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Background Point of care ultrasound (POCUS) education has grown significantly over the past two decades. Like most curricular items, POCUS education is siloed within individual graduate medical education (GME) programs. The purpose of this study was to evaluate the effectiveness of a shared GME POCUS curriculum between five GME programs at a single institution. Methods Post-graduate-year-1 (PGY-1) residents from emergency medicine (EM), family medicine (FM), internal medicine (IM), combined internal medicine-pediatrics (IM-Peds) and combined emergency medicine-pediatrics (EM-Peds) residency programs were enrolled in a core POCUS curriculum. The curriculum included eleven asynchronous online learning modules and ten hands-on training sessions proctored by sonographers and faculty physicians with POCUS expertise. Data was gathered about the curriculum’s effectiveness including participation, pre- and post-curricular surveys, pre- and post-knowledge assessments, and an objective skills assessment. Results Of the 85 residents enrolled, 61 (72%) participated in the curriculum. Engagement varied between programs, with attendance at hands-on sessions varying the most (EM 100%, EM-Peds 100%, FM 40%, IM 22%, Med-Peds 11%). Pre- and post-knowledge assessment scores improved for all components of the curriculum. Participants felt significantly more confident with image acquisition, anatomy recognition, interpreting images and incorporating POCUS findings into clinical practice ( p  < 0.001) after completing the curriculum. Conclusion In this shared GME POCUS curriculum, we found significant improvement in POCUS knowledge, attitudes, and psychomotor skills. This shared approach may be a viable way for other institutions to provide POCUS education broadly to their GME programs.

Background There is little to no data evaluating long term usage of point of care ultrasound (POCUS) after a training intervention for medical students. The purpose of this study was to examine the impact of an intensive POCUS training program on medical student’s usage at 9-months post-program. Methods This was a prospective cross-sectional study of rising second year medical students who participated in a 2-week summer POCUS training program. Instruction consisted of 8 h of asynchronous online didactic material, 2–4 h of daily hands-on instructor-led and independent scanning, and instruction on how to teach POCUS. Students were assessed pre- and post-program, and again at 9 months post-program to evaluate POCUS usage. Results A total of 56 students participated in the program over 2 summers; 52 (92.9%) responded to the 9-month post-program survey. At 9 months, 49 (94.2%) of students taught POCUS after the program to peers or faculty. Students reported serving as a POCUS instructor in 283 subsequent teaching sessions accounting for 849 h of POCUS instruction time. Six (11.5%) students were involved in the creation of a POCUS interest group on their regional campus, 7 (13%) created a POCUS curriculum for their student interest group, and 4 (7.7%) created an opt-in co-curricular POCUS program for students at their regional campus. Three (5.8%) students did not serve as educators after the program and only one student reported not using POCUS again after the program. Conclusion After a 2-week intensive POCUS training program for medical students, the majority of students demonstrated continued involvement in POCUS learning and education at 9-month follow-up including serving as peer instructors and assisting with limitations in financial resources and trained faculty.

Purpose Medical students are integrated into an interprofessional team to help them learn how to provide effective, patient-centered care. Indiana University School of Medicine (IUSM) introduced a unique, easy-to-implement interprofessional exercise into each clerkship to improve students’ understanding of each professional’s contribution to patient care. Methods Between 2022 and 2023, IUSM medical students interviewed a variety of healthcare professionals engaged in the care of mutual patients using a template of questions; they wrote a brief report and evaluated the experience. Students interviewed a different professional in each clerkship to broaden their exposure. Results 3088 encounters occurred, 68% at the Indianapolis campus and 32% at regional campuses. More than 82% of students agreed or strongly agreed to each of the following prompts regarding the exercise: aided their understanding of the benefits of an interprofessional team to patient care, better understood when participation of the specific healthcare professional would benefit their patient, the experience contributed to their understanding of the role of that profession within the healthcare team, their confidence in engaging other healthcare professionals on the health care team improved, and the experience aided in understanding of their own role as a member of the health care team. Conclusion This exercise was easy to implement across a multi-campus system and improved student comprehension of the interprofessional team and indications for their engagement in patient care.

Adherence to positive airway pressure (PAP) therapy is a challenge in patients with allergic rhinitis. We present a case of a 62-year-old male with OSA who had been struggling with PAP therapy for 10 years. Intranasal fluticasone alone did not result in tolerance of PAP therapy. However, the combination of once-daily intranasal oxymetazoline with fluticasone led to significant improvement in tolerance and adherence to PAP therapy. Although twice-daily oxymetazoline alone has been associated with developing rhinitis medicamentosa, this side effect was not experienced by our patient. Some studies have shown that using intranasal oxymetazoline along with an intranasal steroid once daily for 4 weeks demonstrated improved effectiveness in relieving nasal symptoms with no development of rebound congestion or rhinitis medicamentosa. This strategy may be helpful in improving continuous PAP tolerance for patients with concurrent obstructive sleep apnea and rhinitis, a potential area to explore in the future to improve PAP adherence. Citation: Anokwute A, Manchanda S, Wallach PM. Improvement of CPAP tolerance and adherence in a patient with obstructive sleep apnea with the use of nasal steroids and nasal oxymetazoline. J Clin Sleep Med. 2025;21(4):733–734.

Background: Previous research on Emergency Medical Technician (EMT) programs as an early clinical experience indicates that medical students' confidence in patient care and team-building skills increases with participation. However, very little is known about the unplanned, long-term effects of EMT courses on medical students once they enter medical school. Objectives: This study examined the immediate outcomes produced by the month-long summer EMT course and the unplanned outcomes that students reported 1 year later. Methods: Pre/postsurveys were collected on all 25 students who graduated from the EMT course offered before their first year. These survey data were analyzed using a paired-samples t test. A subset of students (N = 14) consented to taking a survey and be interviewed on the lasting impact of their EMT experience. Interviews were conducted 10 months after the 2016 cohort completed the EMT course and at 22 months for the 2015 cohort. They were audio-recorded, transcribed, and analyzed using inductive content analysis. Results: Survey results indicated that students' confidence in patient care and team-building skills increased significantly for all identified skills at the P < 0.05 level. Overall confidence in patient care increased 1.5 points (P = 0.001) on 1-4 Likert-type scale. Overall confidence in team-building skills increased at 0.7 points (P = 0.01). Qualitative analysis of interviews discovered four themes, including the retention and transferability of practical skills, a developed understanding of team communication, comfort with patient interactions, and the development of a framework for assessing patients' needs. Students applied the EMT skills in various extracurricular volunteering experiences and in clinical skills courses. Conclusions: This study concludes that EMT programs have both immediate and lasting effects that seem to assist students with making sense of and navigating other learning opportunities. Specifically, EMT courses offered to students prior to their entry into medical school may help orient them to team-based health care and triaging patient care.

BackgroundAs electronic health records (EHRs) became broadly available in medical practice, effective use of EHRs by medical students emerged as an essential aspect of medical education. While new federal clinical documentation guidelines have the potential to encourage greater medical student EHR use and enhance student learning experiences with respect to EHRs, little is known nationally about how students have engaged with EHRs in the past.ObjectiveThis study examines medical student accounts of EHR use during their internal medicine (IM) clerkships and sub-internships during a 5-year time period prior to the new clinical documentation guidelines.DesignAn online survey about EHR use was administered to medical students immediately after they completed USMLE Step 2 CK.ParticipantsThe sample included 16,602 medical students planning to graduate from US medical schools from 2012 to 2016.Main MeasuresDescriptive statistics were computed to determine the average percentage of students engaged in various health record activities during their IM educational experiences by graduation year.Key ResultsThe vast majority (99%) of medical students used EHRs during IM clerkships or sub-internships. Most students reported that they entered information into EHRs during the inpatient component of the IM clerkship (84%), outpatient component of the IM clerkship (70%), and the IM sub-internship (92%). Yet, 43% of the students who graduated in 2016 never entered admission orders and 35% of them never entered post-admission orders.ConclusionsMedical school graduates ought to be able to effectively document clinical encounters and enter orders into EHR systems. Although most students used and entered information into EHRs during their IM clinical training, many students appear to have received inadequate opportunities to enter notes or orders, in particular. Implications for graduate medical education preparedness are considered. Future research should address similar questions using comparable national data collected after the recent guideline changes.

Introduction In institutional assessments of faculty, scholarly activity is often cited as a deficiency. Faculty lack the training and resources needed to produce peer-reviewed, quality scholarship. Although a variety of formats have been suggested and used to fill this void, fellowships are a commonly used format to foster educational leaders within institutions. In 2010, the Educational Innovation Institute at the Medical College of Georgia created an educational research fellowship to address this need. Methods To assess the success of our programme, we compared all graduating fellows’ current curriculum vitae (CVs) with the version submitted at the time of their application, looking for educational scholarship produced during and after their participation in the fellowship. Qualitative data sources, such as article reflections, mid-fellowship surveys, and exit surveys were analyzed to identify the mechanisms that contributed to their success. The constant comparative method was used to identify themes and patterns. Results A comparison of CVs collected at the time of application with a current CV indicate the 11 participants produced: 60 presentations at regional or national meetings, 16 peer reviewed publications, received funding for 7 grants supporting educational research, and won 7 national research awards. Our qualitative analysis identified three major mechanisms: 1) dedicated time to conducting educational research, 2) opportunities to engage with others, and 3 ) understanding the differences between educational and clinical research. Discussion Previous criticisms of fellowships include faculty not producing educational scholarship after completing their programme. Our retrospective analysis indicates our research fellowship was successful in developing physicians and clinical educators to become educational researchers. What was most useful was having dedicated time to work with others interested in producing educational scholarship, and expert guidance in understanding the differences between clinical and educational research. The most challenging aspect of conducting education research was their need to use conceptual frameworks and learning theory in their work. Implications for this study include the need for a strong curricular focus on the differences between clinical and educational research for any fellowship programme.

Objectives  Lack of faculty skill and confidence in performing and teaching point-of-care ultrasound (POCUS) remains a significant barrier to implementation of a longitudinal ultrasound curriculum in undergraduate medical education. Our objective was to assess faculty comfort, knowledge and skill with performing and teaching POCUS before and after a focused workshop. Methods  This was a prospective study assessing faculty from multiple specialties. Faculty completed a pre- and post-workshop survey and ultrasound knowledge assessment, and a post-workshop objective structured clinical examination (OSCE) to assess ability to perform POCUS. Differences between pre- and post-workshop responses were analyzed using Fisher's Exact and Wilcoxon tests, and statistical significance was accepted for p<0.05. Results We analyzed data on 78 faculty from multiple disciplines. Faculty had a median of 7.5 years of experience with medical student teaching. Sixty-eight percent of faculty had performed <25 prior ultrasound (US) examinations. Comparing pre- to post-workshop responses, we found significant reductions in barriers to using US, and improved confidence with using, obtaining and interpreting POCUS (p<0.01). Faculty felt significantly more comfortable with the idea of teaching medical students POCUS (p<0.01). POCUS knowledge improved from 50% to 86% (p<0.01). On the post-workshop OSCE, 90% of anatomic structures were correctly identified with a median image quality of 4 out of 5. Conclusion After attending a six-hour workshop, faculty across multiple specialties had increased confidence with using and teaching POCUS, showed improved knowledge, and were able to correctly identify pertinent anatomic structures with ultrasound while obtaining good image quality.

This perspective is a counterpoint to Dr. Brass’ article, Basic biomedical sciences and the future of medical education: implications for internal medicine . The authors review development of the US medical education system as an introduction to a discussion of Dr. Brass’ perspectives. The authors agree that sound scientific foundations and skill in critical thinking are important and that effective educational strategies to improve foundational science education should be implemented. Unfortunately, many students do not perceive the relevance of basic science education to clinical practice. The authors cite areas of disagreement. They believe it is unlikely that the importance of basic sciences will be diminished by contemporary directions in medical education and planned modifications of USMLE. Graduates’ diminished interest in internal medicine is unlikely from changes in basic science education. Thoughtful changes in education provide the opportunity to improve understanding of fundamental sciences, the process of scientific inquiry, and translation of that knowledge to clinical practice.