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UC San Diego Health System (UCSDHS) is an academic medical center and integrated care network in the US-Mexico border area of California contiguous to the Mexican Northern Baja region. The COVID-19 pandemic deeply influenced UCSDHS activities as new public health challenges increasingly related to high population density, cross-border traffic, economic disparities, and interconnectedness between cross-border communities, which accelerated development of clinical collaborations between UCSDHS and several border community hospitals - one in the US, two in Mexico - as high volumes of severely ill patients overwhelmed hospitals. We describe the development, implementation, feasibility, and acceptance of a novel critical care support program in three community hospitals along the US-Mexico border. We created and instituted a hybrid critical care program involving: 1) in-person activities to perform needs assessments of equipment and supplies and hands-on training and education, and 2) creation of a telemedicine-based (Tele-ICU) service for direct patient management and/or consultative, education-based experiences. We collected performance metrics surrounding adherence to evidence-based practices and staff perceptions of critical care delivery. In-person intervention phase identified and filled gaps in equipment and supplies, and Tele-ICU program promoted adherence to evidence-based practices and improved staff confidence in caring for critically ill COVID-19 patients at each hospital. A collaborative, hybrid critical care program across academic and community centers is feasible and effective to address cross-cultural public health emergencies.

Introduction and background: In 2010, the UC San Diego School of Medicine launched a new curriculum, the integrated scientific curriculum. As part of this curricular redesign, the school instituted academic communities. This perspective article outlines our experience with the first 8 years of these academic communities. Single-institution experience: We initiated academic communities with the hope that this structure would cultivate enhanced student-student and student-faculty engagement, improve faculty-student mentoring, and create additional service-learning and student leadership opportunities. The communities would also provide an environment for small group learning throughout the 4-year curriculum. After 8 years of experience, a comparison of student survey data pre- and post establishment of academic communities demonstrated enhanced connectedness between students and faculty and higher scores for faculty mentoring and for career planning. Our own lived experience with the communities revealed several unanticipated outcomes. The community directors became a source of support and advice for one another. Some faculty and administrators whose previous roles were affected by start of the academic communities needed to adjust expectations. Conclusions: The establishment of academic communities was associated with improvement in student-faculty engagement, student assessment of faculty mentoring, and career planning.

In addition to online questionnaires, many medical schools use supplemental evaluation tools such as focus groups to evaluate their courses. Although some benefits of using focus groups in program evaluation have been described, it is unknown whether these inperson data collection methods provide sufficient additional information beyond online evaluations to justify them. In this study, we analyze recommendations gathered from student evaluation team (SET) focus group meetings and analyzed whether these items were captured in open-ended comments within the online evaluations. Our results indicate that online evaluations captured only 49% of the recommendations identified via SETs. Surveys to course directors identified that 74% of the recommendations exclusively identified via the SETs were implemented within their courses. Our results indicate that SET meetings provided information not easily captured in online evaluations and that these recommendations resulted in actual course changes.

Despite improved understanding of the pathobiology of pulmonary arterial hypertension (PAH), it remains a severe and progressive disease, usually culminating in right heart failure, significant morbidity and early mortality. Over the last decade, some major advances have led to substantial improvements in the management of PAH. Much of this progress was pioneered by work in animal models. Although none of the current animal models of pulmonary hypertension (PH) completely recapitulate the human disease, they do provide insight into the cellular pathways contributing to its development and progression. There is hope that future work in model organisms will help to define its underlying cause(s), identify risk factors and lead to better treatment of the currently irreversible damage that results in the lungs of afflicted patients. However, the difficulty in defining the etiology of idiopathic PAH (IPAH, previously known as primary pulmonary hypertension) makes this subset of the disease particularly difficult to model. Although there are some valuable existing models that are relevant for IPAH research, the area would value from the development of new models that more closely mimic the clinical pathophysiology of IPAH.

Background This article is the last of a four-part series to guide educators on the construction and evaluation of multiple-choice test items in the post-licensure environment. Previous articles in this series described the problem and the mechanics of test item construction and evaluation. Method A replicable strategy for evaluating the organizational process for constructing multiple-choice test questions is provided. Steps taken to create change are described; work tools are provided. Results Guidance and training are needed to create multiple-choice test questions. Many educators have not had training in item construction. Educators welcomed training. Personalized mentorship resulted in improvement. Asynchronous learning alone was helpful and well received and improved self-perceived knowledge, yet fell short of achieving competence. Conclusion Voluntary training may not be adequate to assure enculturation of best practices without accountability standards and monitoring. Future research is indicated to assess the situation and provide national standards for adoption within health care organizations. [J Contin Educ Nurs. 2024;55(11):535–542.]

Background Multiple-choice test questions are among the main measures of knowledge used by educators in the postlicensure environment; however, these tests are often constructed in the absence of guidelines or the means to evaluate examination quality after administration. Method Previously, guidance was provided on constructing quality test items. Here we present instruction for professional development specialists to use postadministration test data for an item analysis, providing insight on test flaws and opportunities for iterative examination improvement. Results The topics of item difficulty, index of discrimination, and distractor analysis are covered for independent analysis, and topics such as reliability are addressed for those who have access to a formal program. Conclusion Three levels of strategies are described: using a learning management system for item analysis, using free open-source software, and using a minimal standards method of evaluating test items. [J Contin Educ Nurs. 2024;55(10):487–492.]

Background: This article provides nursing educators practical tips and evidence-based strategies for effective construction of multiple-choice questions (MCQs). Well-designed MCQs that align with the intended learning objectives are critical for implementing sound assessment practices. Method: This article offers a step-by-step approach to test construction, starting with the assessment blueprint and followed by important considerations when writing the specific components of the MCQ. Results: Appropriate inclusion of clinical context in the MCQ and a description of common flaws to avoid, with suggested remedies, are also addressed. Conclusion: Ultimately, the goal of this article is to equip nurse educators with the foundational tools to create high-quality MCQs that effectively assess knowledge acquisition by learners. [J Contin Educ Nurs. 202x;5x(x):xx–xx.]

Hematopoietic stem cell transplants (HSCT) are becoming more widespread as a result of optimization of conditioning regimens and prevention of short-term complications with prophylactic antibiotics and antifungals. However, pulmonary complications post-HSCT remain a leading cause of morbidity and mortality and are a challenge to clinicians in both diagnosis and treatment. This comprehensive review provides a primer for non-pulmonary healthcare providers, synthesizing the current evidence behind common infectious and non-infectious post-transplant pulmonary complications based on time (peri-engraftment, early post-transplantation, and late post-transplantation). Utilizing the combination of timing of presentation, clinical symptoms, histopathology, and radiographic findings should increase rates of early diagnosis, treatment, and prognostication of these severe illness states.

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death by disease worldwide and has a 30-day readmission rate of 22.6%. In 2015, COPD was added to the Medicare Hospital Readmission Reductions Program. The objective of this paper was to survey the current medical technologies for remote patient monitoring (RPM) tools that forecast COPD exacerbations in order to reduce COPD readmissions. We searched literature and digital health news to find commercially available RPM devices focused on predicting COPD exacerbations. These technologies were reviewed and compared according to four criteria: forecasting ability, cost, ease of use, and appearance. A rating system was developed to facilitate the evaluation process. As of June 2019, a list of handheld and hands-free devices was compiled. We compared features and found substantial variations. Devices that ranked higher on all criteria tended to have a high or unlisted price. Commonly mass-marketed devices like the pulse oximeter and spirometer surprisingly fulfilled the least criteria. The COPD RPM technologies with most technological promise and compatibility with daily living appear to have high or unlisted prices. Consumers and providers need better access to product information to make informed decisions.