A Mini Chalk Talk Workshop for Fourth-Year Medical Students: Facilitating the Transition From Student to Resident Educator.

Introduction: There is increasing recognition that incoming interns benefit from formal training in teaching skills during UME. Many medical schools have capstone courses well suited for teacher-training content. Mini chalk talks (MCTs) are a common clinical teaching modality requiring a variety of teaching skills. We developed a session for our institution's capstone course in which students prepared and delivered MCTs. Methods: The voluntary flipped classroom session was offered virtually in 2021 and in person in 2022. Before the session, students reviewed materials on creating effective MCTs and developed and practiced their own MCT. During the 90-minute session, students presented their MCT to a group of students in the same or similar future specialties and received feedback from their peers and a facilitator. Results: Twenty-six percent of graduating students (95 of 370) in 16 specialties participated. Students had a statistically significant increase in confidence delivering effective MCTs (p < .01). On a 5-point Likert scale (1 = did not learn, 5 = a great amount), students' mean ratings of clinical knowledge and teaching skills gained from the session were 4.4 and 4.5, respectively. Qualitative feedback highlighted the benefits of receiving feedback on teaching (31 of 77 respondents, 40%), practicing teaching skills (21 of 77, 27%), and experiencing other students' MCTs (13 of 77, 17%). Discussion: Our MCT session provides a versatile, resource-efficient method of supporting students in transitioning to the role of resident educators. It also offers them an opportunity to receive valuable feedback on their teaching in a low-stakes environment.

Hyperleukocytosis and leukostasis in acute and chronic leukemias.

Leukostasis is a life-threatening complication of high concentrations of circulating leukemic cells, most often myeloblasts. Effective care of patients with leukostasis involves early recognition and treatment, and aggressive management of concurrent complications of the underlying leukemia. The relatively poor prognosis in patients with leukostasis underscores the importance of the timely and effective care of this hematologic emergency. While cytoreductive measures such as hydroxyurea, corticosteroids, intravenous chemotherapy, and leukapheresis are available to urgently reduce high cell counts, characterization of the leukemia and initiation of tailored, definitive treatment is a parallel priority. However, data supporting any specific cytoreductive approach are limited, making clinical practice guided primarily by expert opinion. In this review, we discuss the pathophysiology, clinical manifestations, diagnosis, and management of leukemic hyperleukocytosis and leukostasis, with an emphasis on how to acutely manage this oncologic emergency in patients with acute myeloid leukemia, which is the most common cause of symptomatic leukostasis.

Internal Medicine Residents' Perceptions of Virtual Morning Report: a Multicenter Survey.

IMPORTANCE: The COVID-19 pandemic disrupted graduate medical education, compelling training programs to abruptly transition to virtual educational formats despite minimal experience or proficiency. We surveyed residents from a national sample of internal medicine (IM) residency programs to describe their experiences with the transition to virtual morning report (MR), a highly valued core educational conference. OBJECTIVE: Assess resident views about virtual MR content and teaching strategies during the COVID-19 pandemic. DESIGN: Anonymous, web-based survey. PARTICIPANTS: Residents from 14 academically affiliated IM residency programs. MAIN MEASURES: The 25-item survey on virtual MR included questions on demographics; frequency and reason for attending; opinions on who should attend and teach; how the virtual format affects the learning environment; how virtual MR compares to in-person MR with regard to participation, engagement, and overall education; and whether virtual MR should continue after in-person conferences can safely resume. The survey included a combination of Likert-style, multiple option, and open-ended questions. RESULTS: Six hundred fifteen residents (35%) completed the survey, with a balanced sample of interns (39%), second-year (31%), and third-year (30%) residents. When comparing their overall assessment of in-person and virtual MR formats, 42% of residents preferred in-person, 18% preferred virtual, and 40% felt they were equivalent. Most respondents endorsed better peer-engagement, camaraderie, and group participation with in-person MR. Chat boxes, video participation, audience response systems, and smart boards/tablets enhanced respondents' educational experience during virtual MR. Most respondents (72%) felt that the option of virtual MR should continue when it is safe to resume in-person conferences. CONCLUSIONS: Virtual MR was a valued alternative to traditional in-person MR during the COVID-19 pandemic. Residents feel that the virtual platform offers unique educational benefits independent of and in conjunction with in-person conferences. Residents support the integration of a virtual platform into the delivery of MR in the future.

A 48-Year-Old Man with Fevers and Weight Loss.

A 48-Year-Old Man with Fevers and Weight Loss48-year-old man presented for evaluation of fevers, night sweats, and a 20-pound unintentional weight loss over 3 months. He also had a dry cough over the same time, without dyspnea, chest discomfort, or hemoptysis. On examination, he was febrile and tachycardic, with tenderness in the right upper quadrant on abdominal palpation. What is the diagnosis?

Measuring teacher identity during the transition from medical school to residency.

Residents undergo professional identity formation during training, and the integration of a teacher identity into that of a clinician is part of this process. We aimed to measure the teacher identity of incoming interns of various specialties. In this cross-sectional, survey-based study, we modified a validated teacher identity scale and distributed it to residents attending orientation at a large, academic institution. A total of 297 residents took the survey, including 272 interns; 80% (218/272) of interns completed the survey and permitted use of their data. The mean score for global teacher identity was 4.16 (SD 0.67) on a 1 to 5 Likert scale. There were significant differences between interns' current self-assessed teaching abilities and their desired future performance as teachers (P < 0.001 for all domains). Male interns had higher global teacher identity scores (4.27) than female interns (4.05; P = 0.02). There were no differences in global teacher identity between interns in medical, surgical, and supportive specialties. Interns who had participated in a student-as-teacher program in medical school had higher global teacher identity (P < 0.001) than those who had not. In conclusion, teacher identity is high in incoming interns, with higher scores in men and in those who completed student-as-teacher programs in medical school.

Preparing for Medical Internship: A Case-Based Strategy to Teach Management of Common Overnight Calls to Students.

Introduction: More medical schools are offering a transition-to-intern-year course to better prepare graduates for residency. Sessions where students simulate receiving cross-cover calls are frequently included and highly rated. However, simulated sessions are often resource intensive and therefore challenging to implement in all schools. We developed a case-based exercise to address this need. Methods: In 2009, our school implemented a required course focused on the transition-to-intern year, including a common overnight calls (COC) module. Students rotated through different stations in small groups which were each led by a facilitator. Topics have evolved in response to feedback, and current topics included altered mental status, chest pain, and other frequent calls. Results: Over 1,000 students have participated in the module. The students consistently reported that they perceived themselves to be more prepared for internship. Between 2009 and 2016, the mean rating of "the COC module helped prepare me for internship" was 6.29 on a 7-point Likert scale (1 = strongly disagree and 7 = strongly agree). The 2017 data are limited. In 2018 and 2019, students continued to feel more prepared for their intern year, 4.72 in 2018 and 4.71 in 2019 on a 5-point Likert scale (1 = strongly disagree and 5 = strongly agree). The students perceived the COC format as effective. Discussion: Small-group case-based classroom simulations are an effective way to improve students' perceived preparedness for responding to common overnight calls during intern year.