Developing internal medicine subspecialty fellows’ teaching skills: a needs assessment

Abstract Background For academic physicians, teaching represents an essential skill. The proliferation of educator training programs aimed at residents and medical students signals the increasing commitment of training programs to develop teaching skills in their trainees as early as possible. However, clinical fellowships represent an important opportunity to advance training as educators. In addition to enriching the pipeline of future teachers, developing fellows as teachers augments the training experience for more junior trainees and may impact patient care. Fellows’ needs for programs to improve teaching skills have been largely unexplored. Methods We conducted a multi-institutional needs assessment of internal medicine (IM) subspecialty fellows to gauge interest in teaching and improvement of teaching skills. We surveyed IM subspecialty fellows at three academic medical centers about their access to fellow-as-teacher programs and other mechanisms to improve their teaching skills during fellowship. We also elicited their attitudes towards teaching and interest in training related to teaching skills. Results One hundred eighty-three fellows representing 20 programs and nine different subspecialties responded to the survey (48% response rate). The majority of participants (67%) reported having no specific training focused on teaching skills and only 12% reported receiving regular feedback about their teaching during their fellowship. Seventy-nine percent of fellows anticipated teaching to be part of their careers, and 22% planned to participate in medical education scholarship. Fellows reported a strong interest in teaching and programs aimed at improving their teaching skills. Conclusions The majority of fellows reported a lack of mechanisms to advance their teaching skills as fellows, despite anticipating teaching to be an important aspect of their future careers and having strong interest in such programs. Our findings at three academic medical centers confirm a lost opportunity among subspecialty fellowships to accelerate teaching skills development for future educators.https://deepblue.lib.umich.edu/bitstream/2027.42/145709/1/12909_2018_Article_1283.pd

Sub-internship high grades by internal medicine clerkship performance.

Sub-internship high grades by internal medicine clerkship performance.</p

Paired student grades for the medicine sub-internship, stratified by third year internal medicine clerkship performance.

Paired student grades for the medicine sub-internship, stratified by third year internal medicine clerkship performance.</p

Paired student grades for the medicine sub-internship.

Paired student grades for the medicine sub-internship.</p

Participant flow and analysis.

Participant flow and analysis.</p

Peripheral CD5+B Cells in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis

Objective. CD5(+) B cells have been conceptualized as a possible surrogate for Breg cells. The aim of the present study was to determine the utility of CD5(+) B cells as biomarkers in antineutrophil cytoplasmic antibody-associated vasculitis (AAV). Methods. The absolute and relative numbers (percentages) of CD5(+) B cells (explanatory variables) were measured longitudinally during 18 months in 197 patients randomized to receive either rituximab (RTX) or cyclophosphamide (CYC) followed by azathioprine (AZA) for the treatment of AAV (Rituximab in ANCA-Associated Vasculitis [RAVE] trial). Outcome variables included disease activity (status of active disease versus complete remission), responsiveness to induction therapy, disease relapse, disease severity, and, in RTX-treated patients, relapse-free survival according to the percentage of CD5(+) B cells detected upon B cell repopulation. Results. CD5(+) B cell numbers were comparable between the treatment groups at baseline. After an initial decline, absolute CD5(+) B cell numbers progressively increased in patients in the RTX treatment arm, but remained low in CYC/AZA-treated patients. In both groups, the percentage of CD5(+) B cells increased during remission induction and slowly declined thereafter. During relapse, the percentage of CD5(+) B cells correlated inversely with disease activity in RTX-treated patients, but not in patients who received CYC/AZA. No significant association was observed between the numbers of CD5(+) B cells and induction treatment failure or disease severity. The dynamics of the CD5(+) B cell compartment did not anticipate disease relapse. Following B cell repopulation, the percentage of CD5(+) B cells was not predictive of time to flare in RTX-treated patients. Conclusion. The percentage of peripheral CD5(+) B cells might reflect disease activity in RTX-treated patients. However, sole staining for CD5 as a putative surrogate marker for Breg cells did not identify a subpopulation of B cells with clear potential for meaningful clinical use. Adequate phenotyping of Breg cells is required to further explore the value of these cells as biomarkers in AAV