Optimizing Lectures From a Cognitive Load Perspective

Lectures are a common instructional method in medical education. Understanding the cognitive processes and theories involved in learning is essential for lecturers to be effective. Cognitive load theory is one theory that is becoming increasingly recognized in medical education and addresses the appropriate use of one’s working memory. Memory is essential to knowledge acquisition. Two types of memory can be considered, working memory (processing of information) and long‐term memory (storage of information). Working memory has a limited capacity. Cognitive load refers to the amount of information processing activity imposed on working memory and can be divided into three domains: intrinsic, extraneous, and germane. By attending to cognitive load, educators can promote learning. This paper highlights various ways of improving cognitive load for learners during lecture‐based instruction by minimizing extraneous load, optimizing intrinsic load, and promoting germane load.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/156199/2/aet210389.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/156199/1/aet210389_am.pd

Medical Student Milestones in Emergency Medicine

Objectives Medical education is a continuum from medical school through residency to unsupervised clinical practice. There has been a movement toward competency‐based medical education prompted by the Accreditation Council for Graduate Medical Education ( ACGME ) using milestones to assess competence. While implementation of milestones for residents sets specific standards for transition to internship, there exists a need for the development of competency‐based instruments to assess medical students as they progress toward internship. The objective of this study was to develop competency‐based milestones for fourth‐year medical students completing their emergency medicine ( EM ) clerkships (regardless of whether the students were planning on entering EM ) using a rigorous method to attain validity evidence. Methods A literature review was performed to develop a list of potential milestones. An expert panel, which included a medical student and 23 faculty members (four program directors, 16 clerkship directors, and five assistant deans) from 19 different institutions, came to consensus on these milestones through two rounds of a modified Delphi protocol. The Delphi technique builds content validity and is an accepted method to develop consensus by eliciting expert opinions through multiple rounds of questionnaires. Results Of the initial 39 milestones, 12 were removed at the end of round 1 due to low agreement on importance of the milestone or because of redundancy with other milestones. An additional 12 milestones were revised to improve clarity or eliminate redundancy, and one was added based on expert panelists' suggestions. Of the 28 milestones moving to round 2, consensus with a high level of agreement was achieved for 24. These were mapped to the ACGME EM residency milestone competency domains, as well as the Association of American Medical Colleges ( AAMC ) core entrustable professional activities for entering residency to improve content validity. Conclusions This study found consensus support by experts for a list of 24 milestones relevant to the assessment of fourth‐year medical student performance by the completion of their EM clerkships. The findings are useful for development of a valid method for assessing medical student performance as students approach residency. Resumen Objetivos La formación médica es un continuo que va desde la universidad, pasando por la residencia, hasta la práctica clínica no supervisada. Ha habido un movimiento hacia la formación médica basada en la adquisición de competencias promovido por el Accreditation Council for Graduate Medical Education ( ACGME ) mediante los hitos para evaluar la competencia. Mientras la implementación de los hitos para los residentes establece normas específicas para la transición a residente, existe necesidad de desarrollar instrumentos basados en la competencia para evaluar a los estudiantes de medicina según progresan hacia la residencia. El objetivo de este estudio fue desarrollar los hitos basados ​​en competencias para los estudiantes de medicina de cuarto año al completar sus prácticas clínicas en Medicina de Urgencias y Emergencias ( MUE ) (indistintamente si el estudiante planeaba acceder a la MUE ) utilizando un método riguroso para lograr evidencia válida. Metodología Se realizó una revisión de la literatura para desarrollar una lista de hitos potenciales. Un panel de expertos, que incluyó 23 profesores de la facultad cuyas responsabilidades eran directores de programa (4), directores de prácticas clínicas (16), vicedecanos (5) y un estudiante de medicina de 19 instituciones diferentes, llegaron a un consenso sobre estos hitos a través de 2 rondas del protocolo de Delphi modificado. La técnica Delphi construye un contenido válido y es un método aceptado para desarrollar un consenso mediante la obtención de opiniones de expertos a través de múltiples rondas de preguntas. Resultados De los 39 hitos iniciales, se eliminaron 12 al final de la primera ronda debido al bajo acuerdo sobre la importancia del hito o debido a su redundancia con otros hitos. Se revisaron 12 hitos adicionales para mejorar la claridad o eliminar la redundancia, y se añadió uno basado en las sugerencias del panel de expertos. De los 28 hitos que llegaron a la segunda ronda, se alcanzó un consenso con un alto nivel de acuerdo para 24 de los hitos. Estos hitos se esquematizaron a los dominios de competencia de los hitos de la residencia de MUE del ACGME , así como a las actividades profesionales recomendadas para acceder a la residencia de la Association of American Medical Colleges ( AAMC ) para mejorar la validez de contenido. Conclusiones Este estudio llegó a un consenso apoyado por expertos para una lista de 24 hitos relevantes para evaluar el rendimiento de los estudiantes de medicina de cuarto año al finalizar su práctica clínica en MUE . Los hallazgos son útiles para el desarrollo de un método válido para evaluar el rendimiento de los estudiantes de medicina a medida que éstos se acercan a la residencia.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/108261/1/acem12443-sup-0002-DataSupplementS2.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/108261/2/acem12443.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/108261/3/acem12443-sup-0001-DataSupplementS1.pd

A skin abscess model for teaching incision and drainage procedures

<p>Abstract</p> <p>Background</p> <p>Skin and soft tissue infections are increasingly prevalent clinical problems, and it is important for health care practitioners to be well trained in how to treat skin abscesses. A realistic model of abscess incision and drainage will allow trainees to learn and practice this basic physician procedure.</p> <p>Methods</p> <p>We developed a realistic model of skin abscess formation to demonstrate the technique of incision and drainage for educational purposes. The creation of this model is described in detail in this report.</p> <p>Results</p> <p>This model has been successfully used to develop and disseminate a multimedia video production for teaching this medical procedure. Clinical faculty and resident physicians find this model to be a realistic method for demonstrating abscess incision and drainage.</p> <p>Conclusion</p> <p>This manuscript provides a detailed description of our model of abscess incision and drainage for medical education. Clinical educators can incorporate this model into skills labs or demonstrations for teaching this basic procedure.</p

Dealing with the difficult student in emergency medicine

Dealing with a student who is perceived as difficult to work with or teach is inevitable in any academic physician's career. This paper will outline the basic categories of these difficulties pertinent to Emergency Medicine rotations in order to facilitate appropriate identification of problems. Strategies for evaluation and reporting of the difficult student are presented. Remediation, based on the type of difficulty, is addressed. Timeliness of reporting, evaluation, and feedback are invaluable to allow for appropriate assessment of the outcome of the remediation plan

DNA-PK-Dependent RPA2 Hyperphosphorylation Facilitates DNA Repair and Suppresses Sister Chromatid Exchange

Hyperphosphorylation of RPA2 at serine 4 and serine 8 (S4, S8) has been used as a marker for activation of the DNA damage response. What types of DNA lesions cause RPA2 hyperphosphorylation, which kinase(s) are responsible for them, and what is the biological outcome of these phosphorylations, however, have not been fully investigated. In this study we demonstrate that RPA2 hyperphosphorylation occurs primarily in response to genotoxic stresses that cause high levels of DNA double-strand breaks (DSBs) and that the DNA-dependent protein kinase complex (DNA-PK) is responsible for the modifications in vivo. Alteration of S4, S8 of RPA2 to alanines, which prevent phosphorylations at these sites, caused increased mitotic entry with concomitant increases in RAD51 foci and homologous recombination. Taken together, our results demonstrate that RPA2 hyperphosphorylation by DNA-PK in response to DSBs blocks unscheduled homologous recombination and delays mitotic entry. This pathway thus permits cells to repair DNA damage properly and increase cell viability

Rad51 Inhibits Translocation Formation by Non-Conservative Homologous Recombination in Saccharomyces cerevisiae

Chromosomal translocations are a primary biological response to ionizing radiation (IR) exposure, and are likely to result from the inappropriate repair of the DNA double-strand breaks (DSBs) that are created. An abundance of repetitive sequences in eukaryotic genomes provides ample opportunity for such breaks to be repaired by homologous recombination (HR) between non-allelic repeats. Interestingly, in the budding yeast, Saccharomyces cerevisiae the central strand exchange protein, Rad51 that is required for DSB repair by gene conversion between unlinked repeats that conserves genomic structure also suppresses translocation formation by several HR mechanisms. In particular, Rad51 suppresses translocation formation by single-strand annealing (SSA), perhaps the most efficient mechanism for translocation formation by HR in both yeast and mammalian cells. Further, the enhanced translocation formation that emerges in the absence of Rad51 displays a distinct pattern of genetic control, suggesting that this occurs by a separate mechanism. Since hypomorphic mutations in RAD51 in mammalian cells also reduce DSB repair by conservative gene conversion and stimulate non-conservative repair by SSA, this mechanism may also operate in humans and, perhaps contribute to the genome instability that propels the development of cancer

A global agenda for advancing freshwater biodiversity research

Global freshwater biodiversity is declining dramatically, and meeting the challenges of this crisis requires bold goals and the mobilisation of substantial resources. While the reasons are varied, investments in both research and conservation of freshwater biodiversity lag far behind those in the terrestrial and marine realms. Inspired by a global consultation, we identify 15 pressing priority needs, grouped into five research areas, in an effort to support informed stewardship of freshwater biodiversity. The proposed agenda aims to advance freshwater biodiversity research globally as a critical step in improving coordinated actions towards its sustainable management and conservation

A global agenda for advancing freshwater biodiversity research

Global freshwater biodiversity is declining dramatically, and meeting the challenges of this crisis requires bold goals and the mobilisation of substantial resources. While the reasons are varied, investments in both research and conservation of freshwater biodiversity lag far behind those in the terrestrial and marine realms. Inspired by a global consultation, we identify 15 pressing priority needs, grouped into five research areas, in an effort to support informed stewardship of freshwater biodiversity. The proposed agenda aims to advance freshwater biodiversity research globally as a critical step in improving coordinated actions towards its sustainable management and conservation.Peer reviewe

Smaller total and subregional cerebellar volumes in posttraumatic stress disorder:a mega-analysis by the ENIGMA-PGC PTSD workgroup

Although the cerebellum contributes to higher-order cognitive and emotional functions relevant to posttraumatic stress disorder (PTSD), prior research on cerebellar volume in PTSD is scant, particularly when considering subregions that differentially map on to motor, cognitive, and affective functions. In a sample of 4215 adults (PTSD n = 1642; Control n = 2573) across 40 sites from the ENIGMA-PGC PTSD working group, we employed a new state-of-the-art deep-learning based approach for automatic cerebellar parcellation to obtain volumetric estimates for the total cerebellum and 28 subregions. Linear mixed effects models controlling for age, gender, intracranial volume, and site were used to compare cerebellum volumes in PTSD compared to healthy controls (88% trauma-exposed). PTSD was associated with significant grey and white matter reductions of the cerebellum. Compared to controls, people with PTSD demonstrated smaller total cerebellum volume, as well as reduced volume in subregions primarily within the posterior lobe (lobule VIIB, crus II), vermis (VI, VIII), flocculonodular lobe (lobule X), and corpus medullare (all p -FDR &lt; 0.05). Effects of PTSD on volume were consistent, and generally more robust, when examining symptom severity rather than diagnostic status. These findings implicate regionally specific cerebellar volumetric differences in the pathophysiology of PTSD. The cerebellum appears to play an important role in higher-order cognitive and emotional processes, far beyond its historical association with vestibulomotor function. Further examination of the cerebellum in trauma-related psychopathology will help to clarify how cerebellar structure and function may disrupt cognitive and affective processes at the center of translational models for PTSD.</p

Smaller total and subregional cerebellar volumes in posttraumatic stress disorder:a mega-analysis by the ENIGMA-PGC PTSD workgroup

Although the cerebellum contributes to higher-order cognitive and emotional functions relevant to posttraumatic stress disorder (PTSD), prior research on cerebellar volume in PTSD is scant, particularly when considering subregions that differentially map on to motor, cognitive, and affective functions. In a sample of 4215 adults (PTSD n = 1642; Control n = 2573) across 40 sites from the ENIGMA-PGC PTSD working group, we employed a new state-of-the-art deep-learning based approach for automatic cerebellar parcellation to obtain volumetric estimates for the total cerebellum and 28 subregions. Linear mixed effects models controlling for age, gender, intracranial volume, and site were used to compare cerebellum volumes in PTSD compared to healthy controls (88% trauma-exposed). PTSD was associated with significant grey and white matter reductions of the cerebellum. Compared to controls, people with PTSD demonstrated smaller total cerebellum volume, as well as reduced volume in subregions primarily within the posterior lobe (lobule VIIB, crus II), vermis (VI, VIII), flocculonodular lobe (lobule X), and corpus medullare (all p -FDR &lt; 0.05). Effects of PTSD on volume were consistent, and generally more robust, when examining symptom severity rather than diagnostic status. These findings implicate regionally specific cerebellar volumetric differences in the pathophysiology of PTSD. The cerebellum appears to play an important role in higher-order cognitive and emotional processes, far beyond its historical association with vestibulomotor function. Further examination of the cerebellum in trauma-related psychopathology will help to clarify how cerebellar structure and function may disrupt cognitive and affective processes at the center of translational models for PTSD.</p