United States

Background
Peutz-Jeghers syndrome (PJS), is an uncommon autosomal dominant disorder caused by a mutation at 19p13.3 that manifests as mucocutaneous pigmentation and hamartomatous polyps in the gastrointestinal system. We report a case of a 19-year-old young girl presented with intermittent episodes of abdominal pain and few occasions of fresh per rectal bleeding as well as features of anemia.
Case Presentation
A 19-year-old female patient with a urinary tract infection was brought into our internal medicine department. It was discovered that she had mucocutaneous pigmentation and iron deficiency anemia. She also reported having vague stomach ache and a couple instances of hematochezia since she was fifteen. Colonic polyps, colon cancer, or any other gastrointestinal condition were not present in the family history. Physical examination revealed no abnormalities, except for the presence of dark-brown pigmented maculae around the oral mucosa, lower lip and pulp of fingers. Numerous pedunculated polyps were seen dispersed throughout the colon during a colonoscopy. There were a lot of giant polyps. Polyps were seen in the large as well as small bowels during MR enterography.
Background
Peutz-Jeghers syndrome (PJS), is an uncommon autosomal dominant disorder caused by a mutation at 19p13.3 that manifests as mucocutaneous pigmentation and hamartomatous polyps in the gastrointestinal system. We report a case of a 19-year-old young girl presented with intermittent episodes of abdominal pain and few occasions of fresh per rectal bleeding as well as features of anemia.
Case Presentation
A 19-year-old female patient with a urinary tract infection was brought into our internal medicine department. It was discovered that she had mucocutaneous pigmentation and iron deficiency anemia. She also reported having vague stomach ache and a couple instances of hematochezia since she was fifteen. Colonic polyps, colon cancer, or any other gastrointestinal condition were not present in the family history. Physical examination revealed no abnormalities, except for the presence of dark-brown pigmented maculae around the oral mucosa, lower lip and pulp of fingers. Numerous pedunculated polyps were seen dispersed throughout the colon during a colonoscopy. There were a lot of giant polyps. Polyps were seen in the large as well as small bowels during MR enterography.
© 2018 American Medical Association. All rights reserved.
Discussion: PJS syndrome is incredibly rare; babies with an estimated incidence of 1:8,500 to 1:200,000 are affected. The young lady in our presentation met the inclusion criteria for the syndrome since she had mucocutaneous pigments on her hands and lips in addition to many Peutz-Jeghers polyps in the small the small and large intestine. Approximately 95% of PJS patients have mucocutaneous pigmentations, which may be the initial clinical clue prior to the onset of gastrointestinal symptoms. When a kid has iron deficiency anemia, which is common in youngsters, it is crucial to perform a complete physical examination and look into the family history. This enables the early detection of uncommon illnesses like Peutz-Jeghers syndrome. PJS patients have a cancer incidence that is almost fifteen times greater than the normal population. This case emphasizes the value of routine surveillance, patient education, and tertiary prevention strategies in preventing complications in individuals with post-diagnosed Puetz-Jeghers syndrome.

AMA Research Challenge 2024 

Iron Deficiency Anemia and Mucocutaneous Pigmentation: Diagnostic Clues for Peutz-Jeghers Syndrome

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Charles Lopresto, DO

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AMA Research Challenge 2022

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AMA would like to thank Laurel Road for sponsoring a $10,000 grand prize for the winner of the AMA Research Challenge. Laurel Road is not involved in winner selection process. The winner will be announced on February 20, 2025 during the AMA Research Challenge finals. Payment of the grand prize will be directly from Laurel Road. See the AMA Research Challenge Official Rules for terms and conditions.

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Background
Medical school training must prepare future clinicians to care for our aging population by providing them with skills and knowledge about older adults, including tools for avoiding the negative health impacts of ageism. Mentoring programs with older adults have been previously shown to improve medical students’ attitudes toward aging patients but have been difficult to sustain. A more reliable approach is needed. 
Methods
The authors performed a scoping review to describe the landscape and impact of programs using older adults as mentors for medical students, and then designed an innovative pilot curriculum involving older medical school alumni as the mentors for learning about aging. In December 2023, scoping review authors searched OVID Medline, Embase, Web of Science, and PsycInfo for relevant articles. The pilot curriculum on aging included an introduction session and four topic-focused calls between students and alumni: the evolution of medicine; perceptions of aging; life stages; and ageism, ableism, diversity/ equity/ inclusion. The spring 2024 pilot program involved seven student-alumni mentoring pairs, curriculum implementation, a debrief session, and analysis of feedback surveys.
Results
The scoping review included 26 studies in the final analysis. In all programs, the senior mentors were drawn from patient panels or the general community and both students and mentors reported a positive experience. None of the programs utilized medical school alumni as mentors and public data indicated that just 47.4% (n = 9) of the programs are still ongoing. For the pilot program, anonymous student and mentor surveys revealed that 100% students and mentors rated their experience as effective and the connection with their mentor or student as positive. Students commented that they enjoyed connecting with an individual from a different generation, and mentors commented that they felt value from the opportunity to share their stories. 
Conclusion
This scoping review reveals that prior older adult mentorship programs are positively received by students but may be difficult to sustain. Our pilot program took a different, potentially more sustainable approach, using older medical school alumni as mentors and locating ageism in intersectionality with a larger health equity context. This pilot program, highly rated by both students and mentors, proved to be a positive experience for both mentors and students, provided a balance of career advising and insight into the aging experience, and offered a potentially powerful model for combating ageism and preparing students to care for older adults with empathy and excellence.

Older medical school alumni as mentors: A scoping review and pilot program for medical students

Objective: According to the CDC, HPV vaccination can prevent over 90% of HPV-related cancers, including cervical and oropharyngeal cancers. However, the rate of HPV vaccination in eligible adults remains low. We conducted two qualitative studies to gain a better understanding on what cervical and oropharyngeal cancer patients know about the HPV vaccine and how they have approached discussing the vaccine with others. Using data from the two studies, the objective of this analysis is to compare specific perceptions of the HPV vaccine within cervical cancer patients versus oropharyngeal cancer patients. 

Methods: Patients with a history of oropharyngeal or cervical cancer were identified through EMRs and invited to participate. In focus group discussions, patients were asked about their knowledge on HPV and its relation to their cancer, their discourses with others about HPV vaccination, and barriers preventing further conversation. After reviewing the interviews, common responses were coded. 

Results: The cervical cancer group consisted of 23 participants between August 2016 and March 2017, of which all who answered a demographics questionnaire were white females and had an average age of 49. The oropharyngeal cancer group consisted of 14 participants between April 2024 and June 2024, which consisted of 71% white males, 29% white or black females, and an average age of 60. Most patients in the cervical cancer group had some previous knowledge of HPV, whereas 78% patients in the oropharyngeal cancer group had never heard of HPV until their cancer diagnosis. By the time of interviews, only 42% of the oropharyngeal group knew that HPV could cause cancer. The largest barrier to HPV vaccination discussions was stigma in the cervical cancer group, versus the overwhelming lack of knowledge of HPV and the vaccine endorsed by 71% of the oropharyngeal cancer group. Both groups showed general uncertainty of vaccinations especially since COVID-19 pandemic, although most patients were willing to serve as healthcare educators if it could prevent others from developing cancer. 

Conclusion: For patients to become community advocators on the importance of HPV vaccination, barriers such as lack of knowledge and reducing stigma must be addressed, especially among oropharyngeal cancer patients.

Comparing Perception of HPV Vaccination in Cervical and Oropharyngeal Cancer Patients

Background: Although mandated by the ACGME, access to comprehensive abortion training is severely limited, and recent legislative restrictions have further decimated educational opportunities for learners. In states with limited to no abortion access, resident physicians must travel to external programs to gain this necessary training. Simulation-based training has been shown to increase clinical proficiency and improve patient care outcomes. There is a critical need for pre-clinical, comprehensive, simulation-based training to prepare resident physicians for abortion care clinical experiences. 

Methods: Using an iterative design process, we created an innovative, affordable, and modifiable pelvic training model with an associated clinical curriculum under the guidance of two board-certified obstetrics and gynecology (OB/GYN) physicians. The ReproSTART model and curriculum is designed to teach five key surgical techniques necessary for procedural abortion and is modifiable for various clinical situations. OB/GYN physicians and trainees tested each procedural station and component of the model to provide qualitative feedback. Thirty-one resident physicians representing all years of training completed three varying workshops and provided feedback via pre- and post-session evaluations. A website was created to disseminate the ReproSTART model and curriculum to other institutions (https://obgyn.mcw.edu/repro-start/ password:abortion). 

Results: Abortion care experts and resident trainees found the ReproSTART model and associated curriculum to be superior to currently available models and hands-on trainings for abortion procedural techniques. Learners across all levels of training found the simulation to be useful for developing familiarity with procedural techniques, and first-year resident physicians showed a significant improvement in reported confidence with the abortion-related procedural techniques after completing the training. Furthermore, Ob/Gyn Residency Programs have reported success in building the model and implementing the training using only the website as a guide. 



Conclusion: The novel ReproSTART model and curriculum is an innovative simulation-based training to familiarize resident physicians with abortion procedural techniques. The model provides a more accurate, dynamic, and comprehensive pelvic anatomy than previous models, and the simulation allows for increased familiarity with procedural techniques and improved confidence in early learners. The ReproSTART model, curriculum, and website allows for more equitable and accessible abortion procedural training. The simplicity and adaptability of the ReproSTART model provides potential additional wide-reaching benefits for simulation-based training in obstetrics and gynecology.

ReproSTART: An Innovative Five-Station Simulation Model to Teach Procedural Abortion Skills

Background: Improving knowledge of common ocular diseases can lead to earlier detection and better health outcomes. However, both student and patient education face significant challenges: medical curricula allocate limited time to ocular diseases and readability of patient education materials frequently exceeds patient comprehension. Videos have been shown to be a more accessible medium of education, and virtual reality (VR) videos specifically offer a novel approach to education by allowing viewers to experience eye diseases from the patient's perspective, rather than merely presenting information. This study aims to examine how virtual reality videos impact patient and student understanding of common ocular diseases, as well as subsequent behaviors and beliefs. 

Methods: Patients and students were analyzed independently in this pilot study. 189 patients were surveyed in 2020 at a blood pressure screening event, while 299 students were surveyed during a virtual eye health teaching session. Both surveys contained virtual reality videos created by the National Institute of Health (NEI) on four common ocular diseases: cataracts, glaucoma, diabetes, and age-related macular degeneration. Wilcoxon signed rank tests analyzed participant responses before and after watching the videos. A stepwise multiple regression analysis assessed the presence of predictor variables. 

Results: The VR videos significantly increased patient understanding of the 4 ocular disorders (Mdn = 4.00 pre-survey vs Mdn = 5.00 post survey, z = -8.93, p<0.001), motivation to receive annual eye exams (45.45%, N=85), and likeliness to recommend having future virtual health visits that include videos like these (80.85%, N=152). Students also significantly increased their comfort with understanding eye pathologies (p<0.001). Despite most students having no prior eye care experience, the majority felt more motivated to learn about ocular diseases (86.96%, N=240) and believed the videos should remain a part of the curriculum (80.36%, N=221). 

Conclusion: The findings of this pilot study demonstrate that virtual reality videos may help improve comfort in understanding common ocular pathologies among both patients and medical students. Current literature already explores the role of virtual modalities in improving patient comprehension and student surgical training, but our study is unique in that it implements virtual reality videos that simulate the patient’s experience of an ocular disorder. This added awareness may be more beneficial to patient and student knowledge and empathy. Moving forward, future research should explore long-term effects of these videos and sample more locations. Through improving medical education, we can strive towards higher quality patient care and improved patient outcomes.

Addressing Gaps in Ophthalmology Education Through Virtual Reality Videos: A Pilot Study of Patients and Students

Background
Simulation training is becoming increasingly recognized as a powerful learning tool in medical education, as it offers a unique advantage to practice surgical skills in a low-risk environment. The Ophthalmology Interest Group at the Long School of Medicine, in partnership with the UT Health Ophthalmology Department, created an Eye Suture Workshop for medical students. The aim of this workshop was to provide students with hands-on experience and exposure to the field of ophthalmology, as well as to assess knowledge gained in a prospective cohort study. 
Methods
Twelve first year medical students participated in an eye suture workshop. The students were divided into six groups of two and given cow eyes for suturing under the supervision of an ophthalmology faculty member and residents. Pre- and post-workshop surveys using 1-10 Likert scale questions were administered to participants to assess the degree of agreement with questions on surgical and ophthalmology interest, comfort with microscope use, and confidence in suturing skills. Suture technique knowledge and ocular anatomy were also assessed through multiple choice and matching quizzes. Results were analyzed in STATA using a Student’s T-Test and Wilcoxon Signed Rank Test (p <0.05 indicating significance). 
Results
Self-reported interest in both a surgical specialty (p-value = 0.0455) and in ophthalmology (p-value = 0.0462) increased significantly following the workshop, as well as student confidence in suture skills (p-value = 0.002) and microscope comfort (p-value = 0.0016). Basic suturing technique skills (p-value = 0.0001) and ocular anatomy (p-value = 0.0462) similarly improved following the workshop. On additional post-test Likert questions that assessed agreement with statements about their perception of the workshop, students rated that receiving hands-on demonstrations of eye suturing skills was helpful (mean: 9.83 (SD: 0.39)) and that they would recommend this workshop to other preclinical students (mean: 9.83 (SD: 0.39)). 
Conclusion
This workshop proved to be a highly effective educational intervention by improving student confidence in suturing techniques and increasing knowledge of suture skills and ocular anatomy, as well as increasing interest in ophthalmology and in surgical specialties. Limitations to this study include a lack of distant outcome measurements to assess persistence of the knowledge gained. Furthermore, the small sample size due to capacity limits in the lab reduces the power of this study.

Precision in Practice: Teaching Ophthalmology Suturing Skills to Medical Students

Background: Total hip and knee arthroplasty (THA and TKA) are two of the most common joint arthroplasties performed in the United States, with the prevalence of these procedures anticipated to continue increasing with the aging population. Therefore, medical education programs must expose students to the pathology, mechanisms of surgical intervention, and variance in implant materials for THA and TKA. One of the purposes of the WMed Skeletal Teaching and Research (STaR) Series is to target this educational goal, however, considering whether the collection is representative of the surrounding population is imperative when training medical providers to care for local communities. As few formal skeletal collections exist within the United States, research pertaining to representation of orthopedic surgeries is arguably nonexistent. The WMed STaR Series aims to target this gap in research, comparing representation of THA and TKA from the series to community statistics.

Methods: Donors from the WMed STaR Series were thoroughly evaluated for the presence of THAs and TKAs, as well as associated musculoskeletal pathology. The type and material of implant, laterality of intervention, donor medical history, and donor demographics were documented. Preliminary data collected from the series was evaluated in comparison to national statistics, and will plan to be compared to analogous data from orthopedic patients seen at the WMed Health clinic.

Results: The American College of Rheumatology cites about 1.2 million TKA and THA procedures in the U.S. annually with approximately 36.3% being THA and 63.7% being TKA. Upon evaluation of the STaR series, there were six THA (83% with a metal femoral head and a polymer socket, and the remaining 17% with a ceramic femoral head and a polymer socket) and seven TKA (all with metal tibial and femoral components and plastic spacers). This results in a relative frequency of 46.2% THA and 53.8% TKA in the WMed STaR Series, showing that while WMed has a similar proportion of THA and TKA to the national statistic, the STaR Series shows slightly higher prevalence of THA. 

Conclusion: The development of the WMed STaR Series will provide educators with a reference for orthopedic implants available for medical education, and will offer a unique perspective for further understanding of musculoskeletal pathology and mechanism for surgical intervention. Medical education resources that reflect the surrounding populations, such as the WMed STaR series, are imperative to prepare medical trainees to deliver comprehensive care to their communities. 


An Examination of Orthopedic Implants in the WMed Skeletal Teaching and Research Series: Presenting a Resource for Medical Education and Research

Introduction
The Journal of the American Academy of Orthopaedic Surgeons (JAAOS) is a high-impact journal that publishes crucial research to inform surgeons’ clinical decision-making. Recent studies examining orthopaedic surgery journals have found a median time to acceptance of 119 days and have found little evidence of nonscientific factors affecting time to publication. The purpose of this study was to determine the median time from submission to acceptance for articles published by the JAAOS and to evaluate factors which may influence time to acceptance.

Methods
All studies published in JAAOS from 2020-2022 were obtained. Abstracts were screened for submission and acceptance dates, and time to acceptance was calculated. Studies were excluded if dates were unavailable. Data extracted included article type, main topic, and sex of the first author. Univariate and multivariate analyses were used to assess time to acceptance. Simple linear regression, analysis of variance (ANOVA), and independent samples t-test were utilized for univariate analysis. For multivariate analyses, a standard least squares regression was applied. 

Results
We analyzed 754 articles. Over the past 3 years, time to acceptance has not significantly changed (p = 0.894). Regarding article type, letters had the shortest time to acceptance (median 5 days, IQR 2-10, p<0.0001), followed by guidelines (median 63.5 days, IQR 20.75-178.25). Interventional studies had the longest time to acceptance (median 171.5 days, IQR 106-309.5), followed by review articles (median 147.5 days, IQR 91.25-214) and observational articles (median 127 days, IQR 87.5-191.5). Articles pertaining to COVID-19 (median 62 days, IQR 2-121), diversity (median 90 days, IQR 24-156), and training (median 92 days, IQR 63.5-150) had the shortest times to acceptance. Articles pertaining to radiology (median 189.5 days, IQR 100-309.5), trauma (median 183 days, IQR 126.5-269.5), and sports (median 157.5 days, IQR 100-269.5) had the longest times to acceptance (p<.0008). Time to acceptance was not significantly different between male and female first authors. 

Conclusion
This study provides a tool for authors to estimate their mean time from submission to acceptance based on the characteristics of their study. With literature submissions constantly increasing each year with unknown times to acceptance, authors may make a more informed decision with journal selection based on the qualities of their study.

Factors for Predicting Time to Acceptance in the JAAOS

Background
Historically, women are underrepresented in the field of orthopedic surgery. To evaluate progress in this area, it is important to assess not only representation but also activity at high profile orthopedic conferences in the field.
Methods
Poster presentations from the 2023 and 2024 AAOS annual meetings were identified via the AAOS ePoster archive. First, second and last authors were recorded for each poster that met inclusion criteria. For each author included in the data, gender was determined and recorded. In addition gender, degree title (as listed on the AAOS website) was recorded, including authors’ AAOS membership status if listed. The Elsevier database, Scopus, was used to determine each authors’ academic influence at the time of data collection. H-indexes, an author specific metric that evaluates scientific output based on publications and citations, were recorded for each author.
Results
Chi-squared analysis for independence revealed a statistically significant difference in distribution of authorship positions by sex (P=0.03). Using a student's T-test, H-index for male first authors (M = 9, SD = 8) were found to be significantly higher than that for female first authors (M = 5, SD = 6), P < .001. Similar trends were observed for second authors (male: M = 10, SD = 8; female: M = 8, SD = 7), P < .001, and senior authors (male: M = 27, SD = 19; female: M = 17, SD = 18), P < .001. There was also a statistically significant difference in the proportion of male and female authors between the two years (P=0.03). Finally, there was an increase in the proportion of female authors from 14.3% in 2023 to 16.3% in 2024.
Conclusion
In our analysis of the two most recent AAOS summit authorship data, male authors dominate all authorship positions—first author, second author, and senior author. This disparity is most pronounced in the senior author role, where only 9.6% of senior authors are female. These findings further underscore a persistent gender imbalance in authorship positions at the AAOS annual meeting. Additionally, male authors generally have higher citation impacts than their female counterparts across all author positions. An increase in the proportion of female authors from 14.3% in 2023 to 16.3% in 2024 indicates a positive trend toward greater female representation in orthopedic presentations at the AAOS annual meeting. This significant increase suggests ongoing efforts to promote gender diversity in the field, which remains predominantly male.

Representation of Female Authorship to Evaluate Gender Diversity in Orthopedics

Background
Lumbar fusion has long been the gold standard operation for degenerative disc disease; however, lumbar disc replacement has recently gained popularity due to its motion-sparing benefits and increasing patient demand influenced by social media. The social media platform X (formerly Twitter) is widely used in healthcare for sharing patient experiences, and sentiment analysis can assess the emotional tone of these tweets to gauge public perception of medical procedures. The aim of this study was to analyze tweets referencing lumbar fusion and lumbar disc replacement to evaluate the tone of the content and to assess the trend of patient preference for disc replacement over fusion.

Methods
All tweets containing keywords most frequently adopted in discussions related to lumbar fusion and disc replacement were collected from January 2013 through August 2023. These phrases included: lumbar fusion, lumbar arthrodesis, lumbar interbody fusion, lumbar disc replacement, lumbar disk replacement, total disc replacement, total disk replacement, lumbar disc arthroplasty, lumbar disk arthroplasty, total disc arthroplasty, and total disc arthroplasty. Sentiment analysis was then performed using TweetNLP, a cutting-edge natural language processing library, and sentiment analysis time series plots were created. ANOVA was used for combined sentiment analysis, and the Wilcoxon Rank-Sum test for time series plots.

Results
There were 7377 and 1572 tweets mentioning lumbar fusion and lumbar disc replacement, respectively. Sentiment analysis demonstrated 1254 positive, 1389 negative, and 4734 neutral lumbar fusion related tweets (p < 0.001). For lumbar disc replacement, there were 248 positive, 113 negative, and 1211 neutral tweets (p < 0.001). The percentage of positive tweets each month was slightly higher for lumbar fusion (16.16% ± 7.28%) compared to disc replacement (15.20% ± 14.41%), while negative sentiment was 2.6 times higher for lumbar fusion (17.79% ± 8.42%) than disc replacement (6.77% ± 7.89%) (p < 0.001), with a continued rise over the past 5 years.

Conclusion
Over the past decade, patients have increasingly used X to share opinions on lumbar fusion vs. disc replacement. Though the number of tweets discussing lumbar fusion outnumber those of disc replacement, there has been considerably more negative sentiment across tweets discussing lumbar fusion. This trend may reflect the growing preference for disc replacement among patients, and spine surgeons should recognize the influence of social media on patient perceptions and its potential impact on their practice.

Understanding Public Perception Through Natural Language Processing: Lumbar Fusion vs. Disc Replacement

Strong physician communication skills are an essential component to physician training that help strengthen patient satisfaction and health outcomes. Our study will analyze how implementation of a communication training program into standard medical education conferences will improve physician-patient communication skills and overall patient satisfaction. Our study has three goals: to improve physician-patient relations through a strong communication curriculum focused on relationship centered care and empathy, to build a strong foundation in physician-patient communication skills using communication tools, and to assess resident comfort level before and after interventions with education on physician communication skills. Our QI project followed a group of pediatric residents and attendings through a 10-month, block-based curriculum with each month catered towards a specific communication goal. Participants completed monthly surveys throughout the intervention to assess for efficacy and a post-intervention survey was administered to assess for changes in resident comfort in utilizing communication techniques. Through the mid-intervention survey’s, an increased number of individuals began utilizing these techniques and subjective level of comfort with these phrases was widely noted. Our study reinforces the importance of integrating hands-on, cumulative communication education and emphasizes how helpful techniques can create stronger doctor-patient relationships and more confident, empathetic physicians.

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