A Student-Led Methodology for Evaluating Curricular Redundancy

Background: Curricular redundancy can be a significant problem for any educational curriculum. Redundancy can be both desirable and undesirable, but differentiating the two can be quite challenging. Further, pinpointing undesirable redundancy and quantifying it so as to produce an estimate of inefficiency is even more difficult. Purpose: The purpose of this research is to describe a student-led strategy for evaluating redundancy in a highly integrated medical school curriculum. It is our hope that the methodology presented here will serve as a useful evaluation model for persons attempting similar work in various educational arenas. Setting: A highly-integrated medical school at a large public university. Intervention: This research did not require an intervention. Research Design: We identified two advanced medical students and asked them to identify redundant material across the first two years of the medical school curriculum. The students had to operationalize ‘redundancy’, develop an evaluation plan/framework, and evaluate the extent to which undesirable redundancy was prevalent in the current curriculum. Data Collection and Analysis: Students reviewed course syllabi, notes, and materials and documented the amount of redundant material they found in the curriculum. Findings: A total of approximately 167 hours, or 8.35 weeks, could be eliminated from the curriculum; the vast majority of the redundancy occurred as a result of small group activities

An expanded phase I/II trial of cyclophosphamide, etoposide, and carboplatin plus total body irradiation with autologous marrow or stem cell support for patients with hematologic malignancies

AbstractThe major cause for failure of autologous stem cell transplantation for hematologic malignancies is the risk of recurrent disease. As a result, new treatment regimens that include novel agents or combinations of agents and approaches are needed. The current report describes a large Phase I/II, single-center trial that includes 60 patients with a variety of hematologic malignancies. These patients received a fixed dose of carboplatin (1 g/m2/d × 72 hours by CI) etoposide (600 mg/m2/d × 3 days) and cyclophosphamide (2 g/m2/d × 3 days), plus escalating doses of total body irradiation (TBI) (at 1000, 1200, and 1295 cGy) over 3 days. Eleven patients received infusion of autologous marrow, 32 received peripheral blood stem cells, and 17 patients received both. The maximum tolerated dose of this regimen was a radiation dose of 1200 cGy given in 200-cGy fractions BID × 3 days. The dose-limiting toxicity was mucositis, with 97% of patients requiring narcotic analgesia for mouth pain. Overall treatment-related mortality was 6.7%, with 2 of the 4 deaths occurring in a group of 9 patients aged 60 and older. Responses were seen in all patient groups, but the most encouraging outcomes were seen in 12 patients with high-risk or advanced acute myelocytic lymphoma (AML), 7 of whom remain alive and free of disease beyond 5 years. This regimen is intensive and causes considerable mucositis but is otherwise well tolerated and has demonstrated activity in a number of hematologic malignancies, especially AML

Non-Hodgkin lymphoma (NHL) subtypes defined by common translocations: Utility of fluorescence in situ hybridization (FISH) in a case–control study

We used fluorescence in situ hybridization (FISH) assays to identify t(14;18) translocations in archival paraffin-embedded tumor sections from non-Hodgkin lymphoma (NHL) cases enrolled in a population-based study. t(14;18) was identified in 54% of 152 cases, including 39% of diffuse large cell lymphomas (26 of 66 cases) and 84% of follicular lymphomas (36 of 43 cases). Eighty-seven percent of t(14;18)-positive cases and 57% of t(14;18)-negative cases expressed bcl-2. FISH assays detected twice as many t(14;18)-positive follicular lymphomas as PCR assays. Overall, study findings support the use of FISH assays to detect t(14;18) in archival tumor samples for epidemiologic studies of NHL subtypes

2018 Research & Innovation Day Program

A one day showcase of applied research, social innovation, scholarship projects and activities.https://first.fanshawec.ca/cri_cripublications/1005/thumbnail.jp

Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study

Abstract: Background: The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods: This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings: Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions: The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown

Burnout in U.S. hematologists and oncologists: impact of compensation models and advanced practice provider support

Burnout is prevalent in throughout medicine. Few large-scale studies have examined the impact of physician compensation or clinical support staff on burnout among hematologists and oncologists. In 2019, the American Society of Hematology conducted a practice survey of hematologists and oncologists in the American Medical Association Masterfile; burnout was measured using a validated, single-item burnout instrument from the Physician Work Life Study, while satisfaction was assessed in several domains using a 5-point Likert scale. The overall survey response rate was 25.2% (N = 631). Of 411 respondents with complete responses in the final analysis, 36.7% (N = 151) were from academic practices and 63.3% (N = 260) from community practices; 29.0% (N = 119) were female. Over one-third (36.5%; N = 150) reported burnout, while 12.0% (N = 50) had a high level of burnout. In weighted multivariate logistic regression models incorporating numerous variables, compensation plans based entirely on relative value unit (RVU) generation were significantly associated with high burnout among academic and community physicians, while the combination of RVU + salary compensation showed no significant association. Female gender was associated with high burnout among academic physicians. High advanced practice provider utilization was inversely associated with high burnout among community physicians. Distinct patterns of career dissatisfaction were observed between academic and community physicians. We propose that implementation of compensation models not based entirely on clinical productivity, increased support for women in academic medicine, and expansion of advanced practice provider support in community practices may address burnout among hematologists and oncologists