L’intégration des évaluations de l’apprentissage autorégulé dans les activités d’évaluation dans les professions de la santé : un appel à l’action

How well have healthcare professionals and trainees been prepared for the inevitable demands for new learning that will arise in their future? Given the rapidity with which ‘core healthcare knowledge’ changes, medical educators have a responsibility to audit whether trainees have developed the capacity to effectively self-regulate their learning. Trainees who engage in effective self-regulated learning (SRL) skilfully monitor and control their cognition, motivation, behaviour, and environment to adaptively meet demands for new learning. However, medical curricula rarely assess trainees’ capacity to engage in this strategic process. In this position paper, we argue for a paradigm shift toward assessing SRL more deliberately in undergraduate and postgraduate programs, as well as in associated licensing activities. Specifically, we explore evidence supporting an innovative blend of principles from the science on SRL, and on preparation for future learning (PFL) assessments. We propose recommendations for how program designers, curriculum developers, and assessment leads in undergraduate and postgraduate training programs, and in licensing bodies can work together to develop integrated assessments that measure how and how well trainees engage in SRL. Claims about lifelong learning in health professions education have gone unmatched by responsive curricular changes for far too long. Further neglecting these important competencies represents a disservice to medical trainees and a potential risk to the future patients they will care for.Dans quelle mesure les professionnels de la santé et les étudiants ont-ils été préparés aux exigences inévitables de nouveaux apprentissages qui se présenteront à eux à l’avenir? Étant donné la rapidité avec laquelle les « connaissances de base en matière de soins de santé » évoluent, les enseignants en médecine ont la responsabilité de vérifier si les étudiants ont développé la capacité d’autoréguler adéquatement leurs apprentissages. Ceux qui pratiquent efficacement l’apprentissage autorégulé (AAR) surveillent et contrôlent habilement leur cognition, leur motivation, leur comportement et leur environnement pour s’adapter à la nécessité de nouveaux apprentissages. Cependant, les programmes d’études médicales évaluent rarement la capacité des étudiants à s’engager dans ce processus stratégique. Dans cet exposé de position, nous plaidons en faveur d’un changement de paradigme vers une évaluation plus ciblée de l’AAR dans les formations doctorale et postdoctorale, ainsi que pour les activités d’évaluation. Plus précisément, nous explorons les résultats convaincants de l’emploi d’un mélange innovant de principes issus de la recherche en matière d’AAR et d’évaluations de la préparation à l’apprentissage futur. Nous proposons des recommandations pour une collaboration entre les responsables de la conception de programmes d’études, ceux de l’élaboration du cursus, ceux chargés de l’évaluation dans les programmes d’études prédoctorales et postdoctorales et les organismes responsables de l’octroi d’un titre de compétence en vue de créer des évaluations intégrées qui mesurent la méthode et la qualité de l’AAR chez les étudiants. Les programmes d’études tardent encore à traduire dans la pratique la reconnaissance de l’importance de l’apprentissage tout au long de la vie dans l’éducation médicale. Continuer à négliger ces compétences importantes ne ferait que nuire aux étudiants en médecine et potentiellement à leurs futurs patients

Who is teaching and supervising our junior residents' central venous catheterizations?

Article deposited according to agreement with BMC, December 6, 2010.YesFunding provided by the Open Access Authors Fund

Mucinous cystic neoplasms of the mesentery: a case report and review of the literature

<p>Abstract</p> <p>Background</p> <p>Mucinous cystic neoplasms arise in the ovary and various extra-ovarian sites. While their pathogenesis remains conjectural, their similarities suggest a common pathway of development. There have been rare reports involving the mesentery as a primary tumour site.</p> <p>Case presentation</p> <p>A cystic mass of uncertain origin was demonstrated radiologically in a 22 year old female with chronic abdominal pain. At laparotomy, the mass was fixed within the colonic mesentery. Histology demonstrated a benign mucinous cystadenoma.</p> <p>Methods and results</p> <p>We review the literature on mucinous cystic neoplasms of the mesentery and report on the pathogenesis, biologic behavior, diagnosis and treatment of similar extra-ovarian tumors. We propose an updated classification of mesenteric cysts and cystic tumors.</p> <p>Conclusion</p> <p>Mucinous cystic neoplasms of the mesentery present almost exclusively in women and must be considered in the differential diagnosis of mesenteric tumors. Only full histological examination of a mucinous cystic neoplasm can exclude a borderline or malignant component. An updated classification of mesenteric cysts and cystic tumors is proposed.</p

Common germline polymorphisms associated with breast cancer-specific survival

Abstract Introduction Previous studies have identified common germline variants nominally associated with breast cancer survival. These associations have not been widely replicated in further studies. The purpose of this study was to evaluate the association of previously reported SNPs with breast cancer-specific survival using data from a pooled analysis of eight breast cancer survival genome-wide association studies (GWAS) from the Breast Cancer Association Consortium. Methods A literature review was conducted of all previously published associations between common germline variants and three survival outcomes: breast cancer-specific survival, overall survival and disease-free survival. All associations that reached the nominal significance level of P value <0.05 were included. Single nucleotide polymorphisms that had been previously reported as nominally associated with at least one survival outcome were evaluated in the pooled analysis of over 37,000 breast cancer cases for association with breast cancer-specific survival. Previous associations were evaluated using a one-sided test based on the reported direction of effect. Results Fifty-six variants from 45 previous publications were evaluated in the meta-analysis. Fifty-four of these were evaluated in the full set of 37,954 breast cancer cases with 2,900 events and the two additional variants were evaluated in a reduced sample size of 30,000 samples in order to ensure independence from the previously published studies. Five variants reached nominal significance (P <0.05) in the pooled GWAS data compared to 2.8 expected under the null hypothesis. Seven additional variants were associated (P <0.05) with ER-positive disease. Conclusions Although no variants reached genome-wide significance (P <5 x 10−8), these results suggest that there is some evidence of association between candidate common germline variants and breast cancer prognosis. Larger studies from multinational collaborations are necessary to increase the power to detect associations, between common variants and prognosis, at more stringent significance levels

On embedding assessments of self-regulated learning into licensure activities in the health professions: A call to action

How well have healthcare professionals and trainees been prepared for the inevitable demands for new learning that will arise in their future? Given the rapidity with which ‘core healthcare knowledge’ changes, medical educators have a responsibility to audit whether trainees have developed the capacity to effectively self-regulate their learning. Trainees who engage in effective self-regulated learning (SRL) skilfully monitor and control their cognition, motivation, behaviour, and environment to adaptively meet demands for new learning. However, medical curricula rarely assess trainees’ capacity to engage in this strategic process. In this position paper, we argue for a paradigm shift toward assessing SRL more deliberately in undergraduate and postgraduate programs, as well as in associated licensing activities. Specifically, we explore evidence supporting an innovative blend of principles from the science on SRL, and on preparation for future learning (PFL) assessments. We propose recommendations for how program designers, curriculum developers, and assessment leads in undergraduate and postgraduate training programs, and in licensing bodies can work together to develop integrated assessments that measure how and how well trainees engage in SRL. Claims about lifelong learning in health professions education have gone unmatched by responsive curricular changes for far too long. Further neglecting these important competencies represents a disservice to medical trainees and a potential risk to the future patients they will care for.Dans quelle mesure les professionnels de la santé et les étudiants ont-ils été préparés aux exigences inévitables de nouveaux apprentissages qui se présenteront à eux à l’avenir? Étant donné la rapidité avec laquelle les « connaissances de base en matière de soins de santé » évoluent, les enseignants en médecine ont la responsabilité de vérifier si les étudiants ont développé la capacité d’autoréguler adéquatement leurs apprentissages. Ceux qui pratiquent efficacement l’apprentissage autorégulé (AAR) surveillent et contrôlent habilement leur cognition, leur motivation, leur comportement et leur environnement pour s’adapter à la nécessité de nouveaux apprentissages. Cependant, les programmes d’études médicales évaluent rarement la capacité des étudiants à s’engager dans ce processus stratégique. Dans cet exposé de position, nous plaidons en faveur d’un changement de paradigme vers une évaluation plus ciblée de l’AAR dans les formations doctorale et postdoctorale, ainsi que pour les activités d’évaluation. Plus précisément, nous explorons les résultats convaincants de l’emploi d’un mélange innovant de principes issus de la recherche en matière d’AAR et d’évaluations de la préparation à l’apprentissage futur. Nous proposons des recommandations pour une collaboration entre les responsables de la conception de programmes d’études, ceux de l’élaboration du cursus, ceux chargés de l’évaluation dans les programmes d’études prédoctorales et postdoctorales et les organismes responsables de l’octroi d’un titre de compétence en vue de créer des évaluations intégrées qui mesurent la méthode et la qualité de l’AAR chez les étudiants. Les programmes d’études tardent encore à traduire dans la pratique la reconnaissance de l’importance de l’apprentissage tout au long de la vie dans l’éducation médicale. Continuer à négliger ces compétences importantes ne ferait que nuire aux étudiants en médecine et potentiellement à leurs futurs patients

Role of plasma EBV DNA levels in predicting recurrence of nasopharyngeal carcinoma in a western population

<p>Abstract</p> <p>Background</p> <p>Loco-regionally advanced nasopharyngeal carcinomas can be cured by the combination of chemotherapy and radiotherapy. In Eastern countries, plasma levels of viral Epstein-Barr deoxyribonucleic acid (DNA) are accurate in predicting recurrence, but few data are available in Western populations. The aim of this prospective study was to evaluate the relationship between viral Epstein-Barr DNA copy numbers in plasma and the response rate, progression-free survival and overall survival in a cohort of Western patients with stage IIb-IVb nasopharyngeal cancer.</p> <p>Methods</p> <p>We evaluated plasma samples from 36 consecutive patients treated with induction chemotherapy followed by chemoradiation. EBV copy numbers were determined after DNA extraction using real-time quantitative polymerase chain reaction. Survival curves were estimated using the Kaplan–Meier method.</p> <p>Results</p> <p>Circulating Epstein-Barr virus DNA levels were measured before treatment, at the end of concomitant chemo- and radiotherapy, and during the follow-up period. Pre-treatment levels significantly correlated with the initial stage and probability of relapse. Their increase was 100% specific and 71.3% sensitive in detecting loco-regional or metastatic recurrence (an overall accuracy of 94.4%). Three-year progression-free and overall survival were respectively 78.2% and 97.1%.</p> <p>Conclusions</p> <p>The results of this study confirm that patients from a Western country affected by loco-regionally advanced nasopharyngeal carcinoma have high plasma Epstein-Barr virus DNA levels at diagnosis. The monitoring of plasma levels is sensitive and highly specific in detecting disease recurrence and metastases.</p