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Article ; Online: “I never should have been a doctor”

Alaina Chodoff / Lynae Conyers / Scott Wright / Rachel Levine

BMC Medical Education, Vol 23, Iss 1, Pp 1-

a qualitative study of imposter phenomenon among internal medicine residents

2023 Volume 8

Abstract: Abstract Introduction Imposter phenomenon is common among medical trainees and may influence learning and professional development. The authors sought to describe imposter phenomenon among internal medicine residents. Methods In 2020, using emailed ... ...

Abstract	Abstract Introduction Imposter phenomenon is common among medical trainees and may influence learning and professional development. The authors sought to describe imposter phenomenon among internal medicine residents. Methods In 2020, using emailed invites we recruited a convenience sample of 28 internal medicine residents from a teaching hospital in Baltimore, Maryland to participate in an exploratory qualitative study. In one-on-one interviews, informants described experiences of imposter phenomenon during residency training. Using thematic analysis to identify meaningful segments of text, the authors developed a coding framework and iteratively identified and refined themes. Informants completed the Clance Imposter Phenomenon Scale. Results Informants described feelings and thoughts related to imposter phenomenon, the contexts in which they developed and the impact on learning. Imposter phenomenon has profound effects on residents including: powerful and persistent feelings of inadequacy and habitual comparisons with others. Distinct contexts shaping imposter phenomenon included: changing roles with increasing responsibilities; constant scrutiny; and rigid medical hierarchy. Learning was impacted by inappropriate expectations, difficulty processing feedback, and mental energy diverted to impression management. Discussion Internal medicine residents routinely experience imposter phenomenon; these feelings distort residents’ sense of self confidence and competence and may impact learning. Modifiable aspects of the clinical learning environment exacerbate imposter phenomenon and thus can be acted upon to mitigate imposter phenomenon and promote learning among medical trainees.
Keywords	Imposter phenomenon ; Medical trainees ; Medical education ; Learning environment ; Special aspects of education ; LC8-6691 ; Medicine ; R
Subject code	370
Language	English
Publishing date	2023-01-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Ten simple rules for hitting a home run with your elevator pitch.

Whitney Rachel Morgan / Erik Scott Wright

PLoS Computational Biology, Vol 17, Iss 3, p e

2021 Volume 1008756

Keywords	Biology (General) ; QH301-705.5
Language	English
Publishing date	2021-03-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
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Article ; Online: Sample-efficient identification of high-dimensional antibiotic synergy with a normalized diagonal sampling design.

Jennifer Brennan / Lalit Jain / Sofia Garman / Ann E Donnelly / Erik Scott Wright / Kevin Jamieson

PLoS Computational Biology, Vol 18, Iss 7, p e

2022 Volume 1010311

Abstract: Antibiotic resistance is an important public health problem. One potential solution is the development of synergistic antibiotic combinations, in which the combination is more effective than the component drugs. However, experimental progress in this ... ...

Abstract	Antibiotic resistance is an important public health problem. One potential solution is the development of synergistic antibiotic combinations, in which the combination is more effective than the component drugs. However, experimental progress in this direction is severely limited by the number of samples required to exhaustively test for synergy, which grows exponentially with the number of drugs combined. We introduce a new metric for antibiotic synergy, motivated by the popular Fractional Inhibitory Concentration Index and the Highest Single Agent model. We also propose a new experimental design that samples along all appropriately normalized diagonals in concentration space, and prove that this design identifies all synergies among a set of drugs while only sampling a small fraction of the possible combinations. We applied our method to screen two- through eight-way combinations of eight antibiotics at 10 concentrations each, which requires sampling only 2,560 unique combinations of antibiotic concentrations.
Keywords	Biology (General) ; QH301-705.5
Language	English
Publishing date	2022-07-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
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Article ; Online: Long-term efficacy and safety of inclisiran in patients with high cardiovascular risk and elevated LDL cholesterol (ORION-3): results from the 4-year open-label extension of the ORION-1 trial.

Ray, Kausik K / Troquay, Roel P T / Visseren, Frank L J / Leiter, Lawrence A / Scott Wright, R / Vikarunnessa, Sheikh / Talloczy, Zsolt / Zang, Xiao / Maheux, Pierre / Lesogor, Anastasia / Landmesser, Ulf

The lancet. Diabetes & endocrinology

2023 Volume 11, Issue 2, Page(s) 109–119

Abstract: Introduction: Whether long-term treatment with the twice-yearly, siRNA therapeutic inclisiran, which reduces hepatic production of proprotein convertase subtilisin/kexin type 9 (PCSK9), results in sustained reductions in LDL cholesterol with an ... ...

Abstract	Introduction: Whether long-term treatment with the twice-yearly, siRNA therapeutic inclisiran, which reduces hepatic production of proprotein convertase subtilisin/kexin type 9 (PCSK9), results in sustained reductions in LDL cholesterol with an acceptable safety profile is not known. The aim of this study was to assess the effect of long-term dosing of inclisiran in patients with high cardiovascular risk and elevated LDL cholesterol. Methods: ORION-3 was a 4-year open-label extension study of the placebo-controlled, phase 2 ORION-1 trial, conducted at 52 sites across five countries. Patients with prevalent atherosclerotic cardiovascular disease or high-risk primary prevention and elevated LDL cholesterol despite maximally tolerated statins or other LDL-lowering treatments, or with documented statin intolerance, who had completed the ORION-1 trial were eligible. Patients receiving inclisiran in ORION-1 received twice-yearly 300 mg subcutaneous inclisiran sodium throughout ORION-3 (inclisiran-only arm), whereas patients receiving placebo in ORION-1 first received subcutaneous evolocumab 140 mg every 2 weeks until day 360 thereafter transitioning to inclisiran twice-yearly for the remainder of ORION-3 study (switching arm). The primary efficacy endpoint was the percentage change in LDL cholesterol with inclisiran from the start of ORION-1 through to day 210 of the open label extension phase in the inclisiran-only arm (approximately 570 days of total inclisiran exposure in the modified intention-to-treat population). Secondary and exploratory endpoints included changes in LDL-C cholesterol and PCSK9 concentrations levels up to day 1440 (4 years) in each arm, and safety. ORION-3 is registered with ClinicalTrials.gov, NCT03060577. Findings: Of the original ORION-1 cohort of 497 patients, 290 of 370 patients allocated to drug continued into the inclisiran-only arm and 92 of 127 patients allocated to placebo entered the switching-arm in the ORION-3 extension study conducted between March 24, 2017, and Dec 17, 2021. In the inclisiran-only arm, LDL cholesterol was reduced by 47·5% (95% CI 50·7-44·3) at day 210 and sustained over 1440 days. The 4-year averaged mean reduction of LDL-C cholesterol was 44·2% (95% CI: 47·1-41·4), with reductions in PCSK9 ranging from 62·2% to 77·8%. Adverse events at the injection site were reported in 39 (14%) of 284 patients in the inclisiran-only arm and 12 (14%) of 87 patients in the switching arm. The incidence of treatment-emergent serious adverse events possibly related to the study drug was 1% (three of 284) in the inclisiran-only arm and 1% (one of 87) in the switching arm. Interpretation: Twice-yearly inclisiran provided sustained reductions in LDL cholesterol and PCSK9 concentrations and was well tolerated over 4 years in the extension study. This is the first prospective long-term study to assess repeat hepatic exposure to inclisiran. Funding: Novartis Pharma.
MeSH term(s)	Humans ; Anticholesteremic Agents/therapeutic use ; Cardiovascular Diseases/drug therapy ; Cardiovascular Diseases/prevention & control ; Cardiovascular Diseases/chemically induced ; Cholesterol, LDL ; Heart Disease Risk Factors ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use ; Proprotein Convertase 9 ; Prospective Studies ; Risk Factors ; RNA, Small Interfering/adverse effects
Chemical Substances	ALN-PCS ; Anticholesteremic Agents ; Cholesterol, LDL ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; PCSK9 protein, human (EC 3.4.21.-) ; Proprotein Convertase 9 (EC 3.4.21.-) ; RNA, Small Interfering
Language	English
Publishing date	2023-01-05
Publishing country	England
Document type	Controlled Clinical Trial ; Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2213-8595
ISSN (online)	2213-8595
DOI	10.1016/S2213-8587(22)00353-9
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Article ; Online: Getting CLOSLER ("Closer to Osler")

Charlie Stube / Margaret Chisolm / Gretchen Miller / Dean Chien / Scott Wright

MedEdPublish, Vol 8, Iss

Developing an Online Community Focused on Clinical Excellence

2019 Volume 1

Abstract: Clinical excellence is the goal in healthcare delivery, at both the provider and system level. At Johns Hopkins University School of Medicine, The Miller Coulson Academy of Clinical Excellence (MCACE) was established to celebrate and promote clinical ... ...

Abstract	Clinical excellence is the goal in healthcare delivery, at both the provider and system level. At Johns Hopkins University School of Medicine, The Miller Coulson Academy of Clinical Excellence (MCACE) was established to celebrate and promote clinical excellence in hopes of optimizing the care experienced by patients. The MCACE describes clinical excellence as achieving a level of mastery in several areas including, but not limited to, communication and interpersonal skills, professionalism and humanism, diagnostic acumen, and negotiation of the healthcare system. The Academy's definition also puts an emphasis on teaching others to serve our patients and being a role model for clinical excellence. To have a positive influence on those beyond their immediate reach at Hopkins, the MCACE team launched CLOSLER, a free and open access medical education website (closler.org). With the goal of sharing thoughtful clinical stories and perspectives to stimulate reflection about providing exceptional care to every patient, CLOSLER takes its name from William Osler, the founder of academic medicine in the United States and an early champion of patient-centered care worldwide. CLOSLER offers articles written by healthcare professionals relaying pearls and lessons from practice for all, organized into four sections: Connecting with Patients, Clinical Reasoning, Passion in the Medical Profession, and Lifelong Learning in Clinical Excellence. CLOSLER has ushered in a new era of education that can help to move us closer to Osler and clinical excellence; it pushes the perspectives of outstanding role models to all who are interested in developing in this realm.
Keywords	clinical excellence ; Miller Coulson Academy of Clinical Excellence (MCACE) ; patient care ; CLOSLER ; medical education ; Special aspects of education ; LC8-6691 ; Medicine ; R
Subject code	610
Language	English
Publishing date	2019-03-01T00:00:00Z
Publisher	F1000 Research Ltd
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: The effect of racial and gender concordance between physicians and patients on the assessment of hospitalist performance

Damian Crawford / Suchitra Paranji / Shalini Chandra / Scott Wright / Flora Kisuule

BMC Health Services Research, Vol 19, Iss 1, Pp 1-

a pilot study

2019 Volume 5

Abstract: Abstract Background Lack of racial concordance between physicians and patients has been linked to health disparities and inequities. Studies show that patients prefer physicians who look like them; however, there are too few underrepresented minority ... ...

Abstract	Abstract Background Lack of racial concordance between physicians and patients has been linked to health disparities and inequities. Studies show that patients prefer physicians who look like them; however, there are too few underrepresented minority physicians in the workforce. Hospitalists are Internal Medicine physicians who specialize in inpatient medicine. At our hospital, hospitalists care for 60% of hospitalized medical patients. We utilized the validated Tool to Assess Inpatient Satisfaction with Care from Hospitalists (TAISCH) to assess the effect of patient-provider race and gender concordance on patients’ assessment of their physician’s performance. Methods Four hundred thirty-seven inpatients admitted to the non-teaching hospitalist service, cared for by a unique hospitalist physician for two or more consecutive days, were surveyed using the validated TAISCH instrument. The influence of gender and racial concordance on TAISCH scores for patient - hospitalist pairs were assessed by comparing the specific dyads with the overall mean scores. T-tests were used to compare the means. Generalized estimating equations were used to account for clustering. Results Of the 34 hospitalist physicians in the analysis, 20% were African American (AA-non-Hispanic), 15% were Caucasians (non-Hispanic) and 65% were in the “other” category. The “other” category consisted of predominantly physicians of South East Asian decent (i.e. Indian subcontinent) and Hispanic. Of the 437 patients, 66% were Caucasians, and 32% were AA. The overall mean TAISCH score, as these 437 patients assessed their hospitalist provider was 3.8 (se = 0.60). The highest mean TAISCH score was for the Caucasian provider-AA patient dyads at 4.2 (se = 0.21, p = 0.05 compared to overall mean). The lowest mean TAISCH score was 3.5 (se = 0.14) seen in the AA provider/AA patient dyads, significantly lower than the overall mean (p = 0.013). There were no statistically significant differences noted between mean TAISCH scores of gender and racially concordant ...
Keywords	Hospitalization ; Patient satisfaction ; Gender ; Race ; Concordance ; Public aspects of medicine ; RA1-1270
Subject code	616
Language	English
Publishing date	2019-04-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
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Article ; Online: What’s a book club doing at a medical conference?

Margaret Chisolm / Amin Azzam / Manasa Ayyala / Rachel Levine / Scott Wright

MedEdPublish, Vol 7, Iss

2018 Volume 3

Abstract: The prevalence of burnout among physicians in the United States now exceeds 50%, with many physicians feeling isolated and lacking in a sense of community. Book clubs among colleagues may be one way to foster community and restore joy to medicine. The ... ...

Abstract	The prevalence of burnout among physicians in the United States now exceeds 50%, with many physicians feeling isolated and lacking in a sense of community. Book clubs among colleagues may be one way to foster community and restore joy to medicine. The authors introduced two book clubs at the annual meetings of the Society for General Internal Medicine (SGIM) and the Association for Academic Psychiatry (AAP). Response rates for completed surveys for the SGIM and AAP book clubs were 71% and 86%, respectively. About half of the book club participants were already members of a book club, and had read an average of 10 non-medical books in the past year. Eighty-one percent reported the discussions had "a lot" or "tremendous" impact on their learning, and that they would be "likely" or "very likely" to look for a non-medical book in the future as a resource to assist in their professional growth. Sixty-seven percent said they would be "likely" or "very likely" to organize their own book club. Participants listed the "most enjoyable and/or impactful non-medical book read in past year." Survey responses speak to the impact of book club participation on attendees' professional growth, learning, and recognition of overall value of reading non-medical books. These findings support the role of the humanities in professional development to encourage physicians to challenge assumptions, tolerate ambiguity, appreciate cultural influences, and honor the unique perspectives of our patients. In the increasingly complex and challenging work environment of academic health centers, faculty must find mechanisms to maintain workplace meaning and prevent burnout. Reading a book prior to attending one's annual professional society meeting and participating in thoughtful discussions was enjoyable and useful. When facilitators are thoughtfully prepared to guide conversations, professional growth can result in useful insights related to academic practices and pursuits.
Keywords	medical education: CME ; medical humanities ; self-care ; physician satisfaction ; continuing professional development ; Special aspects of education ; LC8-6691 ; Medicine ; R
Subject code	028
Language	English
Publishing date	2018-07-01T00:00:00Z
Publisher	F1000 Research Ltd
Document type	Article ; Online
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Article ; Online: Recent developments in the management of patients resuscitated from cardiac arrest.

Jentzer, Jacob C / Clements, Casey M / Murphy, Joseph G / Scott Wright, R

Journal of critical care

2017 Volume 39, Page(s) 97–107

Abstract: Cardiac arrest is the leading cause of death in Europe and the United States. Many patients who are initially resuscitated die in the hospital, and hospital survivors often have substantial neurologic dysfunction. Most cardiac arrests are caused by ... ...

Abstract	Cardiac arrest is the leading cause of death in Europe and the United States. Many patients who are initially resuscitated die in the hospital, and hospital survivors often have substantial neurologic dysfunction. Most cardiac arrests are caused by coronary artery disease; patients with coronary artery disease likely benefit from early coronary angiography and intervention. After resuscitation, cardiac arrest patients remain critically ill and frequently suffer cardiogenic shock and multiorgan failure. Early cardiopulmonary stabilization is important to prevent worsening organ injury. To achieve best patient outcomes, comprehensive critical care management is needed, with primary goals of stabilizing hemodynamics and preventing progressive brain injury. Targeted temperature management is frequently recommended for comatose survivors of cardiac arrest to mitigate the neurologic injury that drives outcomes. Accurate neurologic assessment is central to managing care of cardiac arrest survivors and should combine physical examination with objective neurologic testing, with the caveat that delaying neurologic prognosis is essential to avoid premature withdrawal of supportive care. A combination of clinical findings and diagnostic results should be used to estimate the likelihood of functional recovery. This review focuses on recent advances in care and specific cardiac intensive care strategies that may improve morbidity and mortality for patients after cardiac arrest.
Language	English
Publishing date	2017-06
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	632818-0
ISSN	1557-8615 ; 0883-9441
ISSN (online)	1557-8615
ISSN	0883-9441
DOI	10.1016/j.jcrc.2017.02.011
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Article ; Online: Convalescent plasma use in the USA was inversely correlated with COVID-19 mortality

Arturo Casadevall / Quigly Dragotakes / Patrick W Johnson / Jonathon W Senefeld / Stephen A Klassen / R Scott Wright / Michael J Joyner / Nigel Paneth / Rickey E Carter

eLife, Vol

2021 Volume 10

Abstract: Background: The US Food and Drug Administration authorized COVID-19 convalescent plasma (CCP) therapy for hospitalized COVID-19 patients via the Expanded Access Program (EAP) and the Emergency Use Authorization (EUA), leading to use in about 500,000 ... ...

Abstract	Background: The US Food and Drug Administration authorized COVID-19 convalescent plasma (CCP) therapy for hospitalized COVID-19 patients via the Expanded Access Program (EAP) and the Emergency Use Authorization (EUA), leading to use in about 500,000 patients during the first year of the pandemic for the USA. Methods: We tracked the number of CCP units dispensed to hospitals by blood banking organizations and correlated that usage with hospital admission and mortality data. Results: CCP usage per admission peaked in Fall 2020, with more than 40% of inpatients estimated to have received CCP between late September and early November 2020. However, after randomized controlled trials failed to show a reduction in mortality, CCP usage per admission declined steadily to a nadir of less than 10% in March 2021. We found a strong inverse correlation (r = −0.52, p=0.002) between CCP usage per hospital admission and deaths occurring 2 weeks after admission, and this finding was robust to examination of deaths taking place 1, 2, or 3 weeks after admission. Changes in the number of hospital admissions, SARS-CoV-2 variants, and age of patients could not explain these findings. The retreat from CCP usage might have resulted in as many as 29,000 excess deaths from mid-November 2020 to February 2021. Conclusions: A strong inverse correlation between CCP use and mortality per admission in the USA provides population-level evidence consistent with the notion that CCP reduces mortality in COVID-19 and suggests that the recent decline in usage could have resulted in excess deaths. Funding: There was no specific funding for this study. AC was supported in part by RO1 HL059842 and R01 AI1520789; MJJ was supported in part by 5R35HL139854. This project has been funded in whole or in part with Federal funds from the Department of Health and Human Services; Office of the Assistant Secretary for Preparedness and Response; Biomedical Advanced Research and Development Authority under Contract No. 75A50120C00096.
Keywords	COVID ; virus infection ; convalescent plasma ; Medicine ; R ; Science ; Q ; Biology (General) ; QH301-705.5
Subject code	610
Language	English
Publishing date	2021-06-01T00:00:00Z
Publisher	eLife Sciences Publications Ltd
Document type	Article ; Online
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Article ; Online: Profiling medical school learning environments in Malaysia

Sean Tackett / Hamidah Abu Bakar / Nicole A. Shilkofski / Niamh Coady / Krishna Rampal / Scott Wright

Journal of Educational Evaluation for Health Professions, Vol

a validation study of the Johns Hopkins Learning Environment Scale

2015 Volume 12

Abstract: Purpose: While a strong learning environment is critical to medical student education, the assessment of medical school learning environments has confounded researchers. Our goal was to assess the validity and utility of the Johns Hopkins Learning ... ...

Abstract	Purpose: While a strong learning environment is critical to medical student education, the assessment of medical school learning environments has confounded researchers. Our goal was to assess the validity and utility of the Johns Hopkins Learning Environment Scale (JHLES) for preclinical students at three Malaysian medical schools with distinct educational and institutional models. Two schools were new international partnerships, and the third was school leaver program established without international partnership. Methods: First- and second-year students responded anonymously to surveys at the end of the academic year. The surveys included the JHLES, a 28-item survey using five-point Likert scale response options, the Dundee Ready Educational Environment Measure (DREEM), the most widely used method to assess learning environments internationally, a personal growth scale, and single-item global learning environment assessment variables. Results: The overall response rate was 369/429 (86%). After adjusting for the medical school year, gender, and ethnicity of the respondents, the JHLES detected differences across institutions in four out of seven domains (57%), with each school having a unique domain profile. The DREEM detected differences in one out of five categories (20%). The JHLES was more strongly correlated than the DREEM to two thirds of the single-item variables and the personal growth scale. The JHLES showed high internal reliability for the total score (α=0.92) and the seven domains (α, 0.56-0.85). Conclusion: The JHLES detected variation between learning environment domains across three educational settings, thereby creating unique learning environment profiles. Interpretation of these profiles may allow schools to understand how they are currently supporting trainees and identify areas needing attention.
Keywords	Educational assessment ; Learning ; Malaysia ; Medical students ; Validation studies ; Special aspects of education ; LC8-6691 ; Medicine ; R
Subject code	370
Language	English
Publishing date	2015-07-01T00:00:00Z
Publisher	Korea Health Insurance Licensing Examination Institute
Document type	Article ; Online
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