Clinical reasoning for acute dyspnoea: comparison between final-year medical students from discipline- and competency-based undergraduate programmes

Abstract: Clinical reasoning for acute dyspnoea: Comparison of final-year medical students from discipline- andcompetency-based undergraduate programmes. Background: The global shift to competency-based medical education aims to improve the performance of itstrainees, including in the key competency domain of clinical reasoning. However, research on whether such educationactually improves clinical reasoning is sparse. The purpose of this study is to compare assessed clinical reasoningperformance in digitally presented cases of acute dyspnoea between final-year medical students from a traditional,discipline-based and those from an integrated, competency-based undergraduate programme. Methods: A total of 60 medical students in their final-year clerkships participated in the study; 30 were from adiscipline-based programme, and 30 were from a competency-based programme of the same faculty. The studentscompleted a knowledge test consisting of 22 single choice items and a computer-based test of clinical reasoning withsix video-based case scenarios with different underlying diseases leading to dyspnoea. The operationalized measures ofclinical reasoning were the number and relevance of the diagnostic tests chosen, time to diagnosis and diagnosticaccuracy. Results: The two groups did not differ in their knowledge of the acute dyspnoea content domain. With regard toclinical reasoning, the selection of relevant tests, time required to make a diagnosis and accuracy of the diagnosisvaried across the six case scenarios in both groups. However, the results from the measures of the clinical reasoningprocess did not differ between the students from the two types of undergraduate medical programmes. No significantdifferences were found with regard to the selection of relevant diagnostic tests (M = 63.8% vs. M = 62.8%), the time toa diagnosis (M = 128.7 s vs. M = 136.4 s) or the accuracy of diagnosis (M = 82.2% vs. M = 77.0%). Conclusions: Key indicators of the clinical reasoning process, when assessed with objectively measured parameters,did not differ between final-year medical students from a traditional, discipline-based and those from an integrated,competency-based undergraduate programme in the domain of acute dyspnoea. The results substantiate and expandthose of previous studies based on subjective assessor ratings that showed limited change in the clinical reasoningperformance of medical students with competency-based undergraduate education

Plastid DNA sequences and oospore characters of some European taxa of Tolypella section Tolypella (Characeae) identify five clusters, including one new cryptic Tolypella taxon from Sardinia, but they do not coincide with current morphological descriptions

In Europe, the genus Tolypella (Characeae) comprises four to eight Tolypella taxa in sections Rothia and Tolypella that have been distinguished by vegetative morphology and gametangial characters such as antheridial size and oospore wall ornamentation. However, morphological differentiation is difficult in some cases due to overlapping and variable vegetative features, which in many cases are difficult to observe clearly. To clarify the taxonomic status of the five European taxa of Tolypella in section Tolypella, sequence data of the plastid genes atpB, rbcL and psbC for Tolypella glomerata (Desv.) Leonh., Tolypella hispanica Allen, Tolypella nidifica (O.F. Müll.) A. Braun, Tolypella normaniana (Nordst.) Nordst. and Tolypella salina Cor. were combined with data on oospore morphology, including oospore wall ornamentation. Gene sequence data identified five distinct clusters, but they were not consistent with the morphologically identified five taxa. T. glomerata consisted of some of the samples morphologically identified as T. glomerata and seven samples of T. normaniana, while the remaining T. glomerata samples clustered with specimens of unclear affiliation (Tolypella sp.). We identified two clusters of T. hispanica within the European material: cluster T. hispanica I consisted of samples from various locations, whereas the second cluster (T. hispanica II) consisted of samples of T. hispanica from Sardinia Island. The remaining cluster consisted of all the specimens that had been determined as T. salina or T. nidifica in addition to two specimens of T. normaniana. Oospore morphology was most clearly distinguishable for T. glomerata. Oospore characteristics for all other taxa were not as informative but showed some geographical and/or environmentally influenced differences, especially for T. nidifica and T. salina. Our results suggest the need to further check the different taxonomy of Tolypella sect. Tolypella in which specimens normally identified as T. glomerata might be two different taxa, T. glomerata and an unidentified taxon; T. nidifica and T. salina are not separate taxa; T. normaniana is a diminutive variant of two different Tolypella taxa; and T. hispanica comprises two different taxa, one from the Mediterranean island Sardinia.publishedVersio

What we really know about the dormancy, reproduction, germination and cultivation of charophytes (Characeae)

This expanded review aims to provide information on previous basic research by charophyte experts in the areas of reproduction, dormancy, germination of oospores and cultivation. Therefore, published information, the author’s PhD thesis and further results have been combined to summarise the current state of knowledge for Characeae of permanent and temporary waterbodies. The understanding of evolutionary, systematic and molecular pathways require multidimensional approaches using combined results of morphology, anatomy, physiology, genetics, geobotanics and ecology. The application of zonobioms from geobotanies for performed germination studies resulted in a linkage between environmental conditions and dormancy breakage treatment. Besides this, the combination of environmental logger data and species-specific cultivation knowledge resulted in an optimised in-vitro system that allow the successful gametangia initiation and maturation under artificial laboratory conditions in monoecious diplostichous Chara species

What we really know about the dormancy, reproduction, germination and cultivation of charophytes (Characeae)

This expanded review aims to provide information on previous basic research by charophyte experts in the areas of reproduction, dormancy, germination of oospores and cultivation. Therefore, published information, the author’s PhD thesis and further results have been combined to summarise the current state of knowledge for Characeae of permanent and temporary waterbodies. The understanding of evolutionary, systematic and molecular pathways require multidimensional approaches using combined results of morphology, anatomy, physiology, genetics, geobotanics and ecology. The application of zonobioms from geobotanies for performed germination studies resulted in a linkage between environmental conditions and dormancy breakage treatment. Besides this, the combination of environmental logger data and species-specific cultivation knowledge resulted in an optimised in-vitro system that allow the successful gametangia initiation and maturation under artificial laboratory conditions in monoecious diplostichous Chara species

What we really know about the dormancy, reproduction, and germination of charophytes and the new method of ECO-IN-VITRO-CULTIVATION

This paper aims to provide information on previous basic research by charophyte experts mainly in the field of reproduction, dormancy, and germination of oospores. Therefore, published information, the author’s PhD thesis and further new results have been combined to summarise the state of knowledge for Characeae of permanent and temporary water bodies. The understanding and integration of evolutionary, systematic, and ecological knowledge enables the successful establishment of laboratory cultures as well as axenic cultures. The combination of ecological field monitoring and species-specific background knowledge led to the new cultivation method of ECO-IN-VITRO-CULTIVATION as shown for Chara hispida.This paper is dedicated to two experts of the Characeae research who passed away too early. Tim Steinhardt, the best oospore lab colleague and Andrzej Pukacz with whom I had the talk of transferring field ecology into my Chara cultures during my visit in Poznań, when you wanted to teach me the use of all my properties

What we really know about the dormancy, reproduction, and germination of charophytes and the new method of ECO-IN-VITRO-CULTIVATION

This paper aims to provide information on previous basic research by charophyte experts mainly in the field of reproduction, dormancy, and germination of oospores. Therefore, published information, the author’s PhD thesis and further new results have been combined to summarise the state of knowledge for Characeae of permanent and temporary water bodies. The understanding and integration of evolutionary, systematic, and ecological knowledge enables the successful establishment of laboratory cultures as well as axenic cultures. The combination of ecological field monitoring and species-specific background knowledge led to the new cultivation method of ECO-IN-VITRO-CULTIVATION as shown for Chara hispida.This paper is dedicated to two experts of the Characeae research who passed away too early. Tim Steinhardt, the best oospore lab colleague and Andrzej Pukacz with whom I had the talk of transferring field ecology into my Chara cultures during my visit in Poznań, when you wanted to teach me the use of all my properties

Establishment and optimization of a new model organism to study early land plant evolution: Germination, cultivation and oospore variation of Chara braunii Gmelin, 1826

For studying land plant evolution, the establishment and optimization of model organisms representing streptophytic algae, sister to land plants, is essential. Long-term cultivation experiments with Chara braunii S276 were performed over 8 years, since 4 years (Nov. 2018) under constant conditions. Additionally, short-term experiments for optimization of culture conditions were performed with three strains of C. braunii (S276, NIES-1604 and Lausiger Teiche, LaT-2708). Germination success after application of sterilization agents, addition of gibberellic acid and under different incubation conditions with respect to pre-treatment, irradiance regime and substrate was investigated in order to develop protocols for generative cultivation of at least unialgal cultures. The resulting cultivation protocols for C. braunii S276, allowing maintenance of vegetative as well as generative cultures are presented in detail, including protocols for germination induction and growth of sterilized and unsterilized oospores

Resilience of aquatic ecosystems - vitality of seed banks

Die Eutrophierung aquatischer Systeme steigt durch erhöhte anthropogene Einflussnahme. Restaurierungsprozesse beziehen das Element der Makrophyten, v.a. das der Characeen, aktiv mit ein. Eine Abschätzung des Potentials (Ausnutzung systemeigener Diasporen) setzt jedoch eine Bestimmung der Diasporenbankzusammensetzung und der Vitalität voraus. Multivariater Analysen konnten zur Artidentifizierung ausgenutzt werden. Die Bestimmung der Vitalität von Oosporen kann über den Nachweis von Dehydrogenasen mittels 2,3,5 – Triphenyltetrazoliumchlorid erfolgen.The eutrophication of aquatic systems rises by an increased anthropogenic influence. Restoration processes incorporates the element of macrophytes, especially that of Characeae, actively. However, the estimate of the potential of the exploitation of native diaspores requires the determination of seed bank composition and vitality of oospores. Multidimensional analyses were used for species identification. The determination of the vitality of oospores can be effected by means of the detection of dehydrogenases by 2,3,5-Triphenyltetrazoliumchloride

Introducing an assessment tool based on a full set of end-of-training EPAs to capture the workplace performance of final-year medical students

BackgroundWhile literature on the theoretical value of entrustable professional activities (EPAs) for assessment is rapidly expanding, little experience exists on its application. The aims of this study are to develop and explore the utility of an EPA-based assessment tool for capturing the workplace performance of final-year medical students based on a full set of end-of-training EPAs.MethodsThe tool was developed in a systematic iterative process. Twelve 12 end-of-undergraduate medical training EPAs were nested into 72 smaller EPAs and cross-mapped onto a 6-point supervision level scale, both adjusted to the context of final-year clerkships. One version was created for students' self-assessment of their ability to carry out tasks and their history of carrying out tasks, and another version was created for supervisors' assessment of students' ability to carry out tasks. The tool was administered to final-year clerkship students and their clinical supervisors to explore its utility as an assessment approach. The results were analysed using descriptive and interferential statistics.ResultsWe enrolled a total of 60 final-year medical students. For 33 students, ratings were provided from one supervisor and for 27 students from two supervisors. With regard to the reliability and validity of the tool, students' and supervisors' ratings showed an overall good internal consistency as well as variability between and within the EPAs. Over the full EPA range, students rated their ability to perform a task slightly higher than their task performance history and slightly lower than the supervisors' ratings. Students' self-ratings of their ability to perform a task correlated with their history in performing the task. Supervisors' ratings correlated among supervisors and not with students' ratings. Concerning educational outcomes, supervisors' average rating of students' ability to perform the EPAs without direct supervision was 64%, and key findings being double-checked.ConclusionsThis study introduces a tool that is adjusted to the final-year clerkship context and can assess the workplace performance of trainees based on a full set of end-of-training EPAs. Its utility characteristics suggest that the tool may be employed as a formative and outcome-aligned approach to the assessment of final-year students before entering into residency.</p

Morphological adaptations of <i>Chara baltica</i> and <i>Chara liljebladii</i> (Characeae) under different light conditions

<p>Individuals within wild populations differ substantially in their fitness as a result of either genetic differences or acclimation. Within the Charophyte algae, the two taxa <i>Chara baltica</i> and <i>C</i>. <i>liljebladii</i> predominate at different water depths of the same habitat. The two taxa are mainly distinguished by quantitative characteristics, pointing to light acclimation. In particular, they differ by a length of the internode and the bract cells, as well as the cortication type. Genetic analyses revealed that individuals of both morphotypes are genetically identical, and hence may belong to the same species. In the present paper, we tested a hypothesis that <i>C</i>. <i>liljebladii</i> is a low-light phenotype of <i>C</i>. <i>baltica</i>. Can a <i>C</i>. <i>baltica</i> phenotype be transferred into a <i>C</i>. <i>liljebladii</i> (and vice versa) by manipulation of the environmental conditions such as irradiance? We observed significant changes in the morphology of <i>C</i>. <i>baltica</i>: decreasing the irradiance significantly increased the growth of the branchlets and internodal cells. Consequently, the plants grew larger, changing their morphology in the direction of the <i>C</i>. <i>liljebladii</i> morphotype. In the reverse experiment, subjecting <i>C</i>. <i>liljebladii</i> to increasing irradiances, the individuals had slightly better growth, but none of the analysed morphological characteristics changed significantly. Both taxa have thus shown different adaptations to light limitation. Their morphologies cannot be transferred into each other by environmental factors. Thus, the presence of the different morphologies reflects the ecological characteristics of their habitats, such as light availability or turbidity.</p