign GCT due to size, skin and deep structure involvement, multiple lesions and appropriate management.
Copyright (c) 2020 Tristan Nguyen-Luu (Author) https://creativecommons.org/licenses/by-nc/4.0
Sickle cell anemia (SCA) is one of the most prevalent genetic disorders in the world and the most common congenital anemia in the United States. The severity of SCA spans from mild clinical cases, managed by careful living, to severe cases involving bone crises, infection, stroke, and multi-organ failure. Hematopoietic stem cell transplantation (HSCT) is the most widely known and effective method to cure the disease and is used today in only severe cases due to risks of graft rejection and fatal infections. The use of stem cells for the cure of sickle cell disease from the early days of transplantation to the most recent breakthroughs in stem cell therapy, gene therapy and genome-editing will be examined in this review.
Copyright (c) 2020 Tolulope O. Rosanwo (Author) https://creativecommons.org/licenses/by-nc/4.0
The Neural Underpinnings of Sacral Neuromodulation Therapy for Functional Gastrointestinal Disorders
Sacral Neuromodulation (SNM) is an established nerve stimulation treatment for Functional Gastrointestinal Disorders (FGIDs) such as Faecal Incontinence (FI), Slow Transit Constipation (STC) and ileus. SNM may involve the surgical placement of electrodes against the sacral roots of the spinal cord to alter the physiological function of the target organs. It can also be performed by using Transcutaneous Electrical Nerve Stimulation (TENS) which is a non-invasive and cost-effective SNM technique consisting of placing electrodes on the intact skin instead of implantation. However, despite the increasing application of this therapy, the neural underpinnings of SNM are poorly understood. One of the consequences of this poor understanding is that currently SNM is administrated on a trial-and-error basis and there are no standard guidelines on the optimal therapeutic parameters.
Copyright (c) 2020 Mitra Shokrollahi (Author) https://creativecommons.org/licenses/by-nc/4.0
Self-Tracking, Hacking, or Slacking? Health Justice in an Era of mHealth Technology
As the doctor-patient relationship continues to evolve, there is increased enthusiasm for the role of mHealth technologies (smartphone apps or wearable sensors that monitor/log health-related functions) in the promotion of precision medicine. But numerous challenges have also emerged in the collection, transmission, and storage of personal health data. This paper addresses the ethical, legal, and public policy implications of mHealth use in the just allocation of health care resources. First, it utilizes Beauchamp and Childress' four principles of medical ethics (autonomy, beneficence, nonmaleficence, and justice) to weigh ethical considerations; next, it reviews privacy issues (e.g. informed consent, use of personal health information), and marketing influences, all of which raise legal concerns; and, finally, it looks at practical implementation of mHealth data/analysis, discussing evidence of current and future impacts upon health policy.
Copyright (c) 2020 Nancy Tuck (Author) https://creativecommons.org/licenses/by-nc/4.0
Too Loose, Too Tight, But Never Just Right: Adhesions, Aspirations, and Atelectasis
This case report presents a detailed autopsy examination of a 72-year-old woman who died following complications from ventral hernia repair surgery. The case illustrates how multiple factors including post-surgical adhesions, atelectasis, a pleural effusion, gastroparesis from a previous Nissen fundoplication, and an aspiration event combined to cause respiratory failure. The report also includes an educational discussion of biofilms and their clinical significance in medical device infections, demonstrating the intersection of materials science and clinical medicine.
Copyright (c) 2022 Layla Siraj (Author) https://creativecommons.org/licenses/by-nc/4.0
The Danger of Genetic Risk Scores for Worsening Race-Based Disparities in Healthcare
This review examines how polygenic risk scores, developed primarily using data from white European populations, may worsen existing healthcare disparities. The author explains why these scores perform poorly in non-white populations, discusses the danger of clinical deployment without diverse representation in genetic databases, and proposes solutions including increasing diversity in genetic research and developing new analytical tools to improve prediction accuracy across different ancestry groups.
Copyright (c) 2022 Sohail Zahid (Author) https://creativecommons.org/licenses/by-nc/4.0
Reducing Childhood Respiratory Infections through Interventions in Indoor Household Air Pollution in Rural Underdeveloped Countries
Introduction: Acute lower respiratory infections (ALRIs) are a major cause of mortality in young children, especially for those living in rural areas of underdeveloped nations. A major risk factor for lower respiratory infections is indoor household air pollution. A common source of this pollution in rural areas of underdeveloped nations is cooking. This review sets out to assess interventions related to cooking to see if they provide any long-term clinically important outcomes. Methods: A literature review using PubMed in July 2019 using terms relating to childhood pneumonia and air pollution. Full-text reports for relevant studies were included in this review. Results: Interventions for the reduction of indoor air pollution generally fell into one of three categories, i) switching from polluting fuels to cleaner fuel types, ii) alternative-cooking devices, and iii) behavioral modifications. Findings regarding the use of clean fuel over biomass fuels and alternative-cooking devices were controversial. Behavioral modifications were more consistent in findings of decreased respiratory infections. Conclusion: It was concluded that interventions for indoor household air pollution, and in particular, behavioral modifications, have the potential to provide significant reductions in ALRI in young children. However, more research is needed to elucidate how best to enact interventions in rural areas of underdeveloped nations.
Copyright (c) 2022 Lisle Blackbourn, Erin Walton-Ball (Author) https://creativecommons.org/licenses/by-nc/4.0
Addressing Pervasive Homophobia in Medical Education
This reflective viewpoint explores the experiences of a gay medical student in the Deep South and examines the persistent homophobia within medical education. The author discusses personal encounters with discrimination, the impact on LGBTQ+ medical students, and provides recommendations for creating more inclusive medical learning environments, including increasing LGBTQ+ representation, establishing allied organizations, and implementing mandatory diversity training.
Copyright (c) 2022 Michael H. O'Brien (Author) https://creativecommons.org/licenses/by-nc/4.0
Race and Medicine: Black People Are Not Born Sick
This viewpoint critically examines the use of race-based corrections in medical diagnostic tools, particularly in pulmonary function tests. The author, a Black medical student, traces the historical origins of race-based medicine and argues that social determinants of health, rather than inherent biological differences, account for health disparities. The piece calls for medical education to better integrate discussions of structural racism and social conditions when teaching about health outcomes.
Copyright (c) 2022 Tiana Walker (Author) https://creativecommons.org/licenses/by-nc/4.0
Gun Violence is Every Doctors' Lane: Ways Healthcare Providers Can Protect Public Health
This viewpoint examines the role of healthcare providers in addressing gun violence as a public health issue. The author describes a personal experience with establishing credibility on gun violence policy and reviews evidence-based interventions including safe storage counseling, violence intervention programs, and extreme risk protection orders. The article argues for the legitimacy of healthcare providers to counsel patients on firearm use and safety.
Copyright (c) 2022 Alexander Pomerantz (Author) https://creativecommons.org/licenses/by-nc/4.0
Advancing Preclinical Medical Education through High Fidelity Simulation and Standardized Patient Families
Introduction: Simulated patient encounters in preclinical medical education are being implemented at various medical schools throughout the United States. In this study, we aimed to evaluate the perceived effectiveness of early preclinical simulations on medical students' education. Methods: Two classes of osteopathic medical students, class of 2019 and class of 2020, participated in two simulated clinical experiences using high-fidelity patient mannequins and standardized family members during their second year of medical school. These same students, who are now completing their clinical rotations, completed a survey to assess if the experience with a simulated patient/family Results: A total of 379 students were emailed a survey. Out of 379 total students, 122 surveys were completed (59 from the Class of 2019, 63 from the Class of 2020). The overall response rate was 32%. A majority of the respondents responded positively, with 63% of students stating in their free responses that the simulated patient encounters were experiences that improved their ability to interact professionally and appropriately with patients and family members. P-values between the classes for each survey question was greater than 0.05, indicating that there were no statistically significant differences between the classes of 2019 and 2020 in their survey responses. Conclusion: This study provides evidence that early simulated patient encounters provide a self-reported experience that improves empathy and communication for the students during their clinical rotations.
Copyright (c) 2022 Benjamin W. Cooper, Nicholas A. Jaeger, Maureen A. Hirthler, Cathy J. King (Author) https://creativecommons.org/licenses/by-nc/4.0
What's in the Cauldron: Witches, Folk Remedies, and their Contributions to Modern Medicine
Disease is a part of the human condition and before the rigor of the scientific process and peer review, healers had to work with anecdotal folk remedies and word of mouth medicines. These folk remedies were often known by women and shaman who, throughout time, passed on their esoteric knowledge. Some of these remedies, like excretions from toads, Hemlock, Yew, and Foxglove have persisted for centuries and were used for a wide range of ailments. In modern days, with the use of the scientific process and peer review, these plants form the foundation of many medications. This demonstrates the benefit that can be gained with the investigation of folk medicine.
Copyright (c) 2022 Mason Tate Bennett (Author) https://creativecommons.org/licenses/by-nc/4.0
Mental Health Referrals in Physician Aid in Dying Laws
This review examines the provisions related to mental health referrals in physician aid in dying (PAD) statutes across U.S. jurisdictions. The authors analyze the varying statutory language regarding when and how mental health professionals should be involved in evaluating patients requesting PAD medication. The article proposes standardizing the statutory language and recommends adding guidance for early, continuous supportive counseling for qualified terminally ill patients, rather than focusing solely on eligibility determination.
Copyright (c) 2022 Raquel Atencio, Matthew Deblinger (Author) https://creativecommons.org/licenses/by-nc/4.0
How the Texas Heartbeat Bill Will Affect Low-Income Women of Color Across the U.S.: A Commentary
Governor Greg Abbott of Texas signed a law in May 2021 that will prohibit healthcare providers from performing abortion services after the detection of a fetal heartbeat. With this, Texas has joined several other states, mostly concentrated in the South and Midwest, that ban abortions after approximately six weeks. In this commentary, we discuss how the loss of access to abortion in the heavily populated, diverse state of Texas will overwhelmingly affect low-income individuals and women of color. We also seek to explain how this law is part of a larger agenda that will have a greater impact on all fifty states. Ultimately, we aim to demonstrate how laws aimed at restricting access to abortion will disproportionately affect Black, Hispanic, and low-income women, exacerbating racial health disparities already faced by marginalized groups.
Copyright (c) 2022 Natalia Eugene, Anna Kheyfets, Mackenzie Bennett (Author) https://creativecommons.org/licenses/by-nc/4.0
With increasing globalization in communication, travel, economics, and innovation, medicine and plastic surgery have also made great advancements. The following essay looks at plastic surgery in South Korea, and the innovations South Korean plastic surgeons have made in the field. We explore the cultural, societal, and economic influences that may have impacted the development and popularity of plastic surgery in South Korea, and the rise of South Korean medical tourism. We also compare South Korean plastic surgery versus American plastic surgery, showing differences and similarities in procedures performed, costs, and in patient demographics. Additionally, we look at the possible impacts of plastic surgery on mental health.
Copyright (c) 2022 Annie Jin, Ian Whittall (Author) https://creativecommons.org/licenses/by-nc/4.0
Colorectal Cancer Screening During COVID-19: FIT testing as the Suggested Solution
In March 2020, healthcare in the United States changed, with primary care and preventative care, particularly colorectal cancer screening, grinding to a halt. COVID-19 brought to the forefront the racial healthcare disparities in the United States with the pandemic disproportionately affecting minority communities, reflecting the well-established disparities in colorectal cancer outcomes which are expected to be exacerbated by the lack of screening. This article aims to promote the use of FIT testing for colorectal cancer screening during this pandemic particularly for minority communities. Studies have shown that FIT tests have a high sensitivity and specificity, are inexpensive, and have better adherence than colonoscopies.
Copyright (c) 2022 Aleeza J. Leder Macek (Author) https://creativecommons.org/licenses/by-nc/4.0
Integrating a Smoking Cessation Initiative for the Uninsured at a Student-Run Free Clinic
Cigarette smoking is the leading cause of preventable deaths and diseases in the United States. Student-run clinics play an invaluable role in connecting underserved patients with preventative care. To reduce smoking in uninsured communities, the University of Missouri student-run free MedZou Community Health Clinic developed a Smoking Cessation initiative as part of a preventative health service in 2013. Patients utilizing the smoking cessation services receive a combination of motivational interviewing, patient education, and pharmacotherapy. There is currently limited literature on the structure and implementation of student-run preventative health clinics. The smoking cessation initiative described here can provide an example for other student-run clinics to successfully implement similar programs.
Copyright (c) 2022 Cynthia Y. Tang, Lauren E. Flowers, Emra Bosnjak, Tricia Haynes, Jamie B. Smith, Laura E. Morris (Author) https://creativecommons.org/licenses/by-nc/4.0
Completing the Results of a Pan-Canadian Survey on the State of Oncology Education in Family Practice Residency Programs: Comparison of One Province to the Rest of Canada
Introduction: The incidence and prevalence of cancer in Canada is rising, and family physicians will increasingly provide care at all stages of a patient's cancer journey. This highlights the importance of adequate oncology education in family practice training programs. A survey study done in 2017 to assess the state of oncology education in Canadian family practice residency programs did not include the University of British Columbia (UBC). The purpose of our study was to obtain this data for the UBC family practice residency program and to compare the results to those from the rest of Canada. Methods: A web-based survey was emailed to UBC family practice residents and program directors. The survey assessed depth of the oncology curriculum, current teaching methods and perceived gaps. Results were compared to the non-UBC survey data and interpreted with descriptive statistics. Results: 54/348 UBC family practice residents and 10/20 program directors completed the survey. 3% of UBC and 7% of non-UBC family practice residents felt their program adequately prepared them to care for oncology patients. There was uniformity among all participants in ratings of perceived importance of a list of oncology topics expected to be covered in training for residents. There was discordance in the perceived frequency of topics taught between all family practice residents and program directors. Conclusion: This study can inform further development of oncology specific curriculum in family practice residency programs. Further study is required to understand areas of discordance between family practice residents and program directors.
Copyright (c) 2022 Alanna Janz, Lisa Wang, Svetlana Bortnik, Jaspreet Garcha, Vincent Tam, Steven Yip, Paris Ann Ingledew (Author) https://creativecommons.org/licenses/by-nc/4.0
Primary Care Selection and the Financial Burdens of Medical Education
Preventative medicine and primary care services are the foundations to building healthier communities. Unfortunately, the resources are often limited, and it is estimated that by 2032, the United States could face a shortage of up to 21,000 to 55,200 primary care physicians. This deficit of physicians is even more pronounced in rural areas where residents are almost five times as likely to live in a county with a physician shortage. There are a multitude of factors that contribute to this decline in workforce, but one pressing issue is the impact of medical student specialty selection. In this commentary, we discuss the Geisinger Abigail Scholars Program which is a program offering free medical education and a living stipend in exchange for a commitment to Geisinger employment in primary care fields upon residency completion.
Copyright (c) 2022 Christin Spatz, Kara Romanowski, Tanja Adonizio, Michelle Schmude (Author) https://creativecommons.org/licenses/by-nc/4.0
Vibration-based Microphones as a Solution for Non-invasive Ventilation Related Communication Impairment
The incidence of acute respiratory failure (ARF) has dramatically increased in the past few decades in the United States. From 2002 to 2017, there was a 197% increase in the annual incidence of ARF, and in response, a 437% increase in the use of noninvasive mechanical ventilation (NIV). Multiple studies have demonstrated that use of NIV frequently causes communication impairment (CI), which is strongly associated with anxiety and can in turn contribute to NIV intolerance and failure, and ultimately, mortality. CI also prevents accurate evaluation of patients by providers, which can contribute to worse clinical outcomes. Recently, Lee et al at Pohang University, South Korea, published their development of a flexible, wearable vibration sensor that can amplify speech while minimizing ambient noise. Although this device is intended for use in portable devices such as cell phones, it also poses as a viable solution for NIV-related communication impairment.
Copyright (c) 2022 James Lee (Author) https://creativecommons.org/licenses/by-nc/4.0
About Time: Making Space in the Classroom for Students' Experiences of Trauma
Many medical students have experienced trauma and conditions affecting their mental health. Throughout medical school, especially during psychiatry portions of the curriculum, students and educators may face challenges navigating course material. Adverse classroom and patient interactions can lead to further traumatization, isolation from course content, and lapses in professionalism. Contemporary educational environments have become increasingly sensitive to the prevalence of trauma among students, but debate remains over how to simultaneously respect student needs and ensure engagement with important course content. Principles of trauma-informed medical education (TIME) support medical educators and medical students to work together to create curricula and learning environments that are psychologically safe and appropriately challenging.
Copyright (c) 2022 Christine Xu, David A. Hirsh, Jennifer C. Kesselheim (Author) https://creativecommons.org/licenses/by-nc/4.0