Challenges and Opportunities to Enhance the Clinical Reasoning Skills of Medical Students: Lessons Learned from the Advanced Clinical Transactions Pilot Program

Medical school faculty must foster high-quality patient care while simultaneously assessing the clinical skills and reasoning of students in order to promote their independent functioning in the clinical setting. A growing concern noted across medical faculty is that students may complete their undergraduate medical studies without sufficient understanding of how simple clinical tasks are done with real patients. These concerns have been validated by results from numerous studies that have reported many medical students express a lack of confidence and competence to critically evaluate patient needs based on data, a factor that has been linked to problems in performance and patient safety (Radcliffe and Lester 2003; Seabrook 2004; Chumley et al. 2005; Patey et al. 2007)

Breastfeeding: The Essential Principles

Gelfer did not disclose any financial relationships relevant to this article. Objectives After completing this article, readers should be able to: 1. Understand the physiology of lactation. 2. Discuss the biologic specificity of human milk. 3. Delineate the benefits of breastfeeding for the infant, the mother, and the community. 4. Know relative and absolute contraindications to breastfeeding. 5. Describe current recommendations for breastfeeding

Breastfeeding: The Essential Principles

Gelfer did not disclose any financial relationships relevant to this article. Objectives After completing this article, readers should be able to: 1. Understand the physiology of lactation. 2. Discuss the biologic specificity of human milk. 3. Delineate the benefits of breastfeeding for the infant, the mother, and the community. 4. Know relative and absolute contraindications to breastfeeding. 5. Describe current recommendations for breastfeeding

Application of Data Mining Algorithm to Recipient of Motorcycle Installment

The study was conducted in the subsidiaries that provide services of finance related to the purchase of a motorcycle on credit. At the time of applying, consumers enter their personal data. Based on the personal data, it will be known whether the consumer credit data is approved or rejected. From 224 consumer data obtained, it is known that the number of consumers whose applications are approved is 87% or about 217 consumers and consumers whose application is rejected is 16% or as much as 6 consumers. Acceptance of motorcycle financing on credit by using the method of applying the algorithm through CRIS-P DM is the industry standard in the processing of data mining. The algorithm used in the decision making is the algorithm C4.5. The results obtained previously, the level of accuracy is measured with the Confusion Matrix and Receiver Operating characteristic (ROC). Evaluation of the Confusion Matrix is intended to seek the value of accuracy, precision value, and the value of recall data. While the Receiver Operating Characteristic (ROC) is used to find data tables and comparison Area Under Curve (AUC)

Silicate solubilizing and plant growth promoting bacteria interact with biogenic silica to impart heat stress tolerance in rice by modulating physiology and gene expression

Heat stress caused due to increasing warming climate has become a severe threat to global food production including rice. Silicon plays a major role in improving growth and productivity of rice by aiding in alleviating heat stress in rice. Soil silicon is only sparingly available to the crops can be made available by silicate solubilizing and plant-growth-promoting bacteria that possess the capacity to solubilize insoluble silicates can increase the availability of soluble silicates in the soil. In addition, plant growth promoting bacteria are known to enhance the tolerance to abiotic stresses of plants, by affecting the biochemical and physiological characteristics of plants. The present study is intended to understand the role of beneficial bacteria viz. Rhizobium sp. IIRR N1 a silicate solublizer and Gluconacetobacter diazotrophicus, a plant growth promoting bacteria and their interaction with insoluble silicate sources on morpho-physiological and molecular attributes of rice (Oryza sativa L.) seedlings after exposure to heat stress in a controlled hydroponic system. Joint inoculation of silicates and both the bacteria increased silicon content in rice tissue, root and shoot biomass, significantly increased the antioxidant enzyme activities (viz. superoxidase dismutase, catalase and ascorbate peroxidase) compared to other treatments with sole application of either silicon or bacteria. The physiological traits (viz. chlorophyll content, relative water content) were also found to be significantly enhanced in presence of silicates and both the bacteria after exposure to heat stress conditions. Expression profiling of shoot and root tissues of rice seedlings revealed that seedlings grown in the presence of silicates and both the bacteria exhibited higher expression of heat shock proteins (HSPs viz., OsHsp90, OsHsp100 and 60 kDa chaperonin), hormone-related genes (OsIAA6) and silicon transporters (OsLsi1 and OsLsi2) as compared to seedlings treated with either silicates or with the bacteria alone. The results thus reveal the interactive effect of combined application of silicates along with bacteria Rhizobium sp. IIRR N1, G. diazotrophicus inoculation not only led to augmented silicon uptake by rice seedlings but also influenced the plant biomass and elicited higher expression of HSPs, hormone-related and silicon transporter genes leading to improved tolerance of seedling to heat stress

Effectiveness of Competency Training Program on Modified Early Warning System (MEWS) upon the Knowledge of Nurses in Selected Hospitals, Chennai

Background: Adverse events results in unintended harm to the patients including permanent disability and death. MEWS was introduced to identify and document the deteriorating patients in hospital settings. Adequate training and education of nurses will enhance early recognition and response in preventing adverse events. Objective: The objective of the study was to assess the effectiveness of competency training program on MEWS among nurses. Methodology: A Quasi experimental study was conducted among nurses who were working in inpatient units of selected hospitals, Chennai. 140 nurses were selected as participants out of which (n=70) is constituted to experimental group and (n=70) was constituted to control group. Pre-test knowledge was assessed in both groups. Competency training program on MEWS was given to experimental group of nurses and post test was assessed after one month. Results: The mean post-test knowledge scores was significantly higher in experimental group (M=18.2) to that of control group (M=10.6) which shows the effectiveness of competency training program on MEWS with (t=22.29, p<0.001). Conclusion: The present study reveals that Competency training program on MEWS had a significant increase in the knowledge of nurses in the experimental group

Design, Implementation, and Evaluation of an Intensive Course on Issues in Women's Health and Gender-Based Medicine

OBJECTIVES Sex and gender have profound effects on disease prevalence, presentation, and outcome, but these issues are not covered in depth in standard medical school curricula. To improve understanding of women's health, an intensive 1-month class was offered to fourth-year medical students. METHODS The class combined background lectures on the biological and social determinants of women's health with presentations on specific medical conditions by practicing clinicians and students. Students’ anonymous responses to end-of-class evaluation used by Stony Brook University School of Medicine as well as pre- and post-class answers to the question “why are women twice as likely to go to the doctor” were analyzed using quantitative, descriptive, and qualitative approaches. RESULTS The class was given between 2017 and 2022 to a total of 154 students. Course evaluations were submitted by 133 students. Over 80% of responders ranked the class as good or excellent and many expressed surprise about how much sex and gender influence health. Furthermore, before taking the class responders favored gender stereotypes (82%) and OB/GYN visits (56%) as the main reasons why women utilize healthcare more often than men, whereas only 31% of post-class answers included these factors ( p  < .0001), which were replaced by others including misdiagnosis, high rate of adverse effects of medications, implicit bias, and longevity. CONCLUSION A dedicated class given to students at the end of their undergraduate medical training increased awareness and knowledge of the effects of sex and gender on women's health

Use of student feedback to drive quality improvement (QI) in a preclinical U.S. medical school course

Medical educators are continually looking for ways to enhance integrated learning and help students see how the material taught in their various courses is inter-related. . At Stony Brook School of Medicine, we embarked on a school-wide new curriculum called the Learning focused, Experiential, Adaptive, Rigorous and Novel (LEARN) curriculum and developed several integrated courses that were not based in specific departments. As part of this process, the pre-clinical (Phase-1) curriculum was shortened to 17 months to accommodate an expanded set of clinical offerings. The new structure called for teachers from different departments to lead and conduct the integrated blocks of pre-clinical courses. In this paper, we describe our discouraging experience with the first iteration of an integrated course in Cardiology, Pulmonology and Renal organ systems (CPR), and its transformation into a highly successful second iteration. This involved a systematic course quality improvement (QI) process within the context of a larger school wide curricular reform. As a result, student overall satisfaction with the course increased from 22% (28 of 127 responders) to 83% (111 of 134 responders); the mean score on a standardized NBME content exam increased by 6.7%. We report the systematic process we used to collect data from students and faculty that helped facilitate quality improvement in a key course in Phase-1 of our LEARN curriculum