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Does family history of pancreatic cancer in pathogenic variant carriers identify patients who are diagnosed with pancreatic cancer: Results of a multi-site collaboration [Meeting Abstract]

Karloski, E; Diergaarde, B; Blanco, A; Everett, J N; Levinson, E; Rangarajan, T; Stanich, P P; Childers, K; Brown, S; Drogan, C; Cavestro, G M; Dudley, B; Gordon, K; Singh, A; Baptiste, A N; Simeone, D M; Reich, H; Kastrinos, F; Zakalik, D; Hampel, H; Pearlman, R; Gordon, O K; Kupfer, S S; Puzzono, M; Zuppardo, R A; Brand, R E
Background Previously reported single institution data on family history of pancreatic adenocarcinoma (PDAC) showed that most individuals with a germline pathogenic or likely pathogenic variant (PV/LPV) in a PDAC susceptibility gene who were diagnosed with PDAC would not have met current recommendations for PDAC surveillance established by the National Comprehensive Cancer Network, the American College of Gastroenterology, or International Cancer of the Pancreas Screening Consortium. These recommendations rely on the assumption that PV/LPV carriers with family history of PDAC are at greater risk for developing PDAC as compared to carriers without a family history. This study is a multi-site collaboration to validate the previous findings. Methods Individuals with PDAC who had a germline PV/LPV in ATM, BRCA1, BRCA2, EPCAM, MLH1, MSH2, MSH6, PALB2, or PMS2 were assessed for family history of PDAC in first- (FDR) or second-degree relatives (SDR). A comparison group of individuals with PDAC who had no germline PV/LPV identified through multigene panel testing was also assessed. Chi-square and t-tests were used to determine statistical significance. Results Nine institutions compiled a cohort of 196 individuals with PDAC who had a germline PV/LPV in one of the aforementioned genes. See Table 1 for demographics. Fifty (25.5%) had an FDR and/ or SDR affected by PDAC and 146 (74.5%) had no family history of PDAC. The cohort was significantly more likely to have a PDACaffected FDR or SDR than individuals with PDAC who had no germline PV/LPV (p = 0.004). Significance was also reached for affected FDR alone (p = 0.003), but not for affected SDR alone (p = 0.344). See Table 2. Conclusions This multi-site study confirms that most individuals with PDAC and a PV/LPV in ATM, BRCA1, BRCA2, EPCAM, MLH1, MSH2, MSH6, PALB2, or PMS2 would not meet current pancreatic cancer surveillance recommendations because they do not have family history of PDAC. Family history, particularly an affected FDR, enriches the cohort but alone is insufficient in identifying the majority of high-risk individuals who are at risk for developing PDAC. (Table Presented)
EMBASE:639680287
ISSN: 1573-7292
CID: 5377772

Third year medical students impersonalize and hedge when providing negative upward feedback to clinical faculty

Olvet, Doreen M; Willey, Joanne M; Bird, Jeffrey B; Rabin, Jill M; Pearlman, R Ellen; Brenner, Judith
Medical students provide clinical teaching faculty with feedback on their skills as educators through anonymous surveys at the end of their clerkship rotation. Because faculty are in a position of power, students are hesitant to provide candid feedback. Our objective was to determine if medical students were willing to provide negative upward feedback to clinical faculty and describe how they conveyed their feedback. A qualitative analysis of third year medical students' open-ended comments from evaluations of six clerkships was performed using politeness theory as a conceptual framework. Students were asked to describe how the clerkship enhanced their learning and how it could be improved. Midway through the academic year, instructions to provide full names of faculty/residents was added. Overall, there were significantly more comments on what worked well than suggestions for improvement regarding faculty/residents. Instructing students to name-names increased the rate of naming from 35% to 75% for what worked well and from 13% to 39% for suggestions for improvement. Hedging language was included in 61% of suggestions for improvement, but only 2% of what worked well. Students described the variability of their experience, used passive language and qualified negative experiences with positive ones. Medical students may use linguistic strategies, such as impersonalizing and hedging, to mitigate the impact of negative upward feedback. Working towards a culture that supports upward feedback would allow students to feel more comfortable providing candid comments about their experience.
PMID: 33657329
ISSN: 1466-187x
CID: 4823332

Survival Benefit for Individuals With Constitutional Mismatch Repair Deficiency Syndrome Who Undergo a Surveillance Protocol: A Report From the International Replication Repair Deficiency Consortium [Meeting Abstract]

Ercan, A.; Durno, C.; Bianchi, V.; Edwards, M.; Aronson, M.; Villani, A.; Bouffet, E.; Al-Battashi, A.; Alharbi, M.; Basel, D.; Bedgood, R.; Bendel, A.; Blumenthal, D.; Bornhorst, M.; Bronsema, A.; Cairney, E.; Caroll, S.; Chamdin, A.; Chiaravalli, S.; Constantini, S.; Das, A.; Dvir, R.; Farah, R.; Foulkes, W.; Frenkel, Z.; Gardner, S.; Ghalibafian, M.; Gilpin, C.; Goudie, C.; Hamid, S. Ahmer; Hampel, H.; Hansford, J.; Harlos, C.; Hijiya, N.; Saunders, H.; Kamihara, J.; Knipstein, J.; Koschmann, C.; Larouche, V.; Lassaletta, A.; Lindhorst, S.; Ling, S.; Link, M.; DeMola, R. Loret; Luiten, R.; Lurye, M.; Maciaszek, J.; Issai, V. M.; Maher, O.; Massimino, M.; Mushtaq, N.; Newmark, M.; Nicholas, G.; Nichols, K.; Nicolaides, T.; Opocher, E.; Osborn, M.; Oshrine, B.; Pearlman, R.; Pettee, D.; Rapp, J.; Rashid, M.; Reddy, A.; Reichman, L.; Remke, M.; Robbins, G.; Sabel, M.; Samuel, D.; Scheers, I.; Sen, S.; Stearns, D.; Sumerauer, D.; Swallow, C.; Taylor, L.; Toledano, H.; Tomboc, P.; Van Damme, A.; Winer, I.; Yalon, M.; Yen, L. Y.; Zapotocky, M.; Zelcer, S.; Ziegler, D.; Zimmermann, S.; Azad, V. Fallah; Roy, S.; Tabori, U.
ISI:000581769200033
ISSN: 1545-5009
CID: 4696292

Measuring Duty Hours Made Simple Reply [Letter]

Shine, Daniel; Pearlman, Ellen; Watkins, Brendan
ISI:000283650100010
ISSN: 0002-9343
CID: 114813

Measuring resident hours by tracking interactions with the computerized record

Shine, Daniel; Pearlman, Ellen; Watkins, Brendan
PMID: 20193841
ISSN: 0002-9343
CID: 107787

The reply [Letter]

Shine, D; Pearlman, E; Watkins, B
SCOPUS:78049417166
ISSN: 0002-9343
CID: 656142

"Oh! She doesn't speak english!" Assessing resident competence in managing linguistic and cultural barriers

Zabar, Sondra; Hanley, Kathleen; Kachur, Elizabeth; Stevens, David; Schwartz, Mark D; Pearlman, Ellen; Adams, Jennifer; Felix, Karla; Lipkin, Mack Jr; Kalet, Adina
BACKGROUND: Residents must master complex skills to care for culturally and linguistically diverse patients. METHODS: As part of an annual 10-station, standardized patient (SP) examination, medical residents interacted with a 50-year-old reserved, Bengali-speaking woman (SP) with a positive fecal occult blood accompanied by her bilingual brother (standardized interpreter (SI)). While the resident addressed the need for a colonoscopy, the SI did not translate word for word unless directed to, questioned medical terms, and was reluctant to tell the SP frightening information. The SP/SI, faculty observers, and the resident assessed the performance. RESULTS: Seventy-six residents participated. Mean faculty ratings (9-point scale) were as follows: overall 6.0, communication 6.0, knowledge 6.3. Mean SP/SI ratings (3.1, range 1.9 to 3.9) correlated with faculty ratings (overall r=.719, communication r=.639, knowledge r=.457, all P<.01). Internal reliability as measured by Cronbach's alpha coefficients for the 20 item instrument was 0.91. Poor performance on this station was associated with poor performance on other stations. Eighty-nine percent of residents stated that the educational value was moderate to high. CONCLUSION: We reliably assessed residents communication skills conducting a common clinical task across a significant language barrier. This medical education innovation provides the first steps to measuring interpreter facilitated skills in residency training
PMCID:1484779
PMID: 16704400
ISSN: 1525-1497
CID: 66202

Internal medicine residency training in the 21st century: aligning requirements with professional needs

Charap, Mitchell H; Levin, Richard I; Pearlman, R Ellen; Blaser, Martin J
PMID: 16164893
ISSN: 0002-9343
CID: 58700

Meeting requirements and changing culture. The development of a web-based clinical skills evaluation system

Triola, Marc M; Feldman, Henry J; Pearlman, Ellen B; Kalet, Adina L
The Accreditation Council of Graduate Medical Education (ACGME) and the Residency Review Committee require a competency-based, accessible evaluation system. The paper system at our institution did not meet these demands and suffered from low compliance. A diverse committee of internal medicine faculty, program directors, and house staff designed a new clinical evaluation strategy based on ACGME competencies and utilizing a modular web-based system called ResEval. ResEval more effectively met requirements and provided useful data for program and curriculum development. The system is paperless, allows for evaluations at any time, and produces customized evaluation reports, dramatically improving our ability to analyze evaluation data. The use of this novel system and the inclusion of a robust technology infrastructure, repeated training and e-mail reminders, and program leadership commitment resulted in an increase in clinical skills evaluations performed and a rapid change in the workflow and culture of evaluation at our residency program
PMCID:1492338
PMID: 15109310
ISSN: 0884-8734
CID: 45276

Measuring the competence of residents as teachers

Zabar, Sondra; Hanley, Kathleen; Stevens, David L; Kalet, Adina; Schwartz, Mark D; Pearlman, Ellen; Brenner, Judy; Kachur, Elizabeth K; Lipkin, Mack
Medical residents, frontline clinical educators, must be competent teachers. Typically, resident teaching competence is not assessed through any other means than gleaning learner's comments. We developed, evaluated, and integrated into our annual objective structured clinical examination a resident teaching skills assessment using 'standardized' students. Faculty observers rated residents using a customized 19-item rating instrument developed to assess teaching competencies that were identified and defined as part of our project. This was feasible, acceptable, and valuable to all 65 residents, 8 students, and 16 faculty who participated. Teaching scenarios have potential as reliable, valid, and practical measures of resident teaching skills
PMCID:1492315
PMID: 15109318
ISSN: 0884-8734
CID: 46163