Two out of five medical students have an unconscious bias against obese people, according to a new study by researchers at Wake Forest Baptist Medical Center. The study is published online ahead of print in the Journal of Academic Medicine.

"Bias can affect clinical care and the doctor-patient relationship, and even a patient's willingness or desire to go see their physician, so it is crucial that we try to deal with any bias during medical school," said David Miller, M.D., associate professor of internal medicine at Wake Forest Baptist and lead author of the study.

"Previous research has shown that on average, physicians have a strong anti-fat bias similar to that of the general population. Doctors are more likely to assume that obese individuals won't follow treatment plans, and they are less likely to respect obese patients than average weight patients," Miller said.

Miller and colleagues conducted the study as part of their efforts to update the medical school's curriculum on obesity. The goal was to measure the prevalence of unconscious weight-related biases among medical students and to determine whether the students were aware of those biases.

The three-year study included more than 300 third-year medical students at a medical school in the southeastern United States from 2008 through 2011. The students were geographically diverse, representing at least 25 different states and 12 countries outside the United States.

The researchers used a computer program called the Weight Implicit Association Test (IAT) to measures students' unconscious preferences for "fat" or "thin" individuals. Students also answered a survey assessing their conscious weight-related preferences. The authors determined if the students were aware of their bias by seeing if their IAT results matched their stated preferences.

Overall, 39 percent of medical students had a moderate to strong unconscious anti-fat bias as compared to 17 percent who had a moderate to strong anti-thin bias. Less than 25 percent of students were aware of their biases.

More.

They never said navigating the electronic medical record landscape would be easy — at least not at first. And as new regulations from both federal and state spheres begin to tighten their hold around the industry, the valleys of EHR adoption and EHR mastery are sure to only become more congested and therein, even harder to get a handle on. 

Fortunately, current EHR veterans saw it coming and set out early with open minds — ready to note and reroute the process wherever necessary — and are now reporting back at last on the troubles and tricks that arise when dealing with digitized data.

Panelists on deck in Boston for the recent Health IT Summit session titled "EHR Data: A Touchstone for Quality Care" had plenty of diverging facets to share on the topic of EHR integration, but one primary point remained: We are all in this together.

“For things like this, I think all doctors are created equal,” said Jonathan Leviss, MD, chief medical officer for Rhode Island Quality Institute, a physician for Thundermist Health Center and a clinical assistant professor for Alpert Medical School and Brown University.

“The one thing that I’ve learned most importantly is that these are team-based efforts,” he continued. “We’re talking about getting data out of electronic health records, out of different HIT systems, to drive quality initiatives, which requires us to look at data in a way that an individual person can’t, the individual brain, whether that’s a physician, a nurse or a quality person.”

Beyond that need for a pack mentality in the EMR stratosphere, Reid Coleman, MD, chief medical information officer for evidence-based medicine, Nuance Communications, spoke of the importance of roles distributed to people who both know the importance of data and who want to be strictly involved in the pursuit of it.

More.

The AAMC has released a new report to help medical schools assess the impact of medical school holistic admissions. Roadmap to Excellence: Key Concepts for Evaluating the Impact of Medical School Holistic Admissions is the third in the series of publications from the AAMC Holistic Review Project that aims to help schools establish, implement, and evaluate diversity-related policies to help them achieve their individual missions, while staying within the established legal framework. The publication includes an introductory chapter on evaluation basics and focuses on assessing three main areas: enrollment management, the medical school learning environment, and workforce outcomes.

Read more.

A simulated teaching package that focuses on helping undergraduate medical students to improve their ability to conduct arterial blood gas (ABG) testing has been developed by a team at the Bath Academy in the U.K. This simulated teaching package is expected to advance the competence and confidence levels of Bristol university medical school undergrads to perform these important blood tests.

Arterial blood gases (ABGs) testing is often required in testing sick patients to help diagnose the severity of a condition and assist in assessing treatment. We've learned in highschool that as blood passes through our lungs, oxygen moves into the blood and carbon dioxide moves out of the blood and into the lungs. What an ABG test does is check how well the lungs are able to carry oxygen into the blood and remove carbon dioxide from the blood. The test uses blood drawn from an artery to measure its oxygen and carbon dioxide levels before they enter body tissue.

The Bath Academy, which trains the medical students at the Royal United Hospital, hopes the simulated teaching package will help to improve positive patient outcomes and gain valuable experience for the medical students. For more information, click here>>

If it's a Monday, you can usually find Dr. David Brown parked next to a lake in Miami, spending the day inside a 36-foot-long RV. He's not on vacation. Brown is chief of family medicine at Florida International University's medical school. The RV is the school's mobile health clinic. Every Monday it's parked at the Royal Country Mobile Home Park in northwest Miami-Dade County. "It's a beautiful place right here," he says. "But this is not a wealthy community."

Brown helps direct FIU's Neighborhood HELP program. It's part of the school's curriculum that connects medical students with families in neighborhoods where medical care is scarce. Students visit families in their homes where they conduct examinations and provide basic care. But some things are better done in a clinic. So the medical school bought its own RV. "We're able to bring free basic primary care to our households relatively close to their community," Brown says.

In one of the RV's exam rooms, third-year medical student Veronica Alvarez met recently with patient Maritza Flores. Flores has diabetes and high blood pressure. With help from the school's faculty, Alvarez has been treating her since January.

Flores says with Alvarez's encouragement, she's begun exercising more and has improved her diet. And, thanks to FIU's doctors, she's begun taking medication for her diabetes and high blood pressure. In just a few months, Alvarez says, she's seen a big improvement. "The high blood pressure and the diabetes together is what you worry about," Alvarez says. "And now, her diabetes is well-controlled and her hypertension is well-controlled as well."

Over the last decade, a pressing need for new doctors has led many universities to open medical schools. Seventeen new schools have been accredited since 2005, and several are looking at new ways to train doctors. When it was founded just four years ago, Florida International University took on a mission — to improve the health of nearby communities. Another focus for the school is to train more doctors in primary care.

Nationally, there's a shortage of primary care doctors — one that's expected to worsen as millions more Americans get access to health care under the Affordable Care Act. But Dr. John Rock, the medical school's dean, says the two missions go together. Sending students out to treat patients in their communities teaches them the art of primary care.

FIU just graduated its first class from the medical school. Nearly half of the students, Rock says, are doing residencies in primary care. Several other new medical schools are also developing programs that allow students to develop ongoing relationships with patients. And there are others that, like FIU also have a social mission — to improve the quality of life in medically-underserved communities.

More.

A study released today by George Washington University School of Public Health and Health Services (SPHHS) researchers offers an in-depth look at hospitals nationwide and admissions to intensive care units (ICU). The study, published in the journal Academic Emergency Medicine, finds a sharp increase—nearly 50 percent—in ICU admissions coming from U.S. emergency departments.

"These findings suggest that emergency physicians are sending more patients on to the ICU," said SPHHS researcher and lead author Peter Mullins. "The increase might be the result of an older, sicker population that needs more care." The larger question, one that this study couldn't answer, is whether there will be enough ICU capacity in the future to accommodate the growing number of patients, particularly the oldest of the old, the authors said.

Mullins and his colleagues conducted the study by using data from the National Hospital Ambulatory Care Survey, a sample of U.S. hospital-based emergency departments during a seven-year period. They found that ICU admissions jumped from 2.79 million in 2002-2003 to 4.14 million in 2008-2009. The study also shows that during the same time frame overall emergency department admissions grew by only 5.8 percent.

Other key findings of the study:
- ICU admissions grew the most among patients aged 85 and older—increasing 25 percent every two years.
- Utilization of tests and services provided to emergency department patients on their way to the ICU also jumped during the study period, with the largest rise occurring in computerized tomography (CT) or magnetic resonance imaging (MRI) tests. In fact, CT and MRI tests provided while still in the emergency department increased from 16.8 percent to 37.4 percent.
- The most common reasons for ICU admissions were symptoms such as chest pain or shortness of breath that can signal life-threatening conditions like heart attacks.
- On average, patients had to wait five hours in the emergency department before getting into the ICU.

Additional research must be done to find ways to keep critically ill patients from facing long waits in crowded emergency departments, said co-author Jesse Pines, MD, MBA, MSCE, a practicing emergency physician and an associate professor of emergency medicine and health policy at SPHHS.

"Studies have shown that the longer ICU patients stay in the emergency department, the more likely they are to die in the hospital," Pines said. "Better coordination between the emergency department and ICU staff might help speed transfers and prevent complications caused by long emergency department waits," he said.

Source.

With more than 600,000 performed in the United States each year, hysterectomies are the most commonly administered gynecological surgical procedures. Most hysterectomies have traditionally been performed via traditional, "open" abdominal surgery – but over the past decade, the number performed via minimally invasive surgery has increased substantially. In fact, many healthcare facilities now perform more minimally invasive hysterectomies than open ones.

Commonly used in orthopedic surgery, thoracic surgery, urology, gastrointestinal surgery, and even heart surgery, minimally invasive surgery is also a good choice for many women facing gynecological surgery and hysterectomy. Studies have found that a woman who has undergone a hysterectomy via minimally invasive surgery can expect a significantly shorter hospital stay than one who opted for abdominal surgery – in one study, the length averaged about 1.6 days, versus 3.9 days.

Another advantage: fewer incisions and faster time to heal. A hysterectomy via minimally invasive surgery requires just a few 8- to 12-millimeter incisions, as opposed to traditional hysterectomy, which requires a 6- to 10-inch incision across the abdomen. Fewer, smaller incisions equate to reduced scarring and pain; reduced hemorrhaging and less possible need for blood transfusions following the hysterectomy; and reduced risk of infection as the patient isn't exposed as much or as long as she is during a traditional hysterectomy.

Hysterectomy is a major procedure which renders the patient unable to bear children. As such, the surgery is only recommended when other options for treatment are unavailable. Reasons for recommendation may include a diagnosis of cancer, the discovery of tumors, or chronic pelvic pain. In all cases, it's essential that the surgeon understands the patient's needs, ensuring an exceptional level of care delivery.

It's also necessary that surgeons performing hysterectomies via minimally invasive surgery have mastered an array of high-level, up-to-date skills, including the use of special tools and instruments; proper posture; efficient hand and arm movement; and manual dexterity. And because the patient's internal organs and tissue are viewed via a video screen, the surgeon must develop a range of hand-eye coordination specific to monitoring the surgery while using unique, state-of-the-art surgical equipment.

All these skills can be learned with the use of a virtual reality (VR) simulator for minimally invasive surgery. Education is key to success: simulation offers surgeons a safe environment in which to practice, learn from their mistakes, and most importantly, perform actual hysterectomies with minimal complications and a great deal of confidence. With one in three women undergoing a hysterectomy by age 65, it's absolutely essential that their surgeons are qualified and competent.

Presented by Richard Pizzi, AIA, VP, and healthcare design principal for Lavallee Brensinger Architects.

We had a great response to today's webinar. Feel free to post your questions/comments for Richard in the comments box below.

Abstract: This interactive webinar will explore the planning, programming, and design of clinical simulation centers. We will discuss a collaborative and inclusive process to define your goals and create a space program that accommodates all simulation activities. The webinar will discuss the design of flexible, multi-functional simulation labs and the spatial relationships between labs and support space. The webinar will also review the integration of simulation, AV, and medical equipment as well as lessons learned and current/future trends from active simulation centers.

Richard Pizzi, AIA, VP, is a healthcare design principal for Lavallee Brensinger Architects regional healthcare design firm. Rich has specialized in healthcare design for nearly 19 years. For the past 6 years, he has focused on the research, programming, and design of clinical simulation centers. During this time, Rich has programmed and designed clinical simulation centers for large academic medical centers, community hospitals, medical schools, and nursing schools. His efforts have also included first-hand training observations, site visits, and post-occupancy reviews. Rich is a member of the Society for Simulation in Healthcare.