The predominant learning approaches of medical students

Background By identifying medical students’ learning approaches and the factors that influence students’ learning approaches, medical schools and health care institutions are better equipped to intervene and optimize their learning experience. The aims of our study is to determine the predominant learning approach amongst medical students on a clinical posting in a hospital in Singapore and to examine the demographic factors that affect their learning approach. Methods The Approaches and Study Skills Inventory for Students (ASSIST) questionnaire was administered to 250 medical students from various medical schools on clinical attachment to the Obstetrics and Gynaecology (O&G) department of KK Women’s and Children’s Hospital (KKH) Singapore between March 2013 and May 2015 to determine students’ predominant learning approaches. Multinomial logistic regression was used to examine the association between demographic factors (age, gender and highest education qualification) and predominant learning approach. A cut-off of p \u3c 0.05 was used for statistical significance. Results Amongst 238 students with one predominant learning approach, 96 (40.3%) and 121 students (50.8%) adopted the deep and strategic approach respectively, whilst only 21 (8.8%) adopted the surface approach. Male students appeared less likely to adopt the strategic learning approach than female students (p value = 0.06). Predominant learning approaches were not influenced by demographic characteristics such as age, gender and highest educational qualifications. Conclusions This study provided insight into the learning approaches of a heterogeneous group of medical students in Singapore. While it is encouraging that the majority of students predominantly utilised the deep and strategic learning approach, there was a significant proportion of students who utilised the surface approach. Interventions can be explored to promote deeper learning amongst these students

Impaired Growth and Force Production in Skeletal Muscles of Young Partially Pancreatectomized Rats: A Model of Adolescent Type 1 Diabetic Myopathy?

This present study investigated the temporal effects of type 1 diabetes mellitus (T1DM) on adolescent skeletal muscle growth, morphology and contractile properties using a 90% partial pancreatecomy (Px) model of the disease. Four week-old male Sprague-Dawley rats were randomly assigned to Px (n = 25) or Sham (n = 24) surgery groups and euthanized at 4 or 8 weeks following an in situ assessment of muscle force production. Compared to Shams, Px were hyperglycemic (>15 mM) and displayed attenuated body mass gains by days 2 and 4, respectively (both P<0.05). Absolute maximal force production of the gastrocnemius plantaris soleus complex (GPS) was 30% and 50% lower in Px vs. Shams at 4 and 8 weeks, respectively (P<0.01). GP mass was 35% lower in Px vs Shams at 4 weeks (1.24±0.06 g vs. 1.93±0.03 g, P<0.05) and 45% lower at 8 weeks (1.57±0.12 vs. 2.80±0.06, P<0.05). GP fiber area was 15–20% lower in Px vs. Shams at 4 weeks in all fiber types. At 8 weeks, GP type I and II fiber areas were ∼25% and 40% less, respectively, in Px vs. Shams (group by fiber type interactions, P<0.05). Phosphorylation states of 4E-BP1 and S6K1 following leucine gavage increased 2.0- and 3.5-fold, respectively, in Shams but not in Px. Px rats also had impaired rates of muscle protein synthesis in the basal state and in response to gavage. Taken together, these data indicate that exposure of growing skeletal muscle to uncontrolled T1DM significantly impairs muscle growth and function largely as a result of impaired protein synthesis in type II fibers

Contraction and cation contents of skeletal soleus and EDL muscles in age-matched control and diabetic rats

Skeletal muscle atrophy and neuropathy are two major long term complications of diabetes mellitus (DM). This study investigated the effect of streptozotocin (STZ) - induced type I DM on the characteristics of the animals and on contraction, cation contents, morphology and muscle proteins of Extensor Digitorum Longus (EDL) and soleus skeletal muscles compared to age-matched control rats. Adult Wistar rats were humanely killed and EDL and soleus muscles were located and excised rapidly and placed in organ baths. The muscles were electrically stimulated (EFS, 50 V, I msec, 1-100 Hz) and isometric contraction monitored using a chart recorder. At the end of the experiments the muscles were blotted, weighed and dissolved in concentrated nitric acid for the measurements of cation contents. In another set of experiments, the cation contents were measured using unstimulated muscles. In addition, EDL and soleus isolated muscles were fixed, stained and examined for any morphological changes and levels of actin distribution of muscle fibres in age-matched control and diabetic rats. In the next series of experiments, gel electrophoresis was used to separate actin and myosin. The results showed that STZ-induced diabetic rats have significantly (*PC0.05) reduced body weights, significantly (*P<0.05) elevated blood glucose and significantly (*Fc0.05) reduced blood insulin as well as reduced protein contents compared to healthy age-matched control. EFS evoked frequency dependent contraction in both soleus and EDL muscles of healthy control rats. The response was significantly (*P< 0.05, n= 8) increased in EDL compared to soleus. In diabetic soleus and EDL muscles the force of contraction was significantly (*pc0.05) reduced in both muscle types compared to healthy age-matched controls. Perturbation of extracellular Ca 2+ [Ca2 ]o resulted in a Ca 2 dependent increase in contraction with maximum effect with 5 mM Ca 2 and minimal effect with 0 mM Ca2 . The responses were much large in age-matched control muscle compared to diabetic muscle. Perturbation of extracellular Mg 2 [Mg2 ]0 on EFS-evoked contraction had no significant effect in either control or diabetic muscles at all frequencies tested compared to the responses obtained in normal (1.2 mM) (Mg 24)o. The levels of total sodium (Ni'), potassium (IC), calcium (Ca 2 '), magnesium (Mg2 '), zinc (Zn2 '), copper (Cu 2 ') and iron (Fe2 ') were significantly (*PC0.05) reduced in diabetic soleus and EDL muscles compared to controls. The LDH assay showed an increase in the % lysis of STZ-induced diabetic muscles compared to the age-matched controls. Morphological studies have also demonstrated a reduction in the number and distribution of muscle fibres in both EDL and soleus skeletal muscles of STZ-induced diabetic rats compared to control. Similarly, diabetic EDL and soleus skeletal muscles contain less actin than muscles from healthy age-matched control rats. The results for gel electrophoresis did not show any major significant changes. The results indicate that STZ - induced skeletal muscle atrophy is associated with marked reductions in the force of contraction cation contents, the number of muscle fibres and their distribution and levels of actin compared to the healthy agematched controls in EDL and soleus muscles of the rats. It is postulated that these changes in the muscle properties may be responsible for the diabetes-induced muscle atrophy

The predominant learning approaches of medical students

10.1186/s12909-018-1122-5BMC Medical Education1811

Chemical Inhibition of Histone Deacetylases 1 and 2 Induces Fetal Hemoglobin through Activation of GATA2.

Therapeutic intervention aimed at reactivation of fetal hemoglobin protein (HbF) is a promising approach for ameliorating sickle cell disease (SCD) and β-thalassemia. Previous studies showed genetic knockdown of histone deacetylase (HDAC) 1 or 2 is sufficient to induce HbF. Here we show that ACY-957, a selective chemical inhibitor of HDAC1 and 2 (HDAC1/2), elicits a dose and time dependent induction of γ-globin mRNA (HBG) and HbF in cultured primary cells derived from healthy individuals and sickle cell patients. Gene expression profiling of erythroid progenitors treated with ACY-957 identified global changes in gene expression that were significantly enriched in genes previously shown to be affected by HDAC1 or 2 knockdown. These genes included GATA2, which was induced greater than 3-fold. Lentiviral overexpression of GATA2 in primary erythroid progenitors increased HBG, and reduced adult β-globin mRNA (HBB). Furthermore, knockdown of GATA2 attenuated HBG induction by ACY-957. Chromatin immunoprecipitation and sequencing (ChIP-Seq) of primary erythroid progenitors demonstrated that HDAC1 and 2 occupancy was highly correlated throughout the GATA2 locus and that HDAC1/2 inhibition led to elevated histone acetylation at well-known GATA2 autoregulatory regions. The GATA2 protein itself also showed increased binding at these regions in response to ACY-957 treatment. These data show that chemical inhibition of HDAC1/2 induces HBG and suggest that this effect is mediated, at least in part, by histone acetylation-induced activation of the GATA2 gene

Can digital media affect the learning approach of medical students?

Background: Students’ learning approaches have revealed that deep learning approach has a positive impact on academic performance. There are suggestions of a waning interest in deep learning to surface learning. Aim: To assess if digital media can reduce the incidence of surface learning approach among medical students Method: A digital video introducing three predominant learning approaches (deep, strategic, surface) was shown to medical students between March 2015 and January 2017. The Approaches and Study Skills Inventory for Students (ASSIST), was administered at the beginning and end of their clinical attachment, to determine if there were any changes to the predominant learning approaches. A survey was conducted using a 5-point Likert scale to assess if video resulted in change. Results: Of 351 students, 191 (54.4%) adopted deep, 118 (33.6%) adopted strategic and 42 (12.0%) adopted surface as their predominant learning approach at the beginning of their clinical attachment. At the end of their clinical attachment, 171 (49.6%) adopted deep, 143 (41.4%) adopted strategic and 31 (9.0%) adopted surface learning as their predominant learning approach. The incidence of students predominantly using surface approach decreased from 42 (12.0%) to 31 (9.0%), although not statistically significant. Qualitative feedback from students stated that they were more likely to adopt non-surface learning approaches after viewing the video. Conclusion: This evaluation highlighted the potential of digital media as an educational tool to help medical students reflect on their individual learning approaches and reduce the incidence of surface learning approach