Midcareer research faculty are a vital part of the advancement of science in U.S. medical schools, but there are troubling trends in recruitment, retention, and burnout rates.

The primary sampling frame for this online survey was recipients of a single R01 or equivalent and/or K-award from 2013 to 2019. Inclusion criteria were 3–14 years at a U.S. medical school and rank of associate professor or two or more years as assistant professor. Forty physician investigators and Ph.D. scientists volunteered for a faculty development program, and 106 were propensity-matched controls. Survey items covered self-efficacy in career, research, work-life; vitality/burnout; relationships, inclusion, trust; diversity; and intention to leave academic medicine.

The majority (52%) reported receiving poor mentoring; 40% experienced high burnout and 41% low vitality, which, in turn, predicted leaving intention (P < 0.0005). Women were more likely to report high burnout (P = 0.01) and low self-efficacy managing work and personal life (P = 0.01) and to be seriously considering leaving academic medicine than men (P = 0.003). Mentoring quality (P < 0.0005) and poor relationships, inclusion, and trust (P < 0.0005) predicted leaving intention. Non-underrepresented men were very likely to report low identity self-awareness (65%) and valuing differences (24%) versus underrepresented men (25% and 0%; P < 0.0005). Ph.D.s had lower career advancement self-efficacy than M.D.s (P < .0005).

Midcareer Ph.D. and physician investigators faced significant career challenges. Experiences diverged by underrepresentation, gender, and degree. Poor quality mentoring was an issue for most. Effective mentoring could address the concerns of this vital component of the biomedical workforce.

Nonmedical opioid use (NMOU) has been associated with opioid overdose deaths. This pattern of misuse can be seen in those using opioids for cancer-associated pain. We present a case that highlights the complexities associated with NMOU and a patient’s care at the end of life.

A patient with a metastatic solid tumor malignancy along with co-occurring history of polysubstance abuse was admitted to an acute palliative and supportive care unit (APSCU). The patient demonstrated behaviors concerning for NMOU during her hospital stay but had increased symptom expression concerning for worsening dyspnea while in the APSCU. Unfortunately, she used home opioids, which was unknown to the team at the time along with requesting for higher doses of opioids that were being prescribed. This caused a worsening respiratory status and affected her care. Using an interdisciplinary approach, the providers managed her symptoms and discharged her safely to see her child.

This highlights the complexities of the alleviation of suffering in those with NMOU. It is important to continue to manage NMOU at the end of life due to its effects on quality of life. A multimodal approach is recommended to identify and care for these patients.

Children, who comprise 25% of the US population, are frequently victims of disasters and have special needs during these events.

To prepare NYC for a large-scale pediatric disaster, NYCPDC has worked with an increasing number of providers that initially included a small number of hospitals and agencies. Through a cooperative team approach, stakeholders now include public health, emergency management, and emergency medical services, 28 hospitals, community-based providers, and the Medical Reserve Corps.

The NYCPDC utilized an inclusive iterative process model whereby a desired plan was achieved by stakeholders reviewing the literature and current practice through discussion and consensus building. NYCPDC used this model in developing a comprehensive regional pediatric disaster plan.

The Plan included disaster scene triage (adapted for pediatric use) to transport (with prioritization) to surge and evacuation. Additionally, site-specific plans utilizing Guidelines and Templates now include Pediatric Long-Term Care Facilities, Hospital Pediatric Departments, Pediatric and Ob/Newborn/Neonatal Intensive Care Services and Outpatient/Urgent Care Centers. A force multiplier course in critical care for non-intensivists is provided. An extensive Pediatric Exercise program has been used to develop, operationalize and revise plans based on lessons learned. This includes pediatric tabletop, functional and full-scale exercises at individual hospitals leading to citywide exercises at 13 and subsequently all 28 hospitals caring for children.

The NYCPDC has comprehensively planned for the special needs of children during disasters utilizing a pediatric coalition based regional approach that matches pediatric resources to needs to provide best outcomes.

The NYCPDC has responded to real-time events (H1N1, Haiti Earthquake, Superstorm Sandy, Ebola), and participated in local (NYC boroughs and executive leadership) and nationwide coalitions (National Pediatric Disaster Coalition). The NYCPDC has had the opportunity to present their Pediatric Disaster Planning and Response efforts at local, national and International conferences.

Children are frequently victims of disasters, however important gaps remain in pediatric disaster planning. This includes a lack of resources for pediatric preparedness planning for patients in outpatient/urgent-care facilities. The New York City Pediatric Disaster Coalition (NYCPDC) is funded by the NYC Department of Health and Mental Hygiene (DOHMH) to improve NYC’s pediatric disaster preparedness and response.

After creating planning resources in Pediatric Long-Term Care Facilities, Hospital Pediatric Departments, Pediatric and Neonatal Intensive Care Units and Obstetric/Newborn Services within NYC hospitals, the NYCPDC partnered with leaders and experts from outpatient/urgent-care facilities caring for pediatric patients and created the Pediatric Outpatient Disaster Planning Committee (PODPC). PODPC’s goal was to create guidelines and templates for use in disaster planning for pediatric patients at outpatient/urgent-care facilities.

The PODPC includes physicians, nurses, administrators, and emergency planning experts who have experience working with outpatient facilities. There were 21 committee members from eight organizations (the NYCPDC, DOHMH, Community Healthcare Association of NY State, NY State DOH, NYC Health and Hospitals, Maimonides Medical Center and Presbyterian/Columbia University Medical Center). The committee met six times over a four-month period and shared information to create disaster planning tools that meet the specific pediatric challenges in the outpatient setting.

Utilizing an iterative process including literature review, participant presentations, discussions review, and improvement of working documents, the final guidelines and templates for surge and evacuation of pediatric patients in outpatient/urgent care facilities were created in February 2018. Subsequently, model plans were completed and implemented at five NYC outpatient/urgent-care facilities.

An expert committee utilizing an iterative process successfully created disaster guidelines and templates for pediatric outpatient/urgent care facilities. They addressed the importance of matching the special needs of children to available space, staff, and equipment needs and created model plans for site-specific use.

Effects of a disaster on a community’s mental health can persist after the physical effects of the event have passed. The pediatric population is often overrepresented in disasters and prone to serious mental health disorders based on their age and parental/community response. Pediatric primary healthcare providers require the psychosocial skills necessary to work in disaster zones and to care for children in disasters.

Pediatric Disaster Mental Health Intervention (PDMHI) was initially developed in response to Superstorm Sandy’s impact on children and their families in New York City. The objective was to develop training for primary care providers in pediatric disaster mental healthcare and to study its impact on the trainees.

A faculty of experts in pediatric mental health, psychiatry, psychology, and disaster preparedness was convened to develop curriculum. The faculty developed a four-hour intervention to equip healthcare providers with the skills and knowledge necessary to care for pediatric patients with mental health problems stemming from a disaster via evaluation, triage, intervention, and referral.

Three PDMHI training sessions were held. A total of 67 providers were trained. Of these, there were 31 pediatricians, 18 nurses, 8 social workers, 4 psychologists, 2 psychiatrists, and 4 others. Pre- and post-tests measured knowledge before and impact 3 months post-intervention. 62.5% of responding primary care providers made changes to their practice. 92% felt better equipped to identify, treat, and refer patients. 81% would be willing to work in a disaster zone and felt prepared to treat patients with disaster mental health issues.

PDMHI covers psychosocial responses to disasters from normal to mental health disorders. Participants gained tools for managing pediatric mental health issues in primary care. Study data showed an increase in the participants perceived knowledge and skills about pediatric disaster mental health, and willingness to participate in future disasters.

Children are frequently victims of disasters. However, gaps remain in disaster planning for pediatric patients. The New York City Pediatric Disaster Coalition (NYCPDC) is funded by the New York City Department of Health and Mental Hygiene (DOHMH) to prepare NYC for mass casualty incidents that involve large numbers of children.

On April 26, 2018, the NYCPDC conducted a first full-scale exercise with the New York Fire Department (FDNY) testing evacuation, patient tracking, communications, and emergency response of the obstetrics, newborn, and neonatal units at Staten Island University Hospital North. The goal of the exercise was to evaluate current obstetrics/newborn/neonatal plans and assess the hospital’s ability to evacuate patients.

The exercise planning process included a review of existing obstetrics/newborn/neonatal plans, four group planning meetings, specific area meetings, and plan revisions. The exercise incorporated scenario-driven, operations-based activities, which challenged participants to employ the facility’s existing evacuation plans during an emergency.

The exercise assessed the following: communication, emergency operation plans, evacuation, patient tracking, supplies, and staffing. Internal and external evaluators rated exercise performance on a scale of 1-4. Evaluators completed an exercise evaluation guide based on the Master Scenario Event List.

An After Action Report was written based on the information from the exercise evaluation guides, participant feedback forms, hot wash session, and after-action review meeting. Strengths included the meaningful improvement of plans before the exercise (including the fire department) and the overall meeting of exercise objectives.

Lessons learned included: addressing gaps in effective internal and external communications, adequate supplies of space, staff, and equipment needed for vertical evacuations in addition to providing staging and alternate care sites with sufficient patient care and electrical power resources. The lessons learned are being utilized to improve existing hospital plans to prepare for future full-scale exercise and or real-time events.

The development of medical school courses on medical responses for disaster victims has been deemed largely inadequate. To address this gap, a 2-week elective course on Terror Medicine (a field related to Disaster and Emergency Medicine) has been designed for fourth year students at Rutgers New Jersey Medical School in Newark, New Jersey (USA). This elective is part of an overall curricular plan to broaden exposure to topics related to Terror Medicine throughout the undergraduate medical education.

A course on Terror Medicine necessarily includes key aspects of Disaster and Emergency Medicine, though the converse is not the case. Courses on Disaster Medicine may not address features distinctively associated with a terror attack. Thus, a terror-related focus not only assures attention to this important subject but to accidental or naturally occurring incidents as well.

The course, implemented in 2014, uses a variety of teaching modalities including lectures, videos, and tabletop and hands-on simulation exercises. The subject matter includes biological and chemical terrorism, disaster management, mechanisms of injury, and psychiatry. This report outlines the elective’s goals and objectives, describes the course syllabus, and presents outcomes based on student evaluations of the initial iterations of the elective offering.

All students rated the course as “excellent” or “very good.” Evaluations included enthusiastic comments about the content, methods of instruction, and especially the value of the simulation exercises. Students also reported finding the course novel and engaging.

An elective course on Terror Medicine, as described, is shown to be feasible and successful. The student participants found the content relevant to their education and the manner of instruction effective. This course may serve as a model for other medical schools contemplating the expansion or inclusion of Terror Medicine-related topics in their curriculum.

ColeLA, NatalB, FoxA, CooperA, KennedyCA, ConnellND, SugalskiG, KulkarniM, FeravoloM, LambaS. A Course on Terror Medicine: Content and Evaluations. Prehosp Disaster Med. 2016;31(1):98–101.