An innovative quality improvement curriculum for third-year medical students

Background: Competence in quality improvement (QI) is a priority for medical students. We describe a self-directed QI skills curriculum for medical students in a 1-year longitudinal integrated third-year clerkship: an ideal context to learn and practice QI. Methods: Two groups of four students identified a quality gap, described existing efforts to address the gap, made quantifying measures, and proposed a QI intervention. The program was assessed with knowledge and attitude surveys and a validated tool for rating trainee QI proposals. Reaction to the curriculum was assessed by survey and focus group. Results: Knowledge of QI concepts did not improve (mean knowledge score±SD): pre: 5.9±1.5 vs. post: 6.6±1.3, p=0.20. There were significant improvements in attitudes (mean topic attitude score±SD) toward the value of QI (pre: 9.9±1.8 vs. post: 12.6±1.9, p=0.03) and confidence in QI skills (pre: 13.4±2.8 vs. post: 16.1±3.0, p=0.05). Proposals lacked sufficient analysis of interventions and evaluation plans. Reaction was mixed, including appreciation for the experience and frustration with finding appropriate mentorship. Conclusion: Clinical-year students were able to conduct a self-directed QI project. Lack of improvement in QI knowledge suggests that self-directed learning in this domain may be insufficient without targeted didactics. Higher order skills such as developing measurement plans would benefit from explicit instruction and mentorship. Lessons from this experience will allow educators to better target QI curricula to medical students in the clinical years

Developing Enterprise Skills in Undergraduate Medical Students: A Mixed-methods Evaluation

INTRODUCTION: Support for the development of enterprise skills in medical education exists from the perspectives of educators, researchers, and healthcare leaders. However, literature is limited evaluating the understanding of medical students about these skills. This study aimed to determine whether medical students valued gaining enterprise skills within the course and those skills that they identified and recognized contributed to enterprise practice in subsequent training. METHODOLOGY: Quantitative and qualitative evaluations were undertaken for over three years. Students completed end-of-course evaluations (n = 895) in 2011 and 2012, responding to closed questions utilizing a Likert scale. Subsequent qualitative reflections were collected by interviews one year later with nine students and eight supervisors. RESULTS: Immediately after course completion, students gave positive feedback, identifying the development of independent learning, creativity, and reflection, as these enterprise skills were most valued. However, in subsequent reflection one year later, they were unable to transfer the acquired knowledge and identify the examples of enterprise around them in their later experiences and had mixed beliefs about its value in medicine. CONCLUSION: Enterprise skills need to be revisited explicitly throughout the medical curriculum, with authentic real-life examples, to sustain students’ understanding about the role of enterprise in medicine

An integrated ultrasound curriculum (iUSC) for medical students: 4-year experience

A review of the development and implementation of a 4-year medical student integrated ultrasound curriculum is presented. Multiple teaching and assessment modalities are discussed as well as results from testing and student surveys. Lessons learned while establishing the curriculum are summarized. It is concluded that ultrasound is a well received, valuable teaching tool across all 4 years of medical school, and students learn ultrasound well, and they feel their ultrasound experience enhances their medical education

Dysfunctional GABAergic inhibition in the prefrontal cortex leading to "psychotic" hyperactivation

<p>Abstract</p> <p>Background</p> <p>The GABAergic system in the brain seems to be dysfunctional in various psychiatric disorders. Many studies have suggested so far that, in schizophrenia patients, GABAergic inhibition is selectively but consistently reduced in the prefrontal cortex (PFC).</p> <p>Results</p> <p>This study used a computational model of the PFC to investigate the dynamics of the PFC circuit with and without chandelier cells and other GABAergic interneurons. The inhibition by GABAergic interneurons other than chandelier cells effectively regulated the PFC activity with rather low or modest levels of dopaminergic neurotransmission. This activity of the PFC is associated with normal cognitive functions and has an inverted-U shaped profile of dopaminergic modulation. In contrast, the chandelier cell-type inhibition affected only the PFC circuit dynamics in hyperdopaminergic conditions. Reduction of chandelier cell-type inhibition resulted in bistable dynamics of the PFC circuit, in which the upper stable state is associated with a hyperactive mode. When both types of inhibition were reduced, this hyperactive mode and the conventional inverted-U mode merged.</p> <p>Conclusion</p> <p>The results of our simulation suggest that, in schizophrenia, a reduction of GABAergic inhibition increases vulnerability to psychosis by (i) producing the hyperactive mode of the PFC with hyperdopaminergic neurotransmission by dysfunctional chandelier cells and (ii) increasing the probability of the transition to the hyperactive mode from the conventional inverted-U mode by dysfunctional GABAergic interneurons.</p

Clinical observations in LPS-treated animals.

<p>Clinical observations in LPS-treated animals.</p

Histopathology, hematoxylin and eosin-stained sections.

<p>(A) Neutrophil sequestration (arrows) within pulmonary alveolar capillaries typical of 5/5 rats at hours 4, 8, 24, and 48 post-intraperitoneal LPS injection. (B) Normal pulmonary alveolar capillaries at 48 hours post-intraperitoneal saline injection. (C) Neutrophil sequestration (arrows) within hepatic sinusoids typical of 5/5 rats at hour 4 and 8 post-intraperitoneal LPS injection. (D) Normal hepatic sinusoids at 8 hours post-intraperitoneal saline injection. 400 X original magnification A, B, C, and D. (E) Single cell necrosis of lymphocytes (arrows) within splenic lymphoid follicles typical of 5/5 rats at hours 4 and 8 post-intraperitoneal LPS injection. (F) Normal spleen at 8 hours post-intraperitoneal saline injection. (G) Increased megakaryocytes (arrows) within spleen typical of 5/5 rats at hour 48 post-intraperitoneal LPS injection. 200 X original magnification E, F, and G. (H) Leukocyte accumulation in subepicardial myocardium of the right atrium typical of 5/5 rats at hour 48 post-intraperitoneal LPS injection. Inset 400X original magnification. (I) Normal right atrium at 48 hours post-intraperitoneal saline injection. 40 X original magnification H, I.</p

miRNA Changes in Serum from LPS-Treated Rats.

<p>miRNA Changes in Serum from LPS-Treated Rats.</p