How to Be a Super Model: Using Role Modeling to Become an Exemplary Educator

Over the past several years, published studies have described the qualities and skills of exemplary medical educators. Despite its inclusion in these lists, role modeling is a skill that is not often developed as a skill for use as an educational method. The purpose of this workshop is to assist participants in better understanding the characteristics of effective role modeling and create a paradigm for how to consciously incorporate role modeling into the daily education of students, residents, and colleagues in varied domains, including teaching, professionalism, communication, and patient care. In this workshop, participants are introduced to the concept of role modeling as a metacognitive process where successful educators make their thought processes and reasons for behaviors accessible to learners. Through an interactive icebreaker, participants discuss role modeling behaviors that they have encountered, and reflect on their own professional development, describing the impact of positive and negative role modeled behaviors observed through their training. Participants are then provided a succinct review of the literature on role modeling as an educational method in order to provide a framework for participants’ active experimentation in breakout sessions. During these small group sessions, participants explore the different contexts in which they currently may role model teaching, professionalism, communication, and clinical behaviors. Finally, participants collaborate to develop practical strategies for utilizing role modeling in the daily practice of education using the framework provided, and then share their strategies with the larger group. This workshop has been selected for presentation to national audiences at the Pediatric Academic Society (PAS) Meeting in 2013, The Committee on Medical Student Education in Pediatrics (COMSEP) Meeting in 2012, and the American Academy of Pediatrics Pediatric Hospital Medicine Conference (PHM) in both 2012 and 2013. In addition, this workshop has been adapted by the authors for presentation at their local institutions for Grand Rounds, a faculty development retreat, a workshop for faculty and senior medical student preceptors of a Principles of Clinical Medicine course for first and second year medical students, and for pediatric residents learning leadership and teaching skills during a Global Child Health elective. We have also adapted the small group exercise to discuss other topics, such as professionalism, breaking bad news, and working with the angry/upset family

Cognitive debiasing 2: Impediments to and strategies for change

In a companion paper, we proposed that cognitive debiasing is a skill essential in developing sound clinical reasoning to mitigate the incidence of diagnostic failure. We reviewed the origins of cognitive biases and some proposed mechanisms for how debiasing processes might work. In this paper, we first outline a general schema of how cognitive change occurs and the constraints that may apply. We review a variety of individual factors, many of them biases themselves, which may be impediments to change. We then examine the major strategies that have been developed in the social sciences and in medicine to achieve cognitive and affective debiasing, including the important concept of forcing functions. The abundance and rich variety of approaches that exist in the literature and in individual clinical domains illustrate the difficulties inherent in achieving cognitive change, and also the need for such interventions. Ongoing cognitive debiasing is arguably the most important feature of the critical thinker and the well-calibrated mind. We outline three groups of suggested interventions going forward: educational strategies, workplace strategies and forcing functions. We stress the importance of ambient and contextual influences on the quality of individual decision making and the need to address factors known to impair calibration of the decision maker. We also emphasise the importance of introducing these concepts and corollary development of training in critical thinking in the undergraduate level in medical education

Correlation of efficacy of cerebro placental ratio with adverse perinatal outcome in clinically suspected IUGR pregnancies

Background: IUGR is a most common and complex problem in modern obstetrics. Most commonly use methods to assess fetal condition are BPP and NST which are not sensitive for predicting better perinatal outcome.  Present study was an effort to evaluate the role of ratio of pulsatility index (PI) of middle cerebral artery and umbilical artery which is called cerebro placental ratio as the most sensitive, specific and accurate predictor of adverse perinatal outcome in clinically suspected IUGR Pregnancies.Methods: 50 clinically suspected IUGR Pregnancies attending antenatal clinics Muzaffarnagar Medical College and Hospital, Muzaffarnagar were subjected to Doppler ultrasound evaluation Doppler velocity wave form of umbilical artery and fetal middle cerebral artery were obtained. Pulsatility index ratio of MCA and umbilical artery (cerebro placental ratio) was evaluated in each case. Abnormal ratio is defined as CPR<1.08 considered as cut of value. Ratio was coo related clinically with perinatal outcome.Results: Out of 50 antenatal cases, 63% neonates had birth weight <2.5 kg. There were 6 IUD’S and 44 live births, 9 neonates were admitted to NICU, 7 neonates had 5 min. APGAR score <7 and 13 neonates were born by emergency CS. Of the 6 IUDS, 4 cases had reversal of blood flow umbilical artery and 2 cases had absent diastolic flow. In all cases of reversal Diastolic flow, IUD occurred within 7 days of diagnosis. Conclusions: CPR is the most sensitive, specific and accurate parameter in prediction of adverse perinatal outcome and thus can help in decreasing perinatal mortality

Challenging Situations in Family Centered Rounds: Making the Best out of Worst Case Scenarios

This resource is a workshop intended for both seasoned and novice health care providers who are interested in becoming prepared for challenging scenarios that may be encountered during FCR. Case scenarios of challenging situations relating to discussing sensitive topics, correcting errors, and teaching learners in front of both parents and patients are presented. Tangible opportunities to role model communication skills, efficiency, and teaching skills for trainees are highlighted. The session will conclude with a question and answer session with a multi-specialty panel to share experiences and strategies for addressing the unexpected during FCR. By the end of the workshop, participants will take away concrete strategies that they can share with their home institutions that will enhance the FCR process. AAMC MedEdPORTAL publication ID 9728. Link to original

Impact of an International Nosocomial Infection Control Consortium multidimensional approach on central line-associated bloodstream infection rates in adult intensive care units in eight cities in India

SummaryObjectiveTo evaluate the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control approach on central line-associated bloodstream infection (CLABSI) rates in eight cities of India.MethodsThis was a prospective, before-and-after cohort study of 35650 patients hospitalized in 16 adult intensive care units of 11 hospitals. During the baseline period, outcome surveillance of CLABSI was performed, applying the definitions of the CDC/NHSN (US Centers for Disease Control and Prevention/National Healthcare Safety Network). During the intervention, the INICC approach was implemented, which included a bundle of interventions, education, outcome surveillance, process surveillance, feedback on CLABSI rates and consequences, and performance feedback. Random effects Poisson regression was used for clustering of CLABSI rates across time periods.ResultsDuring the baseline period, 9472 central line (CL)-days and 61 CLABSIs were recorded; during the intervention period, 80898 CL-days and 404 CLABSIs were recorded. The baseline rate was 6.4 CLABSIs per 1000 CL-days, which was reduced to 3.9 CLABSIs per 1000 CL-days in the second year and maintained for 36 months of follow-up, accounting for a 53% CLABSI rate reduction (incidence rate ratio 0.47, 95% confidence interval 0.31–0.70; p=0.0001).ConclusionsImplementing the six components of the INICC approach simultaneously was associated with a significant reduction in the CLABSI rate in India, which remained stable during 36 months of follow-up

International genome-wide meta-analysis identifies new primary biliary cirrhosis risk loci and targetable pathogenic pathways.

Primary biliary cirrhosis (PBC) is a classical autoimmune liver disease for which effective immunomodulatory therapy is lacking. Here we perform meta-analyses of discovery data sets from genome-wide association studies of European subjects (n=2,764 cases and 10,475 controls) followed by validation genotyping in an independent cohort (n=3,716 cases and 4,261 controls). We discover and validate six previously unknown risk loci for PBC (Pcombined<5 × 10(-8)) and used pathway analysis to identify JAK-STAT/IL12/IL27 signalling and cytokine-cytokine pathways, for which relevant therapies exist

Primary Adult Human Retinal Pigment Epithelial Cell Cultures on Human Amniotic Membranes

<b>Purpose: </b> Retinal pigment epithelial (RPE) cells grow well on surfaces that provide an extracellular matrix. Our aim was to establish primary adult human RPE cell cultures that retain their epithelial morphology <i> in vitro</i> using human amniotic membrane (hAM) as substrate. <b> Materials and Methods: </b> Human cadaver eyeballs (16) were obtained from the eye bank after corneal trephination. RPE cells were harvested by a) mechanical dissection of the inner choroid surface (10, group 1) or by b) enzymatic digestion using 0.25&#x0025; Trypsin/0.02&#x0025; EDTA (6, group 2). The cells were explanted onto de-epithelialized hAM, nourished using DMEM/HAMS F-12 media and monitored for growth under the phase contrast microscope. Cell cultures were characterised by whole mount studies and paraffin sections. Growth data in the two groups were compared using the students&#x2032; &#x2032;t&#x2032; test. <b> Results:</b> Eleven samples (68.75&#x0025;) showed positive cultures<b> </b> with small, hexagonal cells arising from around the explant which formed a confluent and progressively pigmented monolayer. Whole mounts showed closely placed polygonal cells with heavily pigmented cytoplasm and indistinct nuclei. The histologic sections showed monolayers of cuboidal epithelium with variable pigmentation within the cytoplasm. Growth was seen by day 6-23 (average 11.5 days) in the mechanical group, significantly earlier (<i> P </i> <0.025) than in the enzymatic group (day 29-35, average 31.6 days). <b>Conclusions:</b> Primary adult human RPE cell cultures retain epithelial morphology <i> in vitro</i> when cultured on human amniotic membranes<i> .</i> Mechanical dissection of the inner choroid surface appears to be an effective method of isolating RPE cells and yields earlier growth in cultures as compared to isolation by enzymatic digestio

Unusually large submandibular epidermoid cyst: A case report, differential diagnosis and therapy

Epidermoid cysts are rare, slow-growing, benign, and developmental cysts that are derived from abnormally situated ectodermal tissue. Epidermoid cysts may grow anywhere on the body and about 7% of them are located in the head and neck. These cysts arise from traumatic implantation of epithelium or entrapment of epithelial remnants during embryonic fusion. Histopathologically, they are lined by stratified squamous epithelium and lumen without any skin appendages. Here, we present a case of large epidermoid cyst occurring in submandibular region

Correlation of efficacy of cerebro placental ratio with adverse perinatal outcome in clinically suspected IUGR pregnancies

Background: IUGR is a most common and complex problem in modern obstetrics. Most commonly use methods to assess fetal condition are BPP and NST which are not sensitive for predicting better perinatal outcome.  Present study was an effort to evaluate the role of ratio of pulsatility index (PI) of middle cerebral artery and umbilical artery which is called cerebro placental ratio as the most sensitive, specific and accurate predictor of adverse perinatal outcome in clinically suspected IUGR Pregnancies.Methods: 50 clinically suspected IUGR Pregnancies attending antenatal clinics Muzaffarnagar Medical College and Hospital, Muzaffarnagar were subjected to Doppler ultrasound evaluation Doppler velocity wave form of umbilical artery and fetal middle cerebral artery were obtained. Pulsatility index ratio of MCA and umbilical artery (cerebro placental ratio) was evaluated in each case. Abnormal ratio is defined as CPR&lt;1.08 considered as cut of value. Ratio was coo related clinically with perinatal outcome.Results: Out of 50 antenatal cases, 63% neonates had birth weight &lt;2.5 kg. There were 6 IUD’S and 44 live births, 9 neonates were admitted to NICU, 7 neonates had 5 min. APGAR score &lt;7 and 13 neonates were born by emergency CS. Of the 6 IUDS, 4 cases had reversal of blood flow umbilical artery and 2 cases had absent diastolic flow. In all cases of reversal Diastolic flow, IUD occurred within 7 days of diagnosis. Conclusions: CPR is the most sensitive, specific and accurate parameter in prediction of adverse perinatal outcome and thus can help in decreasing perinatal mortality