ABSTRACT
BACKGROUND: Community health training benefits both residents and community partners, but many experiences are short-term. This project examined a community health track for internal medicine, pediatrics, and family medicine residents who work with community-based organizations (CBOs) longitudinally over two years. METHODS: Faculty conducted focus groups with 2nd and 3rd year residents at two time points to assess program effectiveness and identify challenges. This data was used to understand how the ENHANCE (ENgaging in Health Advocacy through Neighborhood Collaboratives and Education) track prepares residents to form relationships with BOs and cultivate skills in population and community health and research. Four resident focus groups (2020 and 2021) were conducted. Discussions were recorded and transcribed. Thematic content analysis was done by two external evaluators. RESULTS: Fourteen residents participated in focus groups. Figure 1 depicts the themes and subthemes that emerged. Residents in all focus groups said ENHANCE educated them on the steps needed to cultivate CBO relationships and how to incorporate population health into their clinical framework. Residents in the 2020 groups described communication barriers with faculty during the height of the COVID-19 pandemic, but these did not persist in 2021 after acclimating to online communication. All four groups said communication barriers were a key facet of their relationship with their CBO, worsened by COVID in 2020. CONCLUSIONS: A longitudinal community health track is a valuable resident learning experience. The ENHANCE track offered opportunities to work with CBOs and integrate community health into clinical care. This track remained beneficial through the pandemic despite challenges with communication and in-person site visits. Limitations include data collection only from a single institution and only resident feedback was included. In the future, we hope to gather qualitative data from faculty and CBO staff. Lessons learned from this data can help refine the ENHANCE track and provide more residents with the opportunity to cultivate collaborative continuing relationships with CBOs.
ABSTRACT
This case study describes a 45-year-old Caucasian male with a past medical history of obesity, hypertension, and non-insulin-dependent diabetes mellitus, who in the setting of coronavirus disease 2019 (COVID-19) pneumonia, developed portal vein thrombosis (PVT) presenting as an acute abdomen after hospital discharge from a cholecystitis episode. PVT is a very infrequent thromboembolic condition, classically occurring in patients with systemic conditions such as cirrhosis, malignancy, pancreatitis, diverticulitis, autoimmunity, and thrombophilia. PVT can cause serious complications, such as intestinal infarction, or even death, if not promptly treated. Due to the limited number of reports in the literature describing PVT in the COVID-19 setting, its prevalence, natural history, mechanism, and precise clinical features remain unknown. Therefore, clinical suspicion should be high for PVT, in any COVID-19 patient who presents with abdominal pain or associated signs and symptoms. To the best of our knowledge, this is the first report of COVID-19-associated PVT causing extensive thrombosis in the portal vein and its right branch, occurring in the setting of early-stage cirrhosis after a preceding episode of cholecystitis.