Medical Student Elective to Improve Diagnosis in Health Care: Developing Solutions to Reduce Patient Harm

RATIONALE AND OBJECTIVES

At our institution, a new medical student elective was designed and implemented by the department of radiology to teach medical students about diagnostic error. The purpose of this article is to describe the diagnostic error elective structure and implementation, present objective and subjective evaluations of the elective, and provide a model for other radiology departments to run their own electives.

MATERIALS AND METHODS

Starting in January 2018, a 2-week in-person career exploration session elective was offered for third year medical students. In 2020 due to the COVID pandemic, the elective was expanded to fourth year medical students. All students were required to complete a project that addressed diagnostic error. Subjective comments were recorded, and objective measurements obtained from student evaluations.

RESULTS

A total of 11 sessions were held, consisting of 3 fourth year and 26 third year students. A total of 12 projects (11 groups) were completed, seven of which have been accepted for presentation at national meetings. On a 1 to 5 scale (5 highest), students rated their educational experience at a mean score of 4.61. Subjective comments focused on the benefit of exposure to new topics, mentorship by radiologists, and ability to complete a project in such a short time.

CONCLUSION

Diagnostic errors and solutions are vague, new concepts to medical students and even facilitator faculty. This course allowed students to gain awareness of diagnostic error and could easily be replicated at other institutions with interested faculty and medical school support.

Sex and Emotion Regulation Difficulties Contribute to Depression in Young Adults With Attention-Deficit/Hyperactivity Disorder

Many young adults with attention-deficit/hyperactivity disorder (ADHD) are at risk for depression. Yet, questions remain about factors associated with the development of depression in young adults with ADHD. This study examined the effects of sex and emotion regulation difficulties on depression in a sample of young adults with (n = 172) and without (n = 730) ADHD. Two aspects of emotion regulation difficulties were examined-impairments in emotional insight (i.e., lack of emotional awareness, nonacceptance of emotion, and lack of emotional clarity) and impairments in behavioral response to emotion (i.e., impulse control difficulties, difficulties engaging in goal-directed behavior, and limited access to emotion regulation strategies). Significant correlations between ADHD and all indices of emotion regulation difficulty emerged. Sex moderated the association between ADHD and lack of emotional awareness, difficulties engaging in goal-directed behavior, and limited access to emotion regulation strategies. Specifically, ADHD was significantly associated with limited emotion regulation awareness for women but not men, while ADHD was associated with greater difficulties engaging in goal-directed behavior and limited access to emotion regulation strategies for women compared to men. These three areas of emotion regulation dysfunction simultaneously mediated the association between ADHD and depression. The findings indicate the importance of considering emotion regulation and sex in understanding depression in young adults with ADHD.

A Review of Breast Pain: Causes, Imaging Recommendations, and Treatment

Over two-thirds of women will experience breast pain in their lifetime. As one of the leading breast symptoms for which women seek medical attention, breast pain is suspected to be underreported and under-studied. Cyclical breast pain is related to hormonal changes. Noncyclical breast pain is independent of the menstrual cycle and can be idiopathic and related to chronic pain syndromes, infections, ill-fitting bras, musculoskeletal abnormalities, pregnancy, perimenopause, and postsurgical causes. Breast pain can also present in transgender patients and may require additional considerations as to the underlying cause. Imaging of mastalgia depends upon the suspected etiology. Inappropriate imaging for breast pain is associated with significant utilization of health care resources. Cyclical breast pain does not require an imaging work-up. The work-up of focal, noncyclical breast pain includes ultrasound for women aged younger than 40 years, and mammography and ultrasound for women aged 40 years and older. Management of breast pain is often supportive, as most breast pain resolves spontaneously. If pain persists, imaging and management should follow a step-wise approach. If conservative measures fail, second-line therapy is topical nonsteroidal anti-inflammatory drugs. If breast pain is severe and resistant to conservative methods, additional third-line therapies can be added by breast care specialists with specific knowledge of the potential deleterious side effects of these medications. While the causes of mastalgia are overwhelmingly benign, breast pain can significantly impact quality of life, and the breast radiologist should be familiar with causes, management, and treatment recommendations from a multidisciplinary approach.

Feasibility of Ecological Momentary Assessment of Negative Emotion in Girls With ADHD: A Pilot Study

This study explores the feasibility of using mobile phone ecological momentary assessment to evaluate negative emotion in adolescent girls with attention-deficit/hyperactivity disorder (ADHD). A total of 13 girls with ADHD, ages 12-16 years old (38.5% with comorbid depression), and their mothers completed several daily surveys assessing the intensity and variability of youth negative emotion using mobile phone-based ecological momentary assessment for approximately one week. The rate of response to survey prompts by youth and maternal reports was examined. In addition, associations between girls' and mothers' ratings of negative emotion were calculated. Finally, the severity and fluctuation in negative emotion were compared between girls with and without depression. Girls and their mothers demonstrated a high level of compliance with assessment procedures, and maternal and youth ratings were significantly correlated. In addition, girls with comorbid depression and their mothers endorsed significantly more intense and variable negative emotion compared to girls with ADHD alone. These preliminary findings show that ecological momentary assessment is a feasible and valid method for collecting information on emotion regulation among girls with ADHD and their mothers that can be applied to future work aimed at collecting ecologically valid assessments of functioning in girls with ADHD.