ABSTRACT
Cryptococcal meningitis is a fungal central nervous infection typically occurring in patients with severe immunocompromise. We present a case of cryptococcal meningitis occurring in a patient with active injection drug use (IDU) but no immunocompromising condition. This is the seventh case in the recent literature of cryptococcal central nervous involvement in an otherwise healthy young person with IDU, suggesting a possible association in need of further exploration.
ABSTRACT
BACKGROUND: For years, US medical schools have relied on community-based, private clinicians to educate medical students. There has been a steady decline in the number of physicians willing to take on medical students in their clinical practices. Recent issues related to the pandemic raise questions about how many patients students should see to have a meaningful clinical experience. METHODS: As part of a 16-week longitudinal clinical experience, medical students spend 2 days each week in a family medicine or internal medicine clinic. As repetition enhances learning, maximizing the number of patients students see is important. Using a mixed integer linear program, we sought to determine the optimal schedule that maximizes the number of patients whom students see during a rotation. Patient visits were collected from January to April 2018 for clinics used by the medical school. By maximizing the minimum number of patients per learner over all non-empty day-clinic combinations, we deliver equitable rotation plans based on our assumptions. RESULTS: For this pilot study, multiple experiments were performed with different numbers of students assigned to clinics. Each experiment also generated a weekly rotation plan for a given student. Based on this optimization model, the minimum number of patients per student over 16 weeks was 87 (3 patients per day) and actually increased the number of students who could be assigned to one of the clinics from 1 student per rotation to 8 students. CONCLUSIONS: The mixed integer linear program assigned more students to clinics that have more total visits in order to achieve the optimal and fairest learning quality. In addition, by conducting various experiments on different numbers of students, we observed that we were able to allocate more students without affecting the number of patients students see.
Subject(s)
Students, Medical , Humans , Learning , Pilot Projects , Schools, MedicalABSTRACT
BACKGROUND: The number of learners in clinical settings is increasing as health professions schools increase enrollment in order to develop the future workforce. Too many learners in clinics and hospital wards could create overcrowded conditions and diminish patient and learner experiences. Based on data gathered from a literature review, we identified challenges and solutions to address the increasing numbers of learners in clinical settings. RESULTS: Health care provider workload, physical environment and clinical culture were challenges identified from the literature review. These identified constraints were corroborated by learner and expert reflections on their experiences. CONCLUSION: As the need for more health care providers increases, the number of learners in clinical settings poses a challenge. Innovative models to deliver care, an increasing role for learners, strategic patient scheduling and redesigning workspaces may mitigate problems. The recommendations suggested from this review may offer solutions that individual preceptors and organisations can implement.
