Expanding the basic science debate: the role of physics knowledge in interpreting clinical findings.

Current research suggests a role for biomedical knowledge in learning and retaining concepts related to medical diagnosis. However, learning may be influenced by other, non-biomedical knowledge. We explored this idea using an experimental design and examined the effects of causal knowledge on the learning, retention, and interpretation of medical information. Participants studied a handout about several respiratory disorders and how to interpret respiratory exam findings. The control group received the information in standard textbook format and the experimental group was presented with the same information as well as a causal explanation about how sound travels through lungs in both the normal and disease states. Comprehension and memory of the information was evaluated with a multiple-choice exam. Several questions that were not related to the causal knowledge served as control items. Questions related to the interpretation of physical exam findings served as the critical test items. The experimental group outperformed the control group on the critical test items, and our study shows that a causal explanation can improve a student\u27s memory for interpreting clinical details. We suggest an expansion of which basic sciences are considered fundamental to medical education

Concert/C: A language for distributed programming

Concert/C is a new language for distributed C programming that extends ANSI C to support distribution and process dynamics. Concert/C provides the ability to create and terminate processes, connect them together, and communicate among them. It supports transparent remote function calls (RPC) and asynchronous messages. Interprocess communications interfaces are typed in Concert/C, and type correctness is checked at compile time wherever possible, otherwise at runtime. All C data types, including complex data structures containing pointers and aliases, can be transmitted in RPCs. Concert/C programs run on a heterogeneous set of machine architectures and operating systems and communicate over multiple RPC and messaging protocols. The current Concert/C implementation runs on AIX 3.2 1, SunOS 4.1, Solaris 2.2 and OS/2 2.1, and communicates over Sun RPC, OSF/DCE and UDP multicast. Several groups inside and outside IBM are actively using Concert/C, and it is available via anonymous ftp from software.watson.ibm.com:/pub/concert.

Recognizing the Importance of Materials: Embracing a Sociomaterial Perspective on Interprofessional Collaboration

Recognizing the Importance of Materials: Embracing a Sociomaterial Perspective on Interprofessional Collaboratio

Entrustment of the on-call senior medical resident role: implications for patient safety and collective care

Abstract Background The on-call responsibilities of a senior medicine resident (SMR) may include the admission transition of patient care on medical teaching teams (MTT), supervision of junior trainees, and ensuring patient safety. In many institutions, there is no standardised assessment of SMR competency prior to granting these on-call responsibilities in internal medicine. In order to fulfill competency based medical education requirements, training programs need to develop assessment approaches to make and defend such entrustment decisions. The purpose of this study is to understand the clinical activities and outcomes of the on-call SMR role and provide training programs with a rigorous model for entrustment decisions for this role. Methods This four phase study utilizes a constructivist grounded theory approach to collect and analyse the following data sets: case study, focus groups, literature synthesis of supervisory practices and return-of-findings focus groups. The study was conducted in two Academic Health Sciences Centres in Ontario, Canada. The case study included ten attending physicians, 13 SMRs, 19 first year residents and 14 medical students. The focus groups included 19 SMRs. The later, return-of-findings focus groups included ten SMRs. Results Five core on-call supervisory tasks (overseeing ongoing patient care, briefing, case review, documentation and preparing for handover) were identified, as well as a range of practices associated with these tasks. We also identified challenges that influenced the extent to which SMRs were able to effectively perform the core tasks. At times, these challenges led to omissions of the core tasks and potentially compromised patient safety and the admission transition of care. Conclusion By identifying the core supervisory tasks and associated practices, we were able to identify the competencies for the on-call SMR role. Our findings can further be used by training programs for assessment and for making entrustment decisions

The supervisory encounter and the senior GP trainee: managing for, through and with

OBJECTIVE: Help-seeking supervisory encounters provide important learning experiences for trainees preparing for independent practice. Although there is a body of expert opinion and theories on how supervisor encounters should happen, supporting empirical data are limited. This is particularly true for the senior general practice (GP) trainee. Without knowing what happens during these encounters, we cannot know how to maximise their educational potential. This study aimed to understand what happens when senior GP trainees call on their supervisor when caring for patients and how learning can be enhanced when this occurs. METHODS: This is an analysis of data from a multi-case study of five GP supervisory pairs, each with a GP registrar and their supervisor. The data are recordings of 45 supervisory encounters, 78 post-encounter reflections and six interviews. We used Wenger's communities of practice theory and rhetorical genre theory as analytical lenses. RESULTS: The supervisory encounters followed a consistent format, which fitted the form of a genre. Within this genre, three dominant interactional patterns were identified, which we labelled 'managing for', 'managing through' and 'managing with'. Each pattern presented different opportunities and drew on different skills. The primary agenda was always developing a plan for the patient. Education agendas included acquiring knowledge, developing skills and achieving independence. Other agendas were issues of control, credibility and relationship building. Both supervisor and trainee could be purposeful in their supervisory engagement. CONCLUSIONS: For supervisors and trainees to achieve the educational potential of their supervisory encounters they require flexibility. This depends on understanding the genre of the supervisory encounter, the agendas at play, the options they have in engaging and having the skills to utilise these options. Educators can facilitate supervisors and trainees in acquiring this understanding and these skills. We recommend further research into the genre of the supervisory encounter

Categorizing Patients in a Forced-Choice Triad Task: The Integration of Context in Patient Management

Background: Studies of experts\u27 problem-solving abilities have shown that experts can attend to the deep structure of a problem whereas novices attend to the surface structure. Although this effect has been replicated in many domains, there has been little investigation into such effects in medicine in general or patient management in particular. Methodology/Principal Findings: We designed a 10-item forced-choice triad task in which subjects chose which one of two hypothetical patients best matched a target patient. The target and its potential matches were related in terms of surface features (e.g., two patients of a similar age and gender) and deep features (e.g., two diabetic patients with similar management strategies: a patient with arthritis and a blind patient would both have difficulty with self-injected insulin). We hypothesized that experts would have greater knowledge of management categories and would be more likely to choose deep matches. We contacted 130 novices (medical students), 11 intermediates (medical residents), and 159 experts (practicing endocrinologists) and 15, 11, and 8 subjects (respectively) completed the task. A linear mixed effects model indicated that novices were less likely to make deep matches than experts (t(68) = −3.63, p = .0006), while intermediates did not differ from experts (t(68) = −0.24, p = .81). We also found that the number of years in practice correlated with performance on diagnostic (r = .39, p = .02), but not management triads (r = .17, p = .34). Conclusions: We found that experts were more likely than novices to match patients based on deep features, and that this pattern held for both diagnostic and management triads. Further, management and diagnostic triads were equally salient for expert physicians suggesting that physicians recognize and may create management-oriented categories of patients

Scalable and systematic detection of buggy inconsistencies in source code

Software developers often duplicate source code to replicate functionality. This practice can hinder the maintenance of a software project: bugs may arise when two identical code segments are edited inconsistently. This paper presents DejaVu, a highly scalable system for detecting these general syntactic inconsistency bugs. DejaVu operates in two phases. Given a target code base, a parallel inconsistent clone analysis first enumerates all groups of source code fragments that are similar but not identical. Next, an extensible buggy change analysis framework refines these results, separating each group of inconsistent fragments into a fine-grained set of inconsistent changes and classifying each as benign or buggy. On a 75+ million line pre-production commercial code base, DejaVu executed in under five hours and produced a report of over 8,000 potential bugs. Our analysis of a sizable random sample suggests with high likelihood that at this report contains at least 2,000 true bugs and 1,000 code smells. These bugs draw from a diverse class of software defects and are often simple to correct: syntactic inconsistencies both indicate problems and suggest solutions