International Journal of Medical Students

The Power of Story Slams: A Mixed-Method Analysis of Narrative Medicine Connecting, Encouraging and Comforting Healthcare Trainees and Professionals

Amy Stringer — 2024-09-30

Background: Narratives convey information and emotion, evoke understanding, empathy, and connection. Healthcare professionals can use narratives to reduce burnout, benefiting them, patients, and colleagues. Story slams are narrative sharing events used for group reflection, providing an opportunity for participants and listeners to improve their well-being by processing complex emotions and identities. Story slams have traditionally been popular with creative writers and nonprofit organizations.

Methods: Following a local event hosted by The Moth, the Temple University Lewis Katz School of Medicine (LKSOM) Narrative Medicine program hosted nine story slams over five years with 93 presenters including students and health systems staff. Through a mixed-method analysis, the authors examined the stories for thematic patterns and surveyed presenters to investigate how the experience had impacted markers such as job satisfaction, stress levels, and connection to patients. Eleven presenters were interviewed to provide additional information about the impact they experienced.

Results: Patient-centered care, resilience, and the value of learning comprised over half of all themes presented. Following the event, many presenters experienced improved connections with patients, and everyone reported feeling neutral or increased satisfaction with their profession. The interviews conveyed participation, created a lasting impact, fostered a sense of community, and increased appreciation for diversity.

Conclusions: Overall, story slams nourish humanity and promote diversity, enthusiasm, and encouragement. This study and others suggest that story slams are inexpensive and effective events that can help reduce burnout and provide academic medical centers with a way to restore and cultivate community among students, physicians, and staff.

Stress Levels and Coping Strategies in Medical Students and its Association with Salivary IL-6 Levels

Monica Karanth — 2024-09-30

Background: Medical students face ongoing stress during their training but have developed coping mechanisms. Stress alters various physiological processes, including pro-inflammatory markers like Interleukin-6(IL-6). The present study was conducted to assess stress levels and coping strategies in medical students and their association with salivary IL-6 levels.

Methods: This descriptive study was conducted after obtaining institutional ethical clearance. A total of 76 consenting undergraduate medical students answered the Cohen’s perceived stress scale and BriefCOPE questionnaire. Unstimulated saliva was used to assess salivary IL-6 levels using a Diaclone human IL-6 ELISA kit and the data obtained was analyzed.

Results: Out of the 76 participants, 59(77.6%) were female and 17(22.4%) were male. Mild stress was reported by 9 students, moderate by 53, and severe stress by 14 students. Based on Kruskal-Wallis p test, most students used approach coping for stress of all levels. This active strategy involves problem-solving and future planning. Approach coping has shown better responses to adversity, physical health, and emotional responsiveness. Mild and moderate stressed students used acceptance, positive-refrain, and planning, while severe stressed students used planning, self-distraction, and self-blame. Despite the perceived stress, there were no significant differences in the salivary IL-6 levels among the three categories.

Conclusion: ‘Approach’ coping was commonly used and linked to positive outcomes. Despite this, a number of students have reported to experience stress. Therefore, more effective strategies are needed to handle stress and demands of the profession effectively. Further research with larger samples is recommended to explore salivary IL-6 levels’ relation to stress.

The Impact of the COVID-19 Lockdown on Cancer Referrals in Primary Care in the UK: Two Years On

Olivia Whittle — 2024-09-30

Background: Cancer is common, with most cancer patients presenting initially to a general practitioner. The COVID-19 pandemic led to changes in the delivery of primary care, which could have affected cancer referrals. This observational study looked at two-week cancer referrals (2WRs) made before, during and after the first UK COVID-19 lockdown in 2020, at a GP practice in the Wirral, England.

Methods: A search was conducted to find the cancer referrals made between 23^rd March 2020 - 1^st July 2020, during the first lockdown. Using the same methodology, cancer referral data was collected for the corresponding time periods in 2019 and 2021. The number of 2WRs and positive diagnostic yields were then compared.

Results: The number of cancer referrals decreased by 40.4% in 2020, compared to 2019. In 2021, the number of referrals then increased by 225%, compared to 2020. Overall, the number of cancer referrals increased between 2019-2021. The positive diagnostic yield for the 2020 2WRs increased by 251.4%, compared to that of 2019. The calculated yield for the 2021 data then decreased by 10.8% compared to 2020. Overall, the positive diagnostic yield increased between 2019-2021.

Conclusion: The numbers and outcomes of cancer referrals at this Wirral GP practice have changed considerably following the first UK COVID-19 lockdown in 2020, and the influence of the pandemic was still affecting cancer referrals in 2021. A greater focus on early cancer detection in primary care could help overcome the ways in which the pandemic has affected primary care delivery.

A Descriptive Analysis of the Use of Various Therapeutics in a Cohort of COVID-19 Patients and the Influence of Media Coverage

Alfred A. Mathew — 2024-09-30

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) impacted the healthcare system immensely throughout 2020-2022. Treatment practices varied in Texas, as guidelines were in flux. As a result, a variety of therapeutics were used. Many verified medications with scientific basis were trialed, while others were implemented despite a lack of scientific consensus. This study aimed to identify how practice patterns to treat and manage COVID-19 changed over time in a cohort of patients in the University of Texas Medical Branch hospital system.

Methods: Ninety participants with a COVID-19 diagnosis were included in the analysis for this study. Data was collected by a retrospective chart review, and included medications administered before and during current admission. Medications were categorized as: antiviral, antibiotic, steroid, supplement, antibody, hydroxychloroquine, and others.

Results: Differences in therapeutic use were identified based on hospitalization status (outpatient or inpatient) and month admitted. The largest difference in the antiviral remdesivir (78%), requiring intravenous administration for up to ten days. In the outpatient setting, antibiotics, primarily azithromycin, were quite common. Additionally, month-to-month variation in steroid use and antibiotic use was observed.

Conclusion: This study shows that adapting medical guidelines and strong media coverage played a role in the clinical management of COVID-19 patients. At times, some ineffective medications were prescribed such as hydroxychloroquine. Medical leaders and news coverage should collaborate closely in future public health emergencies to prevent the prescription of ultimately ineffective and potentially hazardous treatments.

Assessment of Antimicrobial Resistance and Susceptibility Pattern of UTI-causing Microorganisms in Southern Punjab, Pakistan

Muhammad Mehwar Anjum — 2024-09-30

Background: Bacterial resistance against antibiotics has become a global challenge and measures are needed to stop this. The aim of this study is to highlight this problem and to determine the antibiotic susceptibility pattern of organisms in Southern Punjab, Pakistan.

Method: This descriptive cross-sectional study was conducted in Sheikh Zayed Medical Hospital, Rahim Yar Khan. The urine samples obtained from 4 different wards were sent for culture and sensitivity analysis. 9 antibiotics (Nitrofurantoin, Fosfomycin, Ciprofloxacin, Ceftriaxone, Trimethoprim-Sulfamethoxazole, Norfloxacin, Linezolid, Amoxicillin, and Imipenem) were tested against 5 isolated strains of uropathogens using Kirby Bauer disk diffusion test. The sensitivity reports were obtained, and data points were entered into a spreadsheet and analysed using SPSS.

Results: Out of 101 samples of uropathogens that showed positive growths (42.08%), 53 (52.4%) were from male patients and 48 (47.5%) positive growths were from females. Escherichia Coli had the highest positive growths (58%) followed by Pseudomonas (19%) Klebsiella (13%), Staphylococcus Aureus (7%) and Coagulase-negative staphylococci (3%). Imipenem was the most sensitive drug whereas the highest resistance by organisms was developed against TMP-SMX. No significant association(p>0.05) was found between any of the anti-microbial drugs and Escherichia coli, gram-positive uropathogens, and gram negative uropathogens.

Conclusion: The high increasing rate of broad-spectrum antibiotics resistance suggests that diagnostic and culture tests should be encouraged in hospitals. Based on these test results, appropriate antibiotics should be prescribed. The limitations include the inability to distinguish between nosocomial and community-acquired urinary tract infections and also did not consider other demographic factors like age.

Improving Access to Syphilis Screening Among Unhoused People in Yolo County, USA

Jenna Kupa — 2024-09-30

Background: This study aimed to increase syphilis screening rates amongst unhoused residents of Yolo County, California, through the implementation of plan-do-study-act (PDSA) cycles. Yolo County has a strategic goal to eliminate congenital syphilis cases. Homelessness is a known risk factor for syphilis.

Methods: The primary researcher was embedded in a street medicine team. Using quality improvement tools like stakeholder interviews, workflow diagrams, and best practices from literature, we outlined the team's workflow for syphilis screening and developed ideas to improve uptake and expand capacity. The most effective cycle implemented gift card incentives for syphilis screening. During the patient intake we offered the option to receive a syphilis test, informing the patient of the gift card incentive.

Results: Prior to gift card incentives, the team screened 1.6 patients on average per clinic for a total of 30 patients screened in April to June of 2022. After the gift card incentive was implemented, the team screened 3.0 patients on average per clinic, screening a total of 223 patients from July 2022 to May 2023. The intervention produced an 87.5% increase in screening rates (P=0.0094). The data showed a significant increase in syphilis testing upon implementing the gift card incentive program.

Conclusion: These findings contribute to evidence supporting the use of patient incentives for public health prevention measures. This model could be applied to other populations to increase health screening participation. More research is needed on the effect of gift card incentives on confirmatory testing and treatment rates for syphilis.

Vascular Anomalies Review of the Head and Neck for Physicians in Training

Caleb M. Allred — 2024-09-30

A basic understanding of vascular anomalies will aid physicians-in-training as they seek to properly diagnose and determine interventions for these patient presentations. The aim of this review is to create a resource for physicians in training that encompasses the most important clinical aspects of vascular anomalies. Vascular anomalies of the head and neck are divided into two categories: vascular tumors and vascular malformations. This review will first describe vascular tumors followed by vascular malformations. This review discusses major pathology found in both categories of vascular anomaly. Vascular anomalies are frequently found in pediatric populations and can persist into adulthood, making it important for trainees to identify them on physical exam. This developing field seeks to improve form, function, and quality of life for patients with vascular anomalies and often requires a multidisciplinary approach (i.e., otolaryngology, dermatology, genetics, plastic surgery, interventional radiology). Various medical and surgical treatment options are available. A basic knowledge of these anomalies will allow for accurate, early diagnosis and appropriate intervention which can ultimately improve patient outcomes.

Search Strategy and Selection Criteria: The MEDLINE/PubMed database was searched for primary research and reviews discussing various vascular anomalies which include infantile hemangioma, congenital hemangioma, pyogenic granuloma, tufted angioma, kaposiform hemangioendothelioma, capillary malformations, lymphatic malformations, venous malformations, and arteriovenous malformations. This search was conducted from 7/5/2023 to 3/21/2024.

A Scoping Review on the Utility of Ultrasound to Visualize Bursae in Anatomical Dissection Courses

Felix Margenfeld — 2024-09-30

Bursitis is a common condition in clinical practice, often causing pain in the shoulder and buttock areas due to inflamed bursae. Proper diagnosis and treatment depend on knowing the presence and exact location of these bursae. Anatomy classes typically provide limited instruction on bursae because they are difficult to demonstrate during dissection courses. High-resolution ultrasound is an essential and versatile technique for detecting bursitis, and it could also serve as a valuable tool for students to better understand bursae. Relevant studies were screened in the following databases: CENTRAL, MEDLINE, BIOSIS Previews, EMBASE, and Web of Science Core Collection. Grey literature was also considered. Literature was screened on January 3, 2023. Only ultrasound investigations in human cadaver bursae were included, specifically using B-Mode ultrasound. The general characteristics of the included studies and the ultrasound-guided approaches for labeling the bursae were analyzed and examined. T The search found 8,899 matches, but only 15 met the criteria. Fifteen different bursae were studied, and 12 studies were included in the analysis. Both the marking substrate and the injected volume varied. Despite a high overall accuracy of 99% achieved using ultrasound-guided labeling approaches in the included studies, caution is advised due to the small sample size (1 to 24). The current study serves as a review to examine ultrasound studies on bursae in human cadavers. Ultrasound-guided labeling techniques achieve high accuracy and could be a valuable teaching tool in dissection courses. These techniques help visualize difficult-to-dissect structures and provide students with an understanding of sonoanatomy.

Integrating Tendinous Pathophysiology Into Rotator Cuff Tears And Greater Trochanteric Pain Syndrome: A Narrative Review

Joshua R. Poole — 2024-09-30

This narrative review aims to use the similarities between the shoulder and hip joints to better understand why rotator cuff (RC) tendinopathy and hip abductor tendinopathy occur and inform about diagnosis and treatment of both orthopedic complaints. A search of the literature was done using Google Scholar and Pubmed and initially followed a systematic review protocol, but the nature of the topic, current literature and data necessitated a narrative review. Reports that discussed pathomechanics of RC and gluteal tendinopathy individually, together and with other muscles groups were reviewed. It was found that the methods measuring and describing the processes of tendinopathy differ significantly, for each individual joint and between all joints. A review of a large body of quantifiable measures and theoretical ideas regarding tendinopathy was performed to address this lack of consensus in current literature. Initial literature yielded 74 articles. After review, only 43 articles were used from a broad range of approaches and methodologies. The review found a body of evidence suggesting that fibrocartilage overgrowth and compressive forces over bony structures cause tendonous pathology of the RC and hip abductor tendons. These findings support the idea that tendinopathy is often caused by intrinsic factors rather than the traditional view of external factors. Earlier treatment and improved outcomes without surgery are possible using current imaging technology to identify these intrinsic factors that affect tendinous properties.

Effects of the COVID-19 Pandemic on Physical Activity in Children: A Systematic Review

Alex Ramirez — 2024-09-30

Background: Extended lockdowns established to minimize the spread of COVID-19, may have affected physical activity (PA). The objective of this systematic review was to report how PA of children was impacted by the COVID-19 pandemic.

Methods: A database search of CINAHOL, Embase, MEDLINE, PsycInfo, and Web of Science was conducted on 03/29/2021 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Studies were included if they reported a measure of PA for children ≤18 years and were published in English in a peer-reviewed journal. The search generated 673 unique citations. After applying the criteria above, 69 articles were included. The quality of the included articles was assessed using the NIH NHLBI Study Quality Assessment Toolbox.

Results: Unstructured play, walking, and virtual PA (e.g., YouTube, online classes) were the most frequently reported modes of PA during the COVID-19 pandemic. The PA of children decreased among 89% of articles that reported changes in PA (e.g., frequency, intensity, duration, or the percentage of children who met PA recommendations) of children during the COVID-19 pandemic. Increased PA was reported more often among younger children, boys, children who lived with other children, and children with more outdoor space.

Conclusion: Globally, PA of children decreased during the COVID-19 pandemic. Further work is needed to develop policies to support global PA increases. Limitations of this review include the use of online surveys which are limited by participants ability to recall PA behaviors and access to online resources.

Intricacies of Using Spaced Repetition Tools

Ahmed Ghani — 2024-09-30

I was really intrigued to read an article by Cooper et al. that described how using spaced repetition study techniques raised GPA, USMLE Step 1, and COMLEX Level 1 results. In addition, I appreciate the writers' efforts in spreading the word about this special study technique that has been shown to improve grades. I do want to draw attention to a few areas of concern with this approach including the proper usage of the software as well as certain things that could have affected and altered the results of the study.

Summer Surgical Elective in Hong Kong

Martin Ho — 2024-09-30

I completed a surgical elective with the Department of Plastic and Reconstructive Surgery in Queen Mary Hospital, Hong Kong Special Administrative Region (SAR), China. I was taught a great deal of surgical knowledge by the team and was inspired as I witnessed the life-changing operations they performed. The experience was professionally and culturally enriching and has cemented my desire to pursue surgery as a career to improve the lives of my future patients. In this article, I will discuss how I secured this elective and my personal experience during the elective. Additionally, I will briefly discuss some differences I observed between the healthcare systems in Hong Kong and Ireland, including different scopes of surgical practice, residency training, and also the similar challenges faced by both public healthcare systems.

Innovating Against Odds: A Medical Student's Research Journey in a Resource-Constrained Environment

Hamrish Kumar Rajakumar — 2024-09-30

"You need not know the R in Research to embark on the journey; a strong motivation is enough to set things in motion and let the journey unfold naturally." In this article, I share my journey as a medical student starting research in a Resource-Constrained Environment. I talk about the learning curve, milestones, setbacks, and presenting my research work. I've created a simple guide for fellow students in similar situations to do impactful research. Beyond studies, the shared journey with my research partner formed a lasting bond, showing how teamwork fosters understanding and innovation. I also discuss institutional barriers, especially the toxic research culture not talked about much. I stress the importance of raising awareness about these challenges for medical students and the need for a supportive and ethical research environment. It's crucial to create a space where aspiring researchers can thrive without unethical practices, emphasizing the value of knowledge pursuit over personal ambitions.

VAXXED & BOOSTED: Increasing COVID-19 Vaccination Rates in West Greenville, NC, USA

Taylor Stamey — 2024-09-30

Pitt County is ranked 48^th out of the 100 counties in North Carolina for COVID-19 vaccination rates, with only 53.8% of the population fully vaccinated. West Greenville, located in Pitt County, is historically of lower economic status, leading to poorer social determinants of health. The goal of the VAXXED & BOOSTED campaign was to increase COVID-19 vaccination rates in West Greenville by combating vaccine hesitancy and easing barriers to vaccination. From June through August of 2022, community ambassadors spoke to members of the community about their vaccine hesitancies and provided them with verified resources about the vaccine. Five vaccination events were hosted at the Community Crossroads Center and the JOY Soup Kitchen throughout July 2022. At each vaccination event, a survey was implemented to determine the effectiveness of the program. Through VAXXED & BOOSTED, 52 people received COVID-19 vaccines: 13 for the first dose, 4 for the second, and 35 for boosters. Of 29 surveyed, 82.8% found community ambassadors helpful, and 51.7% interacted with them before the event. The event influenced 75.9% to get vaccinated, 82.8% learned something new, and 93.1% plan to encourage others to get vaccinated. Word of mouth likely played a significant role in event promotion, as only 51.7% interacted with ambassadors beforehand. The use of community ambassadors and educational events was successful in influencing people to get vaccinated against COVID-19 in West Greenville.

The Shame Is Not Mine: Addressing Abuse of Power Dynamics in Medical Training

Sierra Norman — 2024-09-30

Medical student mistreatment is a longstanding issue that continues to occur far too often. This article narrates my experience with abuse of power dynamics in my medical training. Despite assurances from a site director that my concerns about a negative learning environment would not affect my evaluation and a text that I “finished strong,” he mistakenly sent me an email meant for a colleague, stating he believed I would be giving him a negative evaluation and that he would be failing me. In my evaluation, I was failed clinically with the comment: “it’s a matter of time before she hurts a patient.” The subsequent lack of action highlights the systemic vulnerability medical students face during their training. The article advocates for systemic changes, including institutional action to support their statements against mistreatment and retaliation, accountability for individuals perpetuating mistreatment, and supportive mental health resources. The article introduces A MATTER OF TIME, a project intended to support mental health and contribute to a more positive and compassionate generation of physicians.

Case Report: An Atypical Sellar Mass - Sellar Tuberculoma in a Young Patient

Arwa Moiz Jamali — 2024-09-30

Background: Tuberculosis of the central nervous system is an uncommon but one of the most severe forms. It manifests as tuberculoma and tuberculous meningitis, with the majority of cases affecting children and immunocompromised patients. Overall, tuberculomas make up to 0.15–2 % of all intracranial lesions but sellar tuberculoma is extremely rare.

The Case: An 18-year-old female patient presented with complaint of generalized weakness, eye pain and headache for 3-4 months. Magnetic resonance imaging (MRI) of brain showed sellar and suprasellar space occupying lesion. Trans sphenoidal approach was used to remove the lesion completely. A sellar tuberculoma was confirmed on pathological evaluation and the patient was put on postoperative anti-tubercular therapy.

Conclusion: Although rare, intracranial tuberculomas, particularly those that originate in the sellar, are notorious for mimicking pituitary tumors by jeopardizing pituitary hormonal function and applying compressive forces on surrounding intracranial structures. However, a prompt assessment can help overcome this diagnostic difficulty with the timely initiation of anti-tubercular therapy (ATT).

Successful Subungual Glomus Tumor Removal: A Case Report and Future Guidance on Diagnosis and Treatment

Made Bramantya Karna — 2024-09-30

Background: Glomus tumors are rare benign hamartomas of the glomus body that occur mostly – though not limited to - the distal phalanxes of the digits. This article provides a real-life example of successful rare disease identification and treatment. It also provides a guideline that may help serve as future guidance on diagnosis and treatment.

Case: A 41-year-old male came to our hospital presenting with a chief complaint of episodes of throbbing pain, which occurred spontaneously on the left thumb for the past two years. The pain had worsened in the past two weeks. The patient was positive for Hildreth’s, Love’s pin, and cold sensitivity tests. The previous x-ray showed no abnormalities in the left thumb. MRI found a hyperdense subungual lesion in the dorsal interphalangeal joint of the left thumb. We then performed an excision using the transungual approach. Histopathological findings found a relatively well-circumscribed lesion of the glomus apparatus absent of abnormal mitosis and necrosis. Two months after the excision, the patient reported no symptoms of recurrency, nail deformity, or other adverse outcomes.

Conclusion: Patients typically present a chief complaint of chronic paroxysmal throbbing nail pain that persists for years, increases following exposure to cold environments, and is disproportionately exacerbated with the slightest touch. Hildreth’s, Love’s Pin, and cold sensitivity tests are special examinations that elicit or suppress pain. As with most benign tumors, complete excision usually yields good results. Adequate knowledge about diagnostic methods will help patients achieve early intervention and cure.

Bridging Innovation and Education: IJMS Volume 12 Issue 3 and the 2024 World Conference on Medical Student Research (WCMSR)

Francisco J. Bonilla-Escobar — 2024-09-30

The International Journal of Medical Students (IJMS) is proud to present Volume 12, Issue 3, highlighting innovative research across various medical disciplines. This issue underscores the journal's commitment to fostering medical education and advancing healthcare. Featured articles explore critical areas, including narrative medicine's role in reducing burnout, stress management among medical students, and the long-term impacts of the COVID-19 pandemic on cancer referrals and treatment decisions. Public health concerns such as antimicrobial resistance and access to syphilis screening in vulnerable populations are also examined. Additionally, this edition includes insightful reviews on pediatric allergy consultations and the utility of ultrasound in anatomical dissection courses. Case reports on rare medical conditions, reflections on global surgical electives, and personal experiences in overcoming research challenges further enrich the content. To complement this issue, the IJMS announces the 2024 World Conference on Medical Student Research (WCMSR), taking place on October 26, 2024, with participants from over 40 countries. This event promises to be a valuable platform for showcasing the best global research, fostering discussion, and inspiring the next generation of medical professionals.

Cover, Credits, & Content

Executive Committee of IJMS — 2024-09-30

Evolving Patterns in Inpatient Pediatric Consultations to Allergy/Immunology at an Academic Medical Center

Madeline Wurst — 2024-09-30

Background: Consultations to pediatric allergy/immunology are of benefit to many hospitalized inpatients, but there is limited current information about how T-cell receptor excision circles (TREC) screening may have changed these patterns for pediatric populations. We aimed to determine the types of consults being requested and their relative frequencies for primary pediatric allergy/immunology consults under an academic fellowship program since the start of TREC screening in 2016. Information gained could help identify focal concepts for pediatric allergy inpatient training curricula for fellowship and graduate medical education programs.

Methods: Under an IRB approved study of an academic allergy fellowship consultation log, we retrospectively reviewed electronic medical records of pediatric allergy and immunology consults and categorized consultations by their primary indication.

Results: Three-hundred and eighty-three pediatric allergy/immunology consultations were seen between September 4, 2016 to November 24, 2022. In terms of frequency, the most common consultation was for immunodeficiency evaluation or treatment, n=205 (53.5%), followed by drug allergy n=55 (14.4%), general allergy concerns n=43 (11.2%), skin allergy n=35 (9.1%), and less commonly inflammatory syndromes, n=26 (6.8%) and food allergy, n=19 (5.0%). Questions related to TREC screening comprised 21% of all immunodeficiency consults, at n=43.

Conclusion: At an academic allergy center where all allergy/immunology service lines are currently provided, the most common reason for pediatric consultations were for help with immunodeficiency evaluation/treatment and drug allergy. TREC screening is a new key indication for consultation. Fellowship programs may benefit from focusing on these content areas for the pediatric inpatient setting.