Opinion & Special Articles: Examining the Hidden Curriculum of Medical School From a First-Generation Student Perspective.

With the incorporation of pass/fail outcomes into the curricula of many medical schools, a greater premium is being placed on leadership, research, and other extracurricular pursuits. These activities, as well as the cultivation of social capital, represent a "hidden curriculum" which offers significant benefits to career development that are not often explicitly stated. The hidden curriculum benefits students with generational knowledge of the medical school infrastructure and harms first-generation and/or low-income (FGLI) students, who take longer to integrate into the professional environment and experience more challenges along the way. FGLI students show increased persistence, and they offer diverse perspectives, but poor representation and lack of a clear pathway narrow their entry into several medical specialties, including neurology. As neurologists and educators, we play a role during a critical time of medical student professional development and can help bring the hidden curriculum into the light. Recognition of student backgrounds should guide policies to arm all students with knowledge to make the most of the limited timeframe of medical school. To reduce the lag phase of less enfranchised students, several effective practices can be instituted with minimal modification to existing medical school infrastructure. Efforts to support FGLI students by increasing transparency of the hidden curriculum, formalizing FGLI mentorship groups, and centralizing key information and resources will pay dividends with greater realization of promise and increased diversity and inclusion across more specialties.

Ethical Considerations during the Informed Consent Process for Acute Ischemic Stroke in International Clinical Trials.

We sought to investigate the experiences of researchers in existing active-control trials in acute ischemic stroke comparing investigational therapy to tissue plasminogen activator (tPA) in order to identify the approaches and challenges in obtaining informed consent. Out of 401 articles evaluated, 14 trials met inclusion criteria. Trial representatives were contacted to complete a survey concerning the consent process. None of the 14 trials published materials related to the informed consent process. Trials with 75% to 100% of patients directly consented had shorter door-to-treatment (DTT) times than trials that directly consented less than 50% of patients. Trials that had translators available (for recruiting participants who were not native speakers in the local language) and translated consent documents had longer DTT times. The study findings suggest that differences in the standards of informed consent internationally may allow more patients with moderate strokes to provide direct consent without delaying DTT time. Future trials should emphasize transparency to the public and scientific community in the informed consent process.

Sports Specialization Is Not Associated With Greater Odds of Previous Injury in Elite Male Youth Soccer Players.

OBJECTIVE: To determine the relationship between sport specialization and previous injury in elite male youth soccer players. DESIGN: Retrospective survey. SETTING: U.S. Soccer Development Academy. PARTICIPANTS: Male youth soccer players (N = 2123). ASSESSMENT OF RISK FACTORS: Sport specialization, weekly training volume, training ratio, and age. MAIN OUTCOME MEASURES: Previous sports-related injury, injury type (traumatic vs overuse), injury severity, and injury location. RESULTS: Of 2099 participants (average age 13.2 ± 1.8 years), 61.7% were specialized in soccer (played soccer >8 mo/yr and no other sports) and 38.3% were nonspecialized (played soccer >8 mo/yr and also played other organized sports). Specialized athletes were older than nonspecialized athletes (13.7 ± 1.9 vs 12.5 ± 1.4, P < 0.0001). Thirty-three percent (690/2099) of athletes reported at least one previous sports-related injury for a total of 765 traumatic injuries and 25 overuse injuries. Distribution of injury type was similar for specialized and nonspecialized athletes. Among athletes with overuse injuries, nonspecialized athletes were more likely to report upper-extremity and trunk overuse injuries than specialized athletes. After accounting for age and weekly training volume, specialized athletes had decreased odds of reporting any previous injury compared with nonspecialized athletes [odds ratio (OR), 0.78; 95% confidence interval (CI), 0.64-0.95], and similar odds of reporting a previous lower-extremity (LE) overuse injury as nonspecialized athletes (OR, 0.70; 95% CI, 0.56-1.1). However, specialized athletes missed more practices due to injury than nonspecialized players [median = 3, interquartile range (IQR) 2-4 vs median = 2, IQR 2-4, P = 0.0003]. CONCLUSIONS: In this national sample of elite, male youth soccer players, after accounting for age and weekly training volume, specialized athletes had decreased odds of reporting any previous injury and similar odds of reporting a previous LE overuse injury as nonspecialized athletes. These data suggest the need for further research to determine whether injury risk related to sports specialization depends on sex, chosen sport, and skill/competitive level.

An Overview of Chicago (Illinois USA) Marathon Prehospital Care Demographics, Patient Care Operations, and Injury Patterns.

INTRODUCTION: Large-scale mass-sporting events are increasingly requiring greater prehospital event planning and preparation to address inherent event-associated medical conditions in addition to incidents that may be unexpected. The Bank of America Chicago Marathon (Chicago, Illinois USA) is one of the largest marathons in the world, and with the improvement of technology, the use of historical patient and event data, in conjunction with environmental conditions, can provide organizers and public safety officials a way to plan based on injury patterns and patient demands for care by predicting the placement and timing of needed medical support and resources. PROBLEM: During large-scale events, disaster planning and preparedness between event organizers, Emergency Medical Services (EMS), and local, state, and federal agencies is critical to ensure participant and public safety. METHODS: This study looked at the Bank of America Chicago Marathon, a significant endurance event, and took a unique approach of reviewing digital runner data retrospectively over a five-year period to establish patterns of medical demand geographically, temporally, and by the presenting diagnoses. Most medical complaints were musculoskeletal in nature; however, there were life-threatening conditions such as hyperthermia and cardiac incidents that highlight the need for detailed planning, coordination, and communication to ensure a safe and secure event. CONCLUSIONS: The Chicago Marathon is one of the largest marathons in the world, and this study identified an equal number of participants requiring care on-course and at the finish line. Most medical complaints were musculoskeletal in nature; however, there were life-threatening conditions such as hyperthermia and cardiac incidents that highlight the need for detailed planning, multi-disciplined coordination, and communication to ensure a safe and secure event. As technology has evolved, the use, analysis, and implementation of historical digital data with various environmental conditions can provide organizers and public safety officials a map to plan injury patterns and patient demands by predicting the placement and timing of needed medical support, personnel, and resources.