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The case required a broad differential hitting on virtually every system which was an excellent review of not only the common ailments we may see as primary care providers, but also kept me cognizant of the rare “zebras” one must be aware of when deciding whether a patient can be sent home OR if they need to be further evaluated at a hospital.
Hemophagocytic lymphohistiocytosis (HLH) is a rare and aberrant systemic inflammatory syndrome often trigged by a mechanism that disrupts immune homeostasis. Certain genetic links, malignancy and infectious processes are the most common etiologies, but rheumatologic disorders have also been implicated. This condition is life-threatening requiring prompt treatment while determining the underlying cause. Herein, we describe the case of a 6-year-old patient who developed HLH that was likely triggered by lupus nephritis (LN). The latter condition involves a complex pathogenesis including certain abnormal gene expressions and anomalous immune activation leading to renal inflammation and damage. This case report aims to review the patient’s course as these diagnoses unfolded while briefly outlining their respective diagnostic and treatment modalities.
Mentorship has been influential on my path to becoming a physician. In college, I participated in several mentorship and pipeline programs aimed at students underrepresented in medicine which helped me get to medical school and build meaningful relationships. As a medical student, I became a leader for those same programs I was a part of and participated in pipeline programs for primary care and family medicine. I aim to lift as I climb while undergoing training, and thankfully, the RMSMP here at UVA and UVA faculty mentors are allowing me to continue to do so. It’s important to me to share the work we are doing here and show how impactful mentorship can be for students and residents. After residency, I plan to pursue a career in academic family medicine to continue mentoring while striving to increase the primary care and family medicine workforce.
In 2015, residents at the University of Virginia (UVA) Family Medicine Residency started a longitudinal program connecting UVA medical students interested in family medicine with family medicine resident mentors. The program’s initial goal was to provide peer support for medical students navigating the Match. In 2017 after the second year of the mentoring program, informal feedback on residents’ experiences as mentors was solicited and found to be overwhelmingly positive, suggesting a potential positive impact on resident well-being. The mentoring program has continued with approximately ten mentoring pairs each year, with a brief hiatus from 2020-2022. It is in the renewal process for the 2022-2023 academic year. This study will help determine if the program impacts medical student interest and confidence in family medicine as a career choice, improve comfort with the residency application and match process, and decrease burnout among resident physicians. Participants in this study are medical students and residents currently enrolled in the mentoring program. Mentoring pairs are assigned based on self-reported interests and will meet regularly throughout the academic year. Pre- and post-surveys are provided to participants to measure the outcomes, and both qualitative and quantitative data will be reported.
My interest in optimizing communication with patients at the end of life stems from both personal and professional experiences. As a child, I witnessed my grandmother’s journey with advanced endometrial cancer become even more challenging by a lack of communication about her prognosis from her medical team. Once I began pursuing a career in medicine myself, I grew to understand that even the best-intentioned physicians often fall short in these situations, not due to personal failings, but due to gaps in medical education. This project represents an effort to equip the next generation of physicians (regardless of specialty) early on with the tools to have difficult conversations with patients with serious illness and at the end of life.
This study seeks to elucidate medical student perspectives on end-of-life care and proposes a strategy to mitigate barriers to effective communication regarding this topic. We hypothesize that students who have undergone formal VitalTalk training will report better outcomes in terms of preparedness to engage in EOL conversations, personal attitudes about EOL care, and strength of the therapeutic alliance than students who have not been trained in VitalTalk. These outcomes will be measured using an instrument adapted from a survey initially developed for use in a 2010 study on this subject and has been adapted with the authors’ permission. Participants will also complete a narrative summary of their experiences with EOL care during clerkships at the conclusion of their study participation. Participants will be recruited from the Virginia Tech Carilion School of Medicine classes of 2024, 2025, and 2026. Each cohort will include 12 participants. Prior to beginning their M3 year clinical rotations, each participant will undergo VitalTalk training by Carilion Clinic providers who have been certified to deliver the VitalTalk curriculum. Participants will complete the survey at baseline as well as 3, 6, and 9 months after the training. At 9 months, they will also be asked to write a short narrative summary of their experiences caring for patients at EOL and impression of the study intervention.
As a future physician, I believe that connection to community health is pivotal to addressing the needs of patients. However, without addressing the social determinants of the health of our patient populations, we leave under-resourced populations vulnerable to poor outcomes. It is important to find ways in which we can connect patients to valuable resources that can help them reach their goals outside of patient care rooms. I loved this project because it addresses needs through a collaborative, multidisciplinary, and multi-pronged approach which is key to providing care in complex settings. Additionally, RCSC encourages longitudinal involvement and gives special attention to leadership transitions to ensure continuity over the years. This kind of structure is often missing from other student-led initiatives, making RCSC uniquely poised to care for its community.
Incarcerated youth often face a complex interplay between their healthcare and incarceration status. This is important to family medicine because youth incarceration is linked to many long-term health disparities including PTSD, substance abuse, mood disorders, and Type II Diabetes (1). Approximately 50-80% have mental health diagnoses and many face interruptions of insurance coverage or medical care during transition periods (2-3). Moreover, younger ages of incarceration are strongly linked to adverse health outcomes in adulthood (2,4). Hence, it will be critical to focus research and resources on this vulnerable population to reduce poor long-term health outcomes and healthcare expenditures. To address rehabilitation needs and incarceration prevention, many guidelines have been outlined by the American Academy of Family Physicians (AAFP), American Academy of Pediatrics (AAP), and American Psychological Association (APA). These include increasing collaboration between state and local agencies serving youth, substantive discharge plans that coordinate care and resources, and utilization of diversion programs to behavioral health and substance use programs (2, 4-6). Our project focuses on how medical students can address proposed guidelines. Richmond Child Safety Collaboration (RCSC) is a medical student-run operation that supports and advocates for youth and their families. Under the Juvenile Justice Initiative, our projects include a) community initiatives such as attendance of local truancy meetings to connect youth and families to behavioral health resources, substance use disorder treatments, and diversion programs; b) connecting previously incarcerated youth with VCU Health, and c) creating educational opportunities for medical students and residents relating to the juvenile justice system. References upon request.
As a member of the International/Inner City/Rural Preceptorship (I2CRP) program at VCU, I have always valued community health and actively seek opportunities to understand the social/SES factors that influence disease. My interest in community psychiatry led me to reach out to the ACT team at Chesterfield Mental Health Support Services. There, I spent a day riding around Virginia with the ACT team, visiting patients with severe mental illness in their homes/shelters, and delivering intensive home-care. Through that experience, I learned there was a difference between understanding, versus, actually experiencing, the biopsychosocial factors that influence mental illness. I wanted to share this unique and valuable learning experience with my peers, and created the ACT pilot program as a result. The pre/post surveys, including qualitative and quantitative data, were created to assess whether the program objectives were being met.
Introduction Assertive community treatment (ACT) is a model of community based psychiatric care that employs a multi-disciplinary team to deliver mental health services to patients with severe mental illnesses. ACT teams differ from traditional models of care, employing a holistic approach to care. However, few medical schools offer the opportunity to participate in ACT during psychiatry clerkships. The aim of this project is to outline the design, development, and implementation of a pilot program to integrate an ACT experience in 3rd year psychiatry clerkships. Method Step 1: Assessment began with a literature review of the use of ACT as an educational tool. Key takeaways included:(1) only one other medical school offers an ACT experience in the psychiatry clerkship (2) qualitative reviews describe ACT as a unique learning experience. Step 2: Development first began with establishing a partnership with Chesterfield Mental Health Services. Next, we determined the structure of the program and decided on an opt-in experience where students would spend the day with the ACT team. Students would also receive a detailed orientation document. Step 3: Evaluation includes pre and post surveys collected throughout the year for quality improvement. Discussion Psychiatry clerkships often don’t provide avenues for medical students to appreciate the biopsychosocial factors that influence mental-health. Participation in ACT teams is a valuable but underutilized teaching tool to understand the biopsychosocial elements of psychiatric care. We hope that this research can inspire other medical institutions to integrate ACT experience into core clerkships.
My inspiration for this project stems from my personal experience with anorexia as a child and first hand experiencing the myriad ways an eating disorder (ED) influences physical health. However, during medical school, many of my peers and I perceived that the current education on EDs was sparse and reinforced many stereotypes of EDs. Thus, I wanted to create a learning opportunity that would depthen students’ understanding of EDs such that, as future providers, we will be more confident and capable in identifying and treating EDs. “When a medical provider doesn’t know what to do with someone with an eating disorder, it adds to the isolation and shame because you think this is somebody who went to medical school and even they don’t understand what’s happening to me” – NEDA
Introduction EDs affect 4-5 million Americans and have the second highest mortality rates of all mental illnesses (second only to opioid addiction). Physicians represent an important point of contact for ED identification and treatment, yet studies have found significant knowledge gaps in these realms. The aim of this project is to describe the on-going development and evolution of a student led initiative to develop a M4 elective on EDs. This is an interdisciplinary project in collaboration with the Richmond Center for Eating Disorders (RCED) and Equip, a virtual eating disorders treatment program. Method Step 1: Assessment involved conducting a literature review on the ED landscape. Key takeaways included: Patients with EDs often present first to PCPs with physical manifestations of disease. However, many providers feel unqualified in ED treatment, and few medical schools offer formal, evidence-based learning opportunities on EDs. Step 2: Decision/development involved determining course objectives to address gaps in medical education, and then developing an educational framework to meet objectives: 2 weeks of didactics using learning modules developed with Equip and integrated clinical experiences with RCED. Step 3: Implementation will involve gaining approval to implement the elective for the 2023-4 academic year. Future directions involve MedEd submission. Discussion Patients with EDs often present first to their PCPs. Failure to recognize warning signs contribute to high mortality rates. To the best of our knowledge, there are no medical schools that offer a focused elective on EDs. Thus, this process could serve as a model for other medical schools.