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OBJECTIVE: The purpose of this pilot study was to conduct a process evaluation of a mental health and wellness mobile health (mHealth) application for medical students designed to increase resilience and decrease mental health stigma. METHODS: The customized application, MindfulMEDS, was developed with peer-focused interactive modules specific to medical students within an existing system called Sharpen®. The Sharpen® system contains an extensive library of didactic and experiential mental health and wellness content built specifically to promote evidence-based protective factors for resilience. A mixed-methods approach including surveys and focus groups assessed participant resiliency, perception of mental health within the context of medical school, and evaluation of the app. Assessments were conducted at baseline (n = 66), six months (n = 30), and one year (n = 24). Demographic information was collected once at baseline as a part of the initial survey.  Results: A total of 215 users were registered in MindfulMEDS, consumed 83 courses, and engaged in 1,428 "connect clicks" to community resources and crisis-response supports. Resilience levels did not change significantly between surveys; however, a significant decrease in the perception of mental health stigma associated with utilizing mental health resources was observed. Focus group participants (n = 11) reported the screening tools to be useful, encouraged expansion, and suggested additional reminders to access the app to increase engagement. CONCLUSION: Findings of this pilot study demonstrate the feasibility of implementing MindfulMEDS (an mHealth app focused on mental health and wellness) among medical students. Students found the app experience valuable, accessed mental health screeners embedded within the app, utilized the app to seek help, and engaged with the app to learn more about mental health. There was also a decrease in mental health stigma observed during the course of the study. Based on these results, we propose that medical schools incorporate mobile-based technology into their mental health support programs.

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Purpose Community screening programs have been in effect since they were utilized in the 19th century at county fairs. A free pediatric health screening program was created by an osteopathic medical school in South Carolina in collaboration with a pediatric dental outreach organization to engage the local underserved community and train community-minded medical professionals. This study sought to demonstrate the efficacy and need for a student-run monthly pediatric health screening program in an underserved pediatric demographic. Methods A retrospective study of preexisting de-identified data obtained from a student-run health screening program was analyzed to determine the efficacy of the screening program in detecting chronic health risk factors in children in an underserved population. Patients were recruited through a partnership with a free dental clinic for underserved and uninsured children. Patients who attended the clinic were offered the opportunity to have a free, comprehensive health assessment following their dental visit. The function of this program was unique in that uninsured, underserved patients were provided free dental care and a free health assessment. Pediatric patients were screened for basic health information such as weight, height, BMI, vision, cardiovascular health, hypertension, asthma (reported via questionnaire by either the parent or child when applicable), nutrition, and lead poisoning (via questionnaire). The program also offered families additional support by connecting them to local resources and answering any questions they had about their children's health. Data from 14 health screening events was collected for quality improvement and efficacy monitoring. Descriptive analyses were performed. Results and analysis The health screening program assessed 124 children between October 2021 and March 2023 over 14 health screening events. The patients ranged from one year old to 26 years old, with a mean age of 9.65 years. Patients were predominantly Hispanic (79.67%). About one-third (27.64%) of children who were screened had positive findings associated with increased risk for chronic disease. Nearly half (43.90%) of families that were screened requested further information on ways to obtain health insurance and regular primary care services (utilized Access Health). Of the one-third of children with positive risk factors, 12.20% reported positive findings associated with asthma. Of the patients with positive risk factors, 8.94% had vision abnormalities, most of whom had not been seen by an ophthalmologist. This preliminary analysis will be followed by a secondary analysis that further investigates patient demographics (primarily Hispanic) as well as age distribution across various risk factors. Conclusion This pediatric health screening program has demonstrated a basic level of efficacy by successfully identifying increased risk for chronic disease in the underserved pediatric population. The need for these screening events was highlighted by the identification of untreated positive findings.

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Purpose: Individuals who do not complete substance use disorder treatment (SUDT) have similar outcomes to the untreated. Recovery capital (RC) is the collection of one's resources that contribute to the initiation and maintenance of sobriety. The aim of this paper was to identify individual measures of RC that are associated with SUDT completion. Methods: RC data for 69 residents from a men's recovery center was obtained from questionnaires administered to residents at intake and after SUDT graduation or dismissal. Participant data was divided into two groups, Graduates (n = 39, age 35.87±10.83) and Non-Graduates (n = 30, age 34.35±14.44), and retrospectively analyzed to compare RC between groups at various points during SUDT and which RC measures are associated with SUDT completion. Results: At baseline all participants reported limited RC and there was no significant difference in RC between groups. At graduation, Graduates reported significantly more RC in all measures when compared to baseline and Non-Graduates at dismissal. Non-Graduates reported a significant increase in Checking and Savings at dismissal but no other measure. Conclusion: Baseline levels of RC in both groups were limited and not significantly different which limited the capacity of the study to identify measures of RC associated with SUDT completion. A lack of RC at onset of SUDT did not preclude SUDT completion and obtaining RC during SUDT was associated with completion as only Graduates reported increases in RC. Future study designs should include participants with variable amounts of RC when entering SUDT.

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Objective To determine knowledge and comfort in discussing the human papillomavirus (HPV) vaccine among a sample of physicians practicing in South Carolina. Methods This descriptive cross-sectional study utilized a 33-question survey assessing knowledge of HPV, the HPV vaccine, and comfort in discussing associated topics with patients among a sample of physicians across the state of South Carolina. Descriptive and correlational analyses were performed. Results Of the total 66 participants, most self-reported having sufficient knowledge about HPV, yet responses to fact-based questions yielded an average score of only 7.03/13. Most felt comfortable discussing HPV, while some reported discomfort discussing sex-related topics (3.6%). A positive significant correlation was determined between having sufficient knowledge of HPV and comfort levels discussing both HPV and sex-related topics ((p-value < 0.001), (p = .0028)), comfort levels discussing HPV and comfort levels discussing sex (p = .0030), and comfort level discussing sex and previous communication training (Mantel-Haenszel chi-square = 0.0447). Conclusions The results of this study support the role of future interventions aimed at increasing the HPV knowledge base and training in discussions of sex for providers to help increase HPV vaccination rates in South Carolina.

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INTRODUCTION: Mobile health clinics serve a unique role in which they can offer affordable and adaptable care to the population they serve. The Edward Via College of Osteopathic Medicine (VCOM) mobile clinics began in 2020 as a partnership with the South Carolina Department of Health and Environmental Control (SCDHEC) to address the low vaccination rates that resulted from the COVID-19 pandemic. METHODS:  This study is a descriptive analysis that examines the number of vaccinations of tetanus, diphtheria, and pertussis (Tdap) and human papillomavirus (HPV) at different locations of administration including pediatrician offices, the novel VCOM mobile vaccination clinic, and the Spartanburg Health Department. The variables of interest and the study endpoints focused on Tdap and HPV vaccinations among students aged 11-12 years old in Spartanburg County according to the type of healthcare delivery location. RESULTS: From April to May of 2021, the VCOM mobile clinic was able to administer 279 Tdap vaccines and 189 HPV vaccines to students at local middle schools, which surpasses the number of vaccines administered at other sites from August 2020 to May 2021 when compared individually for both Tdap and HPV vaccinations. CONCLUSIONS: By assessing the total volume of vaccines administered by each group, the VCOM mobile clinic was established as an effective method of delivery and played a crucial role in the vaccination efforts of the Spartanburg community. Mobile medical units should be considered for similar efforts in providing care to resource-limited communities and those with limited access to care.

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OBJECTIVE: The purpose of this study was to use the RE-AIM framework to evaluate the implementation of a mental health app designed for undergraduate and medical students during the COVID-19 pandemic. PARTICIPANTS: Medical (n = 270) and undergraduate students (n = 1386) from five universities in the Appalachian region in the United States participated in this study. METHODS: Universities from the United States were recruited to deploy the Sharpen app for medical and undergraduate students. The Sharpen app provided psychoeducational modules in mental health literacy, social-emotional learning, mindfulness-based stress reduction, and suicide prevention to promote protective factors for students. The utilization of the Sharpen app was analyzed using the RE-AIM framework using a retrospective, cross-sectional design. RESULTS: Reach: A total of 12.72% of medical students and 6.00% of undergraduate students participated in the study. EFFICACY: Medical students viewed significantly more pages, had a significantly higher unique page view average, and a statistically significant exit percentage when compared to undergraduate students. Adoption: A total of 100% of the universities that were recruited participated in the study. IMPLEMENTATION: Five out of six implementation criteria were included, indicating high implementation. Maintenance: All of the universities continued using the Sharpen app following the end of data collection, resulting in a 100% maintenance rate. CONCLUSIONS: The RE-AIM framework indicated usability and maintenance by medical and undergraduate students. Future research needs to implement a more rigorous design to determine the impact of the Sharpen app on mental health outcomes in medical and undergraduate students.

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CONTEXT: Some racial and ethnic groups are underrepresented in the medical field because they face unique barriers to admission to medical school. One admission requirement that can present a barrier for applicants is the physician letter of recommendation (PLOR). Undergraduate students report confusion with the application process and lack of mentorship to be two of their biggest challenges to becoming a doctor. It is especially challenging to those who already have limited access to practicing physicians. Therefore, we hypothesized that in the presence of a PLOR requirement, the diversity of students who apply and matriculate into medical school will be decreased. OBJECTIVES: This study aims to determine if a relationship exists between a PLOR requirement for the medical school application and the proportion of underrepresented in medicine (URM) students applying and matriculating to that school. METHODS: A retrospective study was conducted utilizing data published by the American Association of Colleges of Osteopathic Medicine Application Services (AACOMAS) on the race and ethnicity of applicants and matriculants to osteopathic medical schools during the years 2009-2019. In total, 35 osteopathic schools with 44 campuses were included in the study. Schools were grouped based on whether they required a PLOR. For each group of schools, descriptive statistics were performed for the following variables: number of total applicants, class size, application rate per ethnicity, matriculation rate per ethnicity, number of applicants per ethnicity, number of matriculants per ethnicity, and percentage of student body per ethnicity. The Wilcoxon rank-sum test was utilized to detect differences between the two groups. Statistical significance was assessed at the α=0.05 level. RESULTS: Schools that required a PLOR showed decreases in the number of applicants across all races and ethnicities. Black students showed the greatest difference between groups and were the only ethnicity to show significant reductions across all outcomes in the presence of a PLOR requirement. On average, schools that required a PLOR have 37.3% (185 vs. 295; p<0.0001) fewer Black applicants and 51.2% (4 vs. 8.2; p<0.0001) fewer Black matriculants. CONCLUSIONS: This study strongly suggests a relationship between requiring a PLOR's and decreasing racial and ethnic diversity in medical school matriculants, specifically the Black applicants. Based on this result, it is recommended that the requirement of a PLOR be discontinued for osteopathic medical schools.

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Despite the many advancements in infection prevention, catheter-associated urinary tract infections (CAUTI) continue to be problematic for many hospitals. The large urban teaching hospital featured in this article developed a team that consisted of a registered nurse quality Lean coach, bedside nurses from each inpatient nursing unit, physicians, an infection prevention specialist nurse, an education specialist nurse, and members of the quality department to study this matter. The team focused on understanding current practice related to the use and duration of indwelling urinary catheters. It was discovered that while some indwelling urinary catheters were justified, others could have been avoided altogether or removed earlier. Multifaceted measures were instituted at this hospital to decrease indwelling urinary catheter days and reduce CAUTI rates. The team's journey to successfully decreasing indwelling urinary catheter days by 19.79% and CAUTI rates by 38% is highlighted.

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OBJECTIVE: Approximately 1 in 6 adults 60 and older have experienced a form of abuse in the past year. Many cases remain under-reported due to lack of knowledge and awareness. This study created an educational program on elder abuse for medical students to determine if participation would increase knowledge and awareness of elder abuse. METHODS: This study used a pre and post survey methodology to evaluate students' knowledge and awareness of elder abuse before and after participating in this educational program. Sixty first and second year osteopathic medical students at the Edward Via College of Osteopathic Medicine, Carolinas Campus participated in this study. Students were emailed a pre-survey to evaluate their pre-existing knowledge and awareness. The survey was, previously created by the Student Training on Preventing Domestic Violence (STOP-DV) team using validated measures. Participants then attended educational events about various forms of elder abuse and recognizing its associated signs, and afterward completed the post-survey. The results were compared using t-tests to determine if there was a significant difference. RESULTS: First and second year students differed significantly in pre-survey results of knowledge but not post-survey results. The results showed a significant difference in overall mean knowledge (P-value < .001) and awareness scores (P-value < .001) in all students. CONCLUSION: These results suggest education on elder abuse can enable future physicians to better recognize, understand, and support older adults regarding elder maltreatment.

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In late 2019, the first case of COVID-19 was reported in Wuhan, China. Soon after, cases began to spread globally. This study aimed to examine the psychological impact of the COVID-19 pandemic on the adult population in the United States. We conducted an exploratory cross-sectional study using an anonymous online survey methodology distributed to participants across 13 states. The data collected included demographical information and outcomes from validated mental health screeners (GAD-7, PHQ-9, and IES-R) to assess levels of anxiety, depression, and stress. A total of 1356 participants completed the survey. GAD-7, PHQ-9, and IES-R levels differed significantly (p < 0.05) according to age, gender, and educational level. There was also significant difference between GAD-7 level as well as IES-R level between healthcare and non-healthcare workers (p = 0.02 and p = 0.028). Overall, this study has helped to garner a better understanding of COVID-19's impact on mental health outcomes.

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INTRODUCTION: Physicians-in-training (residents) are typically the primary educators for medical students during clinical clerkships. However, residents are not formally trained to teach or to assess their teaching. The aim of this study was to assess the implementation of a clinical educator rotation aimed at developing residents' competencies related to clinical teaching. METHODS: A mixed-methods approach was used to develop and assess the clinical educator rotation at a teaching community hospital. Internal medicine residents who participated in the rotation and consented to the research were assigned to the clinical educator trainee (CET) group, the remaining residents were assigned to the control group. Osteopathic medical students rotating in the medicine service line were invited to participate. The study used descriptive and qualitative analyses to measure primary and secondary outcomes. RESULTS: The primary outcome measure showed a positive change in resident knowledge, skills and behaviors in communication, reflection, feedback, precepting, and facilitation. Medical student perceptions of resident teaching skills confirmed the observed changes in CETs. Some CETs continued to practice and build their capacity for teaching after completing the rotation. Qualitatively, we derived four common themes among the data; communication, professional engagement, practice-based learning, and systems-based learning. CONCLUSION: Resident teaching capacity was enriched after completing the clinical educator rotation. Other benefits included: enhanced patient communication and education, increased resident confidence, personal satisfaction with training, work life-balance and enhanced career satisfaction. Future research should focus on curricular content, faculty development, and delivery assessment. In addition, research efforts should identify appropriate emerging technologies to include in the curriculum for enhancing teaching capacity.

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CONTEXT: To improve chronic disease self-management among an underserved population and to improve the skills of second-year osteopathic medical students, an educational curriculum, The Other 45, was developed. In addition to a typical 15-minute office visit, this program allows second-year students to provide chronic disease education to patients for 45 minutes in an effort to improve patient disease self-management and associated health outcomes. OBJECTIVE: To determine whether patients who participate in The Other 45 report improvements in their ability to manage their chronic disease(s) and their health outcomes and whether second-year osteopathic medical students report changes in patient-centered care, clinical confidence, and medical/teaching knowledge. METHODS: Patients with a previously diagnosed chronic disease participated in 3 visits for The Other 45. Chronic disease self-management and health outcomes were measured using the Health Education Impact Questionnaire, which participants completed at each visit. Students received a formal presentation on teaching skills, and those who participated in The Other 45 completed a pre- and postclinic survey measuring 3 focused domains: patient-centered care, clinical confidence, and medical/teaching knowledge. RESULTS: A total of 47 patients and 69 students participated in the study. As measured by the Health Education Impact Questionnaire, patients' skill and technique acquisition (P=.01), constructive attitudes and approaches (P=.01), and health services navigation (P=.03) showed significant improvement at the 3-week follow-up visit, and self-monitoring and insight showed significant improvement (P=.01) at the 3-month follow-up visit. Patients' positive and active engagement in life (P=.04 and P=.03) and emotional well-being (P=.003 and P=.0007) significantly improved at the 3-week and 3-month follow-up, respectively. The students improved significantly in all 3 domains as a result of participating in the program: patient-centered care (P=.012), clinical confidence (P<.001), and medical/teaching knowledge (P=.002). CONCLUSIONS: The Other 45 was effective in improving patients' ability to manage their chronic disease(s), as well as improving second-year osteopathic medical students' ability to educate a patient with chronic disease. Implementing this type of program has the potential to affect patients with chronic disease as well as medical students in a rural underserved setting.

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BACKGROUND: Criteria pollutants have been associated with exacerbation of children's asthma, but the role of air toxics in relation to asthma is less clear. Our objective was to evaluate whether exposure to outdoor air toxics in early childhood increased asthma risk or severity. METHODS: Air toxics exposure was estimated using the 2002 National Air toxics Assessment (NATA) and linked to longitudinal data (n=6950) from a representative sample of US children born in 2001 and followed through kindergarten-age in the Early Child Longitudinal Study-Birth Cohort (ECLS-B). RESULTS: Overall, 17.7% of 5.5 year-olds had ever been told by a healthcare professional they had asthma, and 6.8% had been hospitalized or visited an emergency room for an asthma attack. Higher rates of asthma were observed among boys (20.1%), low-income (24.8%), and non-Hispanic black children (30.0%) (p≤0.05). Air toxics exposure was greater for minority race/ethnicity (p<0.0001), low income (p<0.0001), non-rural area (p<0.001). Across all analyses, greater air toxics exposure, as represented by total NATA respiratory hazard index, or when limited to respiratory hazard index from onroad mobile sources or diesel PM, was not associated with a greater prevalence of asthma or hospitalizations (p trend >0.05). In adjusted logistic regression models, children exposed to the highest respiratory hazard index were not more likely to have asthma compared to those exposed to the lowest respiratory hazard index of total, onroad sources, or diesel PM. CONCLUSIONS: Early childhood exposure to outdoor air toxics in a national sample has not previously been studied relative to children's asthma. Within the constraints of the study, we found no evidence that early childhood exposure to outdoor air toxics increased risk for asthma. As has been previously reported, it is evident that there are environmental justice and disparity concerns for exposure to air toxics and asthma prevalence in US children.

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