Baptist Health Madisonville

ABSTRACT Gender Differences in Planned Retirement Age Among Medical Students: Are Changes On the Horizon? Purpose Planned age of retirement has an important effect on the physician workforce. Earlier studies of practicing physicians have reported that the planned as well as actual retirement age was significantly younger for women. Also, previous reports had shown that rural physicians tended to retire earlier. This paper offers a view earlier in the physician pipeline and reports surveys of medical students and pre-medical college students concerning their retirement plans. Methods During 2015-2019, 70 college students and 41 medical students at a regional rural medical campus completed a career eulogy that included their planned retirement age. Results Combining both groups of students, women planned to retire at a mean age of 61.9 and men at 59.1, P=0.048. A longitudinal comparison of just medical students showed that prematriculation students just before starting medical school had the oldest planned age of 66.9, compared to college students (57.4 to 58.9) and medical students (64.0 to 64.6), P=0.049. There was no difference in planned retirement age in rural vs urban upbringing. Conclusions In this group of pathways students, women planned to retire almost 3 years later than men, which differs from earlier reports of physicians in practice. The men planned retirement almost 5 years earlier than in previous reports of planned retirement age. There was no difference in rural vs urban upbringing. Whether this is a generalizable finding will require similar studies in different student populations on other campuses, and our survey instrument is available for others to look deeper into the process of professional identity formation that may explain any differences in planned retirement age.

Background and Objectives: With the growing recreational cannabis use and recent reports linking it to hypertension, we sought to determine the risk of hypertensive crisis (HC) hospitalizations and major adverse cardiac and cerebrovascular events (MACCE) in young adults with cannabis use disorder (CUD+). Material and Methods: Young adult hospitalizations (18–44 years) with HC and CUD+ were identified from National Inpatient Sample (October 2015–December 2017). Primary outcomes included prevalence and odds of HC with CUD. Co-primary (in-hospital MACCE) and secondary outcomes (resource utilization) were compared between propensity-matched CUD+ and CUD- cohorts in HC admissions. Results: Young CUD+ had higher prevalence of HC (0.7%, n = 4675) than CUD- (0.5%, n = 92,755), with higher odds when adjusted for patient/hospital-characteristics, comorbidities, alcohol and tobacco use disorder, cocaine and stimulant use (aOR 1.15, 95%CI:1.06–1.24, p = 0.001). CUD+ had significantly increased adjusted odds of HC (for sociodemographic, hospital-level characteristics, comorbidities, tobacco use disorder, and alcohol abuse) (aOR 1.17, 95%CI:1.01–1.36, p = 0.034) among young with benign hypertension, but failed to reach significance when additionally adjusted for cocaine/stimulant use (aOR 1.12, p = 0.154). Propensity-matched CUD+ cohort (n = 4440, median age 36 years, 64.2% male, 64.4% blacks) showed higher rates of substance abuse, depression, psychosis, previous myocardial infarction, valvular heart disease, chronic pulmonary disease, pulmonary circulation disease, and liver disease. CUD+ had higher odds of all-cause mortality (aOR 5.74, 95%CI:2.55–12.91, p < 0.001), arrhythmia (aOR 1.73, 95%CI:1.38–2.17, p < 0.001) and stroke (aOR 1.46, 95%CI:1.02–2.10, p = 0.040). CUD+ cohort had fewer routine discharges with comparable in-hospital stay and cost. Conclusions: Young CUD+ cohort had higher rate and odds of HC admissions than CUD-, with prevalent disparities and higher subsequent risk of all-cause mortality, arrhythmia and stroke.

Introduction Cardiovascular disease (CVD) is an important threat to public health, especially in rural communities. Clinical medical students at a rural regional campus can be a valuable resource to plan and implement CVD risk factor case finding project in the host community. Methods Directed by a representative county advisory council and supervised by a regional dean, clinical medical students designed and implemented CVD screenings at several public locations, recording health history and measurements of blood glucose, total blood cholesterol, and blood pressure. Those screened with abnormal readings were directed to definitive care including the local student-directed free clinic. Students were surveyed using a Likert scale before and after participation to assess their confidence in executing a community health project. The Baptist Health Madisonville IRB approved the protocol as exempt and the authors have no conflicts of interest. Results Over a period of almost two years in 2017-2019, 572 participants were screened. The demographics reflected those of the entire county, except screening was focused on adults. High blood pressure was found in 43%, high glucose in 28%, and high cholesterol in 48%. These values were similar to published countywide prevalence proportions. The student pre- to post- increase in confidence was remarkable (p&lt; 0.000). Conclusions Our results show that regional campus medical students directed by a representative county advisory council and supervised by a regional dean can successfully implement a community CVD screening effort. The students also expressed a dramatic increase in their confidence in designing and implementing such a project. Lessons learned are shared for consideration by those at other regional health campuses.

A regional medical school dean who is still actively practicing at age 66 considers retirement from clinical practice in the context of his own health risks during the COVID 19 pandemic. Disappointments, truly meaningful clinical interactions, and a vision of buzzards provide a matrix for this personal reflection.

BACKGROUND AND OBJECTIVES&#x0D; Empathy measures were used before and after implementation of a structured professional identity curriculum to determine the effect among a group of family medicine residents.&#x0D; METHODS&#x0D; The Jefferson Scale of Empathy was completed by 18 residents at all three years of training before, immediately after a six month professional identity curriculum intervention, and six months after the curriculum was completed. The curriculum included one hour luncheon sessions on concepts of profession, burnout, and cynicism as well as thoughtful use of electronic medical records, prevention and management of burnout, mindfulness techniques and reflective writing and drawing. The Baptist Health Madisonville IRB approved the protocol as exempt and the authors have no conflicts of interests.&#x0D; RESULTS&#x0D; Similar to previous publications, a decline in empathy across the academic year was found, with a significant decline six months after the end of the curriculum. Residents who attended more sessions showed a non-significant smaller decline, and there were large standard deviations among each training level with some individual residents showing little change across the year. Evaluations of the curriculum were largely positive.&#x0D; CONCLUSIONS&#x0D; This professional identity curriculum in this group of residents may have temporarily mitigated the decline in measured empathy that has been described among residents. Results support some aspects of empathy as a trait in some residents rather than a state that is amenable to a training effect. Further study in this residency including longitudinal empathy measurements and focus groups is ongoing. Other programs’ experience with these issues is needed to add to sample size and diversity of training environments to discern which changes are significant and generalizable.

Introduction: Preclinical medical students with an initial affinity for rural practice often experience urban disruption during training. Longer summer rural immersion experiences have been shown to be somewhat effective in keeping rural students connected to their rural roots. Some students cannot adapt their schedules to these longer experiences. In response, a brief practice experience near home during the winter break of the academic year was established. Methods: Nineteen detailed rural practice assessments were completed by preclinical medical students during school years 2009-2014 and essays and anonymous evaluations of the experience were analyzed. Results: All students reported the four components of the experience increased understanding of rural medicine and all but 2 reported it was relevant to their career objectives. These two, at this early stage in training, decided rural practice was not for them and subsequently chose sub-specialty training. Six of the 12 (50%) who have completed medical school chose a family medicine residency. The themes in the essay portion included insights into rural lifestyle, returning home, health system organization issues, and patient expectations and traditions. Conclusions: Initial experience with a “home for the holidays” approach for rural immersion of rural medical students was successful in reconnecting these students to their roots, and 17/19 (90%) reported their intention to choose rural practice.