Exploring UK medical school differences: the MedDifs study of selection, teaching, student and F1 perceptions, postgraduate outcomes and fitness to practise.

BACKGROUND: Medical schools differ, particularly in their teaching, but it is unclear whether such differences matter, although influential claims are often made. The Medical School Differences (MedDifs) study brings together a wide range of measures of UK medical schools, including postgraduate performance, fitness to practise issues, specialty choice, preparedness, satisfaction, teaching styles, entry criteria and institutional factors. METHOD: Aggregated data were collected for 50 measures across 29 UK medical schools. Data include institutional history (e.g. rate of production of hospital and GP specialists in the past), curricular influences (e.g. PBL schools, spend per student, staff-student ratio), selection measures (e.g. entry grades), teaching and assessment (e.g. traditional vs PBL, specialty teaching, self-regulated learning), student satisfaction, Foundation selection scores, Foundation satisfaction, postgraduate examination performance and fitness to practise (postgraduate progression, GMC sanctions). Six specialties (General Practice, Psychiatry, Anaesthetics, Obstetrics and Gynaecology, Internal Medicine, Surgery) were examined in more detail. RESULTS: Medical school differences are stable across time (median alpha = 0.835). The 50 measures were highly correlated, 395 (32.2%) of 1225 correlations being significant with p < 0.05, and 201 (16.4%) reached a Tukey-adjusted criterion of p < 0.0025. Problem-based learning (PBL) schools differ on many measures, including lower performance on postgraduate assessments. While these are in part explained by lower entry grades, a surprising finding is that schools such as PBL schools which reported greater student satisfaction with feedback also showed lower performance at postgraduate examinations. More medical school teaching of psychiatry, surgery and anaesthetics did not result in more specialist trainees. Schools that taught more general practice did have more graduates entering GP training, but those graduates performed less well in MRCGP examinations, the negative correlation resulting from numbers of GP trainees and exam outcomes being affected both by non-traditional teaching and by greater historical production of GPs. Postgraduate exam outcomes were also higher in schools with more self-regulated learning, but lower in larger medical schools. A path model for 29 measures found a complex causal nexus, most measures causing or being caused by other measures. Postgraduate exam performance was influenced by earlier attainment, at entry to Foundation and entry to medical school (the so-called academic backbone), and by self-regulated learning. Foundation measures of satisfaction, including preparedness, had no subsequent influence on outcomes. Fitness to practise issues were more frequent in schools producing more male graduates and more GPs. CONCLUSIONS: Medical schools differ in large numbers of ways that are causally interconnected. Differences between schools in postgraduate examination performance, training problems and GMC sanctions have important implications for the quality of patient care and patient safety

The Analysis of Teaching of Medical Schools (AToMS) survey: an analysis of 47,258 timetabled teaching events in 25 UK medical schools relating to timing, duration, teaching formats, teaching content, and problem-based learning.

BACKGROUND: What subjects UK medical schools teach, what ways they teach subjects, and how much they teach those subjects is unclear. Whether teaching differences matter is a separate, important question. This study provides a detailed picture of timetabled undergraduate teaching activity at 25 UK medical schools, particularly in relation to problem-based learning (PBL). METHOD: The Analysis of Teaching of Medical Schools (AToMS) survey used detailed timetables provided by 25 schools with standard 5-year courses. Timetabled teaching events were coded in terms of course year, duration, teaching format, and teaching content. Ten schools used PBL. Teaching times from timetables were validated against two other studies that had assessed GP teaching and lecture, seminar, and tutorial times. RESULTS: A total of 47,258 timetabled teaching events in the academic year 2014/2015 were analysed, including SSCs (student-selected components) and elective studies. A typical UK medical student receives 3960 timetabled hours of teaching during their 5-year course. There was a clear difference between the initial 2 years which mostly contained basic medical science content and the later 3 years which mostly consisted of clinical teaching, although some clinical teaching occurs in the first 2 years. Medical schools differed in duration, format, and content of teaching. Two main factors underlay most of the variation between schools, Traditional vs PBL teaching and Structured vs Unstructured teaching. A curriculum map comparing medical schools was constructed using those factors. PBL schools differed on a number of measures, having more PBL teaching time, fewer lectures, more GP teaching, less surgery, less formal teaching of basic science, and more sessions with unspecified content. DISCUSSION: UK medical schools differ in both format and content of teaching. PBL and non-PBL schools clearly differ, albeit with substantial variation within groups, and overlap in the middle. The important question of whether differences in teaching matter in terms of outcomes is analysed in a companion study (MedDifs) which examines how teaching differences relate to university infrastructure, entry requirements, student perceptions, and outcomes in Foundation Programme and postgraduate training

Laboratory Identification of Probable Interstellar Dust Particles Collected by the Stardust Spacecraft

Interstellar dust (ISD) from the local interstellar medium (LISM) streams into the solar system from approximately the direction of the constellation Ophiuchus. Prior to the return of the NASA Stardust spacecraft (1) no recognizable samples of this interstellar dust were available for laboratory study. Thus, our understanding of the properties of contemporary ISD has been derived primarily from astronomical observations of the ISM, including optical properties of the ISD and remote spectroscopy of the gas composition (2-4), and from in situ measurements by the dust analyzers on the Cassini, Ulysses and Galileo spacecraft (5-7). The canonical picture of ISD is that it is dominated by ~0.2 µm diameter (8) amorphous silicate grains, with or without carbonaceous mantles. However, the inferred properties of the particles, including size distribution, density and composition are heavily model dependent

Stardust Interstellar Preliminary Examination V: XRF analyses of interstellar dust candidates at ESRF ID13

Here, we report analyses by synchrotron X-ray fluorescence microscopy of the elemental composition of eight candidate impact features extracted from the Stardust Interstellar Dust Collector (SIDC). Six of the features were unambiguous tracks, and two were crater-like features. Five of the tracks are so-called “midnight” tracks—that is, they had trajectories consistent with an origin either in the interstellar dust stream or as secondaries from impacts on the Sample Return Capsule (SRC). In a companion paper reporting synchrotron X-ray diffraction analyses of ISPE candidates, we show that two of these particles contain natural crystalline materials: the terminal particle of track 30 contains olivine and spinel, and the terminal particle of track 34 contains olivine. Here, we show that the terminal particle of track 30, Orion, shows elemental abundances, normalized to Fe, that are close to CI values, and a complex, fine-grained structure. The terminal particle of track 34, Hylabrook, shows abundances that deviate strongly from CI, but shows little fine structure and is nearly homogenous. The terminal particles of other midnight tracks, 29 and 37, had heavy element abundances below detection threshold. A third, track 28, showed a composition inconsistent with an extraterrestrial origin, but also inconsistent with known spacecraft materials. A sixth track, with a trajectory consistent with secondary ejecta from an impact on one of the spacecraft solar panels, contains abundant Ce and Zn. This is consistent with the known composition of the glass covering the solar panel. Neither crater-like feature is likely to be associated with extraterrestrial materials. We also analyzed blank aerogel samples to characterize background and variability between aerogel tiles. We found significant differences in contamination levels and compositions, emphasizing the need for local background subtraction for accurate quantification

Stardust Interstellar Preliminary Examination X: Impact speeds and directions of interstellar grains on the Stardust dust collector

On the basis of an interstellar dust model compatible with Ulysses and Galileo observations, we calculate and predict the trajectories of interstellar dust (ISD) in the solar system and the distribution of the impact speeds, directions, and flux of ISD particles on the Stardust Interstellar Dust Collector during the two collection periods of the mission. We find that the expected impact velocities are generally low ( 1, and that some of the particles will impact on the cometary side of the collector. If we assume astronomical silicates for particle material and a density of 2 g cm?3, and use the Ulysses measurements and the ISD trajectory simulations, we conclude that the total number of (detectable) captured ISD particles may be on the order of 50. In companion papers in this volume, we report the discovery of three interstellar dust candidates in the Stardust aerogel tiles. The impact directions and speeds of these candidates are consistent with those calculated from our ISD propagation model, within the uncertainties of the model and of the observations

Stardust Interstellar Preliminary Examination III: Infrared spectroscopic analysis of interstellar dust candidates

Under the auspices of the Stardust Interstellar Preliminary Examination, picokeystones extracted from the Stardust Interstellar Dust Collector were examined with synchrotron Fourier transform infrared (FTIR) microscopy to establish whether they contained extraterrestrial organic material. The picokeystones were found to be contaminated with varying concentrations and speciation of organics in the native aerogel, which hindered the search for organics in the interstellar dust candidates. Furthermore, examination of the picokeystones prior to and post X-ray microprobe analyses yielded evidence of beam damage in the form of organic deposition or modification, particularly with hard X-ray synchrotron X-ray fluorescence. From these results, it is clear that considerable care must be taken to interpret any organics that might be in interstellar dust particles. For the interstellar candidates examined thus far, however, there is no clear evidence of extraterrestrial organics associated with the track and/or terminal particles. However, we detected organic matter associated with the terminal particle in Track 37, likely a secondary impact from the Al-deck of the sample return capsule, demonstrating the ability of synchrotron FTIR to detect organic matter in small particles within picokeystones from the Stardust interstellar dust collector

Stardust Interstellar Preliminary Examination VI: Quantitative elemental analysis by synchrotron X-ray fluorescence nanoimaging of eight impact features in aerogel

Hard X-ray, quantitative, fluorescence elemental imaging was performed on the ID22NI nanoprobe and ID22 microprobe beam lines of the European Synchrotron Research facility (ESRF) in Grenoble, France, on eight interstellar candidate impact features in the framework of the NASA Stardust Interstellar Preliminary Examination (ISPE). Three features were unambiguous tracks, and the other five were identified as possible, but not definite, impact features. Overall, we produced an absolute quantification of elemental abundances in the 15 = Z = 30 range by means of corrections of the beam parameters, reference materials, and fundamental atomic parameters. Seven features were ruled out as interstellar dust candidates (ISDC) based on compositional arguments. One of the three tracks, I1043,1,30,0,0, contained, at the time of our analysis, two physically separated, micrometer-sized terminal particles, the most promising ISDCs, Orion and Sirius. We found that the Sirius particle was a fairly homogenous Ni-bearing particle and contained about 33 fg of distributed high-Z elements (Z 12). Orion was a highly heterogeneous Fe-bearing particle and contained about 59 fg of heavy elements located in hundred nanometer phases, forming an irregular mantle that surrounded a low-Z core. X-ray diffraction (XRD) measurements revealed Sirius to be amorphous, whereas Orion contained partially crystalline material (Gainsforth et al. 2014). Within the mantle, one grain was relatively Fe-Ni-Mn-rich; other zones were relatively Mn-Cr-Ti-rich and may correspond to different spinel populations. For absolute quantification purposes, Orion was assigned to a mineralogical assemblage of forsterite, spinel, and an unknown Fe-bearing phase, while Sirius was most likely composed of an amorphous Mg-bearing material with minor Ni and Fe. Owing to its nearly chondritic abundances of the nonvolatile elements Ca, Ti, Co, and Ni with respect to Fe, in combination with the presence of olivine and spinel as inferred from XRD measurements, Orion had a high probability of being extraterrestrial in origin

Final reports of the Stardust Interstellar Preliminary Examination

With the discovery of bona fide extraterrestrial materials in the Stardust Interstellar Dust Collector, NASA now has a fundamentally new returned sample collection, after the Apollo, Antarctic meteorite, Cosmic Dust, Genesis, Stardust Cometary, Hayabusa, and Exposed Space Hardware samples. Here, and in companion papers in this volume, we present the results from the Preliminary Examination of this collection, the Stardust Interstellar Preliminary Examination (ISPE). We found extraterrestrial materials in two tracks in aerogel whose trajectories and morphology are consistent with an origin in the interstellar dust stream, and in residues in four impacts in the aluminum foil collectors. While the preponderance of evidence, described in detail in companion papers in this volume, points toward an interstellar origin for some of these particles, alternative origins have not yet been eliminated, and definitive tests through isotopic analyses were not allowed under the terms of the ISPE. In this summary, we answer the central questions of the ISPE: How many tracks in the collector are consistent in their morphology and trajectory with interstellar particles? How many of these potential tracks are consistent with real interstellar particles, based on chemical analysis? Conversely, what fraction of candidates are consistent with either a secondary or interplanetary origin? What is the mass distribution of these particles, and what is their state? Are they particulate or diffuse? Is there any crystalline material? How many detectable impact craters (> 100 nm) are there in the foils, and what is their size distribution? How many of these craters have analyzable residue that is consistent with extraterrestrial material? And finally, can craters from secondaries be recognized through crater morphology (e.g., ellipticity)

Stardust Interstellar Preliminary Examination XI: Identification and elemental analysis of impact craters on Al foils from the Stardust Interstellar Dust Collector

The Stardust Interstellar Preliminary Examination team analyzed thirteen Al foils from the NASA Stardust interstellar collector tray in order to locate candidate interstellar dust (ISD) grain impacts. Scanning electron microscope (SEM) images reveal that the foils possess abundant impact crater and crater-like features. Elemental analyses of the crater features, with Auger electron spectroscopy, SEM-based energy dispersive X-ray (EDX) spectroscopy, and scanning transmission electron microscope-based EDX spectroscopy, demonstrate that the majority are either the result of impacting debris fragments from the spacecraft solar panels, or intrinsic defects in the foil. The elemental analyses also reveal that four craters contain residues of a definite extraterrestrial origin, either as interplanetary dust particles or ISD particles. These four craters are designated level 2 interstellar candidates, based on the crater shapes indicative of hypervelocity impacts and the residue compositions inconsistent with spacecraft debris