Karishma Patel, MD

All Publications

• 'Trial and Error'-How Do Interns Learn Their Role-Specific Workplace Skills? The clinical teacher Patel, K., Dhaliwal, G. 2026; 23 (1): e70278

  Abstract

  Many of the essential workplace skills interns (graduates of US medical schools who are in their first year of supervised practice as physicians) need to function in their roles are taught briefly (e.g., a single didactic session) or are not formally taught at all. These role-specific skills-for example, managing a task list, constructing a patient handoff and calling a consultant-are not addressed like core medical knowledge subjects (e.g., diabetes) or clinical skills (e.g., procedures), which are reinforced through patient interactions, colleague discussions, supervisor feedback and didactics throughout residency. Understanding how interns learn their role-specific skills could empower them to manage their workplace learning opportunities.We conducted a qualitative study to examine how interns acquire role-specific workplace skills. We conducted semistructured interviews of 16 interns in an internal medicine residency programme. Interview transcripts were analysed using template analysis. Codes were identified, refined and grouped into overarching themes.Interns described an iterative learning process ('trial and error') informed by peers and supervisors, reflection on the outcomes of completed tasks and technology. Participants identified time and workload pressures as positive influences on their learning. Planning, formal goal setting and direct feedback were not described; instead, interns recognised their progress retrospectively and subjectively, rather than using predefined benchmarks.Interns learn many role-specific skills through an iterative and unstructured approach that aligns with workplace learning literature. Targeted reflection and teaching and feedback from supervisors may enhance skill acquisition.

  View details for DOI 10.1111/tct.70278

  View details for PubMedID 41365495

• Changing the way we do things: a qualitative exploration of culture change in clinical care and education before and during the COVID-19 pandemic in an academic health center. Discover health systems Marr, M. C., Patel, K., Harrison, R. A. 2025; 4 (1): 68

  Abstract

  This study investigated the necessity of culture change in clinical care and medical education within a US academic hospital before and during the COVID-19 pandemic. It explored how the syndemics of COVID-19, racism, and the mental health crisis magnified the urgency of culture change in healthcare and aimed to understand the impact of these syndemics on healthcare and educational culture.An 11-item survey with 8 open-ended questions was distributed to healthcare teams and trainees at a large academic medical center before (Dec 2019 to March 2020) and during the pandemic (Feb 2021 to April 2021). The survey examined need for culture change, where it has worked well, and factors contributing to successful culture change. Responses were analyzed and themes were generated by qualitative analysis.The study revealed a strong focus on person-centered care before the pandemic with an emphasis on interdisciplinary care, communication, and safety. Within the pandemic, the focus shifted to COVID-19 safety, increased staffing and support, addressing health disparities and racism in healthcare, and use of telemedicine. As the pandemic evolved, burnout and mental health concerns became more prominent raising questions about the sustainability of culture changes..The study highlighted cultural shifts within healthcare and medical education magnified by syndemics. There is a growing emphasis on anti-racism, respect, and psychological safety. It emphasized the importance of understanding cultural shifts within institutions to drive effective culture change. Future research should explore different healthcare settings and post-pandemic culture changes. This study provided valuable insight into the landscape of culture change, clinical care, and education, especially in response to COVID-19 pandemic challenges.The online version contains supplementary material available at 10.1007/s44250-025-00241-7.

  View details for DOI 10.1007/s44250-025-00241-7

  View details for PubMedID 40486663

  View details for PubMedCentralID PMC12141360

• Osimertinib-induced biventricular cardiomyopathy with abnormal cardiac MRI findings: a case report. Cardio-oncology (London, England) Patel, K., Hsu, K. Y., Lou, K., Soni, K., Lee, Y. J., Mulvey, C. K., Baik, A. H. 2023; 9 (1): 38

  Abstract

  Osimertinib is a third-generation epidermal growth factor receptor (EGFR) inhibitor that is currently the first-line treatment for metastatic EGFR-mutated non-small-cell lung cancer (NSCLC) due to its favorable efficacy and tolerability profile compared to previous generations of EGFR inhibitors. However, it can cause uncommon, yet serious, cardiovascular adverse effects.We present the case of a 63-year-old man with EGFR-mutated NSCLC treated with osimertinib who developed new-onset non-ischemic cardiomyopathy with biventricular dysfunction and heart failure in the context of an enlarging pericardial effusion. For the first time, we demonstrate cardiac MR imaging findings associated with osimertinib-associated cardiomyopathy, including focal late gadolinium enhancement and myocardial edema. The patient's biventricular function normalized after initiation of goal-directed medical therapy for heart failure and holding osimertinib. The patient was subsequently started on afatinib, a second-generation epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI), without recurrence of cardiomyopathy.This case highlights the need to better understand osimertinib-induced cardiotoxicity and strategies to optimize oncologic care in patients who develop severe cardiac toxicities from cancer therapy. It further underlines the importance of specialized multidisciplinary care of cancer patients who develop cardiotoxicities to optimize their oncologic outcomes.

  View details for DOI 10.1186/s40959-023-00190-1

  View details for PubMedID 37908018

  View details for PubMedCentralID PMC10617075

• Factors Associated With Nonattendance at the Adult Congenital Heart Disease Clinic. The American journal of cardiology McGrath, L., Patel, K., Colina Garcia, I., Shalen, E., Burton, Y., Khan, A. 2023; 201: 247-251

  Abstract

  Adults with congenital heart disease (CHD) are a complex population for whom adult CHD-specific care results in better outcomes. Our objective was to identify factors associated with no-shows and cancelations in an adult CHD (ACHD) clinic and evaluate the efficacy of a social worker intervention to promote ambulatory follow-up. The medical record identified adults with a scheduled appointment in the adult CHD clinic from January 2017 to March 2021. Social worker intervention was performed between March 2020 and May 2021 and consisted of phone calls to those who did not show up. Logistic regression and descriptive statistics were performed. Of 8,431 scheduled visits, 56.7% were completed, 4.6% were no-shows, and 17.5% were canceled by patients. The factors associated with no-shows were Medicaid (odds ratio [OR] 1.63, 95% confidence interval [CI] 1.26 to 2.12, p <0.001), previous no-show (OR per 1% increase in previous no-show rate 1.13, 95% CI 1.12 to 1.15, p <0.001), satellite clinic location (OR 3.15, 95% CI 2.06 to 4.74, p <0.001), virtual visit (OR 1.97, 95% CI 1.28 to 2.92, p = 0.001), and Hispanic ethnicity (OR 1.48, 95% CI 1.03 to 2.10, p = 0.031). The factors associated with cancelations were female gender (OR 1.45, 95% CI 1.25 to 1.68, p <0.001) and virtual visits (OR 2.24, 95% CI 1.50 to 3.40, p <0.001). Social worker outreach calls did not impact frequency of rescheduling. No patients accepted additional support. In conclusion, Medicaid insurance, previous number of no-shows, and Hispanic ethnicity were found to be associated with a higher risk of no-show, identifying a high-risk population that may benefit from targeted interventions. Social worker outreach did not have an appreciable impact on the rescheduling rates.

  View details for DOI 10.1016/j.amjcard.2023.06.014

  View details for PubMedID 37393726

• Echocardiographic changes and impact on clinical management in pregnant women with heart disease. Cardiology in the young Patel, K., McGrath, L., Roldan, P., Taunton, M., Brookfield, K., Paré, E., Khan, A. 2023; 33 (3): 449-456

  Abstract

  While guidelines recommend echocardiography for pregnant women with heart disease, there are limited data on its effect on clinical practice. In this study, we investigated pregnancy-associated echocardiographic changes and their impact on management.This was a retrospective study of pregnant women with heart disease followed at an academic medical centre from 2016 to 2020. Data on maternal intrapartum and postpartum echocardiograms were collected and the impact on management analysed.421 echocardiograms in 232 pregnancies were included in the study. The most common cardiac diagnosis was CHD (60.8% of pregnancies), followed by cardiomyopathy (9.9%). The frequency of baseline echocardiographic abnormalities varied by diagnosis, with abnormal right ventricular systolic pressure being the most common (15.0% of pregnancies in CHD and 23.1% of pregnancies with cardiomyopathy). 39.2% of the 189 follow-up echocardiograms had a significant change from the prior study, with the most common changes being declines in right ventricular function (4.2%) or left ventricular function (3.7%), and increases in right ventricular systolic pressure (5.3%) and aortic size (21.2%). 17.8% of echocardiograms resulted in a clinical management change, with the most common change being shorter interval follow-up.Echocardiographic changes in pregnant women with heart disease are common, in particular increases in aortic size. Echocardiography results in changes in management in a small but significant proportion of patients. Further studies are needed to determine how other factors, including patient access and resource allocation, factor into the use of echocardiography during pregnancy.

  View details for DOI 10.1017/S1047951122001135

  View details for PubMedID 35726562

• Utility of continuous electrocardiographic monitoring in pregnant women with cardiovascular disease. International journal of cardiology. Congenital heart disease Roldan, P., McGrath, L., Patel, K., Brookfield, K., Pare, E., Khan, A. 2022; 7: 100305

  Abstract

  Arrhythmias are a common complication in pregnant women with heart disease. While continuous electrocardiographic monitoring is a useful tool for diagnosis, it also has significant associated costs, and identifying which pregnant women are most likely to benefit from monitoring is an important goal.This is a retrospective observational study of pregnant adult women with heart disease cared for at an academic medical center between 2016 and 2020. Clinical information and ambulatory and inpatient monitoring results were abstracted from the electronic health record and descriptive statistics and T-tests were used to characterize the population.A total of 258 pregnancies in 202 unique women were included. The most common type of cardiovascular disease was congenital heart disease (56.6%), followed by cardiomyopathy (11.2%). An ambulatory monitor was ordered in 26.7% of pregnancies in the antepartum period, and 26.1% of these had clinically significant findings. 46.4% of monitors resulted in a clinical management change, with the most common changes being no recommendation for intrapartum electrocardiographic monitoring (20.3%) and starting a new medication (14.5%). Continuous electrocardiographic monitoring was used in 54.8% of deliveries, and detected a significant arrhythmia in only 2 cases (0.1%).A symptom driven protocol for ambulatory monitoring in pregnancy yields abnormal findings in a significant proportion of patients, and nearly half trigger a change in clinical management. Intrapartum electrocardiographic monitoring has a low yield, with a significant arrhythmia detected in less than 1% of pregnancies in this cohort.

  View details for DOI 10.1016/j.ijcchd.2021.100305

  View details for PubMedID 39712259

  View details for PubMedCentralID PMC11657330

• THE IMPACT OF ECHOCARDIOGRAPHY ON CLINICAL MANAGEMENT IN PREGNANT WOMEN WITH HEART DISEASE Patel, K., McGrath, L., Roldan, P., Brookfield, K., Pare, E., Khan, A. ELSEVIER SCIENCE INC. 2021: 3396

  View details for Web of Science ID 000647487503417

• GASTROINTESTINAL MANIFESTATIONS OF COVID-19 IN ICU AND NON-ICU PATIENTS: A MULTI-CENTER COHORT STUDY Patel, A., Sanders, T., Alvencar, S., Choi, A. Y., Law, J., Shah, J., Patel, K., Nguyen, M., Yasin, T., Kim, D. M., Prakash, P., Sidhu, T. K., Srivoleti, P., Chauhan, K., Weissman, S., Holzwanger, E. A., Dhingra, R., Dickstein, A., Parekh, N. K., Tabibian, J. H., Altayar, O., Ciorba, M. A., Yu, J. X., Chen, L., Yang, L., Limketkai, B. N. W B SAUNDERS CO-ELSEVIER INC. 2021: S186

  View details for Web of Science ID 000649085000439

• GASTROINTESTINAL MANIFESTATIONS OF COVID-19 ACROSS THE UNITED STATES: A MULTI-CENTER COHORT STUDY Patel, A., Sanders, T., Alvencar, S., Choi, A. Y., law, J., Shah, J., Patel, K., Nguyen, M., Yasin, T., Kim, D. M., Prakash, P., Sidhu, T. K., Srivoleti, P., Chauhan, K., Weissman, S., Holzwanger, E. A., Dhingra, R., Dickstein, A., Parekh, N. K., Tabibian, J. H., Altayar, O., Ciorba, M. A., Yu, J. X., Chen, L., Yang, L., Limketkai, B. N. W B SAUNDERS CO-ELSEVIER INC. 2021: S187

  View details for Web of Science ID 000649085000442

• The Natural History of Indeterminate Blunt Cerebrovascular Injury. JAMA surgery Crawford, J. D., Allan, K. M., Patel, K. U., Hart, K. D., Schreiber, M. A., Azarbal, A. F., Liem, T. K., Mitchell, E. L., Moneta, G. L., Landry, G. J. 2015; 150 (9): 841-7

  Abstract

  The Denver criteria grade blunt cerebrovascular injuries (BCVIs) but fail to capture many patients with indeterminate findings on initial imaging.To evaluate outcomes and clinical significance of indeterminate BCVIs (iBCVIs).A retrospective review of all patients treated for BCVIs at our institution from January 1, 2007, through July 31, 2014, was completed. Patients were divided into 2 groups: those with true BCVIs as defined by the Denver criteria and those with iBCVIs, which was any initial imaging suggestive of a cerebrovascular arterial injury not classifiable by the Denver criteria.Primary outcomes were rate of resolution of iBCVIs, freedom from cerebrovascular accident (CVA) or transient ischemic attack (TIA), and 30-day mortality.We identified 100 patients with 138 BCVIs: 79 with true BCVIs and 59 with iBCVIs. With serial imaging, 23 iBCVIs (39.0%) resolved and 21 (35.6%) remained indeterminate, whereas 15 (25.4%) progressed to true BCVI. The rate of CVA or TIA in the iBCVI group was 5.1% compared with 15.2% in the true BCVI group (P = .06). Of the 15 total CVAs or TIAs, 11 (73.3%) resulted from carotid injury and 4 (26.7%) from vertebral artery occlusion (P = .03). By Kaplan-Meier analysis, there was no difference in freedom from CVA or TIA for the 2 groups (P = .07). Median clinical follow-up was 91 days. Overall and 30-day mortality for the entire series were 17.4% and 15.2%, respectively. There was no difference in long-term or 30-day mortality between true BCVI and iBCVI groups.Detection of iBCVI has become a common clinical conundrum with improved and routine imaging. Indeterminate BCVI is not completely benign, with 25.4% demonstrating anatomical progression to true BCVI and 5.1% developing cerebrovascular symptoms. We therefore recommend serial imaging and antiplatelet therapy for iBCVI.

  View details for DOI 10.1001/jamasurg.2015.1692

  View details for PubMedID 26200995