Assessment of coronary artery outward remodeling in consequence of excision of epicardial adipose tissue in Ossabaw swine

Background Coronary artery disease (CAD) results from the buildup of cholesterol, inflammatory factors, and proliferating smooth muscle cells within a vessel wall. This plaque impedes on the vessel lumen, decreasing the space through which blood can flow, leading to an array of complications in the human body. To offset these effects, the arterial wall undergoes outward remodeling, a compensatory physiologic phenomenon that blood vessels undertake when burdened with a blockage, such as CAD. In a previously conducted study, a coronary epicardial adipose tissue excision (cEATx) surgery was performed above the left anterior descending (LAD) in Ossabaw swine to investigate the effects of local adipose on the progression of CAD. Compared to the sham control group, pigs that underwent the adipectomy procedure revealed focal attenuation of disease progression at the surgical site within the LAD. Unlike, the previous research question, this current study aims to determine if there was an additional global outward remodeling effect by investigating disease progression in the right coronary artery (RCA) of the same animals. By comparing the two sites, we are able to determine whether the outward remodeling observed in the LAD was due to the local surgical procedure or a physiologic compensation for limitations caused by CAD progression. Methods Images of the RCA lumen were collected using intravascular ultrasound (IVUS). Measurements of the external elastic lamina and lumen area were taken of each collected still-frame image. For each pig, the data were averaged across the proximal 15 mm of the RCA at two separate time points (pre- and post-surgery). Pre-surgery measures were obtained the day the surgery took place while post-surgery measures were obtained 3 months later. Percent stenosis, plaque area, outward remodeling, and lumen area were all assessed. Results Progression of CAD in the RCA, represented by percent stenosis, was not significantly slowed in the adipectomy pigs compared to the control group. Outward remodeling in the RCA, represented by an increase in external elastic lamina circumference, was not significantly higher in the adipectomy pigs compared to the control group. Conclusions These data indicate that the cEATx procedure at the LAD did not attenuate CAD progression in the RCA

Six ways to get a grip on a mentorship program for residents and faculty

Mentorship is recognized as beneficial to the personal and professional development of physicians. It has been shown to positively influence career success and research productivity for the mentee, while being associated with increased job satisfaction and lower risk of burnout for the mentor. At an institutional level, when aligned with strategic priorities, mentorship can facilitate gender and racial equality, and improve faculty retention. Consequently, there are calls to prioritize and formalize mentorship, yet the optimal way to achieve this remains elusive. How exactly do we create a mentorship program that is viewed as effective from the perspective of the mentor, mentee, and the institution? In this article we approach mentorship as a complex system, and through this lens we aim to provide medical educators and leaders with guidance on how to create and evaluate a program that provides mentees with distributed and precision mentoring, while also aligning with institutional priorities

Involvement in teaching improves learning in medical students: a randomized cross-over study

<p>Abstract</p> <p>Background</p> <p>Peer-assisted learning has many purported benefits including preparing students as educators, improving communication skills and reducing faculty teaching burden. But comparatively little is known about the effects of teaching on learning outcomes of peer educators in medical education.</p> <p>Methods</p> <p>One hundred and thirty-five first year medical students were randomly allocated to 11 small groups for the Gastroenterology/Hematology Course at the University of Calgary. For each of 22 sessions, two students were randomly selected from each group to be peer educators. Students were surveyed to estimate time spent preparing as peer educator versus group member. Students completed an end-of-course 94 question multiple choice exam. A paired t-test was used to compare performance on clinical presentations for which students were peer educators to those for which they were not.</p> <p>Results</p> <p>Preparation time increased from a mean (SD) of 36 (33) minutes baseline to 99 (60) minutes when peer educators (Cohen's <it>d </it>= 1.3; p < 0.001). The mean score (SD) for clinical presentations in which students were peer educators was 80.7% (11.8) compared to77.6% (6.9) for those which they were not (<it>d </it>= 0.33; <it>p </it>< 0.01).</p> <p>Conclusion</p> <p>Our results suggest that involvement in teaching small group sessions improves medical students' knowledge acquisition and retention.</p

A Mixed Methods Study on the Effect of Flipping the Undergraduate Medical Classroom

The flipped classroom model is increasingly being adopted in healthcare education, despite the fact that recent systematic reviews in the nursing and medical education literature suggest that this method of instructional design is not inherently better or worse than the traditional classroom. In this study, we used a sequential, explanatory mixed methods design to assess the impact of flipping the hepatology classroom for preclinical medical students. Compared to students in the traditional classroom, students in the flipped classroom had significantly lower mean (SD) ratings of their learning experiences (3.48 (1.10) vs. 4.50 (0.72), p &lt; 0.001, d = 1.10), but better performance on the hepatology content of the end-of-course examination (78.0% (11.7%) vs. 74.2 (15.1%), respectively, p &lt; 0.01, d = 0.3). Based upon our qualitative data analyses, we propose that the flipped classroom induced a change in the learning process of students by requiring increased preparation for classroom learning and promoting greater learner autonomy, which resulted in better retention of learned material, but reduced enjoyment of the learning experience. This dissonance in outcomes is captured in the words of one flipped classroom student: “…I hated it while I was learning it, but boy did I remember it…”. Based upon our dissonant outcomes and the inconsistent findings in the literature, we feel that there is still equipoise regarding the effectiveness of the flipped classroom, and further studies are needed to describe ways of making the flipped classroom a more effective (±more enjoyable) learning experience