Are Our Students Teachers?

Background: Though the practical and philosophical importance of teaching educational skills to students of medicine has been widely acknowledged, the principle accrediting bodies of resident and medical student training in the U.S. do not require medical schools to offer formal training in how to teach. Both recognize resident teaching in their competencies: the Accreditation Council for Graduate Medical Education (ACGME) requires all residencies to have a formal program in teaching; the Liaison Committee on Medical Education (LCME) mandates that all residents and faculty charged with teaching medical students “be prepared for their roles in teaching and assessment.” But many medical students begin to teach their peers and junior students during medical school. In a 2008 poll of 130 accredited, M.D.-granting US medical schools, all 99 responding institutions reported using their students as teachers, though less than half offered formal curriculum in teaching, and among them, the majority of curricula reached only a fraction of graduating students, usually toward the end of their final year. In addition, students teach patients from early in their training, and formal teaching skills may support this activity and thus enhance patient care. Despite favorable argument for the value and efficacy of such programs in the literature of the past three decades, U.S. medical education has largely deferred the formal instruction of educational skills to the postgraduate level. UMMS offers its students a patchwork of peer and patient educational opportunities without presently offering formal background in evidence-based teaching skills. While this type of scattered elective experience can be immensely valuable to students, further formalization may better prepare UMMS students to satisfy the institutional competency of “assuming the role of teacher when appropriate.” The introduction and refinement of teaching skills may in turn benefit the quality of the educational program, the wider institutional and interprofessional learning environment, and patient care and health education across the Commonwealth. Many UMMS students stay on to become teaching residents and faculty, and remain – or later return – to the state to practice and teach. In a demanding era of expanding biomedical complexity, reduced resident duty hours, collaborative health care delivery, and patient-centered decision-making, offering or requiring relevant educational training to our clinicians early in their development may provide substantial benefit to our health care system and patients. Objectives: The objectives of this project were: 1) Quantify the existence of peer and patient teaching opportunities within and outside the formal UMMS educational program at all levels of the curriculum; 2) Describe the receptiveness of faculty and students toward institution of a formal program preparing all UMMS students to teach both peers and patients in a variety of settings common to residency and clinical practice in any field; 3) Report arguments for and against such a program from the vantage of faculty and students, including barriers specific to UMMS; and 4) Propose a blueprint for such a program based on the opportunities already offered, new ideas from faculty and students, and models culled both from the educational literature and from other institutions. Methods: Short online surveys were sent to course-directing faculty and to all currently enrolled UMMS students in years 1-4 of the curriculum using a combination of Likert-scale and open response items. Per the IRB, the survey did not require a formal approval or exemption process. Results: FACULTY: 58% of all course and clerkship faculty responded; 48% stated that their courses already offer some opportunity in peer and patient teaching, though only in select cases do students receive formal training in educational methodology and thorough feedback on their performance as educators. Often, these programs do not apply to all students. 50% of faculty were most (4-5 on a 5-point scale) “interested in incorporating a formal student teaching component into [their] course,” and when asked whether they had particular “ideas for how students might practice their peer education or patient teaching skills within [their] course?” 67% answered “yes,” posing a variety of possibilities for peer and patient education, both familiar and innovative. Students: 143 responses (28%) were received from currently enrolled students, constituting 17.6% of MS1, 25.4% of MS2, 26.9% of MS3, and 39.6% of MS4 and extending students. Self-reported comfort as a peer and patient educator increased modestly over class years, when expressed as an average of responses on a 1-5 Likert scale (Peer: MS1 3.00, MS2 3.13, MS3 3.13, MS4 3.47, MS4 extended 3.57; Patient: MS1 3.32, MS2 3.75, MS3 3.88, MS4 3.95, MS4 extended 4.21). 30.8% of students identified some opportunity to teach within the formal curriculum; outside the formal curriculum, 28.7% of students listed no opportunity, while the rest listed different amounts and frequencies ranging from daily to once a year, depending on how they defined teaching. 75.6% of responding students emphasized the value of “learn[ing] formal teaching skills - small group, lecture, bedside - in medical school” and 77.7% emphasized the value of opportunities to “practice formal teaching skills” (4-5 on a 5-point scale). 41.3% indicated that they would “actively create time to learn, practice, and refine these skills prior to residency if it were not included in the formal academic program.” Conclusion: Though teaching opportunities exist at UMMS, most are not formalized, and those offered reach less than a third of students. While comfort with peer and patient teaching increases across the educational continuum from first to fourth year, the increase remains modest. 84% of graduates report that they felt prepared to teach as interns based on their 2011 AAMC graduation questionnaire responses, but given the importance of teaching in many aspects of medicine, we see room for improvement. Overall, there is a strong call both from both faculty and students at UMMS for formally incorporating educational training into the curriculum, with a particular focus on teaching practice. Free-response items emphasized dramatic differences in student and faculty understanding and recognition of teaching as a professional role among both peers and patients. These discrepancies highlight a need for increased awareness of the teaching responsibilities of medical students, and of the possibilities that are open to them during medical school. A structured approach to medical student teaching skills across the continuum of undergraduate medical education is the first step in this process

Preparing Medical Students to Be Physician Leaders: A Leadership Training Program for Students Designed and Led by Students

Introduction: Leadership is an area of education and training that is critical to the development of medical providers as health care professionals, yet few medical school curricula offer formal training in this area. Methods: We designed and implemented a course to develop and enhance the leadership and teamwork skills of first-year medical students to better prepare them for medical practice. Following a systematic literature review to identify leadership core competencies, the Leadership in Medicine Optional Enrichment Elective (OEE) was developed in accordance with the University of Massachusetts Medical School’s course guidelines. The elective included six interactive sessions to advance skills in the areas of recognizing and utilizing effective leadership styles, communication within the health care team, giving and receiving feedback, delegating responsibilities, and direction setting. We designed a robust, evidence-based, scholarly evaluation plan for the OEE that was integral to ongoing quality improvement of the course. Results: Outcomes were assessed in alignment with the Kirkpatrick method of standardized evaluation. A total of 26 participants completed the course. At completion, participants demonstrated learning and advancement of skills in all five leadership domains. Furthermore, participants found meaning in the course and planned to utilize their skills in future medical practice. Discussion: The development, implementation, and evaluation of this program can serve as a model for future course development, and the program can be adapted and implemented by other institutions in an effort to address the learning gap regarding leadership education

Incorporating Reflective Writing into the Clerkship

During the last decade, medical schools have turned to writing exercises as a means for encouraging students to reflect on their learning experiences during clinical clerkships. The reasons for the increased popularity of reflective writing are broad. Approaches to encouraging reflective writing are quite varied. Recently, three internal medicine clerkships (University of Chicago Pritzker School of Medicine, University of Florida College of Medicine, and University of Massachusetts Medical School) independently implemented reflective writing activities in the clerkship curriculum

Hipermemória, sinestesia, savants: Luria e Borges revisitados

In this paper, we investigated two subjects with superior memory, or hyper memory: Solomon Shereshevsky, who was followed clinically for years by A. R. Luria, and Funes the Memorious, a fictional character created by J. L. Borges. The subjects possessed hyper memory, synaesthesia and symptoms of what we now call autistic spectrum disorder (ASD). We will discuss interactions of these characteristics and their possible role in hyper memory. Our study suggests that the hyper memory in our synaesthetes may have been due to their ASD-savant syndrome characteristics. However, this talent was markedly diminished by their severe deficit in categorization, abstraction and metaphorical functions. As investigated by previous studies, we suggest that there is altered connectivity between the medial temporal lobe and its connections to the prefrontal cingulate and amygdala, either due to lack of specific neurons or to a more general neuronal dysfunction.Neste artigo, investigamos dois sujeitos com memória superior ou hipermemória: Solomon Shereshevsky, que foi seguido clinicamente por anos por A. R. Luria, e Funes o memorioso, um personagem fictício criado por J. L. Borges. Os sujeitos possuem hipermemória, sinestesia e sintomas do que hoje chamamos de transtorno do espectro autista (TEA). Vamos discutir interações dessas características e seu possível papel na memória hiper. Nosso estudo sugere que a hipermemória em nossos sujeitos sinestésicos pode ser devido às suas características de síndrome do DSA-savant. No entanto, esse talento foi acentuadamente diminuído pelo profundo déficit de categorização, abstração e funções metafóricas. Conforme investigado por estudos anteriores, sugerimos que há conectividade alterada entre o lobo temporal medial e suas conexões com o cingulado e a amígdala pré-frontal, devido à falta de neurônios específicos ou a uma disfunção neuronal mais geral.Fil: Fornazzari, Luis. University of Toronto; CanadáFil: Leggieri, Melissa. University of Toronto; CanadáFil: Schweizer, Tom A.. University of Toronto; CanadáFil: Arizaga, Raúl Luciano. Universidad de Buenos Aires. Facultad de Medicina; ArgentinaFil: Allegri, Ricardo Francisco. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Fischer, Corinne E.. University of Toronto; Canad

Hipermemória, sinestesia, savants: Luria e Borges revisitados

In this paper, we investigated two subjects with superior memory, or hyper memory: Solomon Shereshevsky, who was followed clinically for years by A. R. Luria, and Funes the Memorious, a fictional character created by J. L. Borges. The subjects possessed hyper memory, synaesthesia and symptoms of what we now call autistic spectrum disorder (ASD). We will discuss interactions of these characteristics and their possible role in hyper memory. Our study suggests that the hyper memory in our synaesthetes may have been due to their ASD-savant syndrome characteristics. However, this talent was markedly diminished by their severe deficit in categorization, abstraction and metaphorical functions. As investigated by previous studies, we suggest that there is altered connectivity between the medial temporal lobe and its connections to the prefrontal cingulate and amygdala, either due to lack of specific neurons or to a more general neuronal dysfunction

A REDCap-based model for electronic consent (eConsent): Moving toward a more personalized consent

Introduction: The updated common rule, for human subjects research, requires that consents begin with a \u27concise and focused\u27 presentation of the key information that will most likely help someone make a decision about whether to participate in a study (Menikoff, Kaneshiro, Pritchard. The New England Journal of Medicine. 2017; 376(7): 613-615.). We utilized a community-engaged technology development approach to inform feature options within the REDCap software platform centered around collection and storage of electronic consent (eConsent) to address issues of transparency, clinical trial efficiency, and regulatory compliance for informed consent (Harris, et al. Journal of Biomedical Informatics 2009; 42(2): 377-381.). eConsent may also improve recruitment and retention in clinical research studies by addressing: (1) barriers for accessing rural populations by facilitating remote consent and (2) cultural and literacy barriers by including optional explanatory material (e.g., defining terms by hovering over them with the cursor) or the choice of displaying different videos/images based on participant\u27s race, ethnicity, or educational level (Phillippi, et al. Journal of Obstetric, Gynecologic, and Neonatal Nursing. 2018; 47(4): 529-534.). Methods: We developed and pilot tested our eConsent framework to provide a personalized consent experience whereby users are guided through a consent document that utilizes avatars, contextual glossary information supplements, and videos, to facilitate communication of information. Results: The eConsent framework includes a portfolio of eight features, reviewed by community stakeholders, and tested at two academic medical centers. Conclusions: Early adoption and utilization of this eConsent framework have demonstrated acceptability. Next steps will emphasize testing efficacy of features to improve participant engagement with the consent process

Landscape Genetics of Raccoons (\u3ci\u3eProcyon lotor\u3c/i\u3e) Associated with Ridges and Valleys of Pennsylvania: Implications for Oral Rabies Vaccination Programs

Raccoons are the reservoir for the raccoon rabies virus variant in the United States. To combat this threat, oral rabies vaccination (ORV) programs are conducted in many eastern states. To aid in these efforts, the genetic structure of raccoons (Procyon lotor) was assessed in southwestern Pennsylvania to determine if select geographic features (i.e., ridges and valleys) serve as corridors or hindrances to raccoon gene flow (e.g., movement) and, therefore, rabies virus trafficking in this physiographic region. Raccoon DNA samples (n = 185) were collected from one ridge site and two adjacent valleys in southwestern Pennsylvania (Westmoreland, Cambria, Fayette, and Somerset counties). Raccoon genetic structure within and among these study sites was characterized at nine microsatellite loci. Results indicated that there was little population subdivision among any sites sampled. Furthermore, analyses using a model-based clustering approach indicated one essentially panmictic population was present among all the raccoons sampled over a reasonably broad geographic area (e.g., sites up to 36 km apart). However, a signature of isolation by distance was detected, suggesting that widths of ORV zones are critical for success. Combined, these data indicate that geographic features within this landscape influence raccoon gene flow only to a limited extent, suggesting that ridges of this physiographic system will not provide substantial long-term natural barriers to rabies virus trafficking. These results may be of value for future ORV efforts in Pennsylvania and other eastern states with similar landscapes

Burden of respiratory viral infection in persons with human immunodeficiency virus

This study was conducted to determine the prevalence of respiratory viral infections (RVI) in persons living with HIV (PLH) admitted with a respiratory complaint using real-time reverse transcription polymerase chain reaction and primer-independent next-generation sequencing (NGS). Of 82 subjects, respiratory viruses were the most common pathogen identified in 27 (33%), followed by fungus and bacteria in 8 (10%) and 4 (5%) subjects, respectively. Among subjects with RVI, 11 (41%) required ICU admission and 16 (59%) required mechanical ventilation. The proportion of respiratory viruses identified, and the associated complicated hospital course highlights the significant role that RVIs play in the lung health of PLH

Authorship Trends in the Journal of Orthopaedic Research: A Bibliometric Analysis

Publications are an important tool to measure one's success and achievement in academia. They can help propel a career forward and move one into a position of leadership. The overall purpose of this study was to investigate changes in bibliometric variables, authorship, and collaboration trends in the Journal of Orthopaedic Research (JOR®), since its inception in 1983. A bibliometric analysis was completed for all manuscripts meeting the inclusion criteria (638), which were published throughout the inaugural year plus one representative year of each decade. Several parameters were investigated including numbers of manuscripts, authors, collaborating institutions/countries, references, pages, and citations; region of origin and gender of authors over time and by region were main focuses. Significant increases over time were observed in all bibliometric variables analyzed except in the number of pages and citations. There was an approximate 27 percentage point increase for both female first and corresponding authors from 1983 to 2015. While this is most likely due to the increase in the number of women that have entered the field over time, similar increases in the percentage of women holding positions on the JOR editorial board or in leadership positions within in the field may have also contributed to improvements in gender parity. Understanding changes in publishing characteristics over time, by region, and by gender are critical, especially with the rising demands of publishing in academia. JOR has seen increase in most variables analyzed, including improvements in authorship by women in the field of orthopaedic research