Feedback in the Emergency Medicine Clerkship

Objective: Feedback is a technique used in medical education to help develop and improve clinical skills. A comprehensive review article specifically intended for the emergency medicine (EM) educator is lacking, and it is the intent of this article to provide the reader with an in-depth, up-to-date, and evidence-based review of feedback in the context of the EM clerkship. Methods: The review article is organized in a progressive manner, beginning with the definition of feedback, the importance of feedback in medical education, and the obstacles limiting the effective delivery of feedback, and the techniques to overcome these obstacles then follows. The article concludes with practical recommendations to implement feedback in the EM clerkship. To advance the literature on feedback, the concept of receiving feedback is introduced. Results: The published literature regarding feedback is limited but generally supportive of its importance and effectiveness. Obstacles in the way of feedback include time constraints, lack of direct observation, and fear of negative emotional responses from students. Feedback should be timely, expected, focused, based on first-hand data, and limited to behaviors that are remediable. Faculty development and course structure can improve feedback in the EM clerkship. Teaching students to receive feedback is a novel educational technique that can improve the feedback process. Conclusion: Feedback is an important educational technique necessary to improve clinical skills. Feedback can be delivered effectively in the EM clerkship. [West J Emerg Med. 2011;12(4):537–542.]</p

Two-horn quiescent prominence observed in H-alpha and MgII h&k lines with THEMIS and IRIS

Prominences are large magnetic structures in the corona filled by cool plasma with fast evolving fine structure. We aim to better understand the plasma conditions in the fine structure of a quiescent prominence including two transient horns observed at the bottom of the cavity using the high-resolution spectrograph IRIS and the MulTi-Raies (MTR) spectrograph of the THEMIS in the Canary Islands. We analysed the spectra obtained in H-alpha by THEMIS and MgII by IRIS and compare them with a grid of 23940 1D radiative transfer models which include a prominence-to-corona transition region (PCTR). The full observed profiles of MgII in each pixel are fitted completely by synthesised profiles with xRMS (Cross RMS; an improved version of the rolling root mean square (rRMS) method). When the RMS is below a certain threshold value, we recover the plasma conditions from the parameters of the model best fitting the observed line profile. This criterion is met in two regions (the horns and edge of the prominence) where the line profiles can generally be described as single peaked. The 1D models suggest that two different kinds of model atmospheres correspond to these two regions. The region at the edge is found to be fitted mainly with isothermal and isobaric models, while the other area (the horns) is seen to be fitted with models with a PCTR that have optical thicknesses <5. In the prominence edge, the theoretical relationship between the integrated intensities in H-alpha and MgII is verified and corresponds to low emission measure values. In these regions the electron density is ~10^10 cm^{-3}, while it is one order of magnitude less in the horn regions. In the horns, we find some profiles are best fitted with models with high mean temperatures. This suggests that the hot PCTR found in the horns could be interpreted as prominence plasma in condensation phase at the bottom of the coronal cavity.Comment: 24 pages, 19 figures, manuscript accepted to publication in A&

The Associations Between Internalized Racism, Racial Identity, and Psychological Distress

Internalized racism, or the acceptance of negative stereotypes about one’s own racial group, is associated with psychological distress; yet, few studies have explored the longitudinal impact of internalized racism on the psychological well-being of African American emerging adults. Furthermore, racial identity’s role as a protective factor in the context of internalized racism remains unclear. This study examined the longitudinal impact of internalized racism on psychological distress (depressive and anxiety symptoms) and the moderating role of racial identity beliefs among 171 African American emerging adults. Full cross-lagged panel models revealed no main effects of internalized racism beliefs on psychological distress. However, several racial identity beliefs moderated the relationship between internalized racism beliefs and changes in psychological distress over a year later. Initial levels of alteration of physical appearance, internalization of negative stereotypes, and hair change internalized racism beliefs were related to subsequent psychological distress, but only for those with certain levels of racial centrality, private regard, public regard, and assimilationist, humanist, and nationalist ideology beliefs. These findings suggest that, over time, internalized racism and racial identity beliefs can combine to influence the psychological well-being of African American emerging adults

Advanced Topics in Emergency Medicine: Curriculum Development and Initial Evaluation

<p>Background: Emergency medicine (EM) is a young specialty and only recently has a recommended medical student curriculum been developed. Currently, many schools do not require students to complete a mandatory clerkship in EM, and if one is required, it is typically an overview of the specialty.</p> <p>Objectives: We developed a 10-month longitudinal elective to teach subject matter and skills in EM to fourth-year medical students interested in the specialty. Our goal was producing EM residents with the knowledge and skills to excel at the onset of their residency. We hoped to prove that students participating in this rigorous 10-month longitudinal EM elective would feel well prepared for residency.</p> <p>Methods: We studied the program with an end-of-the-year, Internet-based, comprehensive course evaluation completed by each participant of the first 2 years of the course. Graduates rated each of the course components by using a 5-point Likert format from ‘‘strongly disagree’’ to ‘‘strongly agree,’’ either in terms of whether the component was beneficial to them or whether the course expectations were appropriate, or their perceptions related to the course.</p> <p>Results: Graduates of this elective have reported feeling well prepared to start residency. The resident-led teaching shifts, Advanced Pediatric Life Support certification, Grand Rounds presentations, Advanced Cardiovascular Life Support proficiency testing, and ultrasound component, were found to be beneficial by all students.</p> <p>Conclusions: Our faculty believes that participating students will be better prepared for an EM residency than those students just completing a 1-month clerkship. Our data, although limited, lead us to believe that a longitudinal, immersion-type experience assists fourth-year medical students in preparation for residency. [West J Emerg Med. 2011;12(4):543–550.]</p

Two-horn quiescent prominence observed in Hα and Mg II h&k lines with THEMIS and IRIS

Context. Prominences are large magnetic structures in the corona filled by cool plasma with fast evolving fine structure. Aims. We aim to better understand the plasma conditions in the fine structure of a quiescent prominence including two transient horns observed at the bottom of the cavity using the high resolution Interface Region Imaging Spectrograph (IRIS) and the MulTi-Raies (MTR) spectrograph of the Télescope Heliographique pour l’Etude du Magnétisme et des Instabilités Solaires (THEMIS) in the Canary Islands. Methods. We analysed the spectra obtained in Hα by THEMIS and Mg II by IRIS and compare them with a grid of 23 940 1D radiative transfer models which include a prominence-to-corona transition region (PCTR). The full observed profiles of Mg II in each pixel are fitted completely by synthesised profiles with ×RMS (Cross RMS; an improved version of the rolling root mean square (rRMS) method). When the RMS is below a certain threshold value, we recover the plasma conditions from the parameters of the model best fitting the observed line profile. This criterion is met in two regions (the horns and edge of the prominence) where the line profiles can generally be described as single peaked. Results. The 1D models suggest that two different kinds of model atmospheres correspond to these two regions. The region at the edge is found to be fitted mainly with isothermal and isobaric models, while the other area (the horns) is seen to be fitted with models with a PCTR that have optical thicknesses of less than 5. In the prominence edge, the theoretical relationship between the integrated intensities in Hα and Mg II is verified and corresponds to low emission measure values. In these regions the electron density is around 1010 cm−3, while it is one order of magnitude less in the horn regions around 109 cm−3. Conclusions. In the horns, we find some profiles are best fitted with models with high mean temperatures. This suggests that the hot PCTR found in the horns could be interpreted as prominence plasma in condensation phase at the bottom of the coronal cavity

Musicians’ perceptions and experiences of using simulation training to develop performance skills

Simulation has been applied as a tool for learning and training in sports, psychology and medicine for some time, but its current use and potential for training musicians is less well understood. The aim of this study was to explore musicians’ perceptions and experiences of using simulated performance environments. Nine conservatory students performed in two simulations, each with interactive virtual elements and vivid environmental cues: a recital with a virtual audience and an audition with virtual judges. Qualitative data were collected through a focus group interview and written reflective commentaries. Thematic analysis highlighted the musicians’ experiences in terms of (1) their anticipation of using the simulations, (2) the process of performing in the simulations, (3) the usefulness of simulation as a tool for developing performance skills and (4) ways of improving simulation training. The results show that while simulation was new to the musicians and individual levels of immersion differed, the musicians saw benefits in the approach for developing, experimenting with and enhancing their performance skills. Specifically, the musicians emphasised the importance of framing the simulation experience with plausible procedures leading to and following on from the performance, and they recognised the potential for combining simulation with complementary training techniques

The fables of pity: Rousseau, Mandeville and the animal-fable

Copyright @ 2012 Edinburgh University PressPrompted by Derrida’s work on the animal-fable in eighteenth-century debates about political power, this article examines the role played by the fiction of the animal in thinking of pity as either a natural virtue (in Rousseau’s Second Discourse) or as a natural passion (in Mandeville’s The Fable of the Bees). The war of fables between Rousseau and Mandeville – and their hostile reception by Samuel Johnson and Adam Smith – reinforce that the animal-fable illustrates not so much the proper of man as the possibilities and limitations of a moral philosophy that is unable to address the political realities of the state