Journal of general internal medicine
-
Medical education continues to evolve with technologic advances, cultural changes, and progress in the application of learning theories. One example is Cutrer's concept of the Master Adaptive Learner (MAL), where the trainee self-directs learning and innovates to maintain a level of expertise in a domain. We suggest that this concept can be applied alongside ideas of adaptive and teacher expertise to represent the medical educator of the future-the Master Adaptive Clinician Educator (MACE). ⋯ The MACE reflects and continuously develops an educational toolbox, applies lessons from learning theories, and appropriately adapts to various learning environments. In this manuscript, we build upon recent publications outlining roles and competencies of clinician-educators by applying the MAL model; we propose a dynamic, adaptable, and well-trained expert educator who is best poised to lead future generations of medical trainees. We challenge institutional leaders and national societies to take the lead in creating structures to support the growth and promotion of MACEs with the goal of positively reshaping medical education and the clinician educator.
-
Observation stays in Medicare have grown over the last 15 years, yet limited research exists on how observation may impact outcomes for older adults. ⋯ Among Medicare beneficiaries hospitalized for fewer than 5 days, observation stay was associated with higher rates of 30-day unplanned hospital returns compared to inpatient admission. However, we simultaneously observed lower out-of-pocket costs among those hospitalized under an observation stay. The mixed results suggest that additional research and engagement with relevant parties is needed to optimize observation stay policy.
-
Guidelines currently recommend annual screening for albuminuria only among persons with diabetes mellitus (DM). There is no guidance about albuminuria screening in those with other important risk factors for chronic kidney disease (CKD), such as hypertension and/or family history of kidney disease. We sought to create a risk score that predicts the likelihood of albuminuria in adults without diabetes to prompt earlier detection and management of CKD. ⋯ These results suggest that it may be helpful to use a risk score framework for albuminuria screening in people without DM to encourage earlier detection and management of CKD. Longitudinal studies are warranted to confirm this approach along with evaluation of its cost effectiveness.
-
The University of Pittsburgh School of Medicine collaborated with The Addis Clinic to create a global telemedicine elective for fourth-year medical students during the COVID-19 pandemic. The elective aimed to promote cross-cultural understanding by providing unique, hands-on telemedicine experience. ⋯ Implementation of a unique global telemedicine elective was feasible and well received by both medical students and clinical officers in Kenya. The elective can be implemented at other institutions with faculty experienced in global health who would like to partner with The Addis Clinic.