The impact of feedback and personality type upon students’ ability to self-assess skills, attributes and aptitudes

Background: We demonstrate the phenomenon of ‘incompetent and unaware’ in a real world setting. Summary of work: Medical students (193) participated in a self-assessment exercise, requiring predictions of exam grade in 3 domains; knowledge, skills, and behaviours. The exercise was completed 3 times; immediately after January exams, one week after January exams and immediately after May exams. Feedback on assessment ability was given between January and May. Personality type was correlated with self-assessment ability. Students assessed the Conscientiousness Index (CI) scores of themselves and peers. Summary of results: Failing students over predicted their exam performance. Merit students under assessed performance, and pass students accurately self-assessed. Students’ ability to self-assess was not improved after a week of contemplation. Feedback improved failing students’ ability to self-assess but had no impact upon under-assessing merit students. Students were unable to predict their CI scores, but were able to assess peers’ scores. Ability to self-assess was not related to personality type. Conclusions: Ability to self-assess was consistent across physical skills and cognitive aptitudes, but not attributes (conscientiousness). Take home messages: Failing students can become more self-aware with respect to exam performance if they are given appropriate feedback. Self-awareness is crucial for success; students need more guidance on this

The relationship between personality traits, self-report conscientiousness the Conscientiousness Index and academic performance in undergraduate medical students

Personality traits are now accepted as being important factors within the workplace and medical education. Both cognitive ability and conscientiousness have been shown as important predictors of work-related performance within organisational research1. Conscientiousness is in an important trait within any career, but in particular within medicine where a lack of diligence can be disastrous and potentially cost lives. Within undergraduate students, objective measurement of conscientiousness is important since conscientious students are more likely to set and achieve goals. Durham University utilises the Conscientiousness Index (CI) as an objective scalar measure of conscientiousness. The CI has previously been validated against staff and peer views of student professionalism4,5. This study aimed to investigate the relationships between the Big Five personality domains (including the 6 sub-facets of conscientiousness), Conscientiousness Index scores and academic performance in medical students in order to determine whether self-report conscientiousness correlates with the Conscientiousness Index and whether a relationship with academic performance exists

Polymeric Nanovectors Incorporated with Ganciclovir and HSV-tk Encoding Plasmid for Gene-Directed Enzyme Prodrug Therapy

In the area of gene-directed enzyme prodrug therapy (GDEPT), using herpes simplex virus thymidine kinase (HSV-tk) paired with prodrug ganciclovir (GCV) for cancer treatment has been extensively studied. It is a process involved with two steps whereby the gene (HSV-tk) is first delivered to malignant cells. Afterward, non-toxic GCV is administered to that site and activated to cytotoxic ganciclovir triphosphate by HSV-tk enzyme expressed exogenously. In this study, we presented a one-step approach that both gene and prodrug were delivered at the same time by incorporating them with polymeric micellar nanovectors. GCV was employed as an initiator in the ring-opening polymerization of ε-caprolactone (ε-CL) to synthesize hydrophobic GCV-poly(caprolactone) (GCV-PCL), which was furthered grafted with hydrophilic chitosan to obtain amphiphilic polymer (GCV-PCL-chitosan) for the fabrication of self-assembled micellar nanoparticles. The synthesized amphiphilic polymer was characterized using Fourier transform infrared spectroscopy and proton nuclear magnetic resonance. Micellar prodrug nanoparticles were analyzed by dynamic light scattering, zeta potential, critical micelle concentration, and transmission electron microscopy. Polymeric prodrug micelles with optimal features incorporated with HSV-tk encoding plasmids were cultivated with HT29 colorectal cancer cells and anticancer effectiveness was determined. Our results showed that prodrug GCV and HSV-tk cDNA encoded plasmid incorporated in GCV-PCL-chitosan polymeric nanocarriers could be delivered in a one-step manner to HT-29 cells and triggered high cytotoxicity

Promoting patient utilization of outpatient cardiac rehabilitation: A joint International Council and Canadian Association of Cardiovascular Prevention and Rehabilitation position statement

Background: Cardiac Rehabilitation (CR) is a recommendation in international clinical practice guidelines given its’ benefits, however use is suboptimal. The purpose of this position statement was to translate evidence on interventions that increase CR enrolment and adherence into implementable recommendations. Methods: The writing panel was constituted by representatives of societies internationally concerned with preventive cardiology, and included disciplines that would be implementing the recommendations. Patient partners served, as well as policy-makers. The statement was developed in accordance with AGREE II, among other guideline checklists. Recommendations were based on our update of the Cochrane review on interventions to promote patient utilization of CR. These were circulated to panel members, who were asked to rate each on a 7-point Likert scale in terms of scientific acceptability, actionability, and feasibility of assessment. A web call was convened to achieve consensus and confirm strength of the recommendations (based on GRADE). The draft underwent external review and public comment. Results: The 3 drafted recommendations were that to increase enrolment, healthcare providers, particularly nurses (strong), should promote CR to patients face-to-face (strong), and that to increase adherence part of CR could be delivered remotely (weak). Ratings for the 3 recommendations were 5.95±0.69 (mean ± standard deviation), 5.33±1.12 and 5.64±1.08, respectively. Conclusions: Interventions can significantly increase utilization of CR, and hence should be widely applied. We call upon cardiac care institutions to implement these strategies to augment CR utilization, and to ensure CR programs are adequately resourced to serve enrolling patients and support them to complete programs

PANC Study (Pancreatitis: A National Cohort Study): national cohort study examining the first 30 days from presentation of acute pancreatitis in the UK

Background Acute pancreatitis is a common, yet complex, emergency surgical presentation. Multiple guidelines exist and management can vary significantly. The aim of this first UK, multicentre, prospective cohort study was to assess the variation in management of acute pancreatitis to guide resource planning and optimize treatment. Methods All patients aged greater than or equal to 18 years presenting with acute pancreatitis, as per the Atlanta criteria, from March to April 2021 were eligible for inclusion and followed up for 30 days. Anonymized data were uploaded to a secure electronic database in line with local governance approvals. Results A total of 113 hospitals contributed data on 2580 patients, with an equal sex distribution and a mean age of 57 years. The aetiology was gallstones in 50.6 per cent, with idiopathic the next most common (22.4 per cent). In addition to the 7.6 per cent with a diagnosis of chronic pancreatitis, 20.1 per cent of patients had a previous episode of acute pancreatitis. One in 20 patients were classed as having severe pancreatitis, as per the Atlanta criteria. The overall mortality rate was 2.3 per cent at 30 days, but rose to one in three in the severe group. Predictors of death included male sex, increased age, and frailty; previous acute pancreatitis and gallstones as aetiologies were protective. Smoking status and body mass index did not affect death. Conclusion Most patients presenting with acute pancreatitis have a mild, self-limiting disease. Rates of patients with idiopathic pancreatitis are high. Recurrent attacks of pancreatitis are common, but are likely to have reduced risk of death on subsequent admissions

PANC Study (Pancreatitis: A National Cohort Study): national cohort study examining the first 30 days from presentation of acute pancreatitis in the UK

Abstract Background Acute pancreatitis is a common, yet complex, emergency surgical presentation. Multiple guidelines exist and management can vary significantly. The aim of this first UK, multicentre, prospective cohort study was to assess the variation in management of acute pancreatitis to guide resource planning and optimize treatment. Methods All patients aged greater than or equal to 18 years presenting with acute pancreatitis, as per the Atlanta criteria, from March to April 2021 were eligible for inclusion and followed up for 30 days. Anonymized data were uploaded to a secure electronic database in line with local governance approvals. Results A total of 113 hospitals contributed data on 2580 patients, with an equal sex distribution and a mean age of 57 years. The aetiology was gallstones in 50.6 per cent, with idiopathic the next most common (22.4 per cent). In addition to the 7.6 per cent with a diagnosis of chronic pancreatitis, 20.1 per cent of patients had a previous episode of acute pancreatitis. One in 20 patients were classed as having severe pancreatitis, as per the Atlanta criteria. The overall mortality rate was 2.3 per cent at 30 days, but rose to one in three in the severe group. Predictors of death included male sex, increased age, and frailty; previous acute pancreatitis and gallstones as aetiologies were protective. Smoking status and body mass index did not affect death. Conclusion Most patients presenting with acute pancreatitis have a mild, self-limiting disease. Rates of patients with idiopathic pancreatitis are high. Recurrent attacks of pancreatitis are common, but are likely to have reduced risk of death on subsequent admissions. </jats:sec

Characteristics of special circulations

Blood flow through a vascular bed is usually determined by the pressure gradient across it and the diameter of the precapillary resistance vessels. Special circulations have additional specific features of blood flow control. Several organs control their blood supply by autoregulation. Coronary blood flow is linked to myocardial oxygen consumption, primarily by a metabolic mechanism. Increases in demand or decreases in supply of oxygen cause the release of vasodilator metabolites, which act on vascular smooth muscle to cause vessel relaxation and hence increase blood flow. Cerebral blood flow is primarily regulated by a myogenic mechanism whereby increases in transmural pressure stretch the vascular smooth muscle, which responds by contracting. Renal blood flow is regulated by both extrinsic and intrinsic mechanisms; sympathetic vasoconstriction of the afferent arterioles reduces renal blood flow in response to a decrease in effective circulating volume, myogenic mechanisms and tubuloglomerular feedback, as well as the release of vasoactive metabolites from the vascular endothelium regulate renal blood flow intrinsically. Hepatic blood flow is delivered via the portal vein and hepatic artery, and the amount of flow varies in these vessels reciprocally to maintain constant total blood flow. The pulmonary circulation receives the entire cardiac output, and blood flow is regulated both passively and actively. Pulmonary vessels are highly distensible and can accommodate increases in blood flow without significant increases in pressure.Blood flow through a vascular bed is usually determined by the pressure gradient across it and the diameter of the precapillary resistance vessels. Special circulations have additional specific features of blood flow control. Several organs control their blood supply by autoregulation. Coronary blood flow is linked to myocardial oxygen consumption, primarily by a metabolic mechanism. Increases in demand or decreases in supply of oxygen cause the release of vasodilator metabolites, which act on vascular smooth muscle to cause vessel relaxation and hence increase blood flow. Cerebral blood flow is primarily regulated by a myogenic mechanism whereby increases in transmural pressure stretch the vascular smooth muscle, which responds by contracting. Renal blood flow is regulated by both extrinsic and intrinsic mechanisms; sympathetic vasoconstriction of the afferent arterioles reduces renal blood flow in response to a decrease in effective circulating volume, myogenic mechanisms and tubuloglomerular feedback, as well as the release of vasoactive metabolites from the vascular endothelium regulate renal blood flow intrinsically. Hepatic blood flow is delivered via the portal vein and hepatic artery, and the amount of flow varies in these vessels reciprocally to maintain constant total blood flow. The pulmonary circulation receives the entire cardiac output, and blood flow is regulated both passively and actively. Pulmonary vessels are highly distensible and can accommodate increases in blood flow without significant increases in pressure

Improving Knowledge Retention using KEEpad

INTRODUCTION: Knowledge retention following didactic teaching decays at an undesirable rate. The use of audience response systems (ARSs) has been suggested to improve and facilitate learning in a didactic lecture setting by increasing student participation, giving instant feedback, and improving knowledge retention. METHOD: 93 undergraduate medical students attended lectures incorporating the use of the ARS KEEpad. KEEpad was used to ask the students an MCQ before the lecture to assess prior knowledge; at the end of the lecture assessing understanding; and 5 weeks later assessing knowledge retention. Evaluation forms completed by students included 2 questions on the use of KEEpad; The KEEpad audience response system gives me feedback on my progress and The KEEpad audience response system supports the learning experience. RESULTS: 40% of the class selected the correct answer using the ARS, showing a moderate degree of prior knowledge. At the end of the lecture the percentage of students choosing the correct answer increased to 79%. Five weeks later the percentage of students selecting the correct answer was 60%. The evaluation forms showed student satisfaction regarding use of the ARS was 100% and 98% respectively. CONCLUSION: The use of the ARS allowed us to show that learning occurred during the didactic lecture and recall rate was 77% after 5 weeks, considerably higher than the literature suggests. Students' satisfaction on the use of the ARS for feedback and the learning experience during lectures was extremely high