Knowing Their Limits: Assessing the Discernment of Pre-Clinical Medical Students

Introduction: Discernment, or awareness of one’s limitations, is one of the qualities fundamental to entrustment (ten Cate et al., 2015). The AAMC Entrustable Professional Activities (EPA) pilot project lists discernment as an expectation of medical students entering residency (AAMC, 2014). Our institution, Virginia Commonwealth University School of Medicine (VCU SOM), was selected to participate in the EPA pilot. Prior to implementing a pilot curriculum on discernment, our institution gathered data on the current practice of discernment among our pre-clinical medical students. The Practice of Clinical Medicine (PCM) at VCU SOM is a pre-clinical longitudinal course which teaches the core skills of doctoring. Students are assessed on their ability to integrate these skills at the end of each semester with an Objective Structure Clinical Exam (OSCE). Starting with the Class of 2020, a question assessing discernment was incorporated into each OSCE

COURSE PROPOSAL FOR A MATHEMATICAL MODELING COURSE IN A HIGH SCHOOL CURRICULUM

In the winter of 2015, I will be piloting a course on mathematical modeling at Hawken School, an independent high school in Gates Mills, OH. As I develop all elements of this course, such as lesson plans, assessments, and rubrics, I will be mindful of factors such as the newly adopted Common Core mathematics standards, the variety of student backgrounds in such a course, and how various mathematical societies and organizations such as SIAM, MAA, and COMAP can help in implementing it. However, there is one basic question driving my interest in and design of this course: “when am I ever going to need this?” This quote uttered by many high school math students sounds like nails on a chalkboard to teachers who cannot imagine how anyone can take for granted the great beauty in math. While every math student may not appreciate it as an art in its own right, I do believe that every student should be able to appreciate math for its infinite applications. Because of this, I, like many other math teachers, always try to do my best to incorporate many applications of math to a variety of fields in my courses. In doing so, I hope to impress upon them what is probably the most important aspect of mathematics education: the development of critical thinking. However, due to constraints, such as time, adhering to state content standards, etc., such application problems often get pushed to the side in the average math course. This is why the thoughtful addition of a semester long course in mathematical modeling would be an excellent addition to the high school curriculum

EFFECT OF RECREATIONAL TRAIL TRAFFIC LEVEL ON EASTERN RED-BACKED SALAMANDER (PLETHODON CINEREUS) RELATIVE ABUNDANCE

The effects of roads and trails on terrestrial salamanders, primarily plethodontids, can be important. The abundance of terrestrial salamanders often increases with distance from roads. Less is known about the effects of recreational or hiking trails on terrestrial salamanders than is known about the effects of roads. We explored how low and high traffic trails in a suburban biological reserve affect the relative abundance of Eastern Red-backed Salamanders (Plethodon cinereus). We found more salamanders under cover objects next to low traffic trails compared to either high traffic trails or wooded areas without trails. At wooded sites, we found only striped morphs whereas at high traffic sites we found only unstriped morphs. Low traffic sites included a range of color morph frequencies. The proportion of females found in each site did not differ, nor did the mean size of the salamanders. Our results suggest that the impact of recreational walking trails needs to be examined more closely to see how and why the distributions of P. cinereus, and potentially other woodland salamanders, are affected and what trail characteristics are important in driving the apparent effects. Such information will contribute to the design and maintenance of walking trails in natural areas that minimize effects on terrestrial salamanders, and likely other organisms

The Role of Transformative Learning in Fostering Identity Development among Learners in Professional Education Programs of Study

This roundtable discussion engages participants in exploring how professional identity develops for learners engaged in advanced professional education and how they experience the meaning of what it is to become a professional

“I JUST NEED TO GET MYSELF SUPERVISED:” EXPLORING TRANSFORMATIVE LEARNING IN THE DEVELOPMENT OF PROFESSIONALISM AMONG PHYSICIANS IN THE FIRST YEAR OF GRADUATE MEDICAL EDUCATION

The study explored the learning experiences of first-year resident physicians during the first year of graduate medical education. The experiences of four intern physicians in the first year of residency training at an urban academic health system provided the site for the research. An exploratory case study research design was employed to examine the learning experiences of these new physicians. A qualitative approach was used to analyze data from interviews and ethnographic observations. The findings of this research study provide evidence surrounding how and what these physician trainees learned regarding professionalism during the first year of residency training. The findings indicate these first-year resident physicians experienced significant learning related to professionalism through incidental learning in the clinical environment, particularly from role models and the hidden curriculum. The interns learned both positive and negative professional behaviors from attending physicians. The findings illustrate the increases and decreases of confidence due to the development of clinical skills, increase in responsibilities, and increase in autonomy experienced by all four participants across the first year of residency training. Additionally, the findings highlight the important role of critical incidents, particularly memorable patient encounters, as potentially transformative learning experiences for these interns. Finally, the findings enumerate the pervasive influence of the hidden curriculum of graduate medical education on what these new physicians learned about professionalism, particularly the unprofessional social norms transmitted through attending physicians and others within the context of clinical learning. The findings of the research study support the conclusions that a) incidental learning experiences during the first year of residency education directly influenced how and what these new physicians learned regarding professionalism; b) these intern physicians experienced non-transformative learning during the first year of residency, but critical reflection and critical self-reflection after critical incidents did hold the potential to result in learning that was transformative; and c) the ubiquitous nature of the hidden curriculum significantly impacted what these first-year residents learned about professionalism. These conclusions contribute to the literature related to the development of professionalism in the new physician and the power of the hidden curriculum in medical education to influence professional identity development. Implications for medical educators and recommendations for future research are also identified

MEDICAL FAMILY THERAPY IN A PRIMARY CARE SETTING : A MODEL OF INTEGRATION

As the profession of marriage and family therapy (MFT), as well as the emerging sub-discipline of medical family therapy (MedFT), continue to grow and evolve within the current mental health care system, the arena of primary care presents an ideal environment for professionals who are relationally and systemically inclined. As such, this context is seen as a potential home for MedFTs hoping to provide integrated and collaborative health care. In order to address the unique practice based and cultural needs that manifest in medical contexts, the function of MedFTs in these sites must be apparent and accurately identified and described. Such a description is important not only to demonstrate the utility of MedFTs to potential stakeholders (e.g., physicians, medical staff, medical administration), but also to trainers who are charged with the preparation of future generations of MFTs and MedFTs for this type of work. The following dissertation seeks to address this issue from two interrelated venues: (a) to discuss how MedFT is connected to the profession of MFT in both conceptual and practical terms, and (b) to discuss a framework for integrated primary care, utilizing MedFTs, that does not service a targeted population.  Ph.D

A Comparison of Three Modes of Collaboration for Software Development

In the current environment of global collaboration, multiple models for collaborative ventures have been introduced. We consider traditional, contractual interactions as well as three modes of collaboration—supply-chain management, a standard virtual organization, and inter-organizational collaborative software development (ICSD). After outlining multiple characteristics of these modes, and their strengths and weaknesses, we examine how to select an approach for a software project, and characterize non-software-development applications for which an ICSD approach may be appropriate. Each of these can then be used as input in selecting an optimal mode and practices for the project

Hunter-gatherer energetics and human obesity

Western lifestyles differ markedly from those of our hunter-gatherer ancestors, and these differences in diet and activity level are often implicated in the global obesity pandemic. However, few physiological data for hunter-gatherer populations are available to test these models of obesity. In this study, we used the doubly-labeled water method to measure total daily energy expenditure (kCal/day) in Hadza hunter-gatherers to test whether foragers expend more energy each day than their Western counterparts. As expected, physical activity level, PAL, was greater among Hadza foragers than among Westerners. Nonetheless, average daily energy expenditure of traditional Hadza foragers was no different than that of Westerners after controlling for body size. The metabolic cost of walking (kcal kg(-1) m(-1)) and resting (kcal kg(-1) s(-1)) were also similar among Hadza and Western groups. The similarity in metabolic rates across a broad range of cultures challenges current models of obesity suggesting that Western lifestyles lead to decreased energy expenditure. We hypothesize that human daily energy expenditure may be an evolved physiological trait largely independent of cultural differences

Developing a Culturally Proficient Intervention for Young African American Men in Drug Court: Examining Feasibility and Estimating an Effect Size for Habilitation Empowerment Accountability Therapy (HEAT)

African American males between 18 and 29 years of age are substantially less likely than many other participants to graduate successfully from drug court. Unsuccessful termination from drug court can have serious repercussions for these young men, including possible incarceration and negative collateral consequences associated with having a criminal record. This article reports preliminary results from two pilot studies that examined the feasibility of implementing a culturally proficient intervention for young African American men in drug court, and estimated an effect size for the intervention in improving treatment retention and reducing termination rates. Results confirmed that participants with serious criminal and substance use histories were willing and able to complete the lengthy 9-month curriculum, were satisfied with the intervention, and graduated from drug court at substantially higher rates than are commonly observed in this at-risk population. A sufficient basis has been established to justify the effort and expense of examining this intervention — Habilitation Empowerment Accountability Therapy (HEAT) — in fully powered randomized controlled trials

Chemical constituents of lawang root oil

Spectroscopic analysis of lawang root oil identified methyl salicylate as the major component. This result contrasts with the known composition of bark-derived lawang oil, in which eugenol is the major component. The validity of the compositional analysis was confirmed by extraction of an authentic sample of plant root tissue, and comparison with the commercially available essential oil