Redeploying Residents and Fellows in Response to COVID-19: Tensions, Guiding Principles, and Lessons From the University of Washington.
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ABSTRACT:
SUBMITTER: Meo N
PROVIDER: S-EPMC7771595 | biostudies-literature | 2020 Dec
REPOSITORIES: biostudies-literature
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Redeploying Residents and Fellows in Response to COVID-19: Tensions, Guiding Principles, and Lessons From the University of Washington.
Meo Nicholas N Kim Christopher S CS Ilgen Jonathan S JS Choe John H JH Singh Niten N Joyner Byron B
Journal of graduate medical education 20201119 6
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Project description:The COVID-19 pandemic disrupted medical education worldwide, leading medical students to organize response initiatives. This paper summarizes the Washington University Medical Student COVID-19 Response (WUMS-CR) and shares lessons to guide future initiatives. We used a three-principle framework of community needs assessment, faculty mentorship, and partnership with pre-existing organizations to address needs in St. Louis, including contact tracing and childcare. In total, over 12,000 h were volunteered across 15+ projects. Overall, student response initiatives should use appropriate frameworks to guide projects and should capitalize on volunteer participation, speed and flexibility, and the diversity of student interests and skills for maximal impact.
| S-EPMC7872507 | biostudies-literature
Project description:PurposeTo better prepare for potential future large-scale redeployments, this study examines quality of supervision and care as perceived by redeployed residents, fellows, and attendings during a COVID-19 surge.MethodDuring April and May 2020, attendings, fellows, and residents redeployed at 2 teaching hospitals were invited to participate in a survey, which included questions on respondents' prior experience; redeployed role; amount of supervision needed and received; and perceptions of quality of supervision, patient care, and interprofessional collaboration. Frequencies, means, and P values were calculated to compare perceptions by experience and trainee status. Narrative responses to 2 open-ended questions were independently coded; themes were constructed.ResultsOverall, 152 of 297 (51.2%) individuals responded, including 64 of 142 attendings (45.1%), 40 of 79 fellows (50.6%), and 48 of 76 residents (63.2%). Fellows and attendings, regardless of prior experience, perceived supervision as adequate. In contrast, experienced residents reported receiving more supervision than needed, while inexperienced residents reported receiving less supervision than needed and rated overall supervision as poor. Attendings, fellows, and experienced residents rated the overall quality of care as acceptable to good, whereas inexperienced residents perceived overall quality of care as worse to much worse, particularly when compared with baseline.ConclusionsNarrative themes indicated that the quality of supervision and care was buffered by strong camaraderie, a culture of informal consultation, team composition (mixing experienced with inexperienced), and clinical decision aids. The markedly negative view of inexperienced residents suggests a higher risk for disillusionment, perhaps even moral injury, during future redeployments. Implications for planning are explored.
| S-EPMC8855770 | biostudies-literature
Project description:The NIH Roadmap Epigenomics Mapping Consortium aims to produce a public resource of epigenomic maps for stem cells and primary ex vivo tissues selected to represent the normal counterparts of tissues and organ systems frequently involved in human disease. Study of chromatin accessibility and expression using exon arrays. **************** For data usage terms and conditions, please refer to: http://www.drugabuse.gov/funding/funding-opportunities/nih-common-fund/epigenomics-data-access-policies ****************
2010-01-06 | GSE18927 | GEO
Project description:BackgroundCOVID-19 has created a void in surgical education. Given social distancing and postponed surgeries, unique educational opportunities have arisen. Attendings from 10 adult reconstruction fellowships led a multi-institution web-based weekly collaborative, the Arthroplasty Consortium (AC), developed to educate trainees through complex arthroplasty case-based discussions.MethodsWe performed an anonymous survey of AC participants and American Association of Hip and Knee Surgeons (AAHKS) adult reconstruction fellows. Participants were polled with regards to educational tools used before and after COVID-19 and their value. Specifically, participation in the AC, AAHKS FOCAL (Fellows Orthopedic Continued AAHKS Learning) lectures, institutional lectures, industry lectures, textbooks, online videos, journal articles, and webinars was assessed.ResultsFifty-seven participants responded with 49 (86%) at the fellow level. There was an increase in the use of web-based learning, including the AC (Not applicable pre, 61% post), AAHKS FOCAL lectures (Not applicable pre, 82% post), industry lectures (53% pre, 86% post), and AAHKS/AAOS webinars (35% pre, 56% post). Usage declined with institutional lectures (89% pre, 80% post), textbooks (68% pre, 49% post), and journal articles (97% pre, 90% post), with minimal change in the use of online surgical videos (84% pre, 82% post). The majority of fellows not involved in the AC would like to see the addition of a multi-institutional case conference added to fellowship education. Of AC participants, the 2 most valuable educational tools were the AC and FOCAL lectures.ConclusionTrainee education has changed post-COVID-19 with a greater focus on web-based learning. Multi-institutional collaborative lectures and case-based discussions have significant perceived value among trainees and should be considered important educational tools post-COVID 19.
| S-EPMC8054614 | biostudies-literature
Project description:This data was generated by ENCODE. If you have questions about the data, contact the submitting laboratory directly (Richard Sandstrom mailto:sull@u.washington.edu). If you have questions about the Genome Browser track associated with this data, contact ENCODE (mailto:genome@soe.ucsc.edu). This track contains chromatin interaction data from the University of Washington ENCODE group generated using 5C (Chromatin Conformation Capture Carbon Copy). The 5C method is used here to define short and long-range range interactions between transcription start sites (TSS) and DNaseI hypersensitive sites (DHS) or other genomic features. The 5C method is summarized below. Transcription factors bind to promoter-associated proteins, bringing the associated DNA sequences in close proximity to each other. Cross linking the DNA and proteins immobilizes these interactions and thus maintains their close proximity. Cleavage of the sample with restriction endonuclease followed by ligation results in hybrid molecules where a fragment with a regulatory element is physically associated with a fragment containing a TSS. The interactions are then detected by oligonucleotide-dependent, ligation-mediated assays, where one set of primers is complementary to the end of fragments with a TSS and the second set of primers are complementary to fragments with a feature. Primers are designed to the forward strand of the feature and the reverse strand of the TSS so that ligation only occurs between TSS and feature, not between different features. Specific interactions are detected by massively parallel sequencing. The data in this track comprises two different experiment types focusing on targeted regions: Gene-targeted project: Analysis of DNase I hypersensitive sites reveals many genes where there are multiple sites restricted to the cell type where a protein is observed to be expressed. These sites potentially identify regulatory sites for the gene. This set of experiments attempts to observe interactions between these DHS sites and transcription starts in 25 regions selected based on genes expressed in GM06990 (B-lymphocyte), BJ (foreskin fibroblast), HepG2 (liver cancer cell line), or SK-N-SH_RA (neuroblastoma cell line, SKNSH, differentiated with retinoic acid). Myc project: Genome wide association studies have identified SNPs linked to prostate, colon, and breast cancer in the gene desert region upstream of the myc gene. 5C of HindIII fragments interacting with those containing refSeq txStarts in this region were performed in 5 cell types: GM12878 (B-lymphocyte), CaCo2 (colon cancer cell line), LNCaP (prostate cancer cell line), MCF7 (breast cancer cell line), and K562 (erythroleukemia cell line). For data usage terms and conditions, please refer to http://www.genome.gov/27528022 and http://www.genome.gov/Pages/Research/ENCODE/ENCODEDataReleasePolicyFinal2008.pdf
2012-07-19 | GSE39505 | GEO
Project description:Background Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition that often results in poor academic performance. Little is known about how ADHD manifests in residents and fellows. Objective To describe the prevalence and phenotype of ADHD among residents and fellows referred to a centralized remediation program. Methods We conducted a retrospective review of data obtained from referrals to a single-center centralized graduate medical education remediation program from 2017 to 2023. Data included demographic variables, ADHD and mental health history, and training performance characteristics. ADHD was determined by self-report, clinical diagnosis by mental health provider, or neuropsychological testing. Results A total of 173 trainees were referred in the study period. The prevalence of ADHD was 20% (35 of 173). ADHD was most commonly diagnosed in childhood (57%, 20 of 35); however, 26% (9 of 35) were diagnosed during or after medical school. Only 37% (13 of 35) were on medication, and 69% (24 of 35) disclosed at least one concomitant mental health diagnosis. Performance deficits were common in professionalism (69%, 24 of 35), organization/efficiency (O/E; 63%, 22 of 35), and medical knowledge (46%, 16 of 35). Repeated errors in patient care were made by 34% (12 of 35); 29% (10 of 35) failed at least one board examination, and 20% (7 of 35) required extension of residency or fellowship training. When compared to referrals without ADHD, residents and fellows with ADHD were more likely to struggle with O/E, failure to engage, and repeated errors. Conclusions One in 5 trainees referred to a GME remediation program had ADHD, and most were not being treated for ADHD when referred. The deficits identified suggest an ADHD phenotype in GME which may be considered for struggling residents and fellows.
| S-EPMC11641885 | biostudies-literature
Project description:Background The COVID-19 global pandemic has caused unprecedented levels of strain on the United States healthcare and its workforce. Orthopaedic and neurosurgery residents and fellows, as part of this workforce have also experienced some of the uncertainty and stress caused by this pandemic. Concerns exist regarding the effects of the pandemic on spine surgery education due to the cancellation of all elective surgeries. Current Context We explore how this pandemic is affecting orthopaedic and neurosurgery residents and fellows and their spine surgery education and experience. We also examined measures taken by the residency and fellowship programs to protect their residents and fellows, and measures taken by regulatory agencies like the ACGME and the ABOS to give programs some flexibility during these difficult times. Conclusion Orthopaedic and neurosurgery residents and fellows are often on the front lines of patient care. Programs have to ensure adequate resources and training, supervision, and work hour requirements are met. Residents and fellows need to be ready to assist with management of COVID-19 patients if necessary. Residency programs and spine surgery fellowships need to use objective metrics to assess the impact of the pandemic on the spine surgery education of their residents and fellows in order to address any potential area of weakness caused by the decreased exposure to spine surgery.
| S-EPMC7229966 | biostudies-literature
Project description:This data was generated by ENCODE. If you have questions about the data, contact the submitting laboratory directly (Richard Sandstrom mailto:sull@u.washington.edu). If you have questions about the Genome Browser track associated with this data, contact ENCODE (mailto:genome@soe.ucsc.edu). This track was produced as part of the ENCODE Project. This track displays genome-wide maps of histone modifications in different cell lines (http://hgwdev.cse.ucsc.edu/cgi-bin/hgEncodeVocab?type=cellType) using ChIP-seq high-throughput sequencing. For data usage terms and conditions, please refer to http://www.genome.gov/27528022 and http://www.genome.gov/Pages/Research/ENCODE/ENCODEDataReleasePolicyFinal2008.pdf
2012-06-07 | GSE35583 | GEO
Project description:This track is produced as part of the mouse ENCODE Project. This track shows DNaseI sensitivity measured genome-wide in mouse tissues and cell lines using the Digital DNaseI methodology (see below), and DNaseI hypersensitive sites. DNaseI has long been used to map general chromatin accessibility and DNaseI hypersensitivity is a universal feature of active cis-regulatory sequences. The use of this method has led to the discovery of functional regulatory elements that include enhancers, insulators, promotors, locus control regions and novel elements. For each experiment (tissue/cell type) this track shows DNaseI sensitivity as a continuous function using sequencing tag density (Signal), and discrete loci of DNaseI sensitive zones (HotSpots) and hypersensitive sites (Peaks). For data usage terms and conditions, please refer to http://www.genome.gov/27528022 and http://www.genome.gov/Pages/Research/ENCODE/ENCODEDataReleasePolicyFinal2008.pdf
2012-10-03 | GSE37074 | GEO
Project description:This data was generated by ENCODE. If you have questions about the data, contact the submitting laboratory directly (Richard Sandstrom mailto:sull@u.washington.edu). If you have questions about the Genome Browser track associated with this data, contact ENCODE (mailto:genome@soe.ucsc.edu). This track, produced as part of the mouse ENCODE Project, contains deep sequencing DNase data that will be used to identify sites where regulatory factors bind to the genome (footprints). Footprinting is a technique used to define the DNA sequences that interact with and bind DNA-binding proteins, such as transcription factors, zinc-finger proteins, hormone-receptor complexes, and other chromatin-modulating factors like CTCF. The technique depends upon the strength and tight nature of protein-DNA interactions. In their native chromatin state, DNA sequences that interact directly with DNA-binding proteins are relatively protected from DNA degrading endonucleases, while the exposed/unbound portions are readily degraded by such endonucleases. A massively parallel next-generation sequencing technique to define the DNase hypersensitive sites in the genome was adopted. The DNase samples were sequenced using next-generation sequencing machines to significantly higher depths of 300-fold or greater. This produces a base-pair level resolution of the DNase susceptibility maps of the native chromatin state. These base-pair resolution maps represent and are dependent upon the nature and the specificity of interaction of the DNA with the regulatory/modulatory proteins binding at specific loci in the genome; thus they represent the native chromatin state of the genome under investigation. The deep sequencing approach has been used to define the footprint landscape of the genome by identifying DNA motifs that interact with known or novel DNA binding proteins.
2012-09-19 | GSE40869 | GEO