Assessing Virtual Versus In-Person Experiential Learning in Medical Student Pediatric Clerkship Training

Assessing Virtual Versus In-Person Experiential Learning in Medical Student Pediatric Clerkship Training Andrew Berry, Andrew Wigger, Karilynn Craig, Dr. Brock Blankenship, Dr. Jennifer Gibson, Center for Experiential Learning, Quillen College of Medicine, East Tennessee State University, Johnson City, TN. Simulation and experiential training have been incorporated into medical school training for decades. While there are many ways to accomplish experiential-based learning, many faculty and students feel Socratic learning styles provide the best learning experience. As medical students had just finished a predominantly virtual preclinical year due to the COVID-19 pandemic, our research team was interested in understanding students’ perceptions of virtual and in-person experiential learning activities. The primary goal of this study is to compare medical students’ perceptions of the quality and value of in-person versus virtual experiential learning during their pediatric clerkship. Secondary measures of this study examine the differences regarding the retention of case information presented, the clinical relevance of the pediatric cases discussed, and the likelihood that students will attend similar future sessions. Our team hypothesized that students would perceive in-person sessions as more valuable and meaningful to their medical education. One academic year of medical students who participated in two experiential learning encounters during their pediatric clerkship was assessed. Each encounter involved a series of approximately ten patient cases over two hours; one encounter was done in person, and the other was done virtually. Each case was then discussed using a Socratic format; faculty would ask questions and engage students individually, assessing their decision-making capability (including differential diagnosis, treatment plans, and dispositions). Data was collected by a survey administered after both encounters, each with the same questions. Students generally felt the virtual format for this type of training was as well received as the in-person format (56% vs. 52.2% for excellent value ratings, respectively). Similarly, 43.5% of students reported that the in-person cases greatly improved their retention, while 40% said the virtual cases improved their retention of educational material to the same degree. The in-person experiences were reported as being extremely clinically relevant by 56.5% of students, while the virtual cases were perceived as extremely relevant by 48% of respondents. Lastly, survey data showed that 47.8% of respondents said they would very likely attend similar future in-person sessions (compared to 44% for similar virtual events). Our team feels that the results of this study demonstrate that utilizing a Socratic Model of teaching in experiential learning has excellent value, and high-quality training can be accomplished virtually, even during times of potential virtual fatigue. These findings are important as our results show that experiential learning can be adapted, yet still beneficial, when in-person activities cannot take place, such as what we encountered during the COVID-19 pandemic

Thinking for Seeing: Enculturation of Visual-Referential Expertise as Demonstrated by Photo-Triggered Perceptual Reorganization of Two-Tone “Mooney” Images

Two-tones (”Mooney”-esque transformations of grayscale photographs) can be difficult to recognize. However, after viewing the photographs from which two-tones were created, adults experience rapid “perceptual reorganization, ” and the two-tones become immediately recognizable. In contrast to the effortless post-cue recognition seen in adults, preschoolaged children are generally unable to recognize two-tone images even when the photograph is simultaneously available. While simple instructional and perceptual interventions were ineffective, a cognitive intervention in which children were convinced that the photo and two-tone images were transformations of the same physical object improved children’s recognition. We found a similar deficit in recognition in adults from a hunter-gatherer tribe (Pirahã) with a sparse visual symbolic culture and limited exposure to modern visual media. Photo-triggered perceptual reorganization of two-tone images may therefore be a product of prolonged enculturation, reflecting visual-referential expertise. As we gain skill in representing visual correspondences, one of the surprising consequences may be the ability to literally see things we couldn’t see before

Beyond dressing and driving: Using occupation to facilitate community integration in neurorehabilitation

During the process of community integration, individuals with acquired brain injury may experience difficulties in all areas of occupational performance including self-care, home management, community access, leisure, social activities and vocational pursuits. Community based rehabilitation services provide opportunities to minimise such difficulties by working with clients as they engage in meaningful real-life context-based occupations. The therapeutic use of occupation is at the core of occupational therapy practice. We reflect on the nature and principles of occupation and highlight particular benefits for facilitating community integration after brain injury. This is illustrated using the example of executive dysfunction. Several challenges for the occupational therapy profession arise from the shift in focus from hospital to community based rehabilitation, and the need for further research on community integration after brain injury from an occupational perspective is recognised

Pleiotropy among common genetic loci identified for cardiometabolic disorders and C-reactive protein

Pleiotropic genetic variants have independent effects on different phenotypes. C-reactive protein (CRP) is associated with several cardiometabolic phenotypes. Shared genetic backgrounds may partially underlie these associations. We conducted a genome-wide analysis to identify the shared genetic background of inflammation and cardiometabolic phenotypes using published genome-wide association studies (GWAS). We also evaluated whether the pleiotropic effects of such loci were biological or mediated in nature. First, we examined whether 283 common variants identified for 10 cardiometabolic phenotypes in GWAS are associated with CRP level. Second, we tested whether 18 variants identified for serum CRP are associated with 10 cardiometabolic phenotypes. We used a Bonferroni corrected p-value of 1.1×10-04 (0.05/463) as a threshold of significance. We evaluated the independent pleiotropic effect on both phenotypes using individual level data from the Women Genome Health Study. Evaluating the genetic overlap between inflammation and cardiometabolic phenotypes, we found 13 pleiotropic regions. Additional analyses showed that 6 regions (APOC1, HNF1A, IL6R, PPP1R3B, HNF4A and IL1F10) appeared to have a pleiotropic effect on CRP independent of the effects on the cardiometabolic phenotypes. These included loci where individuals carrying the risk allele for CRP encounter higher lipid levels and risk of type 2 diabetes. In addition, 5 regions (GCKR, PABPC4, BCL7B, FTO and TMEM18) had an effect on CRP largely mediated through the cardiometabolic phenotypes. In conclusion, our results show genetic pleiotropy among inflammation and cardiometabolic phenotypes. In addition to reverse causation, our data suggests that pleiotropic genetic variants partially underlie the association between CRP and cardiometabolic phenotypes

Evolution of genes and genomes on the Drosophila phylogeny

Comparative analysis of multiple genomes in a phylogenetic framework dramatically improves the precision and sensitivity of evolutionary inference, producing more robust results than single-genome analyses can provide. The genomes of 12 Drosophila species, ten of which are presented here for the first time (sechellia, simulans, yakuba, erecta, ananassae, persimilis, willistoni, mojavensis, virilis and grimshawi), illustrate how rates and patterns of sequence divergence across taxa can illuminate evolutionary processes on a genomic scale. These genome sequences augment the formidable genetic tools that have made Drosophila melanogaster a pre-eminent model for animal genetics, and will further catalyse fundamental research on mechanisms of development, cell biology, genetics, disease, neurobiology, behaviour, physiology and evolution. Despite remarkable similarities among these Drosophila species, we identified many putatively non-neutral changes in protein-coding genes, non-coding RNA genes, and cis-regulatory regions. These may prove to underlie differences in the ecology and behaviour of these diverse species