Faculty Bibliography

BACKGROUND:Despite the central role of experiential learning in residency training, the actual clinical experiences residents participate in are not well characterized. A better understanding of the type, volume, and variation in residents' clinical experiences is essential to support precision medical education strategies. OBJECTIVE:We sought to characterize the entirety of the clinical experiences had by individual internal medicine residents throughout their time in training. METHOD/METHODS:We evaluated the clinical experiences of medicine residents (n = 51) who completed training at NYU Grossman School of Medicine's Brooklyn campus between 2020 and 2023. Residents' inpatient and outpatient experiences were identified using notes written, orders placed, and care team sign-ins; principal ICD-10 codes for each encounter were converted into medical content categories using a previously described crosswalk tool. RESULTS:Of 152,426 clinical encounters with available ICD-10 codes, 132,284 were mapped to medical content categories (94.5% capture). Residents' clinical experiences were particularly enriched in infectious and cardiovascular disease; most had very little exposure to allergy, dermatology, oncology, or rheumatology. Some trainees saw twice as many cases in a given content area as did others. There was little concordance between actual frequency of clinical experience and expected content frequency on the ABIM certification exam. CONCLUSIONS:Individual residents' clinical experiences in training vary widely, both in number and in type. Characterizing these experiences paves the way for exploration of the relationships between clinical exposure and educational outcomes, and for the implementation of precision education strategies that could fill residents' experiential gaps and complement strengths with targeted educational interventions.

Precision education (PE) uses personalized educational interventions to empower trainees and improve learning outcomes. While PE has the potential to represent a paradigm shift in medical education, a theoretical foundation to guide the effective implementation of PE strategies has not yet been described. Here, the authors introduce a theoretical foundation for the implementation of PE, integrating key learning theories with the digital tools that allow them to be operationalized. Specifically, the authors describe how the master adaptive learner (MAL) model, transformative learning theory, and self-determination theory can be harnessed in conjunction with nudge strategies and audit and feedback dashboards to drive learning and meaningful behavior change. The authors also provide practical examples of these theories and tools in action by describing precision interventions already in use at one academic medical center, concretizing PE's potential in the current clinical environment. These examples illustrate how a firm theoretical grounding allows educators to most effectively tailor PE interventions to fit individual learners' needs and goals, facilitating efficient learning and, ultimately, improving patient and health system outcomes.

BACKGROUND:It is not yet known whether socioeconomic factors (ie, social determinants of health) are associated with readmission following hospitalization for coronavirus disease 2019 (COVID-19). METHODS:We conducted a retrospective cohort study of 6191 adult patients hospitalized with COVID-19 in a large New York City safety-net hospital system between March 1 and June 1, 2020. Associations between 30-day readmission and selected demographic characteristics, socioeconomic factors, prior health care utilization, and relevant features of the index hospitalization were analyzed using a multivariable generalized estimating equation model. RESULTS:The readmission rate was 7.3%, with a median of 7 days between discharge and readmission. The following were risk factors for readmission: age 65 and older [adjusted odds ratio (aOR): 1.32; 95% confidence interval (CI): 1.13-1.55], history of homelessness, (aOR: 2.03 95% CI: 1.49-2.77), baseline coronary artery disease (aOR: 1.68; 95% CI: 1.34-2.10), congestive heart failure (aOR: 1.34; 95% CI: 1.20-1.49), cancer (aOR: 1.68; 95% CI: 1.26-2.24), chronic kidney disease (aOR: 1.74; 95% CI: 1.46-2.07). Patients' sex, race/ethnicity, insurance, and presence of obesity were not associated with increased odds of readmission. A longer length of stay (aOR: 0.98; 95% CI: 0.97-1.00) and use of noninvasive supplemental oxygen (aOR: 0.68; 95% CI: 0.56-0.83) was associated with lower odds of readmission. Upon readmission, 18.4% of patients required intensive care, and 13.7% expired. CONCLUSION:We have found some factors associated with increased odds of readmission among patients hospitalized with COVID-19. Awareness of these risk factors, including patients' social determinants of health, may ultimately help to reduce readmission rates.

Members of the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community experience marginalization, bias, and discrimination, including in the world of academic medicine. People who are transgender and gender non-binary (TGNB) experience further marginalization compared to individuals who are lesbian, gay, bisexual, and queer. According to a recent survey, more than half of medical students who are TGNB chose not to disclose their gender identities during training due to fears of discrimination, feeling a lack of support, and concerns about future career options. Academic medicine has historically pathologized TGNB individuals, perpetuating discrimination structurally and reinforcing discriminatory behaviors in peers and faculty. In this Perspective, the authors provide a comprehensive overview of the challenges that administrators and educators face in creating a learning environment that is inclusive of TGNB trainees. They outline opportunities for change and provide strategies to address administrative and educational challenges, including those related to institutional climate, policies, data collection, physical spaces, health care, the curriculum, mentoring, and the evaluation of TGNB trainees. Finally, the authors issue a call to action for medical educators and administrators to create environments in which trainees who are TGNB can fulfill their primary mission: to learn the practice of medicine.

Limited research has examined the ways in which public health training programs equip students to address health disparities affecting the lesbian, gay, bisexual, and transgender (LGBT) community and other sexual and gender minority (SGM) populations. This study outlines the availability of public health curricula on SGM health topics, and the prevalence of LGBT and SGM-inclusive institutional support services across CEPH-accredited U.S. schools of public health. Content analysis of all course offerings related to gender and sexuality revealed a limited focus on sexual and gender minority health: just 4.7% of courses contained keywords indicating that LGBT or SGM health topics were covered. Similar analysis of institutional support services available at U.S. schools of public health found that only 25% of schools had LGBT student organizations, and just 19% had an office of diversity that specifically advertised LGBT or SGM-inclusive programming or services on the institution's Web site. Finally, only two of 52 schools offered an educational certificate centered on LGBT health. These findings illustrate a significant need for enhanced curricular content and institutional support services that equip public health students to address SGM health disparities. Improvement in this area may encourage future health care professionals to work to reduce these disparities, to improve SGM persons' experiences in health care settings, and to generate further research in this area.