Contribution of 15 Years (2007-2022) of Indo-US Training Partnerships to the Emergency Physician Workforce Capacity in India.

BACKGROUND: Indo-US Masters in Emergency Medicine (MEM) certification courses are rigorous three-year emergency medicine (EM) training courses that operate as a partnership between affiliate hospitals or universities in the United States with established EM training programs and local partner sites in India. Throughout their 15 years of operation, these global training partnerships have contributed to the EM workforce in India. Our objective in this study was to describe Indo-US MEM program graduates, their work environments, and their contribution to the growth of academic EM and to the coronavirus disease 2019 (COVID-19) response. METHODS: An electronic survey was created by US and Indian MEM course stakeholders and distributed to 714 US-affiliated MEM program graduates. The survey questions investigated where graduates were working, their work environments and involvement in teaching and research, and their involvement in the COVID-19 response. We consolidated the results into three domains: work environment and clinical contribution; academic contribution; and contribution to the COVID-19 response. RESULTS: The survey response rate was 46.9% (335 responses). Most graduates reported working within India (210, 62.7%) and in an emergency department (ED) setting (304, 91.0%). The most common reason for practicing outside of India was difficulty with formal MEM certificate recognition within India (97, 79.5%). Over half of graduates reported dedicating over 25% of their work hours to teaching others about EM (223, 66.6%), about half reported presenting research projects at conferences on the regional, national, or international level (168, 50.5%), and almost all graduates were engaged in treating COVID-19 patients during the pandemic (333, 99.4%). Most graduates agreed or strongly agreed that they were satisfied with their overall MEM training (296, 88.4%) and confident in their ability to practice EM (306, 91.6%). CONCLUSION: Indo-US MEM graduates have made a notable contribution to EM in India through clinical service delivery, teaching, and research, even more essential in the context of the COVID-19 pandemic. The roles of these graduates should be acknowledged and can contribute further to expand EM specialty and systems development across India.

Regional variation in the density of Meissner's corpuscles in human fingers.

Manual therapies in medicine rely on a physician's ability to sense and respond to tactile cues from their hands to inform them of symptoms within the patient. Sensory cues through skin may not be equally sensitive among all people, and little is known about the variation in distribution of sensory corpuscles in the human hand. Variation of corpuscle numbers studied in living people are limited to less invasive techniques, limiting their accuracy. Body-donor studies that thoroughly sample the distribution throughout the hand are extremely rare, usually only including a small number of sites around the hand and only a small number of individuals. Does the distribution of Meissner's corpuscles vary greater between individuals, between fingers, along the finger, or at specialized regions of the fingers themselves (pads, over interphalangeal joints, tips)? We tested whether there were significant differences between finger regions (fingertips vs. pads, vs. interphalangeal joints), or from proximal to distal, or between digits, or between individuals by histologically sampling human body-donors to science. There were significant differences in the quantity of Meissner's corpuscles between finger regions, from proximal to distal regions along digits, between individuals, but not between digits. Specifically, fingertips demonstrated higher counts of Meissner's corpuscles than pads and interphalangeal joints, more distally located regions (i.e. tips and distal pads) demonstrated higher Meissner's corpuscles than more proximal regions, and most individuals demonstrated significantly different average amounts of total Meissner's corpuscles from each other. Our results suggest that variability exists in the amounts and distribution of Meissner's corpuscles both between and within fingers of human subjects.

Development of a remote learning educational model for international Emergency Medicine trainees in the era of COVID-19.

BACKGROUND: The COVID-19 pandemic has pressured post-graduate medical education programs to shift from traditional in-person teaching to remote teaching and learning. Remote learning in medical education has been described in the literature mostly in the context of local in-country teaching. International remote medical education poses unique challenges for educators, especially in low-middle income countries (LMICs) who need continued Emergency Medicine (EM) specialty development. Our objective is to describe the development and implementation of our remote educational curriculum for EM trainees in West Bengal, India, and to assess trainee satisfaction with our remote learning curriculum. METHODS: Our curriculum was developed by adapting remote learning techniques used in Western post-graduate medical education, conducting literature searches on remote learning modalities, and through collaboration with local faculty in India. We assessed resident satisfaction in our curriculum with feedback surveys and group discussions. RESULTS: The remote educational curriculum had overall high trainee satisfaction ratings for weekly livestream video lectures and throughout our monthly educational modules (median ratings 9-10 out of a 10-point Likert scale). Qualitative feedback regarding specific lecture topics and educational modules were also received. CONCLUSIONS: International remote education in LMICs poses a unique set of challenges to medical educators. Residents in our study reported high satisfaction with the curriculum, but there is a lack of clarity regarding how a remote curriculum may impact academic and clinical performance. Future studies are needed to further evaluate the efficacy and academic and clinical implications of remote medical education in LMICs.

Regional quantitative histological variations in human oral mucosa.

Oral mucosa demonstrates regional variations that reflect contact with food during mastication. Though known qualitatively, our aim was to quantitatively assess regions to establish a measurable baseline from which one could compare in pathological and comparative studies, in which the abrasiveness of diets may differ. We assessed variations in the epithelial-connective tissue junction (rete ridges counts), collagen organization within the lamina propria, and elastin composition of the lamina propria of 15 regions of the labial (buccal) gingiva, lingual gingiva, vestibule, and palate. All characteristics varied more between regions within the same individual than between individuals. Lingual gingiva had high rete ridges counts, high level of collagen organization, and moderate elastin composition compared to other regions. The labial gingiva had few rete ridges, high collagen organization, and low elastin. The vestibule had the fewest average of rete ridges, least organized collagen, and high elastin. The hard palate had the highest average of rete ridges, high collagen organization, and the lowest elastin content. The soft palate conversely had the smallest average of rete ridges, moderate collagen organization, and the highest elastin composition. Our results indicate that comparison of these quantitative histological differences is warranted only for collagen organization and elastin composition. Differences in rete ridges counts were not statistically significant. Most histological characteristics observed were not significantly different between dentulous and edentulous cadavers, and the group containing all individuals. An exception was the level of collagen fiber organization within the lamina propria, which was higher in most regions when teeth were present.