Recent Publications by CFE Educators

Expanding frontiers of knowledge have prompted medical schools to reconsider how best to promote learning in the face of information overload. Concept mapping (CM) promotes knowledge retention and integration. Students have perceived CM positively in prior studies, but the feasibility and utility of integrating CM into a medical student oncology curriculum as a learning and assessment tool have not been described. At the University of California, San Francisco, 152 medical students in a second-year hematology/oncology course produced concept maps about a single cancer type over 4 weeks. We collected student evaluations about CM. Two of three graders independently scored each map using a standard rubric. We compared CM scores with USMLE Step 1 scores and clerkship grades using regression. All students produced a concept map. Student perception was mixed, and students provided feedback to improve CM utility as a learning tool. Grading was feasible, and inter-rater reliability was high. CM scores did not predict USMLE Step 1 scores or clerkship grades. CM was feasible as a learning tool, and we present strategies based on student feedback and literature review to improve utility. CM was feasible and reliable as an assessment tool; additional validity evidence may improve utility. Future studies should explore whether CM integrated into medical student oncology curricula early, serially, and collaboratively, with iterative practice and feedback, may predict meaningful learning and performance outcomes.

Background

Postoperative opioid prescribing has been linked with persistent opioid use. Ureteroscopy (URS) is a common urologic procedure and a potential area to focus on opioid reduction. We aim to characterize international practice patterns of opioid prescribing post URS and what measures may decrease the need for opioid prescription.

Methods

We developed a survey directed to members of the Endourological Society. The survey queried the frequency of opioid prescribing post URS, challenges when opioids are not prescribed, and measures thought to reduce the need for opioids.

Results

We received 159 responses with the majority reported practicing urology for >20 years (37.1%), and performing 10-20 ureteroscopies/month (45.3%). Forty-one percent were from the United States (US) and Canada. Sixty-six percent completed a fellowship, 84% in endourology. Twenty-six percent prescribe opioids more than half the time and the majority do so less than 10% of the time (61.6%). Thirty-eight percent had no challenges when opioids were omitted. Measures felt to decrease the need for opioids were preoperative counseling, nonsteroidal anti-inflammatory drugs use, and use of adjunct medications. After adjusting for location and type of practice, endourology fellowship completion, years of practice, and number of ureteroscopies/month, we found that respondents from the US and Canada were more likely to prescribe opioids more than half the time post URS compared to respondents from the rest of the world [odds ratio (OR): 87.5, P0.001, 95% confidence interval (CI): 17.3-443.5].

Conclusions

Despite proven feasibility of non-opioid pathway, nearly one-quarter of participants in our survey prescribe opioids >50% of the time post URS. Most important factors felt to reduce opioid prescription post URS were preoperative counseling, nonsteroidal anti-inflammatory drugs use. US and Canadian urologists were more likely to prescribe opioids >50% of the time post URS compared to the rest of the world. We believe best practice guidelines should be considered by the American and Canadian Urological Associations to address post URS opioid prescribing.

Among patients with hepatocellular carcinoma (HCC), elevated α-fetoprotein (AFP) has been shown to predict waitlist dropout, high-risk histopathologic features, and inferior post-liver transplant (LT) outcome. Nevertheless, many patients with HCC have a normal AFP and yet still experience waitlist dropout or post-LT recurrence. Because of the degree of imprecision associated with AFP, there is a quest for other biomarkers that may be complementary to or better than AFP in predicting prognosis in LT. Lectin-reactive AFP (AFP-L3) and des-gamma-carboxyprothrombin (DCP) are biomarkers that have been used in conjunction with AFP as HCC surveillance or diagnostic tools. However, the utility of these biomarkers in LT for HCC is not established.

Internal medicine (IM) residents frequently see patients in subspecialty clinics. However, there are few published core subspecialty curricula targeted to residents' learning and practical needs, and little guidance exists regarding delivery of core subspecialty content to residents rotating across multiple clinical sites. Our study objective was to evaluate a novel oncology video curriculum for IM residents as a model for asynchronous subspecialty resident learning. Using the cognitive theory of multimedia learning, we developed a five-part oncology video curriculum targeted specifically to the needs of IM residents. All second- and third-year residents rotating in oncology clinics from October 2018 to March 2019 at a single training program were invited to participate. We evaluated curricular demand, efficacy, and acceptability, using completion rates, knowledge tests, and a survey. Twenty-eight of 31 (90.3%) residents utilized the curriculum. Resident knowledge improved after utilizing the modules, by 36.9% from pre- to posttests (95% CI [31.3-42.5]; P0.001) and 13.7% from pre- to delayed posttests (95% CI [7.5-20.0]; P0.001). Twenty-four of 31 (77.4%) answered the survey. Most residents agreed or strongly agreed that the curriculum contributed to their knowledge (95.2%) and added educational value beyond the clinical rotation (93.1%). Our curriculum evaluation supports the asynchronous delivery of oncology education targeted to the learning needs of IM residents using a novel core video curriculum. These curricular methods provide a model for delivering subspecialty education to IM residents with complex and busy schedules.