Medical Student Professionalism Narratives: A Thematic Analysis and Interdisciplinary Comparative Investigation

<p>Abstract</p> <p>Background</p> <p>Professionalism development is influenced by the informal and hidden curriculum. The primary objective of this study was to better understand this experiential learning in the setting of the Emergency Department (ED). Secondarily, the study aimed to explore differences in the informal curriculum between Emergency Medicine (EM) and Internal Medicine (IM) clerkships.</p> <p>Methods</p> <p>A thematic analysis was conducted on 377 professionalism narratives from medical students completing a required EM clerkship from July 2008 through May 2010. The narratives were analyzed using established thematic categories from prior research as well as basic descriptive characteristics. Chi-square analysis was used to compare the frequency of thematic categories to prior research in IM. Finally, emerging themes not fully appreciated in the established thematic categories were created using grounded theory.</p> <p>Results</p> <p>Observations involving interactions between attending physician and patient were most abundant. The narratives were coded as positive 198 times, negative 128 times, and hybrid 37 times. The two most abundant narrative themes involved <it>manifesting respect </it>(36.9%) and <it>spending time </it>(23.7%). Both of these themes were statistically more likely to be noted by students on EM clerkships compared to IM clerkships. Finally, one new theme regarding <it>cynicism </it>emerged during analysis.</p> <p>Conclusions</p> <p>This analysis describes an informal curriculum that is diverse in themes. Student narratives suggest their clinical experiences to be influential on professionalism development. Medical students focus on different aspects of professionalism depending on clerkship specialty.</p

Vampires in the village Žrnovo on the island of Korčula: following an archival document from the 18th century

Središnja tema rada usmjerena je na raščlambu spisa pohranjenog u Državnom arhivu u Mlecima (fond: Capi del Consiglio de’ Dieci: Lettere di Rettori e di altre cariche) koji se odnosi na događaj iz 1748. godine u korčulanskom selu Žrnovo, kada su mještani – vjerujući da su se pojavili vampiri – oskvrnuli nekoliko mjesnih grobova. U radu se podrobno iznose osnovni podaci iz spisa te rečeni događaj analizira u širem društvenom kontekstu i prate se lokalna vjerovanja.The main interest of this essay is the analysis of the document from the State Archive in Venice (file: Capi del Consiglio de’ Dieci: Lettere di Rettori e di altre cariche) which is connected with the episode from 1748 when the inhabitants of the village Žrnove on the island of Korčula in Croatia opened tombs on the local cemetery in the fear of the vampires treating. This essay try to show some social circumstances connected with this event as well as a local vernacular tradition concerning superstitions

An in-depth analytical approach to the mechanism of the RAFT process in acrylate free radical polymerizations via coupled size exclusion chromatography-electrospray ionization mass spectrometry (SEC-ESI-MS)

Coupled size exclusion chromatography (SEC)-electrospray ionization mass spectrometry (ESI-MS) was applied to carefully map the product spectrum of a series of acrylate free radical polymerizations mediated via the reversible addition fragmentation chain transfer (RAFT) process. The product stream of a significantly rate retarded RAFT system (i.e. n-butyl acrylate (BA)/cumyl dithiobenzoate (CDB)) was compared with the less rate retarded RAFT polymerizations of BA mediated by cumyl phenyl dithioacetate (CPDA) and methyl acrylate (MA)/CPDA. In each case excellent agreement between the theoretical and experimental masses, as well as the simulated isotopic peak distributions, of polymeric species in the product stream was observed. Although conventional disproportionation and combination bimolecular termination products were clearly identified within the product spectra, the presence of irreversibly terminated RAFT intermediates, i.e. 3-armed star polymers, was not observed. The mass spectroscopic results are compared to modeling estimations (carried out via the PREDICI® program package) of the concentration ratios of 3-armed stars vs. conventional termination products. It is demonstrated that the occurrence of conventional termination products should be accompanied by a significant product stream associated with 3-armed star polymer material if cross termination was operational - at least under the current reaction conditions. The absence of three armed star polymer products in the polymers stream suggests that irreversible cross termination reactions may be of minor importance in the present systems. © 2005 Elsevier Ltd. All rights reserved

Reversible addition fragmentation chain transfer copolymerization: Influence of the RAFT process on the copolymer composition

Reversible addition fragmentation chain transfer (RAFT) mediated and conventional copolymerizations at low monomer conversions have been carried out for the systems methyl methacrylate (MMA)-styrene, methyl acrylate (MA)-styrene and methyl methacrylate-butyl acrylate (BA). The polymer samples have been analyzed via 1H-NMR spectroscopy to obtain the copolymer composition and the terminal model reactivity ratios. In the RAFT mediated copolymerizations, the polymer mole fraction of the monomer with the larger reactivity ratio is increased compared to the conventional copolymerization. Simulations have been carried out using the program package PREDICI ® to examine possible explanations for the experimental findings. The simulations demonstrate that the RAFT process itself may alter the macroradical populations and the copolymer composition by offering additional reaction pathways. Further, the rate coefficients for the initiation reaction and the pre-equilibrium play an important role in determining the copolymer composition. The rate coefficients governing the main equilibrium of the RAFT process have only a minor impact on the copolymer composition. © 2004 Elsevier Ltd. All rights reserved

Living free-radical polymerization of sterically hindered monomers: Improving the understanding of 1,1-disubstituted monomer systems

The sterically hindered, 1,1-disubstituted monomers di-n-butyl itaconate (DBI), dicyclohexyl itaconate (DCHI), and dimethyl itaconate (DMI) were polymerized with reversible addition-fragmentation chain transfer (RAFT) free-radical polymerization and atom transfer radical polymerization (ATRP). Cumyl dithiobenzoate, cumyl phenyl dithioacetate, 2-cyanoprop-2-yl dithiobenzoate, 4-cyanopentanoic acid dithiobenzoate, and S- methoxycarbonylphenylmethyl dithiobenzoate were employed as RAFT agents to mediate a series of polymerizations at 60°C yielding polymers ranging in their number-average molecular weight from 4500 to 60,000 g mol-1. The RAFT polymerizations of these hindered monomers displayed hybrid living behavior (between conventional and living free-radical polymerization) of various degrees depending on the molecular structure of the initial RAFT agent. In addition, DCHI was polymerized via ATRP with a CuCl/methyl benzoate/N,N,N′N″N‴-pentamethyldiethylenetriamine/ cyclohexanone system at 60°C. Both the ATRP and RAFT polymerization of the hindered monomers displayed living characteristics; however, broader than expected molecular weight distributions were observed for the RAFT systems (polydispersity index = 1.15-3.35). To assess the cause of this broadness, chain-transfer-to-monomer constants for DMI, DBI, and DCHI were determined (1.4 × 10-3, 1.3 × 10-3, and 1.0 × 10 -3, respectively) at 60°C. Simulations carried out with the PREDICI program package suggested that chain transfer to monomer contributed to the broadening process, In addition, the experimental results indicated that viscosity had a pronounced effect on the broadness of the molecular weight distributions. © 2006 Wiley Periodicals, Inc