Editor: Deborah Sesok-Pizzini, MD, MBA, chief medical officer, Labcorp Diagnostics, Burlington, NC, and adjunct professor, Department of Clinical Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Implementation of a virtual pathology rotation for visiting medical students
June 2022—Medical student visiting, or “away,” rotations usually occur in medical students’ fourth year and often align with participants’ specialty of interest at an institution for which they have an interest in the residency program. Consequently, visiting rotations have become increasingly important as a means to get to know medical students and may play a role in interviewing and ranking prospective applicants. COVID-19 prevented many in-person medical student rotations and led to various activities being transitioned to online learning experiences. The authors, from the University of Washington Medical Center, Seattle, described the transition of their department of laboratory medicine and pathology from a traditional on-site learning to a remote virtual pathology rotation. They undertook a project to develop and demonstrate methods for minimizing the limitations of virtual learning and enhancing medical students’ experiences. The authors listed their virtual away rotation in the visiting student application service and advertised it via social media and medical student mailing lists. From a pool of 24 applications, they selected nine students (all but one of whom indicated an interest in a pathology residency) to participate in three four-week–long rotations (three students per rotation). The virtual rotations were designed to mimic the in-person rotations, with didactic lectures and daily sign-outs, but included such activities as reviewing digitally scanned slide trays of whole slide images, as well as small group problem-based learning. The authors adapted the teaching materials of a prior virtual medical student pathology course. At the end of the rotation, students, residents, and fellows who led slide presentations were asked to anonymously evaluate the virtual program. Students were asked to rate faculty performance using a Likert scale of one to five, and respondents were asked to provide their perceptions of the positive and negative aspects of the course in the form of free-text answers. The medical students were evaluated using their home institutions’ forms, in the same manner as for traditional visiting rotations. The feedback from the medical student participants and instructors was overwhelmingly positive. The most effective teaching tool was determined to be the virtual slide sessions, and the students reported that reviewing slides virtually did not detract from the experience. Of note, volunteer trainee instructors indicated that the experience improved their teaching and diagnostic skills, and they expressed an interest in teaching future virtual courses. The authors found that because students were not limited to one rotation site, more people could participate, which enhanced the learning experience and sense of community. The authors concluded that, based on their experience, large pathology and laboratory medicine departments can adapt to virtual medical student rotations and that virtual rotations should be considered post-pandemic. Virtual rotations may be particularly advantageous for medical students who find in-person visiting rotations to be cost-prohibitive.
Koch LK, Correll-Buss A, Chang OH. Implementation and effectiveness of a completely virtual pathology rotation for visiting medical students. Am J Clin Pathol. 2022;157(3):406–412.
Correspondence: Dr. Lisa K. Koch at lkoch@uw.edu
Persistence and genetic adaptation of Pseudomonas aeruginosa in patients with COPD
Pseudomonas aeruginosa is seen in up to 20 percent of bacterial airway exacerbations in patients with chronic obstructive pulmonary disease and is associated with higher rates of morbidity and mortality than other pathogens. It is unclear whether this infection is caused by intermittent different P. aeruginosa lineages, persistence of the same lineage, or lineages that have adapted genetically to confer a selective advantage in the airway of the host. The authors conducted a study in which they performed whole genome sequencing on P. aeruginosa-positive sputum samples from a large population of systematically selected patients with chronic obstructive pulmonary disease (COPD). They hypothesized that P. aeruginosa persists in the airways of patients with COPD due to a genetic adaptation in genes encoding clinically important phenotypes, such as antibiotic resistance. The objectives of the study were to determine the prevalence of recurrent P. aeruginosa in sputum samples from patients with COPD up to one year after the initial positive samples, ascertain whether P. aeruginosa infection was due to the same clonal lineage in each patient with COPD or different clonal lineages, and identify gene mutations and COPD-associated pathoadaptive genes in P. aeruginosa lineages. The authors performed whole genome sequencing of P. aeruginosa isolates obtained from the sputum cultures of patients with COPD who were already enrolled in an ongoing randomized clinical trial. They performed sequencing on 153 P. aeruginosa isolates from 23 patients during 365 days of follow-up. The authors observed recurrence of P. aeruginosa in 19 (83 percent) patients after the first positive sputum sample during follow-up. All but one patient carried the same clonal lineage as in the first culture during the study. The authors identified 38 genes that were mutated in parallel in two or more lineages, which suggests positive selection for adaptive mutations. Mutation enrichment analysis showed that genes that played an important role in antibiotic resistance and chronic infections were more likely to be mutated. The study found that recurrent P. aeruginosa persisted for a long time after initial infection in the airways of COPD patients. The authors concluded that persistent P. aeruginosa infection was due to the same clonal lineage in most patients with COPD and that the clone was associated with genetic adaptation. They suggested that further research, including trial data on antibiotics for eliminating P. aeruginosa infection in this population of susceptible patients, is needed to improve therapy.
Eklöf J, Misiakou MA, Sivapalan P, et al. Persistence and genetic adaptation of Pseudomonas aeruginosa in patients with chronic obstructive pulmonary disease. Clin Microbiol Infect. 2022. https://doi.org/10.1016/j.cmi.2022.01.017
Correspondence: Rasmus L. Marvig at rasmus.lykke.marvig@regionh.dk