Identity-Based Challenges to Mental Health in Medical School
Introduction
A major meta-analysis conducted in 2016 found that 1 in 4 medical students internationally met the criteria for depression. Other studies have suggested that students of color face increased prevalence of depression and anxiety, as well as non-male gender students and students with disabilities. However, few studies have assessed student well-being across a multitude of identities and wellness aspects, as well as longitudinally, throughout all 4 medical school classes and years.
Methods
An anonymous, online survey was completed by MS1–4 students at the Spencer Fox Eccles School of Medicine. Questions were a mix of free response and multiple choice. Underrepresented (UR) identity was classified by ethnicity, gender, sexual orientation, first generation in medicine (FGIM), or none. Wellness scores of 0–100 (0 worst, 100 best) were self-reported by responders. Responders were allowed multiple identity categories. Excel and ANOVA were utilized for data analysis.
Results
122 responses were collected (24.4% response rate). Self-reported wellness scores decreased overall for respondents, with the largest decreases in scores coming from students underrepresented in medicine (URiM) by ethnicity, and students who are first-generation in medicine. Students URiM by gender and sexual orientation self-reported an increase in wellness scores during medical school. Wellness scores by year had the largest decrease in the MS2 year, correlating to the highest seeking of wellness services in the MS3 year. Most cited factors impacting wellness in order of descending frequency were: external stressors, academic difficulty, belonging in class, micro-aggressions, mistreatment, and discrimination. Students URiM by sexual orientation had the lowest indication of belonging in medical school, followed by URiM by ethnicity (p = 0.01). 49% of participants indicated at some point having suicidal ideation, and 20% indicated at least “sometimes” having suicidal ideation or more frequently. This was not statistically significant between identity groups.
Recommendations
There are disparities in student- reported wellness by identity and training stage at the UUSOM. Wellness scores have the largest disparity in URiM by ethnicity, however wellness scores decreased overall with second year being a key period for wellness decline. This suggests the need for initiatives that promote mental health, enhance support systems, and foster belonging among students such as opt-out mentorship programs that assign URiM students with URiM faculty.
Previous publication: None
Previous presentation: AAMC Group on Diversity and Inclusion
Enhancing Clinical Decision-Making Through Outdoor Experiential Learning: A Novel Educational Approach for Emergency Medicine Residents
Background
Clinical decision-making is influenced by cognitive biases, yet traditional medical education provides limited opportunities to explore these biases in real-time. This study evaluates whether outdoor experiential learning enhances awareness of decision-making processes and bias recognition among emergency medicine (EM) residents.
Methods
We developed an outdoor experiential workshop where EM residents selected one of three guided backcountry activities. Facilitated discussions integrated clinical and outdoor decision-making concepts, highlighting cognitive biases in real-time. Participants completed pre- and post-course surveys assessing decision-making and workshop experience using Likert-scale measures. The results of the pre-course and post-course surveys were then analyzed using a one-tailed two-sample unequal variance t-test. The workshop experience evaluation was assumed to be normally distributed and reported as a mean and standard deviation.
Results
Of 36 eligible residents, 32 (89%) completed the pre-course survey, and 20 (62.5%) completed the post-course survey. Participants reported high overall enjoyment (4.91/5 ± 0.301), increased awareness of decision-making biases (4.52/5 ± 0.602), and perceived educational value (4.71/5 ± 0.483). Post-course responses demonstrated significant improvement in recognizing clinical and non-clinical decision-making parallels (Δ +0.85, p = 0.001), cognition around biases (Δ +0.347, p = 0.021), and understanding of decision-making biases (Δ +0.304, p = 0.032).
Conclusion
Our preliminary data suggests that outdoor experiential learning may be a valuable tool for improving EM resident understanding of decision-making biases, increasing cognition around cognitive bias, and greater appreciation of the non-clinical parallel decision-making. Future work should examine overall application of these decision-making concepts as well as long-term retention of these principles.
Acute Presentation of Dissecting Pseudoaneurysm of the Extracranial Vertebral Artery
Background
Vertebral artery pseudoaneurysm dissection is a rare vascular pathology affecting 1–5 per 100,000 individuals yearly. Over 80% of vertebral dPSAs are extracranial and can present with a wide variety of symptoms from headache, neck pain, arm pain due to mass effect, to TIA or stroke due to embolic phenomena or mass effect. While blunt trauma often precipitates vertebral dPSAs, the pathology can occur unprovoked. Risk factors for the condition include migraine with aura, smoking, female sex, and hyperlipidemia in addition to trauma. Coiling, flow diversion, and stenting can be used in treatment, however, current literature suggests medical management with anticoagulation is sufficient to achieve good outcomes in most cases.
Case Presentation
We present the case of a 33-year-old woman with pain and decreased strength and sensation in the right face, neck, and upper extremity who was found to have a dPSA of the right extracranial vertebral artery. The patient had a history of migraine with aura, nephrolithiasis, and cholecystitis status post cholecystectomy. She presented with 2 hours of unprovoked pain and weakness with a NIH stroke scale of 6. A brain attack was called on presentation. On exam, she was writhing in bed and would not move her right arm or move her head due to pain. Morphine was given and a CTA head and neck was obtained that showed a 3x6x3mm dPSA of her right V2 at the level of C6. The patient was initiated on DAPT with ASA and plavix. She was admitted to inpatient neurology where she was found to be pregnant in her first trimester. Her symptoms of pain and weakness resolved and she was discharged the following day with presumed MCA TIA as the ultimate cause of her symptomatology.
Conclusion
This case highlights the commonly unprovoked nature of dPSAs and the importance of considering extracranial as well as intracranial vascular pathology for a patient presenting with headache and neurological symptoms.
Previous publication: None
Acute Abdominal Pain as the Initial Presentation of Aortic Dissection with Superior Mesenteric Artery Involvement
Background
Aortic dissection is a life-threatening vascular emergency that typically presents with chest or back pain, but it can manifest atypically with abdominal symptoms. This case is noteworthy for its unusual presentation—isolated abdominal pain as the initial manifestation of a Stanford type B aortic dissection involving the superior mesenteric artery (SMA). The case highlights a rare but critical diagnostic consideration when evaluating patients with signs of acute bowel ischemia.
Case Presentation
A 49-year-old male with a history of hypertension presented to the emergency department with sudden-onset, severe, diffuse abdominal pain. He denied any chest or back pain. On arrival, vital signs were notable for blood pressure of 172/96 mmHg, heart rate of 118 bpm, respiratory rate of 22, temperature of 37.1°C, and oxygen saturation of 97% on room air. He appeared acutely ill—diaphoretic and in visible distress. Physical examination revealed diffuse abdominal tenderness without guarding or rebound. Laboratory studies demonstrated a white blood cell count of 18.4 x10⁹/L, lactate of 4.6 mmol/L, creatinine of 1.8 mg/dL (baseline unknown), and a mildly elevated D-dimer. Liver enzymes and lipase were within normal limits. A CT abdomen and pelvis with IV contrast showed signs concerning for bowel ischemia. CT angiography of the chest, abdomen, and pelvis subsequently revealed a Stanford type B aortic dissection extending to the SMA, with evidence of compromised mesenteric perfusion. Vascular and cardiothoracic surgery were consulted emergently. The patient underwent endovascular repair of the aortic dissection, followed by exploratory laparotomy, which confirmed necrotic bowel requiring resection.
Conclusion
This case illustrates the diagnostic challenge of atypical aortic dissection presentations, particularly when chest or back pain is absent. Isolated abdominal pain and laboratory markers of ischemia should prompt consideration of a vascular cause, especially in patients with known hypertension. Early imaging, including CT angiography, is critical for timely diagnosis and intervention. Clinicians should maintain a broad differential diagnosis for acute abdominal pain to avoid delays in identifying catastrophic vascular
Previous publication: None
Post-Injury Changes to Risk-Taking Behavior in Mountain Bikers
Background
Mountain biking (MTB) is an increasingly popular sport with high injury rates. Previous research has focused on inherent risk factors that may influence rate of injury such as age and gender. Risk homeostasis and risk-taking behavior have been previously studied in other extreme sports, but the effect of injury on risk-taking behavior in MTB has not been studied. Accordingly, the purpose of this study was to evaluate the impact of MTB injuries on behavior changes and to identify predictors associated with change in behavior.
Methods
This is a cross-sectional survey study in which data were collected through online survey completed by adult mountain bikers who had experienced at least one MTB injury. The survey gathered information on demographics, biking habits, injury history, and risk-taking behavior in biking. Injury types such as fractures, dislocations, lacerations, concussions, sprains/strains, and contusions were all included in the study and were further categorized by body part, care setting, treatment interventions, and recovery time. Risk-taking behavior was assessed using a 10-point aggression scale in which participants were asked to reflect on their current behavior and their behavior prior to injury within the single survey.
Results
306 participants completed the survey with 149 meeting selection criteria of at least one prior injury. 104 (70%) were male and 45 (30%) were female. The mean aggression score was 7.27 (SD = 1.45) before injury and 6.39 (SD = 1.82) after injury. A paired sample t-test indicated a significant drop of 0.88 (p < 0.001). Multivariate analysis revealed that higher skill level and diagnosis of a concussion led to a greater change in behavior, while a longer time since injury was associated with smaller changes.
Conclusions
Risk-taking behavior is responsive to previous injury. Bikers who have been injured return to the sport with more caution and protective behaviors. However, as the time from injury increases, risk-taking behavior tends to return toward an individual’s baseline risk tolerance. These findings support the need for public health initiatives that address injury prevention and behavior modification in extreme sports like mountain biking.
Previous publication: None
Guided Meditation to Initiate Emotional Processing of Patient Deaths
Background
: Healthcare providers often experience emotional strain following patient death, yet structured coping mechanisms remain limited. Brief interventions like The Pause show promise. We evaluated the Three-Breath technique—a short guided meditation to honor the deceased and support clinician resilience—for its potential use in emergency medicine.
Methods
Emergency physicians completed a mixed-methods survey assessing experiences with patient death. The survey included multiple-choice, Likert-scale, and free-text items, plus a 3-minute video introducing the Three-Breath technique. Quantitative data were analyzed using descriptive statistics and Spearman’s correlation; qualitative responses underwent thematic analysis.
Results
Of 79 physicians invited, 49 responded (62%; 39% attendings, 61% residents). Attendings reported greater comfort processing death (mean = 4.45) than residents (mean = 3.75; r = 0.29, p = 0.04). Comfort correlated moderately with ease returning to work (r = 0.55, p = 0.00004) and weakly with Three-Breath use (r = 0.117, p = 0.42). Overall, 59% reported using either the Pause or Three-Breath, and 94% felt comfortable coping with patient death. Thematic analysis emphasized team debriefs, moments of silence, and personal strategies (e.g., exercise, meditation), while noting barriers like impersonal wellness programs and administrative burdens.
Conclusion
Comfort with patient death appears to increase with experience. While brief techniques like the Three-Breath method are promising, adoption varies. Findings highlight the value of flexible, personalized coping tools.
Previous publication: None
The Burden of Non-Protocolized Patient Transport Outside of Response Area on a Rural Emergency Medical Services System
Objectives
Prehospital transport decisions depend on a combination of protocols, judgment, and patient acuity/preference. Non-protocolized out-of-area transport may result in unnecessary delays and resource strain.
Methods
We retrospectively reviewed one year of scene transports by a rural, hospital-based EMS system, analyzing transport rationale and comparing hospital admission and specialist consultation as surrogates for decision appropriateness.
Results
Among 2,223 transports, 281 were out-of-area. The most common reasons were patient preference unrelated to prior care (40%) and clinician judgment (24%). Admission rates were highest for per protocol (85%) and patient preference related to prior care (67%), and lowest for no explanation (41%) and clinician judgment (47%). Rates of specialist consultation in the ED were highest in per protocol (69%) and clinician judgment (47%) and lowest in no explanation (23%) and patient preference unrelated to prior care (30%). Clinician judgment was less predictive of admission and specialist consultation for non-trauma and pediatric patients. Median out-of-service time was more than twice as long for out-of-area transports (140 min) versus transports to the nearest facility (62 min). For out-of-area transports discharged from the ED without specialty consultation (n = 104), ambulances traveled an additional 52 miles/patient.
Conclusions
Unit out-of-service time more than doubled for non-protocolized out-of-area transports and rationale for destination decisions variably predicted admission and specialist consultation rates. Patient preference unrelated to prior care and clinician judgement in pediatric and non-trauma populations were less predictive of admission and specialist consultation. Transport guidelines should balance decision rationale with resource preservation, especially in low-resource systems.
Previous publication: Manuscript in Prehospital Emergency Care
Optimizing Dispatch Systems for Stroke Management: A Comprehensive Review
Background/Purpose
Stroke is a leading cause of death and disability worldwide, with mortality rates increasing over the past decade. Timely treatment is crucial and hinges on an optimized “stroke chain of survival.” Despite established guidelines, 22–46% of EMS responses to stroke fail to meet recommended time benchmarks. Emergency dispatch systems play a pivotal role in early stroke identification, enabling rapid activation of specialized medical responses; yet dispatch is only ~40% accurate in detecting strokes. This review evaluates the strengths and limitations of current emergency dispatch systems for stroke and explores potential improvements through evolving technologies and protocols.
Methods
We conducted a structured literature review using PubMed, EMBASE, and the Cochrane Library. Search terms included “Emergency Medical Dispatch,” “Dispatch System,” and “Criteria-Based Dispatch.” We included English-language studies published between 1994 and 2024, focusing on clinical trials, observational studies, and systematic reviews evaluating dispatch protocols for stroke. Studies were screened independently by two reviewers using predefined inclusion (focus on stroke identification, dispatch process analysis) and exclusion (non-EMS settings, pediatric focus) criteria. Data was synthesized thematically.
Results
Among the 193 included studies, we found substantial variability in stroke detection criteria and procedures, resulting in inconsistent sensitivity, specificity, and diagnostic accuracy. Reported sensitivity ranged from 12–94%, and specificity from 20–99%. Accurate stroke identification at dispatch was associated with significant improvements in key process measures, including reduced time to stroke unit arrival, imaging, and thrombolysis. Conversely, delayed identification was linked to increased mortality risk. Technological innovations—such as telemedicine integration, Helicopter EMS (HEMS), and Mobile Stroke Units—enhanced prehospital stroke care by enabling real-time consultation, expedited transport, and early diagnosis. However, their success depends heavily on early, accurate detection by dispatchers.
Conclusions
While dispatch systems are vital to early stroke care, protocol variability contributes to missed or delayed diagnoses. Refining dispatch protocols for stroke could improve care and enhance the impact of emerging prehospital technologies. However, variability in study design and outcomes limits generalizability, underscoring the need for standardized research and protocol development. Future efforts should prioritize dispatch refinement, address barriers to early stroke recognition, and leverage data-driven strategies to improve accuracy.
Previous publication: None
Previous poster presentation: University of Utah Medical Student Research Symposium
GJA1-20K Reduces Levels of Interleukin-6 in Pigs with REBOA-Induced Ischemia-Reperfusion Injury
Introduction
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a resuscitation tool for noncompressible hemorrhage, preserving perfusion to the heart and brain while interrupting life-threatening blood losses. However, patients often suffer ischemia-reperfusion injury after balloon deflation. We previously demonstrated that the protein GJA1-20k protects the mitochondria and reduces serum interleukin-6 (IL-6), an inflammatory marker linked with trauma severity and mortality. This study investigated whether GJA1-20k reduced IL-6 expression in the renal medulla and liver.
Methods
Twelve Yorkshire pigs were subjected to hemorrhagic shock by removing 25% of their blood volume, followed by 45 minutes of complete supra-coeliac REBOA. At 25 minutes, animals received an infusion of 0.9% saline (placebo) or GJA1-20k (0.01 mg/kg). Animals were transfused with autologous blood; the balloon catheter was deflated. Pigs received resuscitation with crystalloids and norepinephrine for MAP > 65 mmHg. Renal medulla and liver samples were obtained. The mRNA and protein IL-6 expression were quantified by reverse transcription polymerase chain reaction (RT-qPCR) and immunohistochemistry (IHC), respectively.
Results
RT-qPCR and IHC analyses revealed no difference in liver expression of IL-6. RT-qPCR revealed lower levels of renal medullary expression of IL-6 in the treatment group compared to the control group (Control: 0.51 [0.33–0.69]; GJA1-20k: 0.16 [0.12–0.3] IL-6 mRNA fold change) (p = 0.0140). IHC showed lower fluorescence in the renal medulla of animals in the treated group, compared to controls (Control: 126.76 [114.57–150.69]; GJA1-20k: 96.61 [94.14–121.95] mean fluorescence) (p = 0.0262).
Conclusions
Animals treated with GJA1-20k had lower levels of IL-6 production in the renal medulla, not the liver.
Previous publication: Manuscript in Critical Care Medicine