Department of Family Medicine & Community Health

The 2018 Pacific Region Indigenous Doctors Congress (PRIDoC) conference featured a student track curriculum that was developed by students at the John A. Burns School of Medicine. Activities were designed around the student track theme, ho'oku'ikahi, meaning "unity" or "unify," as well as the overarching conference theme 'Oi Ola Wai Hōnua meaning "life is better while the earth has water." Following the conference, surveys were distributed among the trainees who had participated in the student track. The survey feedback was used to evaluate the student track curriculum, as well as its execution. Learning objectives developed for the Student Track were (1) to build formal professional networks, (2) to build a knowledge economy with shared knowledge among participants, and (3) to engage in cultural experiences. Analysis of qualitative data suggest that all learning objectives were satisfactorily fulfilled through planned conference activities. The data will be used to facilitate student tracks at future PRIDoC conferences. The student track at PRIDoC aims to establish and contribute to an ever-growing international network of indigenous students that will extend into professional practice.

Acute anisocoria and unilateral mydriasis is physically alarming to patients and diagnostically worrisome to clinicians. We report the case of a 14-year-old girl who presented to the pediatric emergency department with acute anisocoria and unilateral mydriasis after contacting an Angel's trumpet plant and who had complete resolution of symptoms four days following eye contamination. The Angel's trumpet plant contains three active components which can result in mydriasis: hycosamine, atropine, and scopolamine. The three active components occur in different parts of the plant, including on the small glandular hairs that cover the entire plant. This likely explains why even brief contact with the plant can result in unintentional contamination of the eye and in mydriasis. It is critical when obtaining a history from a patient with such a presentation to ask explicitly about any contact with plants prior to onset of symptoms. Although eye contamination with the Angel's trumpet plant is self-limited and resolves within a week, the appearance of a persistently unilateral mydriatic eye can be alarming to patients and clinicians, which too often results in an unnecessary, costly workup.

Accredited medical schools are required to prepare students to recognize the social determinants of health, such as privilege, yet privilege education has been overlooked in medical school curricula. The purpose of this study is to determine whether a single class session on privilege, within a social justice elective offered to first and second year medical students, is sufficient to change the perspective of medical students concerning their own personal privilege. A pre-class survey, followed by a class session on privilege, and post-class survey were conducted. Thirteen of the 18 students enrolled in the elective completed the pre-class survey. Ten students completed the post-class survey, although only 9 completed both the pre-and post-class surveys. The demographic profile of the participants was 93% Asian and 7% White ethnicity, with 57% identifying as being culturally American. There was no significant difference between average male and female or between age groups' self-assessed privilege amounts. For all characteristics tested, except hair color, participants had an increased self-assessed privilege perspective following the class. Three participants had an overall positive difference in privilege perspective, three participants had an overall negative difference in privilege perspective, and three participants had only a minimal change in privilege perspective. The absolute total difference in privilege perspective was 25 units of change. The single class session on privilege was sufficient to change significantly the perspective of medical students on their own personal privilege; however, future studies with larger groups of medical students are needed to elucidate other findings suggested by this study.

Primary care is the greatest physician specialty shortage area nationally and in the State of Hawai'i, and the shortage is expected to worsen in the coming years. During the 2015-2016 academic year, a 6-month Primary Care Mentorship Program (PCMP) for first-year medical students was launched at the John A. Burns School of Medicine (JABSOM). This study sought to determine (1) whether participation in a PCMP as a first-year medical student correlates with an increased likelihood of matching into a primary care graduate medical education (GME) residency specialty, (2) whether the PCMP medical student participants developed lasting mentorship relationships with their assigned mentor, and (3) whether a PCMP is a worthwhile endeavor for medical schools to incorporate into their structured undergraduate medical education curriculum. Mentees were surveyed before and after the PCMP and after the residency Match. Overall, 105 (36%) of the 288 students in the JABSOM classes of 2019-2022 have applied to participate in the PCMP. Seventeen (85%) of the 20 JABSOM class of 2019 PCMP mentees completed the post-Match reflection survey. The study found as follows: (1) participation in a 6-month PCMP as a first-year medical student does not correlate with an increased likelihood of matching into a primary care GME residency specialty, (2) 7 (41%) participants did continue their mentorship relationship following completion of the PCMP, and (3) overwhelmingly positive qualitative feedback from mentees and the number of mentees who did establish lasting mentorship relationships suggest a PCMP is a worthwhile endeavor for medical schools to implement.

The Lana'i Community Health Center (LCHC) like other health care organizations, is striving to implement technology-enabled care (TEC) in the clinical setting. TEC includes such technological innovations as patient portals, mobile phone applications, wearable health sensors, and telehealth. This study examines the utilization of communication technology by members of the Lana'i community and LCHC staff and board members in the home and in their daily lives and evaluates the community's electronic health literacy. Quantitative surveys and qualitative focus groups were utilized. These revealed that members of the Lana'i community and LCHC staff and board members regularly utilize technology, in the form of smart cell phones, WiFi, and internet texting. This community has integrated technology into their daily lives, even though they live on an isolated island with 3,102 people; however, despite this integration, the electronic health literacy of this population appears...

Studies from around the world have found that the preferred place of death is at home. Although desired, the ability to die at home requires personal, social, and structural factors to be in place. In the United States, between 2003 and 2017, there were decreased hospital and nursing facility deaths and increased home and hospice facility deaths. This study aims to determine whether a change in the place of death in those greater than 65 years of age in Hawai'i is similar to the overall United States data and if these changes in place of death are similar across islands/counties in the state of Hawai'i. Data from the Centers for Disease Control and Prevention database were analyzed for natural deaths between 2003 and 2018 in Hawai'i. Between 2003 and 2018, there were 120 115 natural deaths in Hawai'i, with a decrease in the overall percentage of deaths in hospitals from 53% in 2003 to 33% in 2018. During the same period, home deaths increased from 23% to 33%, and nur...

The 2018 Pacific Region Indigenous Doctors Congress (PRIDoC) conference featured a student track curriculum that was developed by students at the John A. Burns School of Medicine. Activities were designed around the student track theme, ho'oku'ikahi, meaning "unity" or "unify," as well as the overarching conference theme 'Oi Ola Wai Honua meaning "life is better while the earth has water." Following the conference, surveys were distributed among the trainees who had participated in the student track. The survey feedback was used to evaluate the student track curriculum, as well as its execution. Learning objectives developed for the Student Track were (1) to build formal professional networks, (2) to build a knowledge economy with shared knowledge among participants, and (3) to engage in cultural experiences. Analysis of qualitative data suggest that all learning objectives were satisfactorily fulfilled through planned conference activities....

in the State of Hawai'i, and the shortage is expected to worsen in the coming years. During the 2015-2016 academic year, a 6-month Primary Care Mentorship Program (PCMP) for first-year medical students was launched at the John A. Burns School of Medicine (JABSOM). This study sought to determine (1) whether participation in a PCMP as a first-year medical student correlates with an increased likelihood of matching into a primary care graduate medical education (GME) residency specialty, (2) whether the PCMP medical student participants developed lasting mentorship relationships with their assigned mentor, and (3) whether a PCMP is a worthwhile endeavor for medical schools to incorporate into their structured undergraduate medical education curriculum. Mentees were surveyed before and after the PCMP and after the residency Match. Overall, 105 (36%) of the 288 students in the JABSOM classes of 2019-2022 have applied to participate in the PCMP. Seventeen (85%) of the 20 JABSOM class ...

Acute anisocoria and unilateral mydriasis is physically alarming to patients and diagnostically worrisome to clinicians. We report the case of a 14-year-old girl who presented to the pediatric emergency department with acute anisocoria and unilateral mydriasis after contacting an Angel's trumpet plant and who had complete resolution of symptoms four days following eye contamination. The Angel's trumpet plant contains three active components which can result in mydriasis: hycosamine, atropine, and scopolamine. The three active components occur in different parts of the plant, including on the small glandular hairs that cover the entire plant. This likely explains why even brief contact with the plant can result in unintentional contamination of the eye and in mydriasis. It is critical when obtaining a history from a patient with such a presentation to ask explicitly about any contact with plants prior to onset of symptoms. Although eye contamination with the Angel's trump...