Undergraduate Medical Education: Lifestyle Medicine Curriculum Implementation Standards.

Lifestyle medicine (LM) is an emerging specialty that is gaining momentum and support from around the world. The American Medical Association passed a resolution to support incorporating LM curricula in medical schools in 2017. Since then, the American College of Lifestyle Medicine Undergraduate Medical Education Task Force has created a framework for incorporating LM into medical school curricula. This article provides competencies for medical school LM curriculum implementation and illustrates how they relate to the Association of American Medical College's Core Entrustable Professional Activities and the LM Certification Competencies from the American Board of Lifestyle Medicine. Finally, standards are presented for how medical schools may receive certification for integrating LM into their curriculum and how medical students can work toward becoming board certified in LM through an educational pathway.

Development and Evaluation of a Nutrition-Centered Lifestyle Medicine Curriculum for Physician Assistant Students.

BACKGROUND: US medical schools are increasingly integrating lifestyle medicine competencies into their academic programs. Yet, physician assistant (PA) academic programs have been slower to respond. METHODS: We developed, implemented, and evaluated a nutrition-centered lifestyle medicine curriculum for 2nd-year PA students (n = 24). The 4-week hybrid, 2-credit hour course activities aligned with the American College of Lifestyle Medicine competencies for primary care providers and reinforced four of the Accreditation Standards for PA Education. We combined didactic lectures with weekly hands-on cooking modules from the "Health meets Food" courseware for medical students. We employed a pre-post evaluation design including a comparison group of 2nd-year PA students in a separate program. We assessed changes in personal nutrition behaviors and knowledge and confidence for counseling in nutrition, exercise/physical activity, weight, smoking, and alcohol, using the modified 5A's framework (assess, advise, agree, assist, and arrange) for lifestyle counseling. RESULTS: Students receiving the intervention demonstrated significantly higher gains in both knowledge and confidence for the 5A's of nutrition counseling compared to the control group. Self-reported knowledge and confidence for the 5A's of counseling for the other lifestyle behaviors similarly improved among the intervention group compared to the control group, but to a lesser extent. CONCLUSION: A nutrition-centered lifestyle medicine course can demonstrate PA academic program adherence to accreditation standards, while also introducing students to nutrition and lifestyle medicine competencies. Hands-on experiences that reinforce didactic instruction may maximize student knowledge and self-efficacy for implementing lifestyle medicine into their practice.

Identifying Patient Door-to-Room Goals to Minimize Left-Without-Being-Seen Rates.

INTRODUCTION: Emergency department (ED) patients in the leave-without-being-seen (LWBS) group risk problems of inefficiency, medical risk, and financial loss. The goal at our hospital is to limit LWBS to <1%. This study's goal was to assess the influence on LWBS associated with prolonging intervals between patient presentation and placement in an exam room (DoorRoom time). This study's major aim was to identify DoorRoom cutoffs that maximize likelihood of meeting the LWBS goal (i.e. <1%). METHODS: We conducted the study over one year (8/13-8/14) using operations data for an ED with annual census~50,000. For each study day, the LWBS endpoint (i.e. was LWBS<1%: "yes or no") and the mean DoorRoom time were recorded. We categorized DoorRoom means by intervals starting with ≤10min and ending at >60 min. Multivariate logistic regression was used to assess for DoorRoom cutoffs predicting high LWBS, while adjusting for patient acuity (triage scores and admission %) and operations parameters. We used predictive marginal probability to assess utility of the regression-generated cutoffs. We defined statistical significance at p<0.05 and report odds ratio (OR) and 95% confidence intervals (CI). RESULTS: Univariate results suggested a primary DoorRoom cutoff of 20', to maintain a high likelihood (>85%) of meeting the LWBS goal. A secondary DoorRoom cutoff was indicated at 35', to prevent a precipitous drop-off in likelihood of meeting the LWBS goal, from 61.1% at 35' to 34.4% at 40'. Predictive marginal analysis using multivariate techniques to control for operational and patient-acuity factors confirmed the 20' and 35' cutoffs as significant (p<0.001). Days with DoorRoom between 21-35' were 74% less likely to meet the LWBS goal than days with DoorRoom≤20' (OR 0.26, 95% CI [0.13-0.53]). Days with DoorRoom>35' were a further 75% less likely to meet the LWBS goal than days with DoorRoom of 21-35' (OR 0.25, 95% CI [0.15-0.41]). CONCLUSION: Operationally useful DoorRoom cutoffs can be identified, which allow for rational establishment of performance goals for the ED attempting to minimize LWBS.

Trauma ultrasound in civilian tactical medicine.

The term "tactical medicine" can be defined in more than one way, but in the nonmilitary setting the term tactical emergency medical services (TEMS) is often used to denote medical support operations for law enforcement. In supporting operations involving groups such as special weapons and tactics (SWAT) teams, TEMS entail executing triage, diagnosis, stabilization, and evacuation decision-making in challenging settings. Ultrasound, now well entrenched as a part of trauma evaluation in the hospital setting, has been investigated in the prehospital arena and may have utility in TEMS. This paper addresses potential use of US in the tactical environment, with emphasis on the lessons of recent years' literature. Possible uses of US are discussed, in terms of both specific clinical applications and also with respect to informing triage and related decision making.