Faculty Bibliography

PURPOSE: The primary goal of this project was to describe the level of knowledge acquisition using detailed test performance outcomes of the EBD SAPL curriculum over its first 7-years of implementation at the NYU College of Dentistry. A secondary goal was to compare performance outcomes impact of the full 60 h base SAPL curriculum as taught to 4-year DDS students vs an abbreviated 30 h base SAPL curriculum as taught to 3-year Advanced Placement DDS students. METHODS: The findings for the period 2004-2010 are reported for 1647 dental students (63.6% 4-year DDS students, 36.3% 3-year Advanced Placement DDS students). The database consisted of the score earned by each student on each individual question of the SAPL course's 4 h final examination in which each student read an original research article and answered all questions on the Literature Analysis Form. RESULTS: The major findings were overall high performance by both groups of students (SAPL exam scores of 85.8 vs 83.7, respectively) as well as very similar outcomes between these two student groups on: 1) recognizing research design elements and on interpreting those design elements for clinical application, 2) detailed performance of knowledge within the specific five traditional sections of research articles, and 3) detailed performance across 18 identified research design topics. CONCLUSION: In conclusion, both course formats appear to be highly effective for their respective student groups, but should not be interpreted as evidence favoring the shorter format given the different characteristics of the two student groups.

NEEDS AND OBJECTIVES: Our annual residency retreat brainstorms innovations to meet needs. In 2010 needs were: to introduce foundation concepts and enable primary care (PC) residents to feel/be competent in clinic earlier; to spiral learning of core concepts, skills and attitudes from the start; and to have residents and faculty connect from the outset.We aim to equip PC clinicians to deliver bio-psychosocial, comprehensive, best evidence-based systems savvy care and to become change agents, leaders, and scholars. To meet these aims we designed a learner centered, team oriented, skills-based Essentials for PC Clinicians (EPIC) curriculum utilizing an initial, rigorous 4 week block with spiral reinforcement through 3 years. The innovation is a comprehensive, reproducible, effective method to ensure residents' progress on paths of clinical, humanistic, and intellectual excellence consistent with the generalist paradigm. SETTING AND PARTICIPANTS: EPIC is part of the NYU Internal Medicine PC Residency. Residents attend public hospital and community continuity clinics. 8 interns take the EPIC block and 24 residents spiral through the curriculum. DESCRIPTION: EPIC begins with a 4 week intern block dedicated to core topics in PC; is reinforced in precepting and subsequent blocks; and has a weekly EPIC conference where these topics are deepened and extended. EPIC Block: The overarching themes throughout the 4 weeks focus on understanding and practice of core skills: workshops/precepting on time management, efficient use of EHR, obtaining best practices, consultation, how one learns best, practice in the medical home and engaging community resources. Week 1 focuses on diabetes, and introduces the pillars: psychosocial medicine, evidence-based practice, and systems-based policy awareness and skill. The second week focuses on hypertension. The last 2 weeks introduce 7 common, high-risk high gain conditions from smoking to hepatitis B. Teaching methods combine group learning and reflective written exercises!

LEARNING OBJECTIVE 1: Identify indications for surgical intervention in the case of hepatic abscesses LEARNING OBJECTIVE 2: Review appropriate management of new pleural effusions CASE: A 56 year-old woman presented with weight loss, malaise and polyuria for two months. On admission, HR 135, BP 107/80, RR 22, T 101, O2 94% on RA. Exam revealed cachexia, bilateral lower extremity edema, decreased breath sounds in lower half of right lung with decreased tactile fremitis and coarse crackles superiorly. Labs were notable for WBC 33 and glucose 559. EKG showed sinus tachycardia. CXR revealed a right pleural effusion. Patient was pan-cultured and empirically started on vancomycin, piperacillin/tazobatam and azithromycin for presumed pneumonia. Despite insulin and IV fluids, she remained tachycardic. CT angiogram revealed a large pulmonary embolus in the left basal pulmonary artery and a large loculated right pleural effusion with no pleural enhancement. Abdominal CT revealed 8 cm septated hepatic mass, hepatic vein thrombus extending into the IVC, and a small amount of air in the wall of the gallbladder. Heparin drip was started and patient was taken for percutaneous drainage of hepatic mass and thoracentesis. Only small samples were obtained given loculation. Pleural fluid was exudative, gram stain showed white cells but no organisms, pH 7.22, glucose 169. Chest tube was placed. Strep viridans grew from pleural and hepatic fluid; blood cultures grew strep anginosus and c. albicans. Antibiotics were narrowed to ceftriaxone and caspofungin. Given pneumobilia, hepatic abscess was presumed to be from GI source with empyema formation from local spread of infection and hepatic vein thrombus from local inflammation. EGD/colonoscopy failed to find communicating track between bowel and biliary systems. Surgical intervention was deemed risky given large clot burden and patient was managed with antibiotics alone. Repeat imaging two months later at discharge showed significant resolution of hepatic and pulmonary!

LEARNING OBJECTIVE 1: Recognize hepatosplenic lymphoma as a rare subtype of T-cell lymphoma LEARNING OBJECTIVE 2: Recognize the dangers of early diagnostic closure CASE: A 30 year-old Guinean man with no past medical history presented with cough, fever, night sweats and weight loss for two months. The patient immigrated to the US 6 years ago. Exam showed cachexia, HR 122, T 101.3, BP 105/72, RR 22, O2 96% on RA, splenomegaly, normal lung exam and no appreciable lymphadenopathy. Labs were significant for a WBC 3.0 with 73%N, Hbg of 7 and a negative rapid HIV. CXR was unremarkable. Patient was isolated for possible tuberculosis. CT revealed splenomegaly, multiple scattered low-density lesions in the liver, prominent mediastinal, hilar, axillary and retroperitoneal lymphadeopthy, with the largest node measuring 3.7 x 2.8 cm. CT-guided biopsy of the retroperitoneal lymph node revealed fibrocollagenous tissue with necrosis. AFB, fungal stains, and cultures were negative. High fevers persisted to Tmax 105.7 F. Despite three negative AFB sputums, patient was started on a liver-sparing TB regimen given clinical suspicion for extra-pulmonary tuberculosis and worsening liver function. A bone marrow biopsy was performed revealing normal bone marrow with slight megakaryocyte hyperplasia but no evidence of lymphoma. Repeat core biopsy of the retroperitoneal lymph node showed necrotic tissue with few CD3+ T cells; AFB and cultures again negative. The course was further complicated by acute hepatic failure and transfusion dependent pancytopenia. On day 20, as the risks of invasive surgical testing increased, decision was made to perform excisional biopsy of a small superficial inguinal lymph node seen on CT. Preliminary pathology showed T-cell lymphoma with cytotoxic features. TB treatment was stopped and chemotherapy with a modified EPOCH regimen was initiated. After biopsy, flank pain, severe agitation from hepatic encephalopathy and DIC developed. This was concerning for retroperitoneal bleed and led to in!