In light of the evolving COVID-19 pandemic, the Association of American Medical Colleges (AAMC) and Liaison Committee on Medical Education (LCME) released a joint statement in March 2020 recommending an immediate suspension of medical student participation in direct patient contact. As graduating medical students who will soon begin residency, the authors fully support this recommendation. Though paid health care workers, like residents, nurses, and environmental services staff, are essential to the management of COVID-19 patients, medical students are not. Students’ continued involvement in direct patient care will contribute to SARS-CoV-2 exposures and transmissions and will waste already limited personal protective equipment. By decreasing nonessential personnel in health care settings, including medical students, medical schools will contribute to national and global efforts to “flatten the curve.” The authors also assert that medical schools are responsible for ensuring medical student safety. Without the protections provided to paid health care workers, students are uniquely disadvantaged within the medical hierarchy; these inequalities must be addressed before medical students are safely reintegrated into clinical roles. Although graduating medical students and institutional leadership may worry that suspending clinical rotations might prevent students from completing graduation requirements, the authors argue the ethical obligation to “flatten the curve” supersedes usual teaching responsibilities. Therefore, the authors request further guidance from the LCME and AAMC regarding curricular exemptions/alternatives and adjusted graduation timelines. The pool of graduating medical students affected by this pause in direct patient contact represents a powerful reserve, which may soon need to be used as the COVID-19 pandemic continues to challenge the U.S. health care infrastructure.

No abstract

No abstract

BACKGROUND: Pediatric somatic symptom and related disorders (SSRDs) are common with high health care costs and use because of lack of standardized, evidence-based practice. Our hospital implemented a clinical pathway (CP) for SSRD evaluation and management. Our study objective was to evaluate health care cost and use associated with the organization’s SSRD CP in the emergency department (ED) and inpatient settings hypothesizing lower cost and use in the CP group relative to controls. METHODS: We conducted a retrospective analysis of costs and use before and after implementation of the SSRD CP. Data were collected from the hospital’s electronic health record and the Pediatric Health Information System database. Participants included pediatric patients on the CP (“P” group) and control groups with an SSRD diagnosis and mental health consultation either the year before the CP (“C” group) or during the CP study period (“T” group). Primary outcomes included costs, length of stay, diagnostic testing, imaging, subspecialty consultation, and readmission rates. RESULTS: The ED P group had more lower-cost imaging, whereas the inpatient T group greater higher-cost imaging than other groups. The inpatient P group had significantly shorter length of stay, fewer subspecialty consults, and lower costs. There were no significant group differences in readmission rates. The CP reduced median total costs per patient encounter by $51 433 for the inpatient group and $6075 for the ED group. CONCLUSIONS: The CP group showed significant reductions in health care cost and use after implementation of a CP for SSRD care. In future work, researchers should explore patient and practitioner experience with the SSRD CP and long-term outcomes.

Among infants with isolated CDH, PPLV, and o:eLHR were significantly associated with PHTN severity, especially among patients requiring ECMO. Prenatal lung size may help predict postnatal PHTN and associated therapies.

A graduating medical student and incoming psychiatry resident reflects on his diagnosis of attentiondeficit/hyperactivity disorder (ADHD) and his treatment for this condition. He also examines the impacts of ADHD and stimulant medication on his career, education, and personal life, as well as the impacts of individual and systemic mental health stigma on mental health care providers as prosumers. Impact StatementThrough personal narrative, a soon-to-be psychiatrist discusses his own diagnosis of and treatment for attention-deficit/hyperactivity disorder. He also discusses the stigma associated with mental health conditions and the barriers it presents for health care providers seeking and utilizing mental health care. This piece serves to demonstrate the impacts of personal mental health diagnoses and stigma on mental health providers' careers and lives.

No abstract

No abstract