Learning machines or the key to care: a qualitative study exploring the impact of the hidden curriculum on medical students’ longitudinal experiences in primary care

Objective Longitudinal learning often faces implementation challenges within UK medical schools. Some have suggested that the hidden curriculum may be implicated, but there is little evidence regarding how the hidden curriculum influences student experiences of, and engagement with longitudinal learning. Given this, our objective was to explore the impact of the hidden curriculum on student experiences of a longitudinal curriculum based in primary care at a research-intensive medical school. Design We conducted a longitudinal qualitative study. Students participated in three serial, in-depth semistructured interviews. We conducted a longitudinal thematic analysis. Setting One research-intensive medical school based in the UK. Data collection occurred in 2021–2022. Participants 12 penultimate year medical students taking part in a longitudinal primary care placement for 1 day a week over the course of one academic year. Results We constructed four themes capturing insights on how hidden curricula influenced students’ experiences: (1) A culture which stresses assessment influences student engagement with longitudinal learning; (2) Longitudinal relationships can challenge the hidden curriculum; (3) Support and continuity within primary care improves skills and can influence belonging and (4) Logistical issues influence engagement with longitudinal learning. Conclusions The hidden curriculum, particularly related to assessment, plays a large role in student perceptions of educational value and subsequent engagement with curricula. In a research-intensive institution, longitudinal learning, particularly within primary care, was perceived as at odds with what was important for assessments. Where longitudinal relationships were successfully established, students became more aware of the benefits of person-centred practice. For primary care longitudinal education to succeed in more research-intensive institutions, there must first be advocacy for greater representation of primary care and person-centred values within organisational structures to ensure meaningful curricular alignment

Coulomb blockade conductance peak fluctuations in quantum dots and the independent particle model

We study the combined effect of finite temperature, underlying classical dynamics, and deformations on the statistical properties of Coulomb blockade conductance peaks in quantum dots. These effects are considered in the context of the single-particle plus constant-interaction theory of the Coulomb blockade. We present numerical studies of two chaotic models, representative of different mean-field potentials: a parametric random Hamiltonian and the smooth stadium. In addition, we study conductance fluctuations for different integrable confining potentials. For temperatures smaller than the mean level spacing, our results indicate that the peak height distribution is nearly always in good agreement with the available experimental data, irrespective of the confining potential (integrable or chaotic). We find that the peak bunching effect seen in the experiments is reproduced in the theoretical models under certain special conditions. Although the independent particle model fails, in general, to explain quantitatively the short-range part of the peak height correlations observed experimentally, we argue that it allows for an understanding of the long-range part.Comment: RevTex 3.1, 34 pages (including 13 EPS and PS figures), submitted to Phys. Rev.

The pathophysiology of restricted repetitive behavior

Restricted, repetitive behaviors (RRBs) are heterogeneous ranging from stereotypic body movements to rituals to restricted interests. RRBs are most strongly associated with autism but occur in a number of other clinical disorders as well as in typical development. There does not seem to be a category of RRB that is unique or specific to autism and RRB does not seem to be robustly correlated with specific cognitive, sensory or motor abnormalities in autism. Despite its clinical significance, little is known about the pathophysiology of RRB. Both clinical and animal models studies link repetitive behaviors to genetic mutations and a number of specific genetic syndromes have RRBs as part of the clinical phenotype. Genetic risk factors may interact with experiential factors resulting in the extremes in repetitive behavior phenotypic expression that characterize autism. Few studies of individuals with autism have correlated MRI findings and RRBs and no attempt has been made to associate RRB and post-mortem tissue findings. Available clinical and animal models data indicate functional and structural alterations in cortical-basal ganglia circuitry in the expression of RRB, however. Our own studies point to reduced activity of the indirect basal ganglia pathway being associated with high levels of repetitive behavior in an animal model. These findings, if generalizable, suggest specific therapeutic targets. These, and perhaps other, perturbations to cortical basal ganglia circuitry are mediated by specific molecular mechanisms (e.g., altered gene expression) that result in long-term, experience-dependent neuroadaptations that initiate and maintain repetitive behavior. A great deal more research is needed to uncover such mechanisms. Work in areas such as substance abuse, OCD, Tourette syndrome, Parkinson’s disease, and dementias promise to provide findings critical for identifying neurobiological mechanisms relevant to RRB in autism. Moreover, basic research in areas such as birdsong, habit formation, and procedural learning may provide additional, much needed clues. Understanding the pathophysioloy of repetitive behavior will be critical to identifying novel therapeutic targets and strategies for individuals with autism

A qualitative evaluation of the impact of a medical student school outreach project on both medical students and school pupils

Objective To explore medical student and school pupil experiences of an outreach school teaching project Setting Community engagement is increasingly commonplace within medical school. Secondary schools offer ample opportunities for community engagement, as medical students teach and engage in service learning. There is a lack of research regarding the impact of school community engagement projects and the impact on pupils, as critical stakeholders in the service medical students provide. In this qualitative study, we set out to explore the perspectives of medical students and school pupils involved in a school teaching project. Participants 10 medical students participated in individual interviews, and 17 school pupils across three schools participated in group interviews. Data were analysed using thematic analysis, and the concept of service learning. Results For medical students, the project fostered communication and teaching skills, but a lack of reflection hampered further benefit. For school pupils, experiences varied – learning about careers in medicine could be inspiring, but content pitched at the incorrect level disengaged some pupils. Conflict between session timing and medical students’ exams negatively influenced engagement. Conclusions To shift the focus of community engagement projects which promote service-learning towards mutual benefit, designing in partnership with relevant community stakeholders and integrating opportunities for reflection on these experiences are critical. Strengths and Limitations of this study • To the authors’ best knowledge, this is the first study exploring the impact of a medical student school outreach project from school pupil perspectives. • This study offers rich qualitative data across stakeholder perspectives. • The theoretical framework of service learning used, casts new light on the ways in which school outreach projects influence learning. • The impact is limited by unanticipated changes in project delivery, which reduced participating medical student opportunities for reflection

Multiple extra-synaptic spillover mechanisms regulate prolonged activity in cerebellar Golgi cell - granule cell loops

Despite a wealth of in vitro and modelling studies it remains unclear how neuronal populations in the cerebellum interact in vivo. We address the issue of how the cerebellar input layer processes sensory information, with particular focus on the granule cells ( input relays) and their counterpart inhibitory interneurones, Golgi cells. Based on the textbook view, granule cells excite Golgi cells via glutamate forming a negative feedback loop. However, Golgi cells express inhibitory mGluR2 receptors suggesting an inhibitory role for glutamate. We set out to test this glutamatergic paradox in Golgi cells. Here we show that granule cells and Golgi cells interact through extra-synaptic signalling mechanisms during sensory information processing, as well as synaptic mechanisms. We demonstrate that such interactions depend on granule cell-derived glutamate acting via inhibitory mGluR2 receptors leading causally to the suppression of Golgi cell activity for several hundreds of milliseconds. We further show that granule cell-derived inhibition of Golgi cell activity is regulated by GABA-dependent extra-synaptic Golgi cell inhibition of granule cells, identifying a regulatory loop in which glutamate and GABA may be critical regulators of Golgi cell-granule cell functional activity. Thus, granule cells may promote their own prolonged activity via paradoxical feed-forward inhibition of Golgi cells, thereby enabling information processing over long timescales