Leadership in medical education : competencies, challenges and strategies for effectiveness

The complex nature of health care and medical educational organizations, their different primary goals (clinical service versus education), different organizational structures and the necessity for ensuring efficient and harmonious relationships between these two types of organizations create a challenging environment in which to provide effective medical education leadership. The calls for reform in both medical education and health care have added to these challenges. The purpose of the study was to develop a framework of leadership for medical education and contribute to the literature on leadership in medical education, based on an analysis of the perceptions of key health education leaders in Saskatchewan medical education organizations at the national level in Canada. The main objectives were the identification of core competencies, challenges and strategies for effectiveness in medical education with a focus on unique aspects of about leadership in the medical education setting. Multiple methods of data collection (individual interviews and an “event” study with components of focus groups interviews and short surveys) with subjects of varied backgrounds and at different levels of leadership in medical education were entailed in this study. The data were collected over a period of 13 months (January, 2009 - February, 2010). The perceptions of 32 medical education leaders, stratified into first- (11), middle- (6) and senior-level (15) leadership positions, based upon the hierarchical position and the scope of the job, were obtained and analyzed. Quantitative data were analyzed through descriptive statistics. Qualitative data were analyzed for themes through content analysis. The findings provide useful information on leadership competencies, challenges and effectiveness strategies in medical education. Leadership competencies included five domains including personal and interpersonal characteristics, skills for effective leadership, skills as an efficient manager, skills in medical education delivery, skills as a teacher and skills as a researcher. All leaders considered personal and interpersonal characteristics to be at the core of leadership; while skills in medical education delivery, and skills as a medical education teacher and researcher were considered least important. The senior-level leaders spent most of their time in activities requiring leadership functions (e.g., strategic planning and creating alignment) followed by activities requiring managerial skills (e.g., operational management). This distinction in the rank ordering of leadership and managerial skills was not obvious for the first- and middle-level leaders; however, most did indicate that they spent more of their time in roles requiring more managerial skills than leadership skills. Among the key competencies, essential at all levels, were effective communication and building and managing relationships. For the most part, the leadership skills were acquired informally with only a few leaders having undergone formal leadership training. The leaders faced three types of challenges: personal and interpersonal challenges including effective time management and personal limitations; organizational challenges including those around structures and processes, organizational communication, personal and organizational relationships, creating engagement and alignment, managing culture and resistance and limited resources; and inter-organizational challenges including competing agendas and interests of stakeholders. The context (societal needs, multiple stakeholders and health care reform), content (medical education delivery and calls for reform) and culture (e.g. professionalism, apprenticeship model of medical education, and the hidden curriculum) of medical education and inherent dualities and conflict require situated leadership skills and strategies. The main leadership theories and approaches helpful in practicing contextual leadership included transactional, transformational, and servant leadership. However, other theoretical approaches, such as moral leadership and learner-centered leadership were also useful. Effective leadership was considered to include personal and interpersonal strategies, strategies for becoming an efficient manager and strategies for practicing inspiring and effective leadership. Personal and interpersonal strategies included looking after self, seeking advice, consciously developing fortitude, allotting time for priorities and thinking and personal development. Becoming an efficient manager involved diligent delegation, appropriate organizational communication and managing priorities. Practicing inspiring leadership involved developing the structure and processes to achieve vision, providing hope, developing mutually valued relationships which were considered key to engagement, alignment, leading change and managing resistance, moving from power to process, using appropriate leadership styles, developing the art of leading change and managing resistance, proactively influencing culture and accomplishing the vision. In conclusion, medical education leadership was perceived as requiring both effective leadership and efficient management. The practice of inspiring and effective leadership, however, appeared to be more an art requiring an alchemy of strategies than a simple matter of application

Algebraic Independence over Positive Characteristic: New Criterion and Applications to Locally Low Algebraic Rank Circuits

The motivation for this work comes from two problems--test algebraic independence of arithmetic circuits over a field of small characteristic, and generalize the structural property of algebraic dependence used by (Kumar, Saraf CCC\u2716) to arbitrary fields. It is known that in the case of zero, or large characteristic, using a classical criterion based on the Jacobian, we get a randomized poly-time algorithm to test algebraic independence. Over small characteristic, the Jacobian criterion fails and there is no subexponential time algorithm known. This problem could well be conjectured to be in RP, but the current best algorithm puts it in NP^#P (Mittmann, Saxena, Scheiblechner Trans.AMS\u2714). Currently, even the case of two bivariate circuits over F_2 is open. We come up with a natural generalization of Jacobian criterion, that works over all characteristic. The new criterion is efficient if the underlying inseparable degree is promised to be a constant. This is a modest step towards the open question of fast independence testing, over finite fields, posed in (Dvir, Gabizon, Wigderson FOCS\u2707). In a set of linearly dependent polynomials, any polynomial can be written as a linear combination of the polynomials forming a basis. The analogous property for algebraic dependence is false, but a property approximately in that spirit is named as ``functional dependence\u27\u27 in (Kumar, Saraf CCC\u2716) and proved for zero or large characteristic. We show that functional dependence holds for arbitrary fields, thereby answering the open questions in (Kumar, Saraf CCC\u2716). Following them we use the functional dependence lemma to prove the first exponential lower bound for locally low algebraic rank circuits for arbitrary fields (a model that strongly generalizes homogeneous depth-4 circuits). We also recover their quasipoly-time hitting-set for such models, for fields of characteristic smaller than the ones known before. Our results show that approximate functional dependence is indeed a more fundamental concept than the Jacobian as it is field independent. We achieve the former by first picking a ``good\u27\u27 transcendence basis, then translating the circuits by new variables, and finally approximating them by truncating higher degree monomials. We give a tight analysis of the ``degree\u27\u27 of approximation needed in the criterion. To get the locally low algebraic rank circuit applications we follow the known shifted partial derivative based methods

Financial Analysis of Meta Platforms Inc

Web3.0 is the latest generation of internet, which is about decentralization and democratization, built on blockchain technology, high computer power and high-speed network. Metaverse overlaps with Web3.0 in terms of decentralization and is built on the same base technologies but talks about virtual realities and brings immersive experiences. This study explores how the web has evolved over the years and analyzes the current market trends of Web3.0. The purpose of the study is to examine the investments made by Meta Platforms Inc. which is one of the market leaders of the Internet industry and provide an in-depth financial analysis by evaluating its financial statements and different financial metrics. The study also includes estimating the value of the company based on the Discounted Cash Flow valuation method. The valuation conducted in this study forecasts Meta Platforms Inc. to be a promising investment with high positive returns. The valuation may be utilized by analysts for further analysis in their research

Management of everolimus-associated adverse events in patients with tuberous sclerosis complex: a practical guide

Tuberous sclerosis complex (TSC) is a genetic disorder characterised by highly variable comorbid dysfunction and subsequent morbidity. The mTOR inhibitor everolimus is indicated for the treatment of adult TSC patients with renal angiomyolipomas (AMLs) and for subependymal giant astrocytoma (SEGA) in both adults and children, based on data from the EXIST-1 and EXIST-2 trials. However, due to the historical predominance of everolimus in the oncology setting, some physicians who treat TSC patients may be unfamiliar with everolimus-associated adverse events (AEs) and appropriate management strategies. This article aims to serve as a resource for specialists including nephrologists, paediatricians, neurologists and geneticists who require practical guidance on the management of events such as non-infectious pneumonitis, rash, stomatitis, infections, and renal AEs. Additional consideration is given to drug interactions, hepatic impairment, fertility, and sexual maturation. Since patients with TSC receive clinical benefit from continued therapy, it is important that everolimus-related events are dealt with appropriately through strategies such as dose modification, interruption, the provision of supportive care, regular monitoring, and patient education

The effect of everolimus on neurocognitive aspects of tuberous sclerosis complex

Tuberous sclerosis complex (TSC) is a multi-system genetic disorder. It is characterised by benign tumour development in many organs, epilepsy and TSC-associated neuropsychiatric disorders, termed TAND that are frequent and have a great impact on the lives of patients and their carers. TSC results from mutations in either TSC1 (encoding TSC1) or TSC2 (encoding TSC2). Loss of functional TSC1 or TSC2 leads to activation of mTORC1 (mammalian target of rapamycin complex 1), a regulator of multiple cellular processes, including cell growth and neuronal function. Everolimus is an inhibitor of mTORC1 and is used in clinical practice for managing TSC-associated tumours and epilepsy. This thesis reports a phase 2, randomised, placebo-controlled trial assessing the safety and efficacy of 6 months of treatment with everolimus in adults with TSC and deficits in memoryand/or executive function. It aimed to determine effect sizes in its placebo and everolimus arms to inform future development of larger trials. Responders were defined as those showing an improvement of ≥1SD in at least one of ten measures of memory and executive function. Microstructural changes in cerebral white matter tracts associated with treatment were assessed using diffusion tensor imaging. Recruitment proved challenging, requiring modification of the original single centre design to a three centre study and revision of eligibility criteria to make them less stringent. Problems with application of one of the eligibility and outcome measures, the 'Test of Everyday Attention', further affected patient numbers for the primary analysis. In the final primary analysis (after adjustment) of 29 participants, 4 of 9 (44.4%) of the placebo group and 14 of 20 (70%) in the everolimus group were responders, satisfying criteria supporting further study as defined in the protoco

EPIDEMIOLOGICAL INVESTIGATION OF LIFESTYLE ASSOCIATED MODIFIABLE RISK FACTORS AMONG MEDICAL STUDENTS

Background: Non-communicable diseases (NCDs) are the leading causes of death globally, out of 57 million global deaths in year 2008, 63%, were due to NCDs. Over 80% of cardiovascular and diabetes deaths, and almost 90% of deaths from chronic obstructive pulmonary disease, occur in low-and middle-income countries. A large percentage of NCDs are preventable through the reduction of their four main behavioural risk factors: tobacco use, physical inactivity, harmful use of alcohol and unhealthy diet. Thus, there is a need to carryout rigorously implemented surveys that estimate the risk factors of NCDs among Medical students. Objective: This study was undertaken to estimate the Load of lifestyle associated risk factors& their correlates in apparently healthy medical students. Materials and Methods: The cross sectional study will be carried out among students of Medical Institute in Western Uttar Pradesh, India. Student’s interview will be done through an age appropriate modified Global school based student health survey structured self-administrated questionnaire on life style associated risk factors. The statistical analysis will be done using SPSS 17- Chi-square test, t-test and ANOVA. Result: This study documented a prevalence rate of active smoking among the study population 6.4% as against 84.2% for non-smoking. Drinking of alcohol as one of the behavioural risk factors for NCDs was also documented by this present study is 1.8% for binge drinking status and 3.8% for heavy drinking status. Conclusion: The study shows a high prevalence of NCD related risk factors in medical students. Primary prevention may be one way to lower the risk burden of NCDs