United States

Background
Opioid use disorder (OUD) continues to drive significant morbidity and mortality across the U.S., yet emergency departments (EDs) remain underutilized as initiation points for evidence-based medication-assisted treatment (MAT). Despite legislation such as the 2023 MAT Act removing prior prescribing restrictions for buprenorphine, most ED physicians remain unfamiliar and reluctant to treat patients experiencing opioid withdrawal with partial opioid agonists such as buprenorphine. Academic centers such as Yale and UCSF have successfully piloted and implemented ED-based buprenorphine programs, but many hospital systems lack comprehensive systems to treat OUD in patients effectively in the fast-paced ED setting. Recognizing this gap, we developed and initiated a streamlined, evidence-informed algorithm for buprenorphine initiation in ED patients presenting with opioid withdrawal at Houston Methodist Hospital in Texas.

Methods
Our team synthesized peer-reviewed protocols and national guidelines from AAEM, ACEP, and published institutional frameworks to construct a simplified algorithm tailored for frontline ED use. The algorithm incorporated patient assessment via the Clinical Opiate Withdrawal Scale (COWS) and guided physicians through staged buprenorphine-naloxone induction steps based on symptom severity. Adjuvant therapy choices were included as algorithm side branches for patients experiencing buprenorphine-induced withdrawal. Recognizing physician hesitancy and knowledge gaps, the algorithm was designed for ease-of-use. Supplemental material for successful adoption by ED physicians incorporated research-driven treatment statistics, education on partial opioid agonists pharmacologic principles, and contraindications for treatment. In collaboration with institution staff, the tool was integrated into ED workflows, paired with a standardized discharge bundle including a curated list of outpatient MAT resources.

Results 
A simplified algorithm was implemented into the emergency department and electronic medical record. Data collection from outcomes of the implementation is ongoing across the Houston Methodist system. Formal tracking of MAT initiation rates and longitudinal patient outcomes are planned. Study design includes evaluation of implementation fidelity, patient engagement at follow-up, and trends in ED recidivism. Patient-facing resources are being distributed at the point of discharge for OUD patients started on buprenorphine, improving continuity of care and outpatient follow-up.

Conclusion
This project demonstrates the feasibility of deploying a simplified ED-based buprenorphine algorithm within a large healthcare system, the first of its kind in Texas. By addressing key barriers to MAT initiation, this approach has the potential to shift emergency departments from treating transient opioid withdrawal toward long-term treatment engagement for patients suffering from OUD. Future evaluation will assess clinical impact and generalizability, with the goal of encouraging replication at other hospitals and institutions nationwide.


2025 AMA Research Challenge – Member Premier Access

ED-Initiated Buprenorphine: Designing a Simplified Algorithm for Opioid Use Disorder Treatment

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Recurrent Hypoglycemia and Dementia Risk in Older Adults with Type 2 Diabetes: A Systematic Review

Background
Type 2 diabetes mellitus (T2DM) affects over 25% of adults aged 65 and older. While tight glycemic control is often indicated to reduce the risk of complications, it also elevates the risk of hypoglycemic episodes, particularly in older adults with reduced regulatory responses. Increasing evidence suggests that the recurrence of hypoglycemia may be linked to long-term cognitive decline and dementia. However, the strength of this association continues to be unclear. This systematic review analyzes current literature to assess how repeated hypoglycemic episodes can negatively impact cognitive function in older adults with T2DM.

Methods
A literature search was conducted in Ovid MEDLINE on May 11, 2025. The search terms included combinations of “type 2 diabetes,” “recurrent hypoglycemia,” “cognitive impairment,” “dementia,” and “older adults.” MeSH keywords were used for sensitivity. The inclusion criteria were: (1) studies involving human subjects older than 60 years of age, (2) a documented association between recurrent hypoglycemia episodes and cognitive outcomes, and (3) English-language publications. Study screening, reviewing, and data extraction were done by two reviewers using the Catchii platform. The final inclusion was determined with consensus, and PRISMA guidelines were followed.

Results
Eighteen studies met the inclusion criteria, including large-scale cohort studies, case-control studies, and meta-analyses. Across these studies, recurrent hypoglycemia was consistently associated with increased risk of dementia, Alzheimer’s disease, and vascular dementia. Several studies demonstrated a dose-response relationship, emphasizing the frequency of these events on the cognitive outcome in patients. Several biological mechanisms have been proposed throughout the studies, including neuronal glucose deprivation, cerebral microvascular damage, and accumulation of amyloid-beta and tau proteins. However, inconsistencies were noted in the definitions of hypoglycemia, cognitive assessment tools, and population characteristics. Most of the studies focused on severe hypoglycemia that required hospitalization, which limits generalizability to outpatient-managed patients.

Conclusion
Recurrent hypoglycemia is a significant risk factor for cognitive decline in older adults with T2DM. Increasing frequencies of hypoglycemic episodes, whether secondary to tight glycemic control or age-related diminished regulatory responses, predict even higher dementia risks. Data suggests a strong association, but limitations remain in the generalizability of the results due to differences in study = design and outcome measures. Future research should aim to standardize the definitions of hypoglycemia and measure specific cognitive functions. Additionally, we should investigate whether preventing hypoglycemia in elderly patients can decrease the risk of cognitive deterioration. These findings highlight the importance of individualized glycemic regimen in elderly diabetic patients to preserve long-term cognitive function.

Recurrent Hypoglycemia and Dementia Risk in Older Adults with Type 2 Diabetes: A Systematic Review

Abstract:
Short-term memory (STM) is a fundamental cognitive ability allowing individuals to store and recall small amounts of information for brief periods. Although STM plays a critical role in everyday cognitive tasks, gender differences in its performance remain underexplored. This study investigates the influence of gender on short-term memory performance in healthy individuals aged 15-20 years. A total of 130 participants (65 males, 65 females) were tested. The results revealed that females outperformed males, with an average recall score of 97% for females compared to 85% for males. These findings suggest that gender may influence short-term memory performance, offering new insights into cognitive gender differences.
Keywords: Short-term memory, gender differences, cognitive function, memory retention


Effect of short term memory on gender difference

Background 
Turnover time (TOT)—the interval between one patient exiting and the next entering the same operating room (OR)—is a key determinant of surgical efficiency. While industry benchmarks suggest a baseline of 30-40 min TOT for most surgical subspecialties, neurosurgery presents unique challenges due to procedural complexity and specialized equipment requirements. Extended turnover times can disrupt perioperative workflows, delay case start times, and decrease potential revenue as OR operational costs range from US$30-100 per minute. This study aims to identify modifiable drivers of prolonged neurosurgical TOT and propose data-driven interventions. 

Methods 
We conducted a mixed-methods study analyzing 1,232 neurosurgical turnovers at a high-volume academic hospital. A linear mixed-effects model was used to assess the influence of factors including inpatient versus outpatient status, procedure type, and temporal variables (day and month). Semi-structured interviews with perioperative staff and administrators (n=18) and direct OR observations were conducted to triangulate findings. 

Results 
Mean TOT was 58.9 minutes (SD = 13.1 minutes), with inpatient status adding 8.6 minutes (p<0.001). Complex procedures (e.g., spine tumor) averaged over 65 minutes, yet the 25th percentile within those categories achieved TOTs 9.6 minutes shorter than average—demonstrating that there is room for TOT improvement even for high-complexity cases. Stakeholders cited delayed patient transport, equipment readiness, and poor team coordination as recurrent issues. Electronic health record alert failures and inconsistent staffing compounded delays. Stakeholders also stressed the critical importance of aligning incentives and transparent accountability across services to ensure all personnel are motivated to achieve more efficient turnovers while maintaining regulatory compliance. Interviewees viewed the 30-minute target as unrealistic for neurosurgery. 

Conclusion 
TOT drivers are multifactorial, stemming from poorly coordinated patient flow, equipment setup inefficiencies, and fragmented intra-team communication. Next steps include piloting OR dashboards with real-time alerts, implementing role-specific turnover checklists, and setting tailored benchmarks by procedure type. Modeling interventions on the most efficient turnovers could reclaim OR time, reduce overtime costs, and improve team workflow without compromising safety.

Multimodal Analysis to Assess Drivers of High Neurosurgical Operating Room Turnover Time

Abstract Title
Enhancing Medical Education and Patient Care Through a Method of Loci-Based Medical Spanish Learning Platform

Background
Language barriers in healthcare, affecting over 41 million Spanish speakers in the U.S., impair patient-provider communication and trust, a problem underscored by studies on healthcare disparities. Traditional language learning methods are time-intensive, limiting adoption by busy medical professionals. Research on the method of loci (MoL) and visual mnemonics demonstrates enhanced vocabulary retention, with a 2022 study showing 20% better retention in language contexts (p < 0.05) and a 2018 study reporting 18% improved recall in paired-associate tasks. This gap in efficient, targeted language tools for providers informs the objective: to determine if a platform using MoL and visual mnemonics accelerates medical Spanish acquisition.

Methods
A language learning platform is being developed, integrating interactive imagery and MoL to teach medical Spanish. The platform anchors terminology using spatial memory techniques. A pilot study is designed with 50 novice Spanish-speaking medical providers, split into two groups: one using the MoL platform, the other a conventional app. Participants will train for 10 hours over 4 weeks, with pre- and post-tests measuring vocabulary retention and conversational fluency for 200 medical terms.

Results
A 2022 study on MoL in English as a foreign language contexts showed 20% better vocabulary retention in immediate post-tests compared to rehearsal methods (p < 0.05). A 2018 study on paired-associate learning found MoL users recalled 18% more words than controls, indicating potential for medical Spanish acquisition. These findings provide evidence of the platform’s potential to enhance retention and engagement, enabling faster mastery of medical terminology in a foreign language.

Conclusion
The platform, utilizing visual mnemonics and MoL, has the potential to accelerate medical Spanish acquisition, offering a more efficient alternative to traditional methods. By enabling providers to communicate in patients’ native languages, it can enhance trust, reduce miscommunication, and improve health outcomes. Future expansion to other languages could address broader language barriers, promoting equitable care across diverse populations.

Enhancing Medical Education and Patient Care Through a Method of Loci-Based Medical Spanish Learning Platform

Abstract Title 

Early Integration of Harm Reduction in Medical Education: A Pilot Curriculum for First-Year Medical Students 



Background 

Harm reduction is an evidence-based public health framework that mitigates the adverse outcomes associated with substance use, mental health crises, and other high-risk behaviors without requiring abstinence. Harm reduction training implemented in graduate medical education has enhanced physician preparedness and effectiveness in caring for people struggling with substance abuse and the formation of trusting patient-physician relationships. These principles are rarely emphasized in formal undergraduate medical training. Consequently, medical students often begin clinical practice without adequate preparation to provide effective, compassionate care for people who use illicit substances, and frequently lack the tools to reduce stigma, establish trust, and apply evidence-based interventions. Despite the proven effectiveness of harm reduction principles in reducing overdose deaths, transmission of infectious diseases, and facilitating the development of a trusting patient-physician relationship to improve patient treatment outcomes, a structured curriculum for harm reduction strategies is lacking in formal undergraduate medical education. This study aims to evaluate the impact of a newly developed pilot curriculum for first-year medical students, assessing their comprehension and application of harm reduction principles throughout their undergraduate medical education. 



Methods 

A novel harm reduction curriculum introduced in the preclinical phase of medical education, with a focus on practical strategies and person-first language to enhance the patient-centered care of those who use illicit substances. An anonymous, online pre- and post- questionnaire will assess first year medical student’s perspectives, bias, beliefs, preparedness, knowledge, and confidence utilizing harm reduction strategies. The curriculum and questionnaires will be administered to first year undergraduate medical students before and after the education session and longitudinally throughout their undergraduate medical education. Participants will serve as their own cross-sectional controls through the pre- and post-curriculum surveys, and longitudinal comparisons will be made using a control group of students from preceding academic years who have not received the novel harm reduction curriculum. 



Results 

Pending IRB approval, the curriculum is set to take place in November 2025. 



Conclusion 

We anticipate the harm reduction curriculum will lead to sustained improvements in the medical student's knowledge, confidence, and clinical application of harm reduction principles. By embedding these practices early in medical training, the curriculum has the potential to shift institutional culture and reduce stigma toward people who use illicit substances, and better prepare future physicians to deliver equitable, person-centered care. This model may serve as a scalable framework for nationwide integration into undergraduate medical health education.

Early Integration of Harm Reduction in Medical Education: A Pilot Curriculum for First-Year Medical Students

Background
Pathway programs have been successful in diversifying the physician workforce, which leads to improved quality of care for all patients. These programs are a key component in advancing equity in medical education to students from various backgrounds. While pathway programs develop a student’s professional skills, they also foster a sense of community that supports learning and growth. Despite the value of community in pathway programs, little qualitative research has explored its impact on pre-medical students. This study examines how the sense of community cultivated within a premedical pathway program influences students’ trajectories toward a career in medicine.

Methods
An in-depth focus group was conducted with 23 students who participated in a structured premedical pathway program. Using Social Cognitive Theory as a conceptual framework, we employed a deductive qualitative approach to thematic analysis and investigated how the social factors within the program affected a student’s sense of self-efficacy. Two independent researchers coded the transcript and identified core themes related to the students’ experiences of community within the program.

Results
Thematic analysis revealed five major themes: “Confidence/Empowerment,” “Professional development,” “Embodied mentorship,” “Shared experience,” and “Structured support.” The average inter-rater agreement was 87.36%. The most common theme that emerged was “Support,” with 21 references, followed by “Shared experience,” with 13 references. Students described the community fostered by the program as a meaningful source of comfort, encouragement, and guidance–particularly in navigating the challenges of the medical school application process. Overall, students were motivated and more confident in their ability to successfully pursue a career in medicine. 

Conclusion
Pathway programs offer more than professional development; they also build communities where students with shared goals and lived experiences can develop a lasting support system. Our analysis of the pre-medical pathway program highlights how this sense of belonging fosters peer mentorship, resource-sharing, and confidence in navigating the medical school application process. As admissions become increasingly competitive, these social resources are essential to increasing the representation of a diverse student body in medicine. Our results further illustrate the value of pathway programs and their place in advancing equity in the future physician workforce. 



Fostering Belonging and Career Confidence Through Community in a Pre-Medical Pathway Program

Background
Students from marginalized backgrounds are underrepresented in higher education, including healthcare.1 Representation in medicine can decrease health disparities through increased trust, patient-centered care, and better treatment adherence.2,3,4 Systemic barriers like cost, lack of social support, lack of mentorship, and lack of career navigation knowledge, prevent marginalized persons from pursuing medicine.5 Encouraging marginalized high schoolers to pursue medicine is shown to help to minimize the disparity and further diversify representation in medicine.6,7 Compton Unified School District (CUSD) teachers revealed a scarcity of medical opportunities for their students. CUSD serves 100% minority students and 46% are economically disadvantaged.8 Literature has shown mentorship programs, medical school field trips, and near-peer teaching decrease barriers.7,9,10 Utilizing these strategies, we created a single event field trip for Los Angeles students to explore medicine. A survey was issued to high school and medical students to measure the effects on barriers and to obtain feedback.

Methods
High school students from CUSD were invited to David Geffen School of Medicine. Pre-medical undergraduates led the students through a tour of UCLA. Physicians hosted conversations during lunch. Medical students led hands-on, small group (1.8 student: 1 medical student) workshops including ultrasound, suturing, vital signs, and simulated patient interviews. After participating in the program, both high school and medical students completed an anonymous survey with Likert Scale (0-4), free-text, and multi-select questions. Data were evaluated with paired two-tailed t-tests and descriptive analysis.

Results 
Twenty-nine high school students and twelve medical students completed the survey. Amongst the high school students, there were statistically significant increases in desire to pursue a career in medicine (3.103, 3.414; p=0.0099) and perceived opportunities to pursue medicine (3.138, 3.517; p=0.0027). Perceived barriers had a significant decrease (2.207, 1.862; p=0.0098). The most common barriers identified were feeling unqualified compared to peers (51.7%; 15) and cost of education (55.2%;16). There was no change in self efficacy (3.103, 3.276; p=0.057). The event had high satisfaction by both high school (93%, 3.51土0.62) and medical students (100%) with requests to host event again.

Conclusion 
Field trips are effective tools for Los Angeles-area high school students from marginalized backgrounds to explore medicine and decrease barriers. The mutual satisfaction from medical student-run events for high school students make this program sustainable. Future projects aim to create a more longitudinal partnership with CUSD.

1. Association of American Medical Colleges. Diversity in Medicine: Facts and Figures 2019. Executive summary. Washington, DC: AAMC; 2019.
2. Hall WJ, Chapman MV, Lee KM, et al. Implicit racial/ethnic bias among health care professionals and its influence on health care outcomes: a systematic review. Am J Public Health. 2015;105(12):e60-e76. doi:10.2105/AJPH.2015.302903
3. Smedley BD, Stith AY, Nelson AR, eds. Patient-provider communication: the effect of race and ethnicity on process and outcomes of healthcare. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academies Press; 2003. https://www.ncbi.nlm.nih.gov/books/NBK220354/
4. GlobalData Plc. The Complexities of Physician Supply and Demand: Projections From 2021 to 2036. Washington, DC: Association of American Medical Colleges; 2024.
5. Joseph J, Dao D, Hwang SM, et al. Perceptions of barriers and facilitators to becoming a medical professional among underrepresented undergraduate and postbaccalaureate learners. Mayo Clin Proc Innov Qual Outcomes. 2021;5(2):347-358. doi:10.1016/j.mayocpiqo.2021.01.003
6. Goodfellow A, Ulloa JG, Dowling PT, et al. Predictors of primary care physician practice location in underserved urban or rural areas in the United States: a systematic literature review. Acad Med. 2016;91(9):1313-1321. doi:10.1097/ACM.0000000000001203
7. Mayrath M, Fontanez D, Abdelbaset F, et al. Increasing diversity in the physician workforce: pathway programs and predictive analytics. Acad Med. 2023;98(10):1154-1158. doi:10.1097/ACM.0000000000005287
8. Compton Unified School District. Accessed June 22, 2025. https://www.usnews.com/education/k12/california/districts/compton-unified-112290
9. Abdulrazzak A, Chandler A, Lu R, et al. Mini-medical school programs decrease perceived barriers of pursuing medical careers among underrepresented minority high school students. J Osteopath Med. 2021;121(12):883-890. doi:10.1515/jom-2021-0125
10. Patel SI, Rodríguez P, Gonzales RJ. The implementation of an innovative high school mentoring program designed to enhance diversity and provide a pathway for future careers in healthcare related fields. J Racial Ethn Health Disparities. 2015;2(3):395-402. doi:10.1007/s40615-015-0086-y

Mini Med School: A Medical Student Community Outreach Program for High School Students in LA

Author: Sirlin Kaur
Co-author: Joanna Appel 
Project Title: The Impact of Racial Bias Discussions on Medical Students' Educational Experiences and Perceptions of Patient Care: A Cultural Humility Perspective

Introduction: This study examines the impact of discussions on racial bias and racial equity on medical students' personal experiences, perceptions of race in healthcare, and approaches to patient care. 

Method: The study design involved semi-structured interviews with first-year medical students at the University of South Carolina School of Medicine who completed a reading assignment of Dorothy Roberts' "Fatal Invention" and participated in small-group discussions during orientation. These activities provided a platform for students to engage deeply with the material and reflect on their own biases, enhancing their educational experiences and informing their future approaches to patient care. 

Results: Utilizing the Cultural Humility Framework, we explore how these educational activities fostered self-reflection, awareness of power imbalances, and institutional accountability, ultimately shaping students' readiness to provide equitable and inclusive patient care. Student responses illuminated their ever-evolving perspectives on the issue of racial bias in medicine and how that affects their interactions with patients as medical students and future physicians. The impact of the study was summarized into 5 categories including personal experience with racial bias, experiences in medical school, perceptions of race and racial bias, perceptions of the impact of race on healthcare, and approach to patient care. Each category was then contextualized within the Cultural Humility framework. 

Conclusion: Our findings underscore the importance of incorporating racial bias education into medical curricula to prepare future healthcare providers to recognize and address biases, thereby improving patient outcomes and fostering trust within minority communities. Medical students should be encouraged to engage in continuous, lifelong self-reflection to challenge their own biases and assumptions with the support of academic institutions to foster this goal and promote equity and inclusion.

The Impact of Racial Bias Discussions on Medical Students' Educational Experiences and Perceptions of Patient Care

Background
Although several MD programs emphasize basic sciences, clinical skills, and biomedical research, very few prioritize health policy and the business of medicine. The executive board of the Healthcare Delivery Interest Group (HDIG) at the Medical College of Georgia (MCG) implemented the Healthcare Equity Case Competition in partnership with the University of Aberdeen (UofA) to address this gap through international collaboration. This report describes this educational initiative, initial participant feedback, and future opportunities for growth. 

Methods
The HDIG executive board developed a case about the hypothetical repeal of the Affordable Care Act (ACA), prompting teams to propose an alternative model for the United States' healthcare system, addressing cost, accessibility, effectiveness, insurance market stability, and transition for individuals previously covered by the ACA. The complexity of the case required students to examine global health systems and leverage existing knowledge from their own national frameworks. HDIG deliberately paired MCG and UofA students within each team. Students gave oral presentations at their respective institutions through a Teams meeting, enabling synchronous sharing with the partner institution. 

Results
In total, 39 students from the Medical College of Georgia and 11 University of Aberdeen students participated in the MCG x UofA Healthcare Equity Case Competition. To analyze whether the competition met its educational objectives, a feedback questionnaire was distributed to all participants, using a 10-point rating scale (1 = least satisfied, 10 = most satisfied). The responses indicated that the event was valuable to the education of the medical students who participated. Students reported international collaboration and faculty mentorship as key to their understanding of the case objectives. Among 24 respondents, paired t-tests demonstrated statistically significant improvements (p<0.05) in self-perceived understanding of the US healthcare system, comparative healthcare models, global health equity, and public health policy. Free-response questions provided insight into changes that could be implemented to increase efficiency for future events.

Conclusion
Unlike other cross-institutional initiatives, this competition incorporated students from different countries within the same teams, requiring the cooperation of diverse knowledge bases and perspectives—an intentional challenge that enriched learning but necessitated coordination. Logistical barriers like costs, time zones, and curricular differences may limit scalability. This event provides a replicable framework for other institutions to utilize integrated international teams as a means of incorporating health policy topics into a comprehensive curriculum that extends beyond the classroom.

Reimagining U.S. Healthcare: A Student-Led, Transatlantic Case Competition on Health Policy

Background
Simulation in surgical education is of growing interest across medical schools. Barriers to implementation include resources like infrastructure, materials, and physician time. Based on previous surgery clerkship feedback, we aimed to create a multicomponent didactic session for the surgery clerkship. Session goals included developing surgical skills and encouraging student participation in surgical care. We hypothesized that the session would be highly valued by medical students on their surgery clerkship.
Methods
Using simulation trainers provided by the Department of Surgery for resident and fellow education, a single two-hour hands-on didactic session of knot tying, fundamentals of laparoscopic surgery (FLS), and focused assessment with sonography for trauma (FAST) was created for third-year medical students during their surgery clerkship. Session facilitators included 3 attending surgeons, 3-4 residents, and 1 fourth-year medical student. Students were surveyed on their experience using a 5-point Likert scale, pick all that apply, and free responses. Likert scale perception decision was determined relative to weighted mean.
Results
Most respondents highly praised the didactic. Knot-tying respondents reported that it helped them appreciate that their skills had improved (81%, n=37) and that they needed more practice to become proficient (59.4%, n=37). FLS respondents recognized they needed more practice to become proficient (78.9%, n=19) and that practicing on a laparoscopic trainer could be helpful in their training (73.7%, n=19). FAST respondents reported that practicing ultrasound with peers was helpful (81%, n=38) and that they could incorporate ultrasound skills in their careers (75.8%, n=38). Regarding session takeaways, 75% of free responses noted that the experience offered an opportunity to practice and develop valuable practical skills (n=20). The most common free response feedback was that respondents wished to spend more time on FLS and FAST (39.1%) (n=23).
Conclusion
Under the leadership of surgical faculty and residents, the use of available training resources led to a highly valued didactic session by students. This highlights the potential utility of simulation in medical student surgical education. Two of six yearly clerkship cohorts have participated, and data collection is ongoing. Future investigations will explore how these sessions shape preparedness for surgical rotations, overall clerkship experience, and perception of surgeons.


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Recurrent Hypoglycemia and Dementia Risk in Older Adults with Type 2 Diabetes: A Systematic Review