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Papers by Bobby Miller
Frontiers in Medicine, 2021
Purpose We have observed that students' performance in our pre-clerkship curriculum does not ... more Purpose We have observed that students' performance in our pre-clerkship curriculum does not align well with their United States Medical Licensing Examination (USMLE) STEP1 scores. Students at-risk of failing or underperforming on STEP1 have often excelled on our institutional assessments. We sought to test the validity and reliability of our course assessments in predicting STEP1 scores, and in the process, generate and validate a more accurate prediction model for STEP1 performance. Methods Student pre-matriculation and course assessment data of the Class of 2020 (n = 76) is used to generate a stepwise STEP1 prediction model, which is tested with the students of the Class of 2021 (n = 71). Predictions are developed at the time of matriculation and subsequently at the end of each course in the programing language R. For the Class of 2021, the predicted STEP1 score is correlated with their actual STEP1 scores, and data agreement is tested with means-difference plots. A similar m...
P E r s P E c t i v E s open access to scientific and medical research Open Access Full text Article
Journal of Biomedical Education, 2015
Nutrition education is an essential component of medical education if new physicians are to be eq... more Nutrition education is an essential component of medical education if new physicians are to be equipped to address common chronic diseases, including obesity and the associated diabetes, cardiovascular disease, and cancer. Most medical students recognize this need and desire nutrition education; however, finding time in a medical school curriculum and funding are challenging. Available, free online resources and small group exercises can be utilized to provide basic, up-to-date nutrition information to medical students.
Regional Studies in Marine Science, 2017
Weight–length relationships, weight conversion factors and somatic indices are presented from a d... more Weight–length relationships, weight conversion factors and somatic indices are presented from a decade (2006 to 2015) for two stocks of Lophius budegassa and L.piscatorius in northern Iberian Atlantic waters (ICES Div. VIIIc–IXa2) and in Celtic Sea, south-western Ireland and Porcupine Bank (Div. VIIb,c,h,j,k). A total of 3298 L.budegassa and 7219 L.piscatorius were sampled from commercial landings and research surveys. Total length (Lt), total weight (Wt), “commercial” weight (Wgl) and “scientific” weight (Wg) were obtained. The parameters (a, b) in the power relationships weight–length for combined sexes in L.budegassa were: 0.020, 2.916; 0.017, 2.929; 0.017, 2.922 for Wt, Wgl and Wg respectively in Div. VIIIc–IXa2; 0.025, 2.841; 0.013, 2.984; 0.013, 2.971 in Div. VIIb,c,h,j,k. For L.piscatorius: 0.025, 2.853; 0.020, 2.868; 0.024, 2.861 in Div. VIIIc–IXa2; 0.027, 2.826; 0.023, 2.825; 0.023, 2.816 in Div. VIIb,c,h,j,k. Significant differences between stocks were found in both species. The conversion factors between total and gutted weight in L.budegassa were: 1.186, 1.236 for Wgl and Wg respectively in Div. VIIIc–IXa2; 1.187, 1.233 in Div. VIIb,c,h,j,k. For L.piscatorius: 1.181, 1.241 in Div. VIIIc–IXa2; 1.210, 1.262 in Div. VIIb,c,h,j,k. The parameters can be used in the process of annual assessment of the state of each stock. Gonadosomatic index (GSI), hepatosomatic index (HSI) and Le Cren’s condition factor, indicators of reproductive and nutritional status, were seasonally analyzed and compared between sexes and stocks. Significant better condition and higher GSI and HSI were found in females. In Div. VIIb,c,h,j,k better condition was found for both species and higher GSI for L.piscatorius. The analysis throughout the year of GSI and HSI for L.budegassa showed seasonality in liver growth previous to spawn and corroborated the spawning season from January to June in VIIIc–IXa2. The parameters obtained were compared with previous ones from these and others Lophiiformes, showing common patterns.
Medical Science Educator, 2015
Purpose: We have observed that students’ performance in our PreClerkship curriculum does not alig... more Purpose: We have observed that students’ performance in our PreClerkship curriculum does not align well with their USMLE STEP1 scores. Students at-risk of failing or underperforming on STEP1 have often excelled in our institutional assessments. We sought to test the validity and reliability of our course-assessments in predicting STEP1 scores, and in the process generate and validate a more accurate prediction model for STEP1 performance.Methods: Student pre-matriculation and course assessment data of the Class of 2020 (n = 76) is used to generate a stepwise STEP1 prediction model, which is tested with the students of the Class of 2021 (n = 71). Predictions are generated for the end of each course in the programing language R. For the Class of 2021, predicted STEP1 score is correlated with their actual STEP1 scores and data-agreement is tested with means-difference plots. A similar model is generated and tested for the Class of 2022.Results: STEP1 predictions based pre-matriculation...
Epocrates, Inc. was privately founded in 1998 and is currently headquartered in San Mateo, Cal i ... more Epocrates, Inc. was privately founded in 1998 and is currently headquartered in San Mateo, Cal i fornia. According to their website (www.epocrates.com), “Epocrates, Inc. develops clinical information and decision support tools that enable healthcare professionals to find answers more quickly and confidently at the point-of-care,” (Epocrates Company Overview, 2009). The company currently employs more than 200 individuals including physicians and pharmacists who continuously review and update clinical content. They proudly state on their website that “more than 900,000 healthcare professionals, including more than one in three U.S. physicians, use Epocrates’ innovative mobile and web-based products to help them reduce medical errors, improve patient care and increase productivity,” (Epocrates Company Overview, 2009).
American Journal of Case Reports
Patient: Male, newborn Final Diagnosis: Hypoxic ischemic encephalopathy Symptoms: Arthrogryposis ... more Patient: Male, newborn Final Diagnosis: Hypoxic ischemic encephalopathy Symptoms: Arthrogryposis • bitemporal wasting • graf type IIa dysplasia • NAS symptoms Medication: — Clinical Procedure: — Specialty: Pediatrics and Neonatology Objective: Congenital defects/diseases Background: With the increasing prevalence of substance use in pregnancy, the rates of neonatal abstinence syndrome (NAS) are dramatically increasing. There is little information on the use of multiple substances in adults, even less so of polysubstance abuse during pregnancy and the consequences for the fetus as well as the mother. Case Report: A newborn male born at 35 weeks presented post-delivery with hips bilaterally dislocated and hyperflexed. The patient’s legs fully extended and their shoulders were bilaterally mid-flexed with arms fully extended. This neonate was also reported to have bilateral hearing and vision loss as well as NAS symptoms of high-pitched crying and respiratory distress. During pregnancy the mother in this case study admitted to using buprenorphine, benzodiazepines, gabapentin, and heroin. The consequences of using this combination has not been well studied in pregnancy. Conclusions: The presented case had severe complications, likely due to maternal polysubstance use and poor prenatal care in pregnancy. Clonidine was used to control the NAS symptoms, ranitidine was used to treat the gastroesophageal reflux, and glycopyrronium bromide was used for the neonate’s excessive secretions. After delivery, the patient was placed on a nasal noninvasive cannula for respiratory distress and was transferred to a different hospital for treatment of the more serious comorbid conditions.
SAGE Open Medicine
Objective: The purpose of this study was to investigate the effect of the use of high-fidelity si... more Objective: The purpose of this study was to investigate the effect of the use of high-fidelity simulators with multidisciplinary teaching on self-reported confidence in residents. Methods: A total of 26 residents participated in a session led by a pediatric faculty member and a Neonatal Intensive Care Unit transport nurse using a high-fidelity pediatric simulator. Multiple scenarios were presented and each resident took turns in various roles. Pre-intervention surveys based on a 5-point Likert-type scale were given before the scenarios and were compared to the results of identical post-intervention surveys. Results: Statistically significant (p
Medical Science Educator, 2015
As medical disciplines have become increasingly interdisciplinary and evidenced-based medicine is... more As medical disciplines have become increasingly interdisciplinary and evidenced-based medicine is widely practiced, there is a need for curricula that reflect these changes. The newly revised LCME standards 1.1 Strategic Planning and Continuous Quality Improvement and 8.3 Curricular Design, Review, Revision/Content Monitoring require ongoing curricular review to assure accreditation compliancy. We have completed a comprehensive review of our curriculum and have moved from a discipline-based curriculum to that of one that focuses on a systems/disease-based model. The approach allows for a more horizontally integrated curriculum in the preclinical years, while the use of 115 distinct disease and eight themes creates a quality assurance mechanism that allows for tracking of vertical integration across the entire curriculum. The first step in the development of this quality assurance model was to establish and empower a newly formed integration subcommittee. This subcommittee was tasked with developing a model to review, track and improve the horizontal and vertical integration of the curriculum. Our integrated curriculum is now in its second year having completed the initial identification of gaps and redundancies through a process that relies on the mapping of diseases and themes throughout the courses. This ongoing review and evaluation process has created a dynamic quality assurance process that allows our faculty to address issues of both horizontal and vertical integration of our curriculum at the course level.
Advances in Medical Education and Practice, 2014
Many schools seek to predict performance on national exams required for medical school graduation... more Many schools seek to predict performance on national exams required for medical school
graduation using pre-matriculation and medical school performance data. The need for targeted
intervention strategies for at-risk students has led much of this interest. Assumptions that preadmission
data and high stakes in-house medical exams correlate strongly with national
standardized exam performance needs to be examined. Looking at pre-matriculation data for
predicting USMLE Step 1 performance, we found that MCAT exam totals and math-science
GPA had the best prediction from a set of pre-matriculation values (adjusted R2=11.7%) for Step
1. The addition of scores from the first medical school exam improved our predictive capabilities
with a linear model to 27.9%. As we added data to the model we increased our predictive values
as expected. However, it was not until we added data from year two exams that we started to get Step 1 prediction values that exceeded 50%. Step-wise addition of more exams in year two resulted in much higher predictive values, but also led to the exclusion of many early variables. Therefore, our best Step 1 predictive value of around 76.7% consisted of three variables from a total of 37. These data suggest that the pre-admission information is a relatively poor predictor of licensure exam performance and that including class exam scores allows for much more accurate determination of students who ultimately proved to be at risk for performance on their licensure exams. The continuous use of this data, as it becomes available, for assisting at-risk students is discussed.
Frontiers in Medicine, 2021
Purpose We have observed that students' performance in our pre-clerkship curriculum does not ... more Purpose We have observed that students' performance in our pre-clerkship curriculum does not align well with their United States Medical Licensing Examination (USMLE) STEP1 scores. Students at-risk of failing or underperforming on STEP1 have often excelled on our institutional assessments. We sought to test the validity and reliability of our course assessments in predicting STEP1 scores, and in the process, generate and validate a more accurate prediction model for STEP1 performance. Methods Student pre-matriculation and course assessment data of the Class of 2020 (n = 76) is used to generate a stepwise STEP1 prediction model, which is tested with the students of the Class of 2021 (n = 71). Predictions are developed at the time of matriculation and subsequently at the end of each course in the programing language R. For the Class of 2021, the predicted STEP1 score is correlated with their actual STEP1 scores, and data agreement is tested with means-difference plots. A similar m...
P E r s P E c t i v E s open access to scientific and medical research Open Access Full text Article
Journal of Biomedical Education, 2015
Nutrition education is an essential component of medical education if new physicians are to be eq... more Nutrition education is an essential component of medical education if new physicians are to be equipped to address common chronic diseases, including obesity and the associated diabetes, cardiovascular disease, and cancer. Most medical students recognize this need and desire nutrition education; however, finding time in a medical school curriculum and funding are challenging. Available, free online resources and small group exercises can be utilized to provide basic, up-to-date nutrition information to medical students.
Regional Studies in Marine Science, 2017
Weight–length relationships, weight conversion factors and somatic indices are presented from a d... more Weight–length relationships, weight conversion factors and somatic indices are presented from a decade (2006 to 2015) for two stocks of Lophius budegassa and L.piscatorius in northern Iberian Atlantic waters (ICES Div. VIIIc–IXa2) and in Celtic Sea, south-western Ireland and Porcupine Bank (Div. VIIb,c,h,j,k). A total of 3298 L.budegassa and 7219 L.piscatorius were sampled from commercial landings and research surveys. Total length (Lt), total weight (Wt), “commercial” weight (Wgl) and “scientific” weight (Wg) were obtained. The parameters (a, b) in the power relationships weight–length for combined sexes in L.budegassa were: 0.020, 2.916; 0.017, 2.929; 0.017, 2.922 for Wt, Wgl and Wg respectively in Div. VIIIc–IXa2; 0.025, 2.841; 0.013, 2.984; 0.013, 2.971 in Div. VIIb,c,h,j,k. For L.piscatorius: 0.025, 2.853; 0.020, 2.868; 0.024, 2.861 in Div. VIIIc–IXa2; 0.027, 2.826; 0.023, 2.825; 0.023, 2.816 in Div. VIIb,c,h,j,k. Significant differences between stocks were found in both species. The conversion factors between total and gutted weight in L.budegassa were: 1.186, 1.236 for Wgl and Wg respectively in Div. VIIIc–IXa2; 1.187, 1.233 in Div. VIIb,c,h,j,k. For L.piscatorius: 1.181, 1.241 in Div. VIIIc–IXa2; 1.210, 1.262 in Div. VIIb,c,h,j,k. The parameters can be used in the process of annual assessment of the state of each stock. Gonadosomatic index (GSI), hepatosomatic index (HSI) and Le Cren’s condition factor, indicators of reproductive and nutritional status, were seasonally analyzed and compared between sexes and stocks. Significant better condition and higher GSI and HSI were found in females. In Div. VIIb,c,h,j,k better condition was found for both species and higher GSI for L.piscatorius. The analysis throughout the year of GSI and HSI for L.budegassa showed seasonality in liver growth previous to spawn and corroborated the spawning season from January to June in VIIIc–IXa2. The parameters obtained were compared with previous ones from these and others Lophiiformes, showing common patterns.
Medical Science Educator, 2015
Purpose: We have observed that students’ performance in our PreClerkship curriculum does not alig... more Purpose: We have observed that students’ performance in our PreClerkship curriculum does not align well with their USMLE STEP1 scores. Students at-risk of failing or underperforming on STEP1 have often excelled in our institutional assessments. We sought to test the validity and reliability of our course-assessments in predicting STEP1 scores, and in the process generate and validate a more accurate prediction model for STEP1 performance.Methods: Student pre-matriculation and course assessment data of the Class of 2020 (n = 76) is used to generate a stepwise STEP1 prediction model, which is tested with the students of the Class of 2021 (n = 71). Predictions are generated for the end of each course in the programing language R. For the Class of 2021, predicted STEP1 score is correlated with their actual STEP1 scores and data-agreement is tested with means-difference plots. A similar model is generated and tested for the Class of 2022.Results: STEP1 predictions based pre-matriculation...
Epocrates, Inc. was privately founded in 1998 and is currently headquartered in San Mateo, Cal i ... more Epocrates, Inc. was privately founded in 1998 and is currently headquartered in San Mateo, Cal i fornia. According to their website (www.epocrates.com), “Epocrates, Inc. develops clinical information and decision support tools that enable healthcare professionals to find answers more quickly and confidently at the point-of-care,” (Epocrates Company Overview, 2009). The company currently employs more than 200 individuals including physicians and pharmacists who continuously review and update clinical content. They proudly state on their website that “more than 900,000 healthcare professionals, including more than one in three U.S. physicians, use Epocrates’ innovative mobile and web-based products to help them reduce medical errors, improve patient care and increase productivity,” (Epocrates Company Overview, 2009).
American Journal of Case Reports
Patient: Male, newborn Final Diagnosis: Hypoxic ischemic encephalopathy Symptoms: Arthrogryposis ... more Patient: Male, newborn Final Diagnosis: Hypoxic ischemic encephalopathy Symptoms: Arthrogryposis • bitemporal wasting • graf type IIa dysplasia • NAS symptoms Medication: — Clinical Procedure: — Specialty: Pediatrics and Neonatology Objective: Congenital defects/diseases Background: With the increasing prevalence of substance use in pregnancy, the rates of neonatal abstinence syndrome (NAS) are dramatically increasing. There is little information on the use of multiple substances in adults, even less so of polysubstance abuse during pregnancy and the consequences for the fetus as well as the mother. Case Report: A newborn male born at 35 weeks presented post-delivery with hips bilaterally dislocated and hyperflexed. The patient’s legs fully extended and their shoulders were bilaterally mid-flexed with arms fully extended. This neonate was also reported to have bilateral hearing and vision loss as well as NAS symptoms of high-pitched crying and respiratory distress. During pregnancy the mother in this case study admitted to using buprenorphine, benzodiazepines, gabapentin, and heroin. The consequences of using this combination has not been well studied in pregnancy. Conclusions: The presented case had severe complications, likely due to maternal polysubstance use and poor prenatal care in pregnancy. Clonidine was used to control the NAS symptoms, ranitidine was used to treat the gastroesophageal reflux, and glycopyrronium bromide was used for the neonate’s excessive secretions. After delivery, the patient was placed on a nasal noninvasive cannula for respiratory distress and was transferred to a different hospital for treatment of the more serious comorbid conditions.
SAGE Open Medicine
Objective: The purpose of this study was to investigate the effect of the use of high-fidelity si... more Objective: The purpose of this study was to investigate the effect of the use of high-fidelity simulators with multidisciplinary teaching on self-reported confidence in residents. Methods: A total of 26 residents participated in a session led by a pediatric faculty member and a Neonatal Intensive Care Unit transport nurse using a high-fidelity pediatric simulator. Multiple scenarios were presented and each resident took turns in various roles. Pre-intervention surveys based on a 5-point Likert-type scale were given before the scenarios and were compared to the results of identical post-intervention surveys. Results: Statistically significant (p
Medical Science Educator, 2015
As medical disciplines have become increasingly interdisciplinary and evidenced-based medicine is... more As medical disciplines have become increasingly interdisciplinary and evidenced-based medicine is widely practiced, there is a need for curricula that reflect these changes. The newly revised LCME standards 1.1 Strategic Planning and Continuous Quality Improvement and 8.3 Curricular Design, Review, Revision/Content Monitoring require ongoing curricular review to assure accreditation compliancy. We have completed a comprehensive review of our curriculum and have moved from a discipline-based curriculum to that of one that focuses on a systems/disease-based model. The approach allows for a more horizontally integrated curriculum in the preclinical years, while the use of 115 distinct disease and eight themes creates a quality assurance mechanism that allows for tracking of vertical integration across the entire curriculum. The first step in the development of this quality assurance model was to establish and empower a newly formed integration subcommittee. This subcommittee was tasked with developing a model to review, track and improve the horizontal and vertical integration of the curriculum. Our integrated curriculum is now in its second year having completed the initial identification of gaps and redundancies through a process that relies on the mapping of diseases and themes throughout the courses. This ongoing review and evaluation process has created a dynamic quality assurance process that allows our faculty to address issues of both horizontal and vertical integration of our curriculum at the course level.
Advances in Medical Education and Practice, 2014
Many schools seek to predict performance on national exams required for medical school graduation... more Many schools seek to predict performance on national exams required for medical school
graduation using pre-matriculation and medical school performance data. The need for targeted
intervention strategies for at-risk students has led much of this interest. Assumptions that preadmission
data and high stakes in-house medical exams correlate strongly with national
standardized exam performance needs to be examined. Looking at pre-matriculation data for
predicting USMLE Step 1 performance, we found that MCAT exam totals and math-science
GPA had the best prediction from a set of pre-matriculation values (adjusted R2=11.7%) for Step
1. The addition of scores from the first medical school exam improved our predictive capabilities
with a linear model to 27.9%. As we added data to the model we increased our predictive values
as expected. However, it was not until we added data from year two exams that we started to get Step 1 prediction values that exceeded 50%. Step-wise addition of more exams in year two resulted in much higher predictive values, but also led to the exclusion of many early variables. Therefore, our best Step 1 predictive value of around 76.7% consisted of three variables from a total of 37. These data suggest that the pre-admission information is a relatively poor predictor of licensure exam performance and that including class exam scores allows for much more accurate determination of students who ultimately proved to be at risk for performance on their licensure exams. The continuous use of this data, as it becomes available, for assisting at-risk students is discussed.