Hypercalcemia Secondary to Calcitriol Production From Dual Combination Immunotherapy in Pulmonary Metastatic Melanoma.

Nivolumab and ipilimumab are immunotherapy agents recommended for the treatment of metastatic melanoma. A rare adverse effect of these agents is hypercalcemia. The mechanism of immunotherapy-mediated hypercalcemia is thought to be due to ectopic calcitriol production from activated macrophages, similar to sarcoidosis. We present a case of a 76-year-old female with metastatic melanoma who developed severe hypercalcemia after completing a cycle of combined nivolumab and ipilimumab therapy. After other common causes of hypercalcemia in malignancy were ruled out, the decision was made to aggressively treat her hypercalcemia while inpatient and hold immunotherapy at discharge. Since holding immunotherapy, she has not had a repeat occurrence of hypercalcemia. This case stresses the importance of including immunotherapy adverse effects in the differential diagnosis for hypercalcemia in malignancy.

Identification and Accommodation of ADHD in Family Medicine Residencies: A CERA Study.

BACKGROUND: An increasing number of medical students applying to residency programs request accommodations for attention deficit hyperactivity disorder (ADHD). Early implementation of accommodations for individuals with ADHD during family medicine (FM) residency could help learners and programs, but the number of programs prepared to invite learners to disclose ADHD and to implement accommodations is unclear. OBJECTIVES: The purpose of this study was to describe practices employed by FM residency programs to identify residents who need accommodations for ADHD. We also chose to examine the frequency with which basic categories of ADHD accommodations are used and whether review of technical standards (ie, resident job description) is associated with timing of accommodations. METHODS: We analyzed responses from the 2022 Council of Academic Family Medicine Educational Research Alliance (CERA) national survey of FM residency program directors, which was distributed via email invitation to all US programs accredited by the Accreditation Council for Graduate Medical Education. A total of 298 program directors (44.3%) responded. RESULTS: Approximately one in six FM residency programs are proactive in their identification of learners with ADHD, typically recognizing the need for accommodations during the interview process or orientation. Once the need is identified, most programs implement accommodations within 1 month, and many employ multiple types of accommodations. CONCLUSIONS: While a small subset of programs has developed processes to identify and accommodate ADHD proactively, results suggested that the majority of programs approach accommodation processes on an ad hoc basis. In turn, ad hoc identification precludes a proactive approach, given use of poor performance to identify the need for supports.

This is My Learner, Not My Patient: Addressing Concerns in Learners With Attention Deficit Hyperactivity Disorder.

With the increasing number of medical students diagnosed with adult ADHD, residency programs face an imperative task to handle accommodations effectively. As medical residents occupy unique roles as learners and employees, defining a clear process to protect residents and programs can be challenging. This article will review legal requirements, disclosure processes, and sample accommodations that can help family medicine programs make sense of their responsibilities and support residents. Collaboration, clear boundaries, and effective documentation increase the likelihood of a predictable process to facilitate inclusion of learners with ADHD into graduate medical education and residency.

Considerations for Implementing Point-of-Care Ultrasound in a Community-Based Family Medicine Residency Program.

BACKGROUND: Prior to implementing Point-of-Care Ultrasound (POCUS) training into our Family Medicine Residency Program, we sought to determine opinions on the most relevant applications according to current Family Medicine residents and recent graduates. As there are so many POCUS applications relevant to Family Medicine, it would be efficient to teach only the most relevant scans. OBJECTIVE: Examine current POCUS use and the perception of future use among current residents and recent graduates of a Family Medicine Residency Program. METHODS: In 2017, an electronic survey was used to examine differences in perceptions regarding the value of POCUS applications, benefits of use, and potential barriers to implementation. RESULTS: Of the 88 surveys sent, 21 of 21 current residents (100%) and 28 of 67 recent graduates (41.8%) completed the survey with a total completion rate of 55.7%. The POCUS practices differed between groups. Current residents were significantly more likely than recent graduates to use POCUS for vascular procedural guidance and other procedural guidance. Recent graduates were significantly more likely to report POCUS use for abdominal aortic aneurysm screening and lower extremity Doppler screening for deep vein thrombosis. All P values were significant at the .05 level. CONCLUSIONS: Point-of-Care Ultrasound training is generally desired by current residents. Some applications are perceived to be of sufficient utility by current residents and recent graduates. Findings would justify investment of time and effort required to implement POCUS training in Family Medicine Residency curriculums. Curriculum should focus on applications viewed as high priority based on usage rates.