Curated Collections for Educators: Eight Key Papers about Feedback in Medical Education

Feedback is an essential part of learning, growth, and academic success. Junior faculty members are often unfamiliar with the grounding literature that defines feedback. Many times they receive little education on providing and receiving feedback, resulting in unhelpful "feedback" for both learners and program leadership alike. This article aims to summarize eight key papers on feedback, to outline relevant information for emerging clinician educators, and identify ways to use these resources for the faculty development. In order to generate a list of key papers that describes the importance and significance of feedback, the authors conducted a consensus-building process to identify the top papers. In August and September, 2018, the 2018-2019 Academic Life in Emergency Medicine (ALiEM) Faculty Incubator program discussed the topic of feedback in medical education. A number of papers on the topic was highlighted. This list of papers was further augmented using the suggestions and expertise of guest experts who are leaders in the field of medical education and feedback. The authors also used social media to conduct an open call on Twitter for important papers regarding feedback (utilizing #meded, #Feedback hashtags). Via this process, a list of 88 key papers was identified on the topic of feedback in medical education. After compiling these papers, the authorship group engaged in a modified Delphi approach to build consensus on the top eight papers on feedback. These papers were deemed essential by the authors and have been summarized with respect to their relevance to junior faculty members and to faculty developers. In this manuscript, we present eight key papers addressing feedback in medical education with discussions and applications for junior faculty members and faculty developers. This list of articles that can serve to help junior clinician educators grow in their ability to give effective feedback and also serve as resources upon which senior faculty can design the faculty development sessions

Obstetric care among refugee populations: reinforcing cultural humility in residency training—preliminary report

The burden of increasing obstetric morbidity and mortality in the United States disproportionately impacts certain populations more than others, one such group being refugees. Poor obstetric outcomes among refugee communities historically have been attributed to delayed initiation of prenatal care, failure to detect co-morbidities, as well as higher rates of Cesarean sections (C-sections), stillbirths, pre-term births, and low birth weight infants in comparison to host-country mothers. Therefore, understanding the contextual nuances that play a role in these poor outcomes among refugee populations is very important

Surface temperature effects on the fouling characteristics of cooling water

A cooling tower system was built and fouling resistances were studied for cooling water flowing over a heated tubular surface. The cooling water studied was formulated in an effort to match industrial cooling water quality. The water used in this study had an average Ryznar Stability Index of 6.23 and was formulated by adding calcium chloride and magnesium carbonate to tap water. Fouling resistance versus time was plotted for each experimental run, and the resulting curves indicate a close approximation to industrial conditions can be made in a laboratory environment. Fouling resistances were obtained at surface temperatures from 136°F to 199°F. The flow velocity and water quality were held constant during these runs. A correlation modeled after the Arrhenius temperature function was developed for surface temperature and asymptotic fouling resistance values. The model obtained has a correlation coefficient of .95 and a standard deviation of 4. 08% for data obtained in this study. The Ryznar Stability Index proved to be a poor indicator of water fouling tendency with the cooling water used in the present study

Current insecticide treatments used in locust control have less of a short-term impact on Australian arid-zone reptile communities than does temporal variation

Author version made available in accordance with the publisher's policyContext: Despite the regular use of pesticides to control locusts, there is a general lack of information on the effects of locust control treatments on reptiles worldwide. Exposure to pesticides poses a significant potential hazard to reptiles, particularly small lizards, both from the direct effects of exposure, and indirectly due to their largely insectivorous diet and small home ranges. Aims: Our study aimed to monitor the effects of two insecticides applied operationally for locust control in Australia.A phenyl pyrazole pesticide, fipronil, and a fungal biopesticide, Metarhizium anisopliae var. acridium (Green Guard®) were applied aerially in either a barrier or block treatment in the absence of high density locust populations, and effects on non-target Australian arid-zone reptiles were measured. Methods: We monitored reptile abundance and community composition responses to treatment methods using a large field-based pitfall trapping experiment with replicated control and spraying treatments which approximated the scale of aerial-based locust control operations in Australia. Key results: Neither reptile abundance nor community composition was significantly affected by locust control treatments. However, both abundance and community composition as detected by pitfall trapping changed over time, in both control and treatment plots, possibly due to a decrease in annual rainfall during the two years of the study. Conclusions: The absence of any significant short-term pesticide treatment effects in our study suggests that the two locust control application methods studied present a relatively insignificant hazard to reptiles at our site, based on a single application. Similar to other areas of Australia, climate or climate driven vegetation change are likely to be stronger drivers of reptile abundance and community structure. Implications: Monitoring over an area which approximates the scale of current locust control operations is an important step in understanding the possible effects of current pesticide exposure on reptile populations and will inform insecticide risk assessments in Australia. However, important information on the immediate response of individuals to insecticide application and any longer-term effects of exposure are still missing. The preliminary research reported in this paper should be complemented by future investigations on long-term and sublethal impacts of pesticide exposure on Australian native reptiles and the possible benefits provided to reptiles by the resource pulses represented in untreated high-density locust population

Urinary interleukin-18 does not predict acute kidney injury after adult cardiac surgery: a prospective observational cohort study

INTRODUCTION: Urinary interleukin-18 (IL-18) measured during the immediate postoperative period could be a promising predictor of acute kidney injury following adult cardiac surgery. METHODS: In a single-centre prospective observational cohort study, we enrolled 100 adult cardiac surgical patients undergoing cardiopulmonary bypass at a tertiary hospital. We measured the urinary concentration of IL-18 and creatinine preoperatively, on arrival in the intensive care unit, and 24 hours postoperatively. We assessed urinary IL-18 concentration and urinary IL-18/urinary creatinine ratio in relation to the postoperative development of acute kidney injury defined as an increase in serum creatinine of greater than 50% from preoperative to postoperative peak value within 48 hours after surgery. RESULTS: Twenty patients developed acute kidney injury. On arrival in the intensive care unit and at 24 hours postoperatively, urinary IL-18 (median [interquartile range]) was not different in patients who subsequently developed acute kidney injury compared with those who did not: on arrival in the intensive care unit (168 [717] versus 104 [256] pg/mL; P = 0.70) and at 24 hours (195 [483] versus 165 [246] pg/mL; P = 0.47). On arrival in the intensive care unit (area under the curve for the receiver operating characteristic curve [AUC-ROCC] 0.53, 95% confidence interval [CI] 0.38 to 0.68; P = 0.70) and at 24 hours postoperatively (AUC-ROCC 0.55, 95% CI 0.40 to 0.71; P = 0.48), urinary IL-18 was not better than chance in predicting acute kidney injury. All findings were confirmed when urinary IL-18 was adjusted for urinary creatinine. Urinary IL-18 correlated with duration of cardiopulmonary bypass (P < 0.001). CONCLUSION: In adults, early postoperative measurement of urinary IL-18 appears not to be valuable in identifying patients who develop acute kidney injury after cardiac surgery, but rather represents a nonspecific marker of cardiopulmonary bypass-associated systemic inflammation

Characterization of the transcriptome profiles related to globin gene switching during in vitro erythroid maturation

<p>Abstract</p> <p>Background</p> <p>The fetal and adult globin genes in the human β-globin cluster on chromosome 11 are sequentially expressed to achieve normal hemoglobin switching during human development. The pharmacological induction of fetal γ-globin (<it>HBG</it>) to replace abnormal adult sickle β^S-globin is a successful strategy to treat sickle cell disease; however the molecular mechanism of γ-gene silencing after birth is not fully understood. Therefore, we performed global gene expression profiling using primary erythroid progenitors grown from human peripheral blood mononuclear cells to characterize gene expression patterns during the γ-globin to β-globin (γ/β) switch observed throughout <it>in vitro </it>erythroid differentiation.</p> <p>Results</p> <p>We confirmed erythroid maturation in our culture system using cell morphologic features defined by Giemsa staining and the γ/β-globin switch by reverse transcription-quantitative PCR (RT-qPCR) analysis. We observed maximal γ-globin expression at day 7 with a switch to a predominance of β-globin expression by day 28 and the γ/β-globin switch occurred around day 21. Expression patterns for transcription factors including <it>GATA1, GATA2, KLF1 </it>and <it>NFE2 </it>confirmed our system produced the expected pattern of expression based on the known function of these factors in globin gene regulation. Subsequent gene expression profiling was performed with RNA isolated from progenitors harvested at day 7, 14, 21, and 28 in culture. Three major gene profiles were generated by Principal Component Analysis (PCA). For profile-1 genes, where expression decreased from day 7 to day 28, we identified 2,102 genes down-regulated > 1.5-fold. Ingenuity pathway analysis (IPA) for profile-1 genes demonstrated involvement of the Cdc42, phospholipase C, NF-Kβ, Interleukin-4, and p38 mitogen activated protein kinase (MAPK) signaling pathways. Transcription factors known to be involved in γ-and β-globin regulation were identified.</p> <p>The same approach was used to generate profile-2 genes where expression was up-regulated over 28 days in culture. IPA for the 2,437 genes with > 1.5-fold induction identified the mitotic roles of polo-like kinase, aryl hydrocarbon receptor, cell cycle control, and <it>ATM </it>(Ataxia Telangiectasia Mutated Protein) signaling pathways; transcription factors identified included <it>KLF1, GATA1 </it>and <it>NFE2 </it>among others. Finally, profile-3 was generated from 1,579 genes with maximal expression at day 21, around the time of the γ/β-globin switch. IPA identified associations with cell cycle control, ATM, and aryl hydrocarbon receptor signaling pathways.</p> <p>Conclusions</p> <p>The transcriptome analysis completed with erythroid progenitors grown <it>in vitro </it>identified groups of genes with distinct expression profiles, which function in metabolic pathways associated with cell survival, hematopoiesis, blood cells activation, and inflammatory responses. This study represents the first report of a transcriptome analysis in human primary erythroid progenitors to identify transcription factors involved in hemoglobin switching. Our results also demonstrate that the <it>in vitro </it>liquid culture system is an excellent model to define mechanisms of global gene expression and the DNA-binding protein and signaling pathways involved in globin gene regulation.</p

Curated Collections for Educators: Five Key Papers about Receiving Feedback in Medical Education

Introduction Feedback is a complex, multi-component interaction that is essential for academic development and advancement. Successful feedback requires active involvement from both the giver and receiver. However, research and guidance on the subject mostly center on the role of the provider of feedback. But the receiver of feedback holds the true power in this interaction, choosing how to interpret the information and deciding whether or not to incorporate the feedback to instill behavioral change. In this article, the authors aim to summarize five key papers related to receiving feedback, in order to outline both relevant information for emerging clinician-educators and discern ways to use this information for faculty development. Methods In order to generate a list of key papers that describe the importance of receiving feedback, the authors conducted a consensus-building process informed by social media sources. Key articles on receiving feedback were aggregated through a literature search. This list was further augmented via an open call on Twitter for important papers regarding receiving feedback. Through these processes, a list of 43 papers was created on the topic of receiving feedback in medical education. After compiling this preliminary list, the authorship group engaged in a modified Delphi approach to build consensus on selecting papers that best described the process of receiving feedback. Results We present the group's five most highly rated papers on the topic of receiving feedback in medical education. These papers were deemed essential and have also been summarized based on their relevance to junior faculty members and faculty developers. Conclusion While giving and receiving feedback are both vital for growth and development, much of the research focuses solely on giving feedback. However, receiving feedback is equally, if not more, important for instilling change in the learner. We explore the power of receiving feedback in medical education through five key papers that analyze the subject. We believe these papers can serve as great learning resources for both junior faculty members and faculty developers. They can assist the junior faculty to cultivate the ability to receive feedback and also serve as resources to aid senior faculty in building faculty-development sessions

Surviving drought: a framework for understanding animal responses to small rain events in the arid zone

Large rain events drive dramatic resource pulses and the complex pulse‐reserve dynamics of arid ecosystems change between high‐rain years and drought. However, arid‐zone animal responses to short‐term changes in climate are unknown, particularly smaller rain events that briefly interrupt longer‐term drought. Using arthropods as model animals, we determined the effects of a small rain event on arthropod abundance in western New South Wales, Australia during a longer‐term shift toward drought. Arthropod abundance decreased over 2 yr, but captures of 10 out of 15 ordinal taxa increased dramatically after the small rain event (\u3c40 \u3emm). The magnitude of increases ranged from 10.4 million% (collembolans) to 81% (spiders). After 3 months, most taxa returned to prerain abundance. However, small soil‐dwelling beetles, mites, spiders, and collembolans retained high abundances despite the onset of winter temperatures and lack of subsequent rain. As predicted by pulse‐reserve models, most arid‐zone arthropod populations declined during drought. However, small rain events may play a role in buffering some taxa from declines during longer‐term drought or other xenobiotic influences. We outline the framework for a new model of animal responses to environmental conditions in the arid zone, as some species clearly benefit from rain inputs that do not dramatically influence primary productivity

Karyotyping of Chromosomes in Human Bronchial Epithelial Cells Transformed by High Energy Fe Ions

Lung cancer induced from exposures to space radiation is one of the most significant health risks for long-term space travels. Evidences show that low- and high- Linear energy transfer (LET)-induced transformation of normal human bronchial epithelial cells (HBEC) that are immortalized through the expression of Cdk4 and hTERT. The cells were exposed to gamma rays and high-energy Fe ions for the selection of transformed clones. Transformed HBEC are identified and analyzed chromosome aberrations (i.e. genomic instability) using the multi-color fluorescent in situ hybridization (mFISH), as well as the multi-banding in situ hybridization (mBAND) techniques. Our results show chromosomal translocations between different chromosomes and several of the breaks occurred in the q-arm of chromosome 3. We also identified copy number variations between the transformed and the parental HBEC regardless of the exposure conditions. We observed chromosomal aberrations in the lowand high-LET radiation-induced transformed clones and they are imperfectly different from clones obtain in spontaneous soft agar growth