Faculty Bibliography

We conducted a retrospective study to examine trends in latent tuberculosis infection (LTBI) and TB disease rates among homeless persons in shelters in New York, NY, 1992-2006. Although TB case rates fell from 1,502/100,000 population to 0, a 31% LTBI rate in 2006 shows the value of identifying and treating TB in the homeless.

To explore the need for faculty development among Chinese medical educators. Leaders at each medical school in China were asked to complete a 123-item survey to identify interest in various topics and barriers and perceived benefits of participating in faculty development programs. Interest levels were high for all topics. Experience with Hospital Management and Research positively correlated with interest in learning more (p < 0.001). Ninety-two percent believe that international experiences are very or extremely important to medical educators' career advancement. Chinese medical education faculty members have a strong interest in faculty development programs.

BACKGROUND: Early residency is a crucial time in the professional development of physicians. As interns assume primary care for their patients, they take on new responsibilities. The events they find memorable during this time could provide us with insight into their developing professional identities. OBJECTIVE: To evaluate the most critical events in the lives of interns. PARTICIPANTS: Forty-one internal medicine residents at one program participated in a two-day retreat in the fall of their first year. Each resident provided a written description of a recent high point, low point, and patient conflict. MEASUREMENTS: We used a variant of grounded theory to analyze these critical incidents and determine the underlying themes of early internship. Independent inter-rater agreement of >90% was achieved for the coding of excerpts. MAIN RESULTS: The 123 critical incidents were clustered into 23 categories. The categories were further organized into six themes: confidence, life balance, connections, emotional responses, managing expectations, and facilitating teamwork. High points were primarily in the themes of confidence and connections. Low points were dispersed more generally throughout the conceptual framework. Conflicts with patients were about negotiating the expectations inherent in the physician-patient relationship. CONCLUSION: The high points, low points, and conflicts reported by early residents provide us with a glimpse into the lives of interns. The themes we have identified reflect critical challenges interns face the development of their professional identity. Program directors could use this process and conceptual framework to guide the development and promotion of residents' emerging professional identities.

Although patient-controlled analgesia (PCA) is considered the standard in postoperative pain control, research examining PCA use among cognitively impaired older adults is lacking. The authors reviewed a case series of 10 adults aged 65 years and older admitted to the geriatrics or orthopedic services of an urban tertiary care center in New York City with acute pain and cognitive impairment or dementia who were administered PCA. Four patients from this cohort are presented in detail, demonstrating the challenges of PCA use in this population. A series of clinical pearls follows each case, outlining strategies for improving pain management. The authors' findings suggest that cognitive evaluations limited to alertness and orientation and failure to perform functional assessments may binder the identification of patients who are poor candidates for PCA. Once PCA has been initiated, clinicians must regularly review device use and document cognitive function and pain score patterns to identify PCA underuse or misuse. Finally, rapid fluctuations in cognitive or functional status may require adoption of a more flexible pain management strategy. Despite these challenges, a subset of cognitively impaired older adults can successfully understand and operate PCA devices. Additional research is needed to (1) develop screening tools for identifying and monitoring older adults who may benefit from PCA and (2) create innovative approaches for improving pain management in the cognitively impaired.