Introduction: While great strides have been made in favor of the LGBT community overall, transgender individuals are still facing many legal challenges and suffer from more marked health issues and disparities compared to other members of the LGBT community. Our multimodal transgender curriculum was designed in accordance with the Kern model to address educational gaps in the area of transgender health. Methods: This three-part module consists of: (1) a didactic PowerPoint presentation reviewing unique health issues and disparities experienced by transgender patients, (2) a small-group session viewing and analyzing a pair of videos showcasing competent and poor communication between a provider and a transgender patient, and (3) a large-group patient panel featuring members of the transgender community. Results: One hundred and sixty-one students returned pre-and postworkshop surveys with 123 matched pairs. When comparing participants reported pre-and postworkshop confidence levels, the mean rating increased significantly for all three learning objectives. Based on a 5-point Likert scale (1 = poor, 5 = excellent), participants' mean ratings were highest for the patient panel at 4.5, compared to 3.9 for the large-group didactic lecture, and 3.8 for the small-group video session. Discussion: The use of this multimodal approach using a didactic session, video-based case discussion, and patient panel provided a strong foundation and primer for transgender health and resulted in an increase in learner confidence in module objectives regarding care for the transgender community.

Laryngoscopy by pediatric residents has substantially decreased over time. This downward trend was not associated with the 2013 Accreditation Council for Graduate Medical Education change in residency requirements.

IntroductionIntermittent hypoxemia (IH) is defined as episodic drops in oxygen saturation (SpO2). Preterm infants are at increased risk for IH due to their immature respiratory control/apnea of prematurity. The clinical relevance of IH is a relatively new observation with rising evidence linking IH to neonatal morbidities and long-term impairment. Hence, assessing factors that influence IH in preterm infants is imperative. Given the epidemic of opioid misuse in the USA, there is an urgent need to understand the impact of prenatal opioid exposure on neonatal outcomes. Hence, we wanted to assess the relationship between isolated prenatal opioid exposure and IH in preterm infants.MethodsIn order to accurately calculate IH, SpO2 data were prospectively collected using high-resolution pulse oximeters during the first 8 weeks of life in preterm infants less than 30 weeks gestational age. Data related to prenatal opioid misuse were retrospectively collected from medical charts. Infants with tobacco or poly-drug exposure were excluded. The primary outcome measure is percent time spent with SpO2 below 80% (%time-SpO2 < 80). The secondary outcome measure is the number of severe IH events/week with SpO2 less than 80% (IH-SpO2 < 80).ResultsA total of 82 infants with isolated opioid exposure (n = 14) or who were unexposed (n = 68) were included. There were no significant differences in baseline characteristics between opioid exposed and unexposed groups. There was a statistically significant increase of 0.23 (95% CI: 0.03, 0.43, p = 0.03) in mean of the square root of %time-SpO2 < 80. The number of IH-SpO2 < 80 events was higher in the opioid exposed group (mean difference = 2.95, 95% CI: −0.35, 6.25, p-value = 0.08), although statistical significance was not quite attained.ConclusionThis study shows that preterm infants prenatally exposed to opioids have increased IH measures compared to unexposed infants. Interestingly, the increased IH in the opioid exposed group persists beyond the immediate postnatal period.

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Preterm infants with respiratory distress may require mechanical ventilation which is associated with increased pulmonary morbidities. Prompt and successful extubation to noninvasive support is a pressing goal. In this communication, we show original data that increased recurring intermittent hypoxemia (IH, oxygen saturation <80%) may be associated with extubation failure at 72 h in a cohort of neonates <30 weeks gestational age. Current-generation bedside high-resolution pulse oximeters provide saturation profiles that may be of use in identifying extubation readiness and failure. A larger prospective study that utilizes intermittent hypoxemia as an adjunct predictor for extubation readiness is warranted.

Lesbian, gay, bisexual, transgender, queer, and other sexual and/or gender minority (LGBTQ+) people experience numerous health disparities. Graduate medical education (GME) programs need curricula to address these disparities. We sought to characterize curricula related to LGBTQ+ health in primary care specialty (internal medicine, combined internal medicine/pediatrics, family medicine, pediatrics, and geriatric medicine) GME, and to identify barriers experienced by program directors (PDs) in incorporating LGBTQ+ curriculum. We conducted a national survey study of PDs in August–October 2020 via Qualtrics. Overall, 292 of 1,571 eligible PDs responded (18.6%). Nearly a third of PDs (n= 96%; 32.9%) indicated that their program did not include any didactic training about LGBTQ+ health. Those who did indicated a mean of 5.4–5.7 hours in each year from PGY1-3 dedicated to LGBTQ+ health. Didactic and clinical training about LGBTQ+ health was overwhelmingly focused on content related to sexual health. PDs who indicated they had ‘out’ faculty were more likely to include didactic and clinical training on multiple aspects of LGBTQ+ health. Our results identify a significant gap and a need for the integration of LGBTQ+ content into primary care GME curricula with additional focus placed on domains associated with known mental and physical health disparities, beyond sexual health, and inclusion of transgender and gender diverse health needs. Programs may aim to accomplish this through recruitment of LGBTQ+ health educators, invitations to content experts in the field, and adaptation of existing resources to teach about LGBTQ+ health.

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