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Background Since 2020, virtual interviews have become the typical way in which applicants assess residency programs. It is unknown whether the change from in-person to virtual interviews has been associated with changes in perceptions of the quality of information gathered by prospective applicants. Objective To ascertain perspectives on the satisfaction with, quality of, and accuracy of information gathered by internal medicine (IM) residency applicants from virtual and in-person interviews. Methods Twenty-nine thousand, seven hundred and seventy-six residents from US and Puerto Rico residency programs sitting for the 2022 American College of Physicians Internal Medicine In-Training Examination (IM-ITE) were surveyed. An optional, 5-question survey was administered at the end of the examination. Responses were analyzed based on interview format-virtual (postgraduate year [PGY]-1-2) or in-person (PGY-3)-and PGY. Results Of 29 776, 23 161 residents responded to the survey (77.8% response rate). Regardless of PGY, respondents reported a high degree of satisfaction with the quality of information gathered from their interview day, though there was a statistically significant difference between virtual and in-person [somewhat/very satisfied: In-person 5938 of 7410 (80.1%); 95% CI [79.2, 81.0] vs virtual 12 070 of 15 751 (76.6%); 95% CI [76.0, 77.3]:P<.001]. Residents in all PGYs reported sessions with residents and one-on-one interviews as the most important factors when creating their rank lists. Conclusions We found differences in satisfaction and perceptions of the quality of information gathered between IM residents who participated in virtual and in-person interviews. However, regardless of format, most respondents reported satisfaction with their interview experience.

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The University of Texas Health Science Center at San Antonio launched an annual university-wide seed grant program in 2019 to foster innovation in interprofessional education (IPE) and increase IPE opportunities for learners. Program objectives included leveraging hypothesis-driven research to identify sustainable IPE activities for integration into educational programs (i.e. mandated for at least one cohort of learners), increasing scholarly dissemination of IPE efforts, and using pilot data to secure extramural funding. Over the first four funding cycles (2019-2022), US$100,509.00 was awarded to support 22 IPE projects (10 curricular, 12 co-curricular) involving 80 faculty and staff collaborators and over 2,100 student participants. To date, funded projects have yielded nine sustained IPE activities (four of which have been integrated), produced 24 scholarly presentations and three peer-reviewed publications, and contributed to the success of one extramural grant. Barriers experienced are discussed in this report alongside lessons learned and unexpected positive outcomes, including identification of future IPE champions.

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BACKGROUND: Growing health professional accreditation mandates and expectations for interprofessional education (IPE) have led to heightened interest amongst health professions educators and administrators in the creation and development of effective and sustainable IPE programming. IPE ACTIVITY: At the University of Texas Health Science Center at San Antonio, an institution-wide initiative called Linking Interprofessional Networks for Collaboration (LINC) was initiated to strengthen IPE knowledge and skills, increase IPE offerings, and integrate IPE into curricula. In 2020, stakeholders developed, implemented, and evaluated a university-wide IPE activity called the LINC Common IPE Experience, which includes three collaborative online learning modules that students complete synchronously using a videoconference platform without direct faculty facilitation. Mini-lectures, interprofessional discussions, and authentic case studies using innovative media facilitated meaningful engagement of 977 students from 26 different educational programs. DISCUSSION: Quantitative and qualitative results from evaluations demonstrated significant student engagement, increased awareness and understanding of teamwork, progress towards interprofessional competency development, and benefits related to professional development. The LINC Common IPE Experience provides a valuable example of a robust, high-impact foundational IPE activity that can serve as a sustainable model for university-wide IPE.

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BACKGROUND: The internal medicine (IM) subinternship (also referred to as acting internship) plays a crucial part in preparing medical students for residency. The roles, responsibilities, and support provided to subinternship directors have not been described. OBJECTIVE: We sought to describe the current role of IM subinternship directors with respect to their responsibilities, salary support, and reporting structure. DESIGN: Nationally representative, annually recurring thematic survey of IM core clerkship directors with membership in an academic professional association as of September 2017. PARTICIPANTS: A total of 129 core clinical medicine clerkship directors at Liaison Committee on Medical Education fully accredited U.S./U.S.-territory-based medical schools. MAIN MEASURES: Responsibilities, salary support, and reporting structure of subinternship directors. KEY RESULTS: The survey response rate was 83.0% (107/129 medical schools). Fifty-one percent (54/107) of respondents reported overseeing both core clerkship inpatient experiences and/or one or more subinternships. For oversight, 49.1% (28/53) of subinternship directors also reported that they were the clerkship director, 26.4% (14/53) that another faculty member directed all medicine subinternships, and 18.9% (10/53) that each subinternship had its own director. The most frequently reported responsibilities for the subinternship directors were administration, including scheduling, and logistics of student schedules (83.0%, 44/53), course evaluation (81.1%, 43/53), and setting grades 79.2% (42/53). The modal response for estimated FTE per course was 10-20% FTE, with 33.3% (16/48) reporting this level of support and 29.2% (14/54) reporting no FTE support. CONCLUSIONS: The role of the IM subinternship director has become increasingly complex. Since the IM subinternship is critical to preparing students for residency, IM subinternship directors require standard expectations and adequate support. Future studies are needed to determine the appropriate level of support for subinternship directors and to define essential roles and responsibilities.

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BACKGROUND: Interprofessional collaborative practice (IPCP) offers great potential to improve healthcare. Increases in IPCP will require educating learners in authentic IPCP settings and will generate opportunities and challenges. METHODS: In January 2015, we implemented an IPCP model called Collaborative Care (CC) for hospitalized adult medical patients. We explored learner perspectives regarding their educational experiences. We deductively coded transcripts from semi-structured interviews with medical learners. Data related to educational experiences were thematically analyzed. RESULTS: Twenty-four of 28 (85.7%) medical learners rotating on CC from January to May 2015 completed interviews. Subsequent inductive analysis of these interviews identified four themes: Loss of Educational Opportunities during Rounds, Feelings of Uncertainty during New Situations, Strategies for Adaptation, and Improved Communication with Patients and the Team. CONCLUSIONS: Increased implementation of IPCP will lead to a greater number of learners being exposed to authentic IPCP settings and will generate opportunities and challenges. Though learners perceived improved communication skills in an IPCP model, they also described loss of profession-specific learning opportunities and feelings of uncertainty. These findings corroborate the need for novel teaching methods aligned with IPCP clinical learning environments and educational assessment strategies that reflect attainment of both profession-specific and interprofessional competencies.

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BACKGROUND: In the rapidly changing landscape of undergraduate medical education (UME), the roles and responsibilities of clerkship directors (CDs) are not clear. OBJECTIVE: To describe the current roles and responsibilities of Internal Medicine CDs. DESIGN: National annual Clerkship Directors in Internal Medicine (CDIM) cross-sectional survey. PARTICIPANTS: One hundred twenty-nine clerkship directors at all Liaison Committee on Medical Education accredited US medical schools with CDIM membership as of September 1, 2017. MAIN MEASURES: Responsibilities of core CDs, including oversight of other faculty, and resources available to CDs including financial support and dedicated time. KEY RESULT: The survey response rate was 83% (107/129). Ninety-four percent of the respondents oversaw the core clerkship inpatient experience, while 47.7% (n = 51) and 5.6% (n = 6) oversaw the outpatient and longitudinal integrated clerkships respectively. In addition to oversight, CDs were responsible for curriculum development, evaluation and grades, remediation, scheduling, student mentoring, and faculty development. Less than one-third of CDs (n = 33) received the recommended 0.5 full-time equivalent (FTE) support for their roles, and 15% (n = 16) had less than 20% FTE support. An average 0.41 FTE (SD .2) was spent in clinical work and 0.20 FTE (SD .21) in administrative duties. Eighty-three percent worked with other faculty who assisted in the oversight of departmental UME experiences, with FTE support varying by role and institution. Thirty-five percent of CDs (n = 38) had a dedicated budget for managing their clerkship. CONCLUSIONS: The responsibilities of CDs have increased in both number and complexity since the dissemination of previous guidelines for expectations of and for CDs in 2003. However, resources available to them have not substantially changed.

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Cognitive load is a key mediator of cognitive processing that may impact clinical reasoning performance. The purpose of this study was to gather biologic validity evidence for correlates of different types of self-reported cognitive load, and to explore the association of self-reported cognitive load and physiologic measures with clinical reasoning performance. We hypothesized that increased cognitive load would manifest evidence of elevated sympathetic tone and would be associated with lower clinical reasoning performance scores. Fifteen medical students wore Holter monitors and watched three videos depicting medical encounters before completing a post-encounter form and standard measures of cognitive load. Correlation analysis was used to investigate the relationship between cardiac measures (mean heart rate, heart rate variability and QT interval variability) and self-reported measures of cognitive load, and their association with clinical reasoning performance scores. Despite the low number of participants, strong positive correlations were found between measures of intrinsic cognitive load and heart rate variability. Performance was negatively correlated with mean heart rate, as well as single-item cognitive load measures. Our data signify a possible role for using physiologic monitoring for identifying individuals experiencing high cognitive load and those at risk for performing poorly during clinical reasoning tasks.

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Cancer stem cells (CSCs) are aggressive subpopulations with increased stem-like properties. CSCs are usually resistant to most standard therapies and are responsible for tumor repropagation. Similar to normal stem cells, isolation of CSCs is challenging due to the lack of reliable markers. Antigen-based sorting of CSCs usually requires staining with multiple markers, making the experiments complicated, expensive, and sometimes unreliable. Here, we study the feasibility of using dielectrophoresis (DEP) for isolation of glioblastoma cells with increased stemness. We culture a glioblastoma cell line in the form of neurospheres as an in vitro model for glioblastoma stem cells. We demonstrate that spheroid forming cells have higher expression of stem cell marker, nestin. Next, we show that dielectric properties of neurospheres change as a result of changing culture conditions. Our results indicate that spheroid forming cells need higher voltages to experience the same DEP force magnitude compared to normal monolayer cultures of glioblastoma cell line. This study confirms the possibility of using DEP to isolate glioblastoma stem cells.

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Electroporation is the process by which applied electric fields generate nanoscale defects in biological membranes to more efficiently deliver drugs and other small molecules into the cells. Due to the complexity of the process, computational models of cellular electroporation are difficult to validate against quantitative molecular uptake data. In part I of this two-part report, we describe a novel method for quantitatively determining cell membrane permeability and molecular membrane transport using fluorescence microscopy. Here, in part II, we use the data from part I to develop a two-stage ordinary differential equation model of cellular electroporation. We fit our model using experimental data from cells immersed in three buffer solutions and exposed to electric field strengths of 170 to 400 kV/m and pulse durations of 1 to 1000 µs. We report that a low-conductivity 4-(2-hydroxyethyl)-1 piperazineethanesulfonic acid buffer enables molecular transport into the cell to increase more rapidly than with phosphate-buffered saline or culture medium-based buffer. For multipulse schemes, our model suggests that the interpulse delay between two opposite polarity electric field pulses does not play an appreciable role in the resultant molecular uptake for delays up to 100 µs. Our model also predicts the per-pulse permeability enhancement decreases as a function of the pulse number. This is the first report of an ordinary differential equation model of electroporation to be validated with quantitative molecular uptake data and consider both membrane permeability and charging.

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This Invited Commentary is written by coauthors working to implement and study new models of interprofessional practice and education in clinical learning environments. There are many definitions and models of collaborative care, but the essential element is a spirit of collaboration and shared learning among health professionals, patients, and family members. This work is challenging, yet the benefits are striking. Patients and family members feel seen, heard, and understood. Health care professionals are able to contribute and feel appreciated in satisfying ways. Learners feel included. Care interactions are richer and less hierarchical, and human dimensions are more central. A crucial insight is that collaborative care requires psychological safety, so that people feel safe to speak up, ask questions, and make suggestions. The most important transformation is actively engaging patients and families as true partners in care creation. A leveling occurs between patients, family members, and health professionals, resulting from closer connections, deeper understandings, and greater mutual appreciation. Leadership happens at all levels in collaborative care, requiring team-level capabilities that can be learned and modeled, including patience, curiosity, and sharing power. These abilities grow as teams work and learn together, and can be intentionally advanced by reconfiguring organizational structures and care routines to support collective team reflection. Collaborative care requires awareness and deliberate practice both individually and as a team together. Respectful work is required, and setbacks should be considered normal at first. Once people have experienced the benefits of collaborative care, most "never want to go back."

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BACKGROUND: Attending rounds remain the primary venue for formal teaching and learning at academic medical centers. Little is known about the effect of increasing clinical demands on teaching during attending rounds. OBJECTIVE: To explore the relationships among teaching time, teaching topics, clinical workload, and patient complexity variables. DESIGN: Observational study of medicine teaching teams from September 2008 through August 2014. Teams at two large teaching hospitals associated with a single medical school were observed for periods of 2 to 4 weeks. PARTICIPANTS: Twelve medicine teaching teams consisting of one attending, one second- or third-year resident, two to three interns, and two to three medical students. MAIN MEASURES: The study examined relationships between patient complexity (comorbidities, complications) and clinical workload variables (census, turnover) with educational measures. Teams were clustered based on clinical workload and patient complexity. Educational measures of interest were time spent teaching and number of teaching topics. Data were analyzed both at the daily observation level and across a given patient's admission. KEY RESULTS: We observed 12 teams, 1994 discussions (approximately 373 h of rounds) of 563 patients over 244 observation days. Teams clustered into three groups: low patient complexity/high clinical workload, average patient complexity/low clinical workload, and high patient complexity/high clinical workload. Modest associations for team, patient complexity, and clinical workload variables were noted with total time spent teaching (9.1% of the variance in time spent teaching during a patient's admission; F[8,549] = 6.90, p < 0.001) and number of teaching topics (16% of the variance in the total number of teaching topics during a patient's admission; F[8,548] = 14.18, p < 0.001). CONCLUSIONS: Clinical workload and patient complexity characteristics among teams were only modestly associated with total teaching time and teaching topics.

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An abnormal chromosome number, a condition known as aneuploidy, is a ubiquitous feature of cancer cells. A number of studies have shown that aneuploidy impairs cellular fitness. However, there is also evidence that aneuploidy can arise in response to specific challenges and can confer a selective advantage under certain environmental stresses. Cancer cells are likely exposed to a number of challenging conditions arising within the tumor microenvironment. To investigate whether aneuploidy may confer a selective advantage to cancer cells, we employed a controlled experimental system. We used the diploid, colorectal cancer cell line DLD1 and two DLD1-derived cell lines carrying single-chromosome aneuploidies to assess a number of cancer cell properties. Such properties, which included rates of proliferation and apoptosis, anchorage-independent growth, and invasiveness, were assessed both under standard culture conditions and under conditions of stress (i.e., serum starvation, drug treatment, hypoxia). Similar experiments were performed in diploid vs. aneuploid non-transformed human primary cells. Overall, our data show that aneuploidy can confer selective advantage to human cells cultured under non-standard conditions. These findings indicate that aneuploidy can increase the adaptability of cells, even those, such as cancer cells, that are already characterized by increased proliferative capacity and aggressive tumorigenic phenotypes.

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We designed a new microfluidic device that uses pillars on the same order as the diameter of a cell (20 µm) to isolate and enrich rare cell samples from background. These cell-scale microstructures improve viability, trapping efficiency, and throughput while reducing pearl chaining. The area where cells trap on each pillar is small, such that only one or two cells trap while fluid flow carries away excess cells. We employed contactless dielectrophoresis in which a thin PDMS membrane separates the cell suspension from the electrodes, improving cell viability for off-chip collection and analysis. We compared viability and trapping efficiency of a highly aggressive Mouse Ovarian Surface Epithelial (MOSE) cell line in this 20 µm pillar device to measurements in an earlier device with the same layout but pillars of 100 µm diameter. We found that MOSE cells in the new device with 20 µm pillars had higher viability at 350 VRMS, 30 kHz, and 1.2 ml/h (control 77%, untrapped 71%, trapped 81%) than in the previous generation device (untrapped 47%, trapped 42%). The new device can trap up to 6 times more cells under the same conditions. Our new device can sort cells with a high flow rate of 2.2 ml/h and throughput of a few million cells per hour while maintaining a viable population of cells for off-chip analysis. By using the device to separate subpopulations of tumor cells while maintaining their viability at large sample sizes, this technology can be used in developing personalized treatments that target the most aggressive cancerous cells.

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OBJECTIVES: Prompt antibiotic treatment of early stage Lyme borreliosis (LB) prevents progression to severe multisystem disease. There is a clinical need to improve the diagnostic specificity of early stage Lyme assays in the period prior to the mounting of a robust serology response. Using a novel analyte harvesting nanotechnology, Nanotrap particles, we evaluated urinary Borrelia Outer surface protein A (OspA) C-terminus peptide in early stage LB before and after treatment, and in patients suspected of late stage disseminated LB. METHOD: We employed Nanotrap particles to concentrate urinary OspA and used a highly specific anti-OspA monoclonal antibody (mAb) as a detector of the C-terminus peptides. We mapped the mAb epitope to a narrow specific OspA C-terminal domain OspA236-239 conserved across infectious Borrelia species but with no homology to human proteins and no cross-reactivity with relevant viral and non-Borrelia bacterial proteins. 268 urine samples from patients being evaluated for all categories of LB were collected in a LB endemic area. The urinary OspA assay, blinded to outcome, utilized Nanotrap particle pre-processing, western blotting to evaluate the OspA molecular size, and OspA peptide competition for confirmation. RESULTS: OspA test characteristics: sensitivity 1.7 pg/mL (lowest limit of detection), % coefficient of variation (CV) = 8 %, dynamic range 1.7-30 pg/mL. Pre-treatment, 24/24 newly diagnosed patients with an erythema migrans (EM) rash were positive for urinary OspA while false positives for asymptomatic patients were 0/117 (Chi squared p < 10(-6)). For 10 patients who exhibited persistence of the EM rash during the course of antibiotic therapy, 10/10 were positive for urinary OspA. Urinary OspA of 8/8 patients switched from detectable to undetectable following symptom resolution post-treatment. Specificity of the urinary OspA test for the clinical symptoms was 40/40. Specificity of the urinary OspA antigen test for later serology outcome was 87.5 % (21 urinary OspA positive/24 serology positive, Chi squared p = 4.072e(-15)). 41 of 100 patients under surveillance for persistent LB in an endemic area were positive for urinary OspA protein. CONCLUSIONS: OspA urinary shedding was strongly linked to concurrent active symptoms (e.g. EM rash and arthritis), while resolution of these symptoms after therapy correlated with urinary conversion to OspA negative.

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We describe the cases of four patients who presented with painful hips and were found to have fractured cemented Exeter™ V40™ stems. Failure was multifactorial. Fractured Exeter™ stems are rarely reported and this series raises a concern that a population of patients may be at risk of such morbidity.

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