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The COVID-19 pandemic has been especially challenging to the academic international medical (AIM) community. The impact on the field of clinical medicine has been the most pronounced, particularly in the way that education is provided and academic medicine is pursued by clinicians. With the goal of providing top quality, highly relevant content for our membership, the American College of Academic International Medicine (ACAIM) teamed up with our sister organizations, the World Academic Congress of Emergency Medicine (WACEM), the Global Research on Acute conditions Team (GREAT, Rome, Italy and Basel, Switzerland), and EMA-INDIA (Indirapuram, India). The goal of this truly global coalition was to jointly host weekly web meetings that focus on topics relevant to participating stakeholder communities, with additional focus on the ongoing COVID-19 pandemic. Summary of these efforts and outcomes is provided in this article. The following core competencies are addressed in this article: Interpersonal and communication skills; Professionalism; Practice-based learning and improvement

Severe pulmonary complications associated with COVID-19 infections are a substantial source of morbidity and/or mortality. Extracorporeal membrane oxygenation (ECMO) has been shown to be a potentially useful therapy in the management of severe COVID-19 infection as a means to facilitate pulmonary recovery. Despite growing evidence to demonstrate the utility of ECMO for COVID-19 respiratory failure, little is known regarding the posthospital discharge recovery and functional status of these patients. Furthermore, concerns regarding potential long-term complications, but data are lacking. We illustrate a case of a previously healthy male, who was supported on ECMO for severe COVID-19 who demonstrated what appears to be a complete subjective and objective pulmonary recovery within a short time postdischarge. Our case provides some optimisms that critically-ill COVID-19 patients might recover completely and be able to return to functional lives.

The evolution of cardiac surgery reflects some of the greatest accomplishments in the history of medicine. Early work, staring with closed procedures on stenotic valves and repairs of traumatic injuries, while considered initially high risk, and challenges were associated with very high morbidity and mortality rates. Despite early concerns that surgery on the heart would never evolve beyond the most basic of procedures, devoted clinicians and researchers, motivated by the inability to help those suffering from what was generally considered untreatable or inherently fatal problems, persisted against much skepticism, failures, and lack of reliable and appropriate technology. However, over the years, with tremendous dedication to advancing the field, therapies for coronary artery disease, structural valve disease, arrhythmias, and heart failure evolved. While many consider “cardiac surgery” a separate field from “cardiology,” as our review of the history will demonstrate, much of the pioneering work done in the operating room – either with or without the use of the heart–lung machine (cardiopulmonary bypass) – set the foundation for further technological developments. The natural progression of such “operative surgical” therapies is to evolve into miniature, minimally invasive, or percutaneous catheter-based intervention. While there are clearly volumes written, and often fictionalized, on many of these topics, a basic understandable of the rich history of cardiac surgery should be of interest to all – especially since it serves as the basis for so much what is currently offered to patients to help extend both the quantity and quality of their lives. The following core competencies are addressed in this article: Patient care, Medical knowledge, Practice-based learning and improvement.

The use of extracorporeal membrane oxygenation (ECMO) was initially used to support patients in acute cardiopulmonary failure, but its utility has expanded to include a broadspectrum of patients with complex medical conditions. As a growing number of cases continue to mount to prove its successes, ECMO has emerged as a versatile treatment modality in a wide range of clinical scenarios. While the literature documents many successes regarding short-term outcomes, long-term data are lacking. We previously reported two separate cases of profound septic shock where ECMO was implemented as rescue therapy and both patients were able to be successfully discharged. We now provide an update to one of those cases to demonstrate long-term meaningful outcomes in a case where ECMO was utilized successfully. The following core competencies are addressed in this article: Medical knowledge, Patient care and procedural skills, and Systems-based practice.

The Medical Center of Aurora, in Aurora, Colorado (USA), served as the host institution for the First Annual Rocky Mountain Healthcare Symposium. The objectives of the Symposium were to offer a series of lectures, provided by a group of internationally recognized leaders in clinical medical research on "How to conduct clinical medical research," and to allow medical residents from regional training programs to highlight their research. Twelve programs, from four US States, were represented. Oral presentations were given for selected abstracts with awards given for best posters and presentations. While the First Annual Symposium was generally viewed as successful based upon feedback metrics, survey results provided both subjective and quantitative foundation for improvements.

The management of patients after cardiothoracic surgery can be very complex. Variabilities exist in hemodynamic status after cardiac surgery and the use of cardiopulmonary bypass - all of which can have a significant impact on myocardial Frank-Starling curves. Typically, invasive monitoring with pulmonary artery catheters is used to assess the complex physiology that these patients experience in the perioperative setting. However, the use of invasive monitoring is not without risk, and the broader benefits are poorly defined. Furthermore, there is growing evidence to support the use of hemodynamic early goal-directed therapy to optimize outcomes in critically ill patients. The purpose of this editorial statement is the review of some of the current literature with regards to the utility of goal-directed therapy as applied to the postoperative cardiac surgical patient.

Osborn waves are produced when the J-point deviates from baseline. While there are many known causes of Osborne waves, hypothermia remains the most common. Previous studies have been inconsistent about the risk of Osborne waves progressing to a deadly arrhythmia. Commonly, once patients are rewarmed, they no longer exhibit Osborne waves or experience cardiac arrhythmias. This patient presented with hypothermia on a hot, humid August day demonstrating two factors known to cause Osborne waves - hypothermia and hypocalcemia. While replenishing the calcium was beneficial, providing ventilator support and active rewarming remained the mainstays of treatment.

Pulmonary cement embolization (PCE) is a rare but significant complication of vertebroplasty surgery. The management of this process is not well studied and depends on the extent and duration of symptoms. Here, a case of 68-year-old woman is presented who was found to have a symptomatic PCE involving the left main pulmonary artery 9 months after a kyphoplasty surgery was performed with polymethylmethacrylate. She was successfully managed surgically by the left main pulmonary embolectomy with complete symptomatic resolution postoperatively. The following core competencies are addressed in this article: Patient care, Medical knowledge.

The purpose of this review is to provide evidence-based, standardized recommendations on intervention for pericardial effusions. The appropriate management strategy is determined by effusion etiology. Pericardiocentesis under echocardiographic or fluoroscopic guidance is recommended for acute viral or idiopathic pericardial effusions. Due to recurrence risk, indwelling pericardial catheter placement is recommended for malignant pericardial effusions. Intrapericardial instillation of sclerosing or antineoplastic agents and percutaneous balloon pericardiotomy are alternative strategies. If less invasive options are not feasible or successful, pericardiotomy may be considered. Wide anterior pericardiectomy is indicated for relapse after repeated drainage. Potential procedural risks and therapeutic benefits are considered in determining the approach to intervention. The following core competencies are addressed in this article: Practice-based learning and improvement, Medical knowledge, and Patient care.

Paragonimiasis is a food-borne parasitic infection that commonly affects humans after ingestion of raw or undercooked crustaceans. The disease is caused by lung flukes of the genus Paragonimus, which is endemic to Southeast Asia. In this report, we describe two cases of paragonimiasis diagnosed in North American immigrants from Southeast Asia. The first patient presented with a 5-year history of hemoptysis. The second presented with a 3-week history of productive cough. Both patients were initially treated with antibiotics for presumed pneumonia. The inciting pathogen was not identified by blood, sputum, or stool analyses. Ultimately, surgical resection was required, leading to the diagnosis of paragonimiasis. In the United States and other nonendemic areas, the diagnosis of paragonimiasis is often delayed due to its rarity. Increased awareness and inclusion in differential diagnoses, especially in patients originating from endemic areas, may prevent diagnostic delay and associated morbidity. The following core competencies are addressed in this article: Practice-based learning and improvement, Medical knowledge, and Patient care.

The Academic International Medicine World Congress (the AIM World Congress) is the official annual meeting of the American College of Academic International Medicine, a United States organization dedicated specifically to connecting academic physicians from diverse areas of expertise toward the common goals of sustainable global medical outreach and multinational clinical research and education. The organization's main focus is to promote academic international medicine and to establish a platform for individuals, academic institutions, and a broad range of multisectoral organizations to converge and work collectively to create a foundation for efficient, effective, and sustainable resource sharing. World-renowned experts and speakers from the AIM community attended and participated in the Third Annual Congress (AIM 2018) held in Brooklyn, New York, from July 27 to July 29, 2018. In addition to an increase in the number of high-profile faculty members, medical students, and other trainees, as well as the doubling our attendance compared with the AIM Congress 2017, this year's Annual Meeting also incorporated the Cochrane Diagnostic Test Accuracy Review Course. The conference theme, “Translating Evidence into Global Innovation” showcased efforts of the academic international medical community to utilize and create objective data to achieve global impact. Finally, the Congress featured the Second Annual Scientific Forum as a platform for exchanging scientific knowledge among scholars. This report presents an overview of this major academic event, including the listing of podium and poster presentations from the 2018 Scientific Forum. The following core competencies are addressed in this article: Practice-based learning and improvement, Systems-based practice, Interpersonal and communication skills, Professionalism.

Introduction: The American Board of Surgery expects competence in interdisciplinary palliative care, and dealing with advancing chronic conditions and end-of-life scenarios are part of Accreditation Council for Graduate Medical Education general surgery milestones. Despite established standards, surgical trainees receive limited amounts of formal palliative care training, if any. Objective: The study purpose was to evaluate baseline knowledge and test effectiveness of an educational session for surgical residents focused on palliative care, hospice care, advance care planning (ACP), and related topics. Methods: The study was completed at Northeast Ohio Medical University with participation from general surgery residents, students, and faculty at Northside Regional Medical Center in Youngstown, Ohio. Participation involved a pretest, lecture, and posttest surrounding palliative and hospice care, ACP, and related topics to teach and assess baseline knowledge and usefulness of an educational session based on test comparison. Mean group scores for pre/post-tests were calculated. A paired one-tailed t-test was used to assess effective change in mean scores. Results: Twenty participants completed the session. The mean pretest score for the group was 60%. The mean posttest score for the group was 75%. Results show that, after the 30-min presentation, there was statistically significant improvement between means (P = 0.00002). Conclusions: Palliative care, hospice care, and ACP are not utilized to potential due to poor residency education as indicated by low mean pretest score. Statistically significant improvement between tests indicates that education focused on these topics can remedy the knowledge gap and presumably improve patient care involving these topics. The following core competencies are addressed in this article: Practice-based learning and improvement, Interpersonal and communication skills, Professionalism.

Successful treatment of traumatic hemothoraces is imperative to reduce morbidity and mortality among patients. Treatment modalities range from more conservative to invasive measures, including antibiotic therapy, thoracostomy tube placement, video-assisted thoracoscopic surgery, or thoracotomy. Various studies have documented success in using fibrinolytics such as tissue plasminogen activator (tPA) in conjunction with deoxyribonuclease administered through a chest tube to resolve a hemothorax. The optimal dose and frequency of fibrinolytic therapy have not yet been determined although most studies report administering therapy two times a day for 3 days. We report a successful case of a one-time dose of fibrinolytic therapy through thoracostomy tube which could support that a single dose may be ideal and sufficient enough to resolve a hemothorax. We also performed this in the acute postoperative period, which has not been well studied, and believe fibrinolytic therapy can be safe to use in this setting.

The American College of Academic International Medicine (ACAIM) represents a group of clinicians who seek to promote clinical, educational, and scientific collaboration in the area of Academic International Medicine (AIM) to address health care disparities and improve patient care and outcomes globally. Significant health care delivery and quality gaps persist between high-income countries (HICs) and low-and-middle-income countries (LMICs). International Medical Programs (IMPs) are an important mechanism for addressing these inequalities. IMPs are international partnerships that primarily use education and training-based interventions to build sustainable clinical capacity. Within this overall context, a comprehensive framework for IMPs (CFIMPs) is needed to assist HICs and LMICs navigate the development of IMPs. The aim of this consensus statement is to highlight best practices and engage the global community in ACAIM's mission. Through this work, we highlight key aspects of IMPs including: (1) the structure; (2) core principles for successful and ethical development; (3) information technology; (4) medical education and training; (5) research and scientific investigation; and (6) program durability. The ultimate goal of current initiatives is to create a foundation upon which ACAIM and other organizations can begin to formalize a truly global network of clinical education/training and care delivery sites, with long-term sustainability as the primary pillar of international inter-institutional collaborations. The following core competencies are addressed in this article: Patient care, Medical knowledge, Professionalism, Interpersonal and communication skills, Practice-based learning and improvement, and Systems-based practice.

The Academic International Medicine (AIM) Congress (the Congress) is the official meeting of the American College of Academic International Medicine, a United States organization dedicated specifically to connecting academic physicians from diverse areas of expertise toward the common goals of sustainable global medical outreach and multinational clinical research and education. The organization's main focus is to promote AIM and to establish a platform for individuals, academic institutions, and a broad range of organizations to collaborate and work collectively to create a foundation for efficient and sustainable resource sharing. World-renowned experts and speakers from the AIM community attended and participated in the 2017 Congress held in Clearwater Beach, Florida, from July 28 to July 30, 2017. This year's Congress also included the participation of the Global Association of Physicians of Indian Origin, the American Association of Physicians of Indian Origin, and the OPUS 12 Foundation, Inc. Finally, the Congress featured the inaugural Annual Scientific Forum as a platform for exchanging scientific knowledge among academic experts. This report presents an overview of this major academic event, including the full listing of podium presentations from the 2017 Scientific Forum. The following core competencies are addressed in this article: Practice-based learning and improvement, Systems-based practice, Interpersonal and communication skills, Professionalism.

Objectives: Extracorporeal membrane oxygenation (ECMO) is a well-established therapy for severe acute cardiac and respiratory distress. Management of complications, such as embolic strokes and intracranial hemorrhage, is essential during such treatment. However, the incidences of these complications as well as clinical outcomes have not been previously examined within a population with a homogenous disease process. Methods: Using de-identified clinical data submitted to the Extracorporeal Life Support Organization, we analyzed cases in which patients were treated with ECMO during the 2009 H1N1 pandemic. This data were examined with a specific focus on neurologic complications. Results: Twenty-two of the 248 patients experienced a confirmed neurological event. Patients with neurologic events were older, more acidotic, and had a higher prior incidence of cardiopulmonary arrest before ECMO therapy. There was also showed an increased incidence of cardiac arrhythmia, hyperbilirubinemia, and severe leukopenia as well as lower rates of successful weaning from ECMO and survival to discharge. Overall, within the patient population treated with ECMO, neurologic complications are not uncommon, and such patients exhibit greater morbidity and mortality. Conclusions: Thus, aggressive neurological assessment before and during ECMO could prove very useful in guiding clinical decisions with respect to further or ongoing therapies. The findings from this study will hopefully improve patient selection for ECMO therapy as well as clinical outcomes for this critically ill patient population. The following core competencies are addressed in this article: Patient care, Systems-based practice, Interpersonal skills and communication.

The Annual INDO-US World Congress of Academic Emergency Medicine (WoCAEM) continues to be India's premier level one conference encompassing emergency care, trauma management, cutting edge critical care, and the corresponding component of translational science. The 2015 Summit provided additional high profile sessions on burn care, cardiovascular, and cerebrovascular topics, as well as environmental and disaster medicine. Competitive faculty selection ensures a high-quality educational experience. In addition to extensive didactic sessions, the WoCAEM incorporated outstanding small group learning and state-of-the-art simulation experiences in thematic blocks. The WoCAEM Leadership Council is pleased to report on the most recent conference that took place from September 30 to October 4 in New Delhi, India. We hope that this report, in addition to serving as a historical record, will generate additional interest regarding the meeting among potential faculty and attendees alike. The following core competencies are addressed in this article: Medical knowledge, patient care, communication and interpersonal skills, system based practice.

The phenomenon of “brain drain,” (BD) or the unanticipated and significant loss of skilled people and the talent they represent via voluntary turnover, continues to be a significant problem across many academic medical centers. This BD is a result of a multifactorial interplay between personal, professional, institutional, peer-driven, and socioeconomic factors and affects mainly academic healthcare organizations characterized by a specific set of leadership, economic, and competitive preconditions. Institutional impact of BD, both financial and nonfinancial, can be profound and is often underappreciated. Financial considerations of BD include loss of clinical and non-clinical income, contraction of institutional expertise, severance and recruitment expenses, as well as costs of onboarding new faculty. This article focuses on how to identify risk factors for BD at both institutional and personnel levels. Proposed steps for prevention and early intervention are outlined. The following core competencies are addressed in this article: Professionalism, Practice-based learning and improvement, Systems-based practice, Interpersonal skills, and Communication.