Using the computer-based feedback (CBF) system to investigate the juniorphysicians’s and clinical-instructors perceptions for the benefits of general medicine clinical-instructors training program

Background: The purpose of this study is to examine the clinical-instructors and junior-physicians (residents and interns) perceptions for the general-medicine training program by using bi-directional interactive and self-assessments computer-based feedback (CBF) and paper-based multisource feedback assessment (PBMFA) systems for the efficiency and benefit evaluation.Methods: Between 2011 January to 2013 December, junior-physicians and their clinical-instructors in the same medical team were enrolled consecutively for monitoring the CBF scores gave by each other after each clinical course. A total of 321 residents, 298 interns and 110 clinical-instructors who participated in the core competency general-medicine training program in 6-months period were included in the study. The CBF and PBMFA evaluations are undergone paralleled to gather the suggested information in different levels of Kirkpatrick evolutional theory.Results: The results showed that lecturers, being 5-10 years as attending physicians, internal medicine sub-specialty clinical-instructors are most benefit from the general medicine training program. Accordingly, the CBF scores of junior-physicians was positively correlated with the times (> 3-times) of exposure to the medical teams that leaded by qualified clinical-instructors. Both clinical-instructors and junior-physicians have positive attitude to the value of the general-medicine training program. Interestingly, a good consistency was existed between residents CBF scores and PBMFA grades for their core-competency performance. Comparatively, the overall perception of clinical-instructors and junior-physicians for the general-medicine training was very positive.Conclusions: Clinical-instructors and junior-physicians had positive perception of CBF and PBMFA systems which could give us different information to improve and strength the further core-competency general-medicine training program by appropriate utilization

Self- and rater-assessed effectiveness of “thinking-aloud” and “regular” morning report to intensify young physicians' clinical skills

Background: This study compared the effects of the “thinking aloud” (TA) morning report (MR), which is characterized by sequential and interactive case discussion by all participants, with “regular” MR for clinical skill training of young physicians. Methods: Between February 2011 and February 2014, young physicians [including postgraduate year-1 (PGY1) residents, interns, and clerks) from our hospital were sequentially enrolled and followed for 3 months. The self- and rater-assessed educational values of two MR models for building up clinical skills of young physicians were compared. Results: The junior (intern and clerk) attendees had higher self-assessed educational values scores and reported post-training application frequency of skills trained by TA MR compared with the senior (PGY1 resident) attendees. Higher average and percentage of increased overall rater-assessed OSCE scores were noted among the regular MR senior attendees and TA MR junior attendees than in their corresponding control groups (regular MR junior attendees and TA MR senior attendees). Interestingly, regular MRs provided additional beneficial effects for establishing the “professionalism, consulting skills and organization efficiency” aspects of clinical skills of senior/junior attendees. Moreover, senior and junior attendees benefited the most by participating in seven sessions of regular MR and TA MR each month, respectively. Conclusion: TA MR effectively trains junior attendees in basic clinical skills, whereas regular MR enhances senior attendees' “work reports, professionalism, organizational efficiency, skills in dealing with controversial and professional issues.” Undoubtedly, all elements of the two MR models should be integrated together to ensure patient safety and good discipline among young physicians

SLCO3A1, A novel crohn's disease-associated gene, regulates nf-κB activity and associates with intestinal perforation.

Background & aimsTo date, only one gene (TNFSF15) has been identified and validated as a Crohn's disease (CD)-associated gene in non-Caucasian populations. This study was designed to identify novel CD-associated single nucleotide polymorphisms (SNPs)/genes and to validate candidate genes using a functional assay.MethodsSNPs from 16 CD patients and 16 age- and sex-matched control patients were analyzed using Illumina platform analysis. Subsequently, we expanded the study and followed 53 CD patients and 41 control patients by Sequenom MassArray analysis. Quantitative PCR and immunohistochemical staining were performed to assess mRNA and protein expression of the candidate gene on tissue isolated from CD patients. Genotype was correlated with CD phenotypes. Finally, the candidate gene was cloned and its effect on NF-κB activity assessed using a reporter luciferase assay.ResultsSLCO3A1 (rs207959) reached statistical significance in the first-stage analysis (P = 2.3E-02) and was further validated in the second-stage analysis (P = 1.0E-03). Genotype and phenotype analysis showed that the rs207959 (T) allele is a risk allele that alters SLCO3A1 mRNA expression and is associated with intestinal perforation in CD patients. Higher levels of mRNA and protein expression of SLCO3A1 were seen in CD patients compared with the control group. Overexpression of SLCO3A1 induced increased NF-κB activity and increased phosphorylation of P65, ERK, and JNK. Nicotine augmented the activation of NF-κB in the presence of SLCO3A1.ConclusionsSLCO3A1, a novel CD-associated gene, mediates inflammatory processes in intestinal epithelial cells through NF-κB transcription activation, resulting in a higher incidence of bowel perforation in CD patients

A model of four hierarchical levels to train Chinese residents’ teaching skills for “practice-based learning and improvement” competency

<div><p></p><p> <i>Objectives:</i> The current study focused on validating a protocol for training and auditing the resident’s practice-based learning and improvement (PBLI) and quality improvement (QI) competencies for primary care. <i>Methods:</i> Twelve second-year (R₂), 12 first-year (R₁) and 12 postgraduate year-1 residents were enrolled into group A, B and C, respectively, as trainees. After three training protocols had been completed, a writing test, self-assessed questionnaire and mini-OSTE and end-of-rotation assessment were used in auditing the PBLI competency, performance and teaching ability of trainees. <i>Results:</i> Baseline expert-assessed PBLI and QI knowledge application tool writing scores were low for the R₁ and R₂ residents. After three training protocols, PBLI and QI proficiencies, performance and teaching abilities were improved to similar levels cross the three training levels of residents based on the expert-assessed writing test-audited assessments and on the faculty and standardized clerk-assessed end-of-rotation-/mini-OSTE-audited assessments. <i>Conclusion:</i> The different four-level hierarchical protocols used to teach group A, B and C were equally beneficial and fitted their needs; namely the different levels of the trainees. Specifically, each level was able to augment their PBLI and QI proficiency. This educational intervention helps medical institutions to train residents as PBLI instructors.</p></div

Additional file 1: Table S1. of Voluntary attendance of small-group brainstorming tutoring courses intensify new clerk’s “excellence in clinical care”: a pilot study

Contents and results of the end-of-clerkship elf-assessed degree of excellence in clinical care of class 2012 clerks. (DOCX 15 kb

Activation of NF-κB by nicotine in SLCO3A1 overexpressing cells.

<p>(A) HEK293T cells were transfected with the NF-κB reporter plasmids, together with an empty vector or SLCO3A1 constructs. Addition of 0.8 µM nicotine for 24 hours resulted in increased NF-κB activity in cells overexpressing SLCO3A1 (*<i>P</i><0.05). (B) Western blot analysis from cell lysates demonstrates equal transfection efficiencies.</p

Genotype and phenotype analysis of SLCO3A1 (rs207959).

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Demographic data of populations in Illumina (stage 1) and Sequenom (stage 2).

<p>*Illumina HumanOmni1-Quad_v1-0_B containing 1,016,423 SNPs.</p><p>**Sequenom MassARRAY system examining 38 SNPs.</p

Overexpression of SLCO3A1 induces NF-κB activation, enhances the phosphorylation of two classes of MAPKs (ERK and JNK), and augments NF-κB activity.

<p>(A) Overexpression of SLCO3A1 induced approximately 6-fold higher NF-κB activation (**<i>P</i><0.01). (B) Overexpression of SLCO3A1 in HEK293T cells resulted in increased p65 expression (*<i>P</i><0.05). (C) ERK and JNK expression increased with overexpression of SLCO3A1, while expression of p38 and AKT showed no difference (*<i>P</i><0.05). All experiments were performed at least 3 times.</p