Medical Students' Perceptions of American Indian-Focused Educational Experiences.

INTRODUCTION: American Indians are burdened with a myriad of health disparities. As South Dakota's largest minority population, increasing medical students' experiences with the healthcare of American Indians can play a significant role in helping to alleviate American Indians' health disparities as these future physicians will be better able to predict, detect, and treat the health care needs of this population. METHODS: Survey data from 103 medical students at the University of South Dakota Sanford School of Medicine (SSOM) was collected and analyzed. Demographic information and perceived levels of being informed about American Indians and populations on reservations were collected. Furthermore, medical students' insights on how the SSOM can improve its students' educational experiences with American Indian populations were also collected. RESULTS: Compared to their perceived knowledge of American Indians prior to beginning medical school (26.2 percent), responding medical students believe they became more informed regarding American Indians (61.2 percent) as they progressed through medical school. Fifty-one of the 64 students (80 percent) who answered the open-ended question noted that their medical training would benefit from increased opportunities (including required) with American Indian people, culture, and reservation-based communities. CONCLUSION: There is a desire amongst medical students to increase and require more cultural information and clinical experiences with American Indian people and populations on reservations. Future research is needed to obtain medical student feedback on the newly implemented curriculum and elective opportunities.

Incorporation of Women's Health Maintenance Screening in the USD Coyote Clinic.

INTRODUCTION: The Coyote Clinic is a student-run clinic that provides free services to Sioux Falls residents without insurance. It has not historically provided routine women's health screenings. The project addressed this lack of preventative care. We aimed to increase the percentage of female patients that are up to date on Papanicolaou (Pap) smears, mammograms, and human papillomavirus (HPV) vaccines through the implementation of screening questions. METHODS: A screening questionnaire was created and asked to female patients between the ages of 18-65 about the dates and results of their last Pap smear, mammogram, and the administration of any HPV vaccine. RESULTS: 27 patients answered the questions. Fifty-two percent were Caucasian, 26 percent Hispanic, 15 percent African American, and 7 percent Middle Eastern. Two patients were eligible for HPV vaccination: one had not received the vaccination and the other was unknown. All 27 women were eligible for Pap smears. Seventy-six percent had normal results, 19 percent were unsure of their results, and 5 percent had abnormal results. Eight patients were eligible for mammograms: five were up to date, two were tested in the last three years, and one had an unknown test date. CONCLUSIONS: The majority of eligible female patients were up to date on Pap smears and mammograms. The health maintenance questionnaire was a valuable resource for patient care, patient health literacy, and medical student education.

Biopsychosocial Pain Management and its Effect on Postoperative Opioid Use.

INTRODUCTION: Medical use and overuse of opioids have become an increasing problem over the past several decades. Postoperative pain control is the strongest indication for the use of opioid analgesics. Previous studies have demonstrated benefit from complementary and alternative therapy (CAT) for postoperative pain relief. A prior study conducted by Riswold et al. found that a unit staff training session on CAT improved patient experiences postoperatively following total joint replacement. The study was limited in that it did not examine if there were any changes in opioid usage following this intervention. METHODS: This study is a continuation of the Riswold et al. study on CAT training intervention. In July 2017, a four-hour staff training session on alternative comfort measures and pain medication administration took place. Opioid administration data was extracted from the PYXIS software for all patients who had received more than three opioid administrations across their hospital stay in the three months prior to CAT training and the three months post-training. Opioid administrations were converted to total oral morphine equivalents. The pre- and post-intervention groups were compared using independent sample t-tests using SPSS software. RESULTS: Statistically significant reduction of total oral morphine equivalents occurred following CAT training intervention (p=.034, CI 2.76, 69.81). Average oral morphine equivalents per day (p=0.023, CI 1.26, 16.57) and per administration (p=0.00048, CI 0.64, 2.25) also were significantly reduced following the CAT training intervention. CONCLUSION: This study strengthens the findings of prior studies, showing that CAT can improve patient satisfaction while also reducing overall opioid burden for post-surgical patients.

Student Initiative Improves HIV Screening Rate in Student-Run Free Clinic.

Background The Center for Disease Control provides recommendations for preventative services and screenings including recommendations for a one-time HIV screening of all adult patients between the ages of 13-64. But not all clinics are fully compliant with these recommendations. We identified a need for increased screening at two clinics in a rural setting. As a healthcare quality improvement initiative, we developed educational informatics to increase screening compliance. Methods This project assessed HIV screening rates before and after educational interventions at two clinics, the Coyote Clinic and the Avera Downtown Clinic. Three changes were implemented to increase the HIV screening rate and ultimately provide more effective high-quality health care. The three initiatives focused on patients, physicians, and student volunteers in order to provide a strong foundation of knowledge to all parties involved in a patient's care. Results Prior to any interventions, the baseline screening rate (screenings/100 persons) at the Avera Downtown Clinic was 0.84 while the screening rate at the Coyote Clinic was 0.00. After the proposed interventions, the screening rate of the Downtown Clinic improved to 3.97 and the screening rate at the Coyote Clinic improved to 29.4. Using a Fisher's Exact test, we found a statistically significant post-intervention increase in HIV screening at the Coyote Clinic after the intervention (p = 0.0002) but not at the Downtown Clinic (p = 0.0940.) Conclusion HIV screening rates improved after the implementation of interventional education initiatives tailored for patients, medical students, and physicians. Implementation of low-cost quality improvement measures such as the ones detailed herein may significantly improve long-term patient management, particularly in the context of screening tests.

An Analysis of the Financial Burden Associated with the Residency Match at the University of South Dakota Sanford School of Medicine.

OBJECTIVE: The application process for residency positions is a costly endeavor. This study aims to quantify the financial expenses incurred by University of South Dakota Sanford School of Medicine (USD SSOM) class of 2016. Our hope is that this study will prepare future students of USD and other smaller programs for the financial burdens associated with the match. This data should be used to guide financial decision making by medical students from USD or by regional students from medical programs that desire to apply to residency programs not offered at their home institution. METHODS: A 10-item online survey was administered in April of 2016 via the USD Sanford School of Medicine email listserv to the graduating MD class of 2016. The survey asked respondents about the number and cost of away-rotations completed, interviews attended, second-look days attended after the interview, preferences for interviewing during an away-rotation, the specialty the applicant matched into, and number on each applicant's rank list that he/she matched. RESULTS: The survey had a 68.3 percent response rate. The mean number of away-rotations completed, interviews attended, and second-look days attended were 1.3, 12.1, and 0.1 per applicant respectively. The mean costs of attendance to away-rotations, interviews, and second-look days were $1,690.63, $4,881.88, and $24 per applicant, respectively. The total mean collective cost of away-rotations, interviews, and second-look days was $6,596.51 per applicant. CONCLUSIONS: The process of applying to residencies among the graduating MD class of 2016 is a costly endeavor. Attendance of interviews for residency positions is the most costly part of the residency application process. Although the financial burden associated with applying to residency programs is high, increasing competition for graduate medical education positions may only drive the cost further.

Obesity and metabolic disease.

Obesity independently increases the risk of developing diabetes 10-fold compared with that for patients who are normal weight. Overweight patients with impaired glucose tolerance (IGT) or impaired fasting glucose (IFG) should be given counseling on weight loss of 5% to 10% of body weight as well as on increasing physical activity to at least 150 min/wk to prevent progression to diabetes. American Diabetes Association (ADA) recommends screening patients older than 45 years with a body mass index (BMI) greater than or equal to 25 for diabetes with fasting glucose every 3 years. Testing should be considered at a younger age or performed more frequently for those who are overweight and have 1 or more risk factors for diabetes.