Scholarship Pathways Program

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  Infections and Patient Satisfaction for WALANT Hand Surgery in Hospital Procedure Room

  Michaela Derby, Kelly N. McKnight, and Robert E. Van Demark Jr.

  Background: Wide awake hand surgery has allowed many hand procedures to be moved out of the operating room and into minor procedure rooms while increasing efficiency, maintaining safety, and reducing both patient and hospital costs. The goal of this study was to evaluate patient satisfaction and postoperative complications of wide-awake local anesthesia with no tourniquet procedures performed in a community-based hospital procedure room.

  Methods: A total of 786 patients underwent 948 elective hand procedures in a hospital procedure room. At the conclusion of their surgeries, the patients were surveyed regarding their satisfaction. Following surgery, patients were evaluated for postoperative complications including infections. The trend in postoperative infection rates across eight age groups was analyzed using a Cochran-Armitage test in R.

  Results: The overall infection rate was 6.2% (n=59). All infections were superficial. Carpal tunnel had the highest number of infections (n=25), followed by trigger finger (n=8), and the combination trigger finger with carpal tunnel (n=7). All infections were managed with antibiotics and/or soaks. Three patients did require a return to the operating room for irrigation and debridement. Ninety-nine percent of patients said the procedure room experience was better or the same as going to the dentist, would recommend wide-awake anesthesia to a friend or family member, and would undergo the procedure again.

  Conclusion: Wide awake procedures performed in a hospital procedure room have low infection rates with high patient satisfaction.

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  Leadership and Team Communication Course for Medical Students as Future Healthcare Leaders

  Claire Foerster

  As healthcare increasingly adopts a team-based model to address complex patient needs, the role of physicians as effective team leaders becomes critical. Despite this, formal leadership training is not a standard component of medical school curricula. This study presents the development and evaluation of a pilot leadership and communication course designed for medical students at the University of South Dakota. The course combined didactic instruction with simulation-based learning to teach essential skills such as active listening, giving and receiving feedback, and effective communication. A pre-course survey assessed students’ confidence and needs, informing the course design. Post-course assessments, including quizzes and participant feedback, evaluated knowledge retention and the emotional realism of the simulations. Results indicated strong student interest, particularly among early-year students, and highlighted the value of experiential learning in leadership development. The study underscores the importance of integrating structured leadership training into medical education and suggests directions for future curriculum enhancement and research.

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  Effects of Calcineurin Mediated Immunosuppressant Cyclosporine on Binge Alcohol Drinking and Stress Responsivity

  Brock Goeden, Emily Dorn, Jennifer Agar, Thomas P. Beresford, and Patrick J. Ronan

  Stress and neuroinflammation are increasingly recognized as interdependent processes that contribute to the development of psychiatric disorders. This study investigates the bidirectional relationship between stress exposure and neuroimmune activation, focusing on the expression of pro-inflammatory cytokines and behavioral outcomes in rodent models. Using the learned helplessness (LH) paradigm, the authors demonstrate that stress-induced neuroinflammation, particularly elevated IL-1β expression in the hypothalamus, is associated with susceptibility to maladaptive behaviors. The immunosuppressant cyclosporine A (CsA) was shown to attenuate stress-induced expression of neuroinflammatory markers, including IL-1β, IL-6, and CRF. Furthermore, direct intracerebroventricular administration of lipopolysaccharide (LPS), a TLR4 agonist, induced LH-like behavioral deficits in the absence of stress, confirming that neuroinflammation alone can mimic stress-induced behavioral phenotypes. These findings underscore a functional link between stress and neuroinflammatory signaling and suggest that targeting neuroimmune pathways may offer therapeutic potential for stress-related disorders such as depression, PTSD, and alcohol use disorder.

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  Utilizing Registered Dietitians to Improve Nutrition Education for Medical Students

  Andee James and Pasquale Manzerra

  Despite the well-established link between nutrition and chronic disease prevention, medical education continues to underemphasize nutrition training. This study explores the impact of integrating registered dietitians (RDs) into pre-clerkship medical education to enhance students’ knowledge, confidence, and perception of nutrition in clinical care. A series of optional, system-based nutrition lectures were delivered by RDs and supplemented by senior medical students who shared real-world clinical case studies. Pre- and post-session surveys assessed students’ confidence in providing dietary counseling, understanding of the physician’s and dietitian’s roles, and the perceived importance of nutrition in disease management. Results showed significant improvements across all metrics, with confidence in counseling rising from 26.9% to 79.1%, and understanding of the dietitian’s role increasing from 64.7% to 92.5%. Student feedback highlighted the value of interdisciplinary teaching and real-world application. This initiative demonstrates that leveraging RDs in medical education can effectively address gaps in nutrition training and better prepare future physicians for holistic patient care.

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  Lightning Assocated with More Visits to the ED for Chest Pain

  Bailee Lichter and Benjamin Aaker

  This study investigates the potential association between lightning events,used as a proxy for thunder, and increased emergency department (ED) visits for chest pain and myocardial infarction (MI). Electronic medical records from Avera McKennan Hospital were analyzed for chest pain and MI diagnoses between June 1 and July 31, 2021. Lightning data within a 100-mile radius were obtained from Vaisala and cross-referenced with patient presentation times. Statistical analysis revealed a significant increase in chest pain-related ED visits within 0.5 hours and between 2.5 to 5.5 hours following lightning strikes, with p-values ranging from 0.018 to 0.047. Although a trend toward increased MI diagnoses on lightning days was observed, the small sample size limited statistical significance. These findings suggest that acute weather-related noise events may contribute to cardiovascular symptoms, warranting further investigation into environmental stressors and their impact on public health.

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  Transitional Understanding of Kindness in Medical Students

  Madigan Moore, Jerome Freeman, Ann Cook, and Jamie Messerli

  This qualitative study explores how medical students at the University of South Dakota Sanford School of Medicine understand and practice kindness throughout their medical education. Through individual interviews and focus groups conducted in two phases, before and after clinical immersion, the research identifies four central themes: definition of kindness, clinical environments, provider practices, and ethics. Findings reveal that students initially view kindness as an innate trait but increasingly recognize it as a deliberate decision influenced by clinical challenges. Contextual factors such as time constraints, emotional exhaustion, and negative work environments were found to hinder expressions of kindness. Students also noted that ethical preparedness improved significantly after clinical exposure and ethics coursework. The study underscores the importance of integrating kindness and humanitarian values into medical curricula to foster compassionate care and ethical decision-making.

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  Developing Program Infrastructure for Effective Intercultural Education at the Sanford School of Medicine

  Andrew Nerland and DenYelle Kenyon

  This study evaluates the intercultural patient care education at the University of South Dakota Sanford School of Medicine (USD-SSOM) through a mixed-methods survey of medical students. The research explores student perspectives on the importance, effectiveness, and preferred formats of intercultural education, with a focus on preparing future physicians to serve diverse and underserved populations. Findings reveal strong student endorsement of intercultural education but mixed satisfaction with current programming, particularly among female and non-white respondents. Students expressed a preference for longitudinal, required, and in-person education delivered in clinical and community settings. Topics such as Native American health disparities, LGBTQ+ care, and the role of Indian Health Services were identified as areas needing greater curricular emphasis. The study highlights the need for curriculum reform aligned with student preferences and suggests integrating public health education and diverse clinical placements to enhance intercultural competency.

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  Maternal Food Insecurity and Adverse Birth Outcomes

  Narysse Nicolet, Amrita Bhagia, Katie Ziegler, Lacey McCormack, Amy Elliott, and Christine Hockett

  Background: Despite being a high-income country, the United States faces persistent food insecurity (FI), disproportionately affecting women of reproductive age. This study investigates the association between prenatal FI and adverse birth outcomes, specifically birth weight (BW) and gestational age (GA), among a diverse cohort of pregnant individuals in South Dakota.

  Methods: A longitudinal analysis was conducted using data from 1,478 mother-infant pairs enrolled in the Safe Passage Cohort of the ECHO study. Prenatal FI was assessed using a modified USDA Household Food Security Questionnaire. Birth outcomes were analyzed using both univariate and multivariate regression models, adjusting for maternal sociodemographic and health variables.

  Results: Unadjusted analyses revealed statistically significant associations between FI and lower BW and earlier GA. Infants born to food-insecure mothers weighed on average 85 grams less and were more likely to be born preterm. However, after adjusting for covariates, these associations were no longer statistically significant. Higher pre-pregnancy BMI, gravidity, and parity remained significantly associated with adverse birth outcomes.

  Conclusion: While prenatal FI showed marginal associations with adverse birth outcomes after adjustment, the findings underscore the importance of addressing FI as a social determinant of health. The study highlights the need for targeted interventions, particularly among American Indian/Alaska Native populations, and calls for further research into the complex interplay between FI, maternal health, and infant outcomes.

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  Minimizing Grief and Loss Through Advance Care Planning

  Hannah Paauw and Victoria Walker

  Advanced Care Planning (ACP) is a process used to identify or update a specific patient’s preferences of care and treatment in the event that they lack the capacity to do so. ACP is especially important for the aging population and those living with chronic conditions. Currently 11% of the world’s population is above the age of 60 and this number is projected to climb to 22% by 2050. The effects of aging are even greater in rural areas, such as South Dakota, where there is a disproportionate number of older and sicker people.

  This study examined the effectiveness of a program designed to inform South Dakota health professionals about the uses and limitations of different ACP tools including Power of Attorney, Living Will, Comfort One, and MOST (Medical Orders for Scope of Treatment). Health care professionals who work with vulnerable adult populations were recruited through partnerships with long-term care organizations. Participants attended four one-hour long discussion-based sessions about grief, loss, and how it relates to ACP. Continued medical education credit was provided. The primary goals were to increase the comfort level of using ACP tools and help decrease the negative emotional impact on the health care professional. A pre/post knowledge survey and the Professional Quality of Life Scale are used to evaluate these measures.

  Overall, the sessions increased the health care professionals’ comfort with using the ACP tools appropriately and increased professional well-being. Additionally, the sessions were well received and facilitated difficult discussions between professionals in various settings. The study was limited by the number of participants and participants who were not in attendance at all sessions. Further research on barriers to using ACP tools and outcomes of addressing these barriers could help with the overall usage of ACP in South Dakota. The use of implementation science in integrating these skills and tools into the clinical setting should be explored.

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  Ultrasonographic Accuracy in Rural vs Urban Counties

  Riley T. Paulsen, Avery D. Franzen, Amy M. Eichfeld, and Laurie Landeen

  Background: Rural communities in the United States face significant barriers to prenatal care, including limited access to birthing facilities and obstetric providers. Accurate prenatal ultrasonography is essential for identifying congenital anomalies and predicting birth outcomes, particularly in these underserved areas.

  Objective: This study aimed to evaluate whether ultrasonographic accuracy differs between rural and urban counties, specifically in predicting birth weight and detecting congenital anomalies.

  Methods: A retrospective chart review was conducted using data from the Sanford Health system. Maternal and fetal data were collected from second trimester ultrasounds and compared with postnatal outcomes. Counties with populations under 50,000 were classified as rural. Statistical analyses included t-tests, ANOVA, and linear regression.

  Results: Fetal weight percentile at the second trimester ultrasound was not predictive of birth weight percentile in either rural (R² = 0.165) or urban (R² = 0.1103) settings, with no significant difference between models (p = 0.7478). Anomaly detection rates were 50.0% in rural and 31.7% in urban counties, also not statistically significant (p = 0.6416). Maternal age and cervical length differed significantly between groups, but other variables showed no meaningful differences.

  Conclusion: Ultrasonographic accuracy in predicting birth weight and detecting anomalies did not significantly differ between rural and urban counties. Further research with larger sample sizes and consideration of equipment variability is needed to validate these findings and improve prenatal care in rural settings.

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  Improving Interactions During Medical Interpretation: Educational Module for Medical Students

  Alyssa Reinschmidt, DenYelle Kenyon, and Hilda Sanchez-Herrera

  As the population of individuals with limited English proficiency (LEP) continues to grow in South Dakota and across the United States, healthcare systems face increasing challenges in providing equitable care. This study evaluates the implementation of an educational module designed to prepare first-year medical students at the University of South Dakota Sanford School of Medicine (SSOM) to work effectively with medical interpreters and patients with LEP. The module included a didactic session, role-play, open discussion, and pre- and post-surveys assessing students’ knowledge, attitudes, preparedness, and perceptions of the educational environment. Results from 68 participants demonstrated statistically significant improvements across all measured domains. Students reported increased confidence and understanding of interpreter roles, and feedback highlighted the value of incorporating virtual interpretation methods. The findings support the integration of formal interpretation training into medical curricula to enhance future physicians’ ability to deliver culturally and linguistically appropriate care.

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  Menstrual Hygiene Screening Needs Assessment in South Dakota

  Mariah M. Shafer and DenYelle Kenyon

  Introduction: Menstrual hygiene management (MHM) is essential to women’s reproductive health; literature demonstrates there are mental, social, and economic consequences to inadequate MHM in rural and developing countries. Emerging studies show that US women who are impoverished, experiencing homelessness, or incarcerated also face poor MHM. To understand the implications of poor MHM in South Dakota, a largely rural state, a thorough gynecologic health history is essential; this needs assessment explores the scope of MHM questions asked by SD providers.

  Methods: This study used survey methodology to determine the quality and depth of gynecologic health histories commonly taken regarding hygiene. The electronic survey was sent to local primary care providers and nursing staff via email. The survey records the provider's awareness of their patients' menstrual hygiene, and the frequency of specific questions asked. The results of this needs-assessment led to the development of a waiting room screening tool that would allow providers efficient access to their patients’ MHM information.

  Results: Providers’ (N = 70) awareness of MHM in South Dakota varied. The maximum score (57) denotes a respondent who selected “very aware” and “always” for each question. The average score was 22.11; scores ranged from 9 to 47. 24% said they were not at all aware of their patients’ access to MHM products. 74% report never asking their patients if they have access to adequate water and sanitation resources. 15% report never asking their patients which type of hygiene product they use.

  Discussion: This needs assessment demonstrates providers may lack vital information with the potential to inform patient care. While poor MHM is considered in less developed nations, it persists unidentified in populations in South Dakota.

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  Walk With Ease Benefiting South Dakota

  Bailey Thooft and Jennifer Kerkvliet

  The Walk With Ease (WWE) program is a free, evidence-based, six-week walking initiative originally developed by the Arthritis Foundation to support adults with arthritis and other chronic conditions. This study evaluates the impact of WWE in South Dakota, focusing on participant outcomes related to overall health, physical activity, and chronic condition management. Participants engaged in either instructor-led or self-directed formats and accessed an online portal for resources. Pre- and post-surveys revealed that most participants improved or maintained their health metrics, with 44% reporting improved management of chronic conditions and 30% increasing daily walking time. The online portal was well-received, with 90% of users rating it as easy or very easy to use. Despite limitations such as a 61% loss to follow-up and a small sample size, the findings suggest that WWE, especially with digital support, can be a valuable tool for promoting physical activity and health management in rural populations like South Dakota’s. Future research should explore program fidelity and compare outcomes before and after the implementation of online resources.

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  Disability Lectures, Panel Discussion Improve Medical Student Attitudes, Knowledge in SD

  Keely Walker and Eric Kurtz

  Despite growing recognition of persons with disabilities (PWDs) as an underserved population, healthcare disparities persist, often exacerbated by provider misconceptions and lack of training. This study evaluated the impact of a two-part educational module consisting of a didactic session and a panel discussion with individuals with disabilities focused on healthcare students’ knowledge and comfort in caring for patients with intellectual and developmental disabilities (IDDs). Conducted at the University of South Dakota, the sessions included pre- and post-surveys assessing attitudes, confidence, and perceived competencies. Results from 35 participants, primarily medical students, showed statistically significant improvements in 11 of 13 measured domains, including communication skills, understanding of disability experiences, and comfort discussing sensitive topics. The findings support the feasibility and effectiveness of brief, low-resource educational interventions in enhancing disability competency among future healthcare providers. The study highlights the importance of integrating disability education into medical curricula and suggests future directions for interdisciplinary and inclusive training.

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  Examining the Relationships between Work Environment and Stress Coping Mechanisms with Burnout in Medical Students

  Oluwafunke Oluwatosin Ogunremi

  Introduction: Throughout the duration of medical training, learners are oftentimes overworked and faced with high levels of stress and pressure; this can decrease quality of life for many individuals. The goal of this study was to gain an understanding of how work environments and stress coping mechanisms play a role in the amount of burnout experienced by medical students.

  Methods: Data was collected from medical students at the University of South Dakota Sanford School of Medicine by using a 22 question Qualtrics survey. The survey remained open until a 50% response rate was achieved from the student body. The results of the survey were analyzed by using 2 sample t-tests and ANOVA tests as appropriate.

  Results: No statistically significant differences were found in total burnout ratings, coping mechanisms, and perception of the work environment between the different cohorts of medical students. Students who had healthier behaviors, such as following CDC recommendations on sleep, exercise, and fruit and vegetable consumption or practicing meditation and mindfulness, had lower levels of burnout compared to those who did not. Students who stated on the survey that they were experiencing burnout had a lower overall score on the survey, indicating higher levels of burnout.

  Conclusion:Some medical students may recognize when they are burning out, so providing resources to help them incorporate healthier behaviors into their lifestyles may help aid in burnout recovery. Finding effective ways to help students deal with stressors and develop coping mechanisms improves their own quality of life and can hence improve patient outcomes.