"Make the Implicit Explicit": Measuring Perceptions of Gender Bias and Creating a Gender Bias Curriculum for Internal Medicine Residents.

BACKGROUND: Gender bias in clinical training has been well established; however, little is known about how perceptions differ between men and women. Furthermore, few curricular options have been developed to discuss gender bias. OBJECTIVE: To measure the prevalence of gender bias, examine qualitative differences between men and women, and create a gender bias curriculum for internal medicine residents. METHODS: We surveyed 114 residents (response rate of 53.5%) to identify the prevalence and types of gender bias experienced in training. We compared estimates between genders and organized qualitative results into shared themes. We then developed a curriculum to promote and normalize discussions of gender bias. RESULTS: Among surveyed residents, 61% reported personal experiences of gender bias during training, with 98% of women and 19% of men reporting experiences when stratified by gender. We identified two domains in which gender bias manifested: role misidentification and a difficult working environment. Residents identified action items that led to the development of a gender bias curriculum. The curriculum includes didactic conferences and training sessions, a microaggression response toolkit, dinners for men and women residents, participation in a WhatsApp support group, and participation in academic projects related to gender bias in training. CONCLUSION: We confirmed a wide prevalence of gender bias and developed a scalable curriculum for gender bias training. Future work should explore the long-term impacts of these interventions.

Remote Patient Monitoring Program for Hospital Discharged COVID-19 Patients.

OBJECTIVE: We deployed a Remote Patient Monitoring (RPM) program to monitor patients with coronavirus disease 2019 (COVID-19) upon hospital discharge. We describe the patient characteristics, program characteristics, and clinical outcomes of patients in our RPM program. METHODS: We enrolled COVID-19 patients being discharged home from the hospital. Enrolled patients had an app, and were provided with a pulse oximeter and thermometer. Patients self-reported symptoms, O2 saturation, and temperature daily. Abnormal symptoms or vital signs were flagged and assessed by a pool of nurses. Descriptive statistics were used to describe patient and program characteristics. A mixed-effects logistic regression model was used to determine the odds of a combined endpoint of emergency department (ED) or hospital readmission. RESULTS: A total of 295 patients were referred for RPM from five participating hospitals, and 225 patients were enrolled. A majority of enrolled patients (66%) completed the monitoring period without triggering an abnormal alert. Enrollment was associated with a decreased odds of ED or hospital readmission (adjusted odds ratio: 0.54; 95% confidence interval: 0.3-0.97; p = 0.039). Referral without enrollment was not associated with a reduced odds of ED or hospital readmission. CONCLUSION: RPM for COVID-19 provides a mechanism to monitor patients in their home environment and reduce hospital utilization. Our work suggests that RPM reduces readmissions for patients with COVID-19 and provides scalable remote monitoring capabilities upon hospital discharge. RPM for postdischarge patients with COVID-19 was associated with a decreased risk of readmission to the ED or hospital, and provided a scalable mechanism to monitor patients in their home environment.

Adolescent Depression: An Interactive Case-Based Session for Medical Students.

INTRODUCTION: The session was designed as part of a yearlong elective within the Association of American Medical Colleges' Education in Pediatrics Across the Continuum (EPAC) pilot at the University of California, San Francisco. The EPAC pilot aims for longitudinal pediatric education across the medical school and pediatric residency years, with specific emphasis on competency-based advancement. The goal of the elective is to cultivate students' early interest in pediatrics. METHODS: This is an interactive case-based session for medical students on the clinical presentation and initial evaluation of adolescent depression. We developed this session based on an informal needs assessment at our local institution as well as prior research documenting the minimal time allocated to child and adolescent psychiatry in medical school curricula. The 80-minute interactive case-based format integrates knowledge and clinical experiences while requiring minimal equipment and preparation. RESULTS: The session was administered at the University of California, San Francisco, in 2015 to 22 students. Fourteen participants completed evaluation questions (64% response rate). Of responders, 92%-100% thought the session was very or extremely effective at meeting the stated objectives, was interactive, had appropriate time allocated, and was very or extremely helpful at reinforcing objectives from the medical school curriculum. Thirteen participants completed postsession knowledge acquisition questions and performed better than controls (90% vs. 75%), but the difference was not statistically significant. DISCUSSION: Other medical schools could easily administer this session as presented or adapt it to a different target audience or for different time constraints. It is an effective, interactive, well-paced, and helpful means of introducing to medical students a topic that is relevant for anyone going into pediatrics. Likewise, it helps to rectify the lack of child and adolescent psychiatry content in most medical school programs, and it aligns with the movement in undergraduate medical education towards more clinically integrated, inquiry-based curricula with attention to professional development.

Comparison of associations of urine protein-creatinine ratio versus albumin-creatinine ratio with complications of CKD: a cross-sectional analysis.

BACKGROUND: Urine albumin-creatinine ratio (ACR) and protein-creatinine ratio (PCR) are important markers of kidney damage and are used for prognosis in persons with chronic kidney disease (CKD). Despite how commonly these measurements are done in clinical practice, relatively few studies have directly compared the performance of these 2 measures with regard to associations with clinical outcomes, which may inform clinicians about which measure of urinary protein excretion is best. We studied the association of ACR and PCR with common complications of CKD. STUDY DESIGN: Cross-sectional study. SETTING & PARTICIPANTS: 3,481 participants with CKD in the Chronic Renal Insufficiency Cohort (CRIC) Study. PREDICTORS: ACR and PCR. OUTCOMES: We examined the association between ACR and PCR with measures of common CKD complications: serum hemoglobin, bicarbonate, parathyroid hormone, phosphorus, potassium, and albumin. MEASUREMENTS: Restricted cubic spline analyses adjusted for estimated glomerular filtration rate (eGFR; calculated by the MDRD [Modification of Diet in Renal Disease] Study equation) were performed to study the continuous association with our predictors with each outcome. RESULTS: Mean eGFR was 43±13 (SD)mL/min/1.73 m2 and median values for PCR and ACR were 140 and 46 mg/g, respectively. In continuous analyses adjusted for eGFR, higher ACRs and PCRs were similar and both were associated with lower serum hemoglobin, bicarbonate, and albumin levels and higher parathyroid hormone, phosphorus, and potassium levels. Across all outcomes, the associations of ACR and PCR were similar, with only small absolute differences in the outcome measure. Similar associations were seen in patients with diabetes mellitus. LIMITATIONS: Participants largely had moderate CKD with low values for ACR and PCR, so results may not be generalizable to all CKD populations. CONCLUSIONS: In persons with CKD, ACR and PCR are relatively similar in their associations with common complications of CKD. Thus, routine measurement of PCR may provide similar information as ACR in managing immediate complications of CKD.