We identified two significant observable preclinical indicators associated with later professionalism concerns: excessive absences and negative peer assessments. Early recognition of students at risk for future professionalism struggles would provide an opportunity for proactive professional development prior to the clinical years, when students' permanent records may be affected. Peer assessment, coupled with attention to frequent absences, may be a method to provide early recognition.
Anabolic androgenic steroid (AAS) and performanceenhancing drug (PED) use is a prevalent medical issue, especially among men, with an estimated 2.9-4 million Americans using AAS in their lifetime. Prior studies of AAS use reveal an association with polycythemia, dyslipidemia, infertility, hypertension, left ventricular hypertrophy, and multiple behavioral disorders. AAS withdrawal syndrome, a state of depression, anhedonia, and sexual dysfunction after discontinuing AAS use, is a common barrier to successful cessation. Clinical resources for these patients and training of physicians on management of the patient using AAS are limited. Many men are hesitant to seek traditional medical care due to fear of judgment and lack of confidence in physician knowledge base regarding AAS. While proposed approaches to weaning patients off AAS are published, guidance on harm reduction for actively using patients remains sparse. Medical education regarding the management of AAS use disorder is paramount to improving care of this currently underserved patient population. Management of these patients must be non-judgmental and focus on patient education, harm reduction, and support for cessation. The approach to harm reduction should be guided by the specific AAS/ PEDs used.
IntroductionAlthough musculoskeletal (MSK) complaints are very common in ambulatory clinics, internal medicine residents report low confidence in performing MSK examinations and intra-articular steroid injections. Our goal is to strengthen residents' MSK competence by using visual, auditory, and kinesthetic educational modalities during an academic half-day session.MethodsOur intervention was a workshop/academic half-day session that included multimodal educational materials on common shoulder and knee MSK complaints. The intervention featured a PowerPoint presentation highlighting three areas of MSK education: history taking, physical examination, and procedural skills. The curriculum contained a novel interactive charades game in which competitors demonstrated joint exams, an engaging anatomy quiz, and the performance of knee and subacromial bursae injections using interactive models and educational videos.ResultsThe effectiveness of our session was measured using a pre- and postsurvey. In our 2017 resident survey to determine the level of comfort in performing knee and shoulder physical examination and intra-articular injections, the majority of respondents perceived themselves as inadequately trained. After the session, confidence in performing knee and shoulder examinations and in performing knee and subacromial bursae injections increased significantly. In addition, 100% of the residents who attended and evaluated the session either agreed or strongly agreed that the experience improved MSK knowledge and employed effective teaching strategies.DiscussionThe workshop/academic half-day session positively enhanced residents' perception of their knowledge of MSK medicine and their ability to perform joint injections.
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