Well prepared for work? Junior doctors' self-assessment after medical education

Background Apart from objective exam results, the overall feeling of preparedness is important for a successful transition process from being a student to becoming a qualified doctor. This study examines the association between self-assessed deficits in medical skills and knowledge and the feeling of preparedness of junior doctors in order to determine which aspects of medical education need to be addressed in more detail in order to improve the quality of this transition phase and in order to increase patient safety. Methods A cohort of 637 doctors with up to two years of clinical work experience was included in this analysis and was asked about the overall feeling of preparedness and self-assessed deficits with regard to clinical knowledge and skills. Three logistic regression models were used to identify medical skills which predict the feeling of preparedness. Results All in all, about 60% of the participating doctors felt poorly prepared for post-graduate training. Self-assessed deficits in ECG interpretation (aOR: 4.39; 95% CI: 2.012-9.578), treatment and therapy planning (aOR: 3.42; 95% CI: 1.366-8.555), and intubation (aOR: 2.10; 95% CI: 1.092-4.049) were found to be independently associated with the overall feeling of preparedness in the final regression model. Conclusions Many junior doctors in Germany felt inadequately prepared for being a doctor. With regard to the contents of medical curricula, our results show that more emphasis on ECG-interpretation, treatment and therapy planning and intubation is required to improve the feeling of preparedness of medical graduates

Massive perturbers and the efficient merger of binary massive black holes

We show that dynamical relaxation in the aftermath of a galactic merger and the ensuing formation and decay of a binary massive black hole (MBH), are dominated by massive perturbers (MPs) such as giant molecular clouds or clusters. MPs accelerate relaxation by orders of magnitude relative to 2-body stellar relaxation alone, and efficiently scatter stars into the binary MBH's orbit. The 3-body star-binary MBH interactions shrink the binary MBH to the point where energy losses from the emission of gravitational waves (GW) lead to rapid coalescence. We model this process based on observed and simulated MP distributions and take into account the decreased efficiency of the star-binary MBH interaction due to acceleration in the galactic potential. We show that mergers of gas-rich galactic nuclei lead to binary MBH coalescence well within the Hubble time. Moreover, lower-mass binary MBHs (<10^8 Msun) require only a few percent of the typical gas mass in a post-merger nucleus to coalesce in a Hubble time. The fate of a binary MBH in a gas poor galactic merger is less certain, although massive stellar structures (e.g. clusters, stellar rings) could likewise lead to efficient coalescence. These coalescence events are observable by their strong GW emission. MPs thus increase the cosmic rate of such GW events, lead to a higher mass deficit in the merged galactic core and suppress the formation of triple MBH systems and the resulting ejection of MBHs into intergalactic space.Comment: 14 pages, 4 figures, 3 tables. More detailed explanations and changes in structure. Section on hypervelocity stars moved to another paper (in preparation). Results and conclusions unchanged. Accepted to Ap

Wavelength-dependent reflectivity changes on gold at elevated electronic temperatures

Upon the excitation by an ultrashort laser pulse the conditions in a material can drastically change, altering its optical properties and therefore the relative amount of absorbed energy, a quan- tity relevant for determining the damage threshold and for developing a detailed simulation of a structuring process. The subject of interest in this work is the d-band metal gold which has an absorption edge marking the transition of free valence electrons and an absorbing deep d-band with bound electrons. Reflectivity changes are observed in experiment over a broad spectral range at ablation conditions. To understand the involved processes the laser excitation is modeled by a com- bination of first principle calculations with a two-temperature model. The description is kept most general and applied to realistically simulate the transfer of the absorbed energy of a Gaussian laser pulse into the electronic system at every point in space at every instance of time. An electronic temperature-dependent reflectivity map is calculated, describing the out of equilibrium reflectivity during laser excitation for photon energies from 0.9 - 6.4 eV, including inter- and intra-band transi- tions and a temperature-dependent damping factor. The main mechanisms are identified explaining the electronic temperature-dependent change in reflectivity: broadening of the edge of the occu- pied/unoccupied states around the chemical potential $\mu$, also leading to a shift of the $\mu$ and an increase of the collision rate of free s/p-band electrons with bound d-band holes

Tidal Disruption of Stellar Objects by Hard Supermassive Black Hole Binaries

Supermassive black hole binaries (SMBHBs) are expected by the hierarchical galaxy formation model in $\Lambda$CDM cosmology. There is some evidence in the literature for SMBHBs in AGNs, but there are few observational constraints on the evolution of SMBHBs in inactive galaxies and gas-poor mergers. On the theoretical front, it is unclear how long is needed for a SMBHB in a typical galaxy to coalesce. In this paper we investigate the tidal interaction between stars and binary BHs and calculate the tidal disruption rates of stellar objects by the BH components of binary. We derive the interaction cross sections between SMBHBs and stars from intensive numerical scattering experiments with particle number $\sim10^7$ and calculate the tidal disruption rates by both single and binary BHs for a sample of realistic galaxy models, taking into account the general relativistic effect and the loss cone refilling because of two-body interaction. We estimate the frequency of tidal flares for different types of galaxies using the BH mass function in the literature. We find that because of the three-body slingshot effect, the tidal disruption rate in SMBHB system is more than one order of magnitude smaller than that in single SMBH system. The difference is more significant in less massive galaxies and does not depend on detailed stellar dynamical processes. Our calculations suggest that comparisons of the calculated tidal disruption rates for both single and binary BHs and the surveys of X-ray or UV flares at galactic centers could tell us whether most SMBHs in nearby galaxies are single and whether the SMBHBs formed in gas-poor galaxy mergers coalesce rapidly.Comment: 43 pages, 12 figures, 2 tables; accepted for publication in Ap

Mentoring programs for medical students - a review of the PubMed literature 2000 - 2008

Abstract Background Although mentoring is acknowledged as a key to successful and satisfying careers in medicine, formal mentoring programs for medical students are lacking in most countries. Within the framework of planning a mentoring program for medical students at Zurich University, an investigation was carried out into what types of programs exist, what the objectives pursued by such programs are, and what effects are reported. Methods A PubMed literature search was conducted for 2000 - 2008 using the following keywords or their combinations: mentoring, mentoring program, medical student, mentor, mentee, protégé, mentorship. Although a total of 438 publications were identified, only 25 papers met the selection criteria for structured programs and student mentoring surveys. Results The mentoring programs reported in 14 papers aim to provide career counseling, develop professionalism, increase students' interest in research, and support them in their personal growth. There are both one-to-one and group mentorships, established in the first two years of medical school and continuing through graduation. The personal student-faculty relationship is important in that it helps students to feel that they are benefiting from individual advice and encourages them to give more thought to their career choices. Other benefits are an increase in research productivity and improved medical school performance in general. Mentored students also rate their overall well-being as higher. - The 11 surveys address the requirements for being an effective mentor as well as a successful mentee. A mentor should empower and encourage the mentee, be a role model, build a professional network, and assist in the mentee's personal development. A mentee should set agendas, follow through, accept criticism, and be able to assess performance and the benefits derived from the mentoring relationship. Conclusion Mentoring is obviously an important career advancement tool for medical students. In Europe, more mentoring programs should be developed, but would need to be rigorously assessed based on evidence of their value in terms of both their impact on the career paths of juniors and their benefit for the mentors. Medical schools could then be monitored with respect to the provision of mentorships as a quality characteristic.</p

Undergraduate medical research: the student perspective

Background: Research training is essential in a modern undergraduate medical curriculum. Our evaluation aimed to (a) gauge students&#x2019; awareness of research activities, (b) compare students&#x2019; perceptions of their transferable and research-specific skills competencies, (c) determine students&#x2019; motivation for research and (d) obtain students&#x2019; personal views on doing research. Methods: Undergraduate medical students (N=317) completed a research skills questionnaire developed by the Centre for Excellence in Teaching and Learning in Applied Undergraduate Research Skills (CETL-AURS) at Reading University. The questionnaire assessed students&#x2019; transferable skills, research-specific skills (e.g., study design, data collection and data analysis), research experience and attitude and motivation towards doing research. Results: The majority of students are motivated to pursue research. Graduate entrants and male students appear to be the most confident regarding their research skills competencies. Although all students recognise the role of research in medical practice, many are unaware of the medical research activities or successes within their university. Of those who report no interest in a career incorporating research, a common perception was that researchers are isolated from patients and clinical practice. Discussion: Students have a narrow definition of research and what it entails. An explanation for why research competence does not align more closely with research motivation is derived from students&#x2019; lack of understanding of the concept of translational research, as well as a lack of awareness of the research activity being undertaken by their teachers and mentors. We plan to address this with specific research awareness initiatives

More mentoring needed? A cross-sectional study of mentoring programs for medical students in Germany

<p>Abstract</p> <p>Background</p> <p>Despite increasing recognition that mentoring is essential early in medical careers, little is known about the prevalence of mentoring programs for medical students. We conducted this study to survey all medical schools in Germany regarding the prevalence of mentoring programs for medical students as well as the characteristics, goals and effectiveness of these programs.</p> <p>Methods</p> <p>A definition of mentoring was established and program inclusion criteria were determined based on a review of the literature. The literature defined mentoring as a steady, long-lasting relationship designed to promote the mentee's overall development. We developed a questionnaire to assess key characteristics of mentoring programs: the advocated mentoring model, the number of participating mentees and mentors, funding and staff, and characteristics of mentees and mentors (e.g., level of training). In addition, the survey characterized the mentee-mentor relationship regarding the frequency of meetings, forms of communication, incentives for mentors, the mode of matching mentors and mentees, and results of program evaluations. Furthermore, participants were asked to characterize the aims of their programs. The questionnaire consisted of 34 questions total, in multiple-choice (17), numeric (7) and free-text (10) format. This questionnaire was sent to deans and medical education faculty in Germany between June and September 2009. For numeric answers, mean, median, and standard deviation were determined. For free-text items, responses were coded into categories using qualitative free text analysis.</p> <p>Results</p> <p>We received responses from all 36 medical schools in Germany. We found that 20 out of 36 medical schools in Germany offer 22 active mentoring programs with a median of 125 and a total of 5,843 medical students (6.9 - 7.4% of all German medical students) enrolled as mentees at the time of the survey. 14 out of 22 programs (63%) have been established within the last 2 years. Six programs (27%) offer mentoring in a one-on-one setting. 18 programs (82%) feature faculty physicians as mentors. Nine programs (41%) involve students as mentors in a peer-mentoring setting. The most commonly reported goals of the mentoring programs include: establishing the mentee's professional network (13 programs, 59%), enhancement of academic performance (11 programs, 50%) and counseling students in difficulties (10 programs, 45%).</p> <p>Conclusions</p> <p>Despite a clear upsurge of mentoring programs for German medical students over recent years, the overall availability of mentoring is still limited. The mentoring models and goals of the existing programs vary considerably. Outcome data from controlled studies are needed to compare the efficiency and effectiveness of different forms of mentoring for medical students.</p