The impact of two multiple-choice question formats on the problem-solving strategies used by novices and experts

BACKGROUND: Pencil-and-paper examination formats, and specifically the standard, five-option multiple-choice question, have often been questioned as a means for assessing higher-order clinical reasoning or problem solving. This study firstly investigated whether two paper formats with differing number of alternatives (standard five-option and extended-matching questions) can test problem-solving abilities. Secondly, the impact of the alternatives number on psychometrics and problem-solving strategies was examined. METHODS: Think-aloud protocols were collected to determine the problem-solving strategy used by experts and non-experts in answering Gastroenterology questions, across the two pencil-and-paper formats. RESULTS: The two formats demonstrated equal ability in testing problem-solving abilities, while the number of alternatives did not significantly impact psychometrics or problem-solving strategies utilized. CONCLUSIONS: These results support the notion that well-constructed multiple-choice questions can in fact test higher order clinical reasoning. Furthermore, it can be concluded that in testing clinical reasoning, the question stem, or content, remains more important than the number of alternatives

Behavior of a forest of NiFe nanowires in KOH and NaCl solution for water electrolysis

The present work investigates the behavior of nanostructured electrodes consisting of an array of nanowires of NiFe alloy in KOH + 0.5 M NaCl solution. The aim is to explore the possibility of using these electrodes for hydrogen production by seawater electrolysis. Seawater splitting requires a highly selective electrode on the anode side, where the evolution of molecular chlorine or the formation of other active chlorine compounds can compete with the oxygen evolution reaction. Nanostructured electrodes, obtained by template electrosynthesis, were tested at room temperature in KOH + 0.5 M NaCl solution, and the results were compared with those obtained in pure KOH. The results showed that the presence of NaCl does not affect the electrocatalytic behavior of the nanostructured NiFe alloy. Furthermore, the chemical–physical characterizations carried out after the long-term galvanostatic tests, have shown that the nanostructured electrodes are also stable in terms of morphology and composition. In addition, the solution used to perform the long-term galvanostatic tests was analyzed to investigate the possible formation of chlorine compounds. The absence of these compounds, together with the measured potential value measured for the oxygen evolution reaction, which was always lower than the thermodynamic redox potential for the hypochlorite formation reaction, leads us to conclude that these electrodes are potentially suitable for seawater electrolysis

Managing the complexity of doing it all : an exploratory study on students' experiences when trained stepwise in conducting consultations

Background: At most medical schools the components required to conduct a consultation, medical knowledge, communication, clinical reasoning and physical examination skills, are trained separately. Afterwards, all the knowledge and skills students acquired must be integrated into complete consultations, an art that lies at the heart of the medical profession. Inevitably, students experience conducting consultations as complex and challenging. Literature emphasizes the importance of three didactic course principles: moving from partial tasks to whole task learning, diminishing supervisors' support and gradually increasing students' responsibility. This study explores students' experiences of an integrated consultation course using these three didactic principles to support them in this difficult task. Methods: Six focus groups were conducted with 20 pre-clerkship and 19 clerkship students in total. Discussions were audiotaped, transcribed and analysed by Nvivo using the constant comparative strategy within a thematic analysis. Results: Conducting complete consultations motivated students in their learning process as future physician. Initially, students were very much focused on medical problem solving. Completing the whole task of a consultation obligated them to transfer their theoretical medical knowledge into applicable clinical knowledge on the spot. Furthermore, diminishing the support of a supervisor triggered students to reflect on their own actions but contrasted with their increased appreciation of critical feedback. Increasing students' responsibility stimulated their active learning but made some students feel overloaded. These students were anxious to miss patient information or not being able to take the right decisions or to answer patients' questions, which sometimes resulted in evasive coping techniques, such as talking faster to prevent the patient asking questions. Conclusion: The complex task of conducting complete consultations should be implemented early within medical curricula because students need time to organize their medical knowledge into applicable clinical knowledge. An integrated consultation course should comprise a step-by-step teaching strategy with a variety of supervisors' feedback modi, adapted to students' competence. Finally, students should be guided in formulating achievable standards to prevent them from feeling overloaded in practicing complete consultations with simulated or real patients

Personal control of the indoor environment in offices: Relations with building characteristics, influence on occupant perception and reported symptoms related to the building-the officair project

Personal control over various indoor environment parameters, especially in the last decades, appear to have a significant role on occupants' comfort, health and productivity. To reveal this complex relationship, 7441 occupants of 167 recently built or retrofitted office buildings in eight European countries participated in an online survey about personal/health/work data as well as physical/psycho-social information. The relationship between the types of control available over indoor environments and the perceived personal control of the occupants was examined, as well as the combined effect of the control parameters on the perceived comfort using multilevel statistical models. The results indicated that most of the occupants have no or low control on noise. Half of the occupants declared no or low control on ventilation and temperature conditions. Almost one-third of them remarked that they do not have satisfactory levels of control for lighting and shading from sun conditions. The presence of operable windows was shown to influence occupants' control perception over temperature, ventilation, light and noise. General building characteristics, such as floor number and floor area, office type, etc., helped occupants associate freedom positively with control perception. Combined controlling parameters seem to have a strong relation with overall comfort, as well as with perception regarding amount of privacy, office layout and decoration satisfaction. The results also indicated that occupants with more personal control may have less building-related symptoms. Noise control parameter had the highest impact on the occupants' overall comfort

A prospective randomized trial of content expertise versus process expertise in small group teaching

Article deposited according to agreement with BMC, December 6, 2010.YesFunding provided by the Open Access Authors Fund

Involvement in teaching improves learning in medical students: a randomized cross-over study

<p>Abstract</p> <p>Background</p> <p>Peer-assisted learning has many purported benefits including preparing students as educators, improving communication skills and reducing faculty teaching burden. But comparatively little is known about the effects of teaching on learning outcomes of peer educators in medical education.</p> <p>Methods</p> <p>One hundred and thirty-five first year medical students were randomly allocated to 11 small groups for the Gastroenterology/Hematology Course at the University of Calgary. For each of 22 sessions, two students were randomly selected from each group to be peer educators. Students were surveyed to estimate time spent preparing as peer educator versus group member. Students completed an end-of-course 94 question multiple choice exam. A paired t-test was used to compare performance on clinical presentations for which students were peer educators to those for which they were not.</p> <p>Results</p> <p>Preparation time increased from a mean (SD) of 36 (33) minutes baseline to 99 (60) minutes when peer educators (Cohen's <it>d </it>= 1.3; p < 0.001). The mean score (SD) for clinical presentations in which students were peer educators was 80.7% (11.8) compared to77.6% (6.9) for those which they were not (<it>d </it>= 0.33; <it>p </it>< 0.01).</p> <p>Conclusion</p> <p>Our results suggest that involvement in teaching small group sessions improves medical students' knowledge acquisition and retention.</p

Optimized two-dimensional thin layer chromatography to monitor the intracellular concentration of acetyl phosphate and other small phosphorylated molecules

Acetyl phosphate (acetyl-P) serves critical roles in coenzyme A recycling and ATP synthesis. It is the intermediate of the Pta-AckA pathway that inter-converts acetyl-coenzyme A and acetate. Acetyl-P also can act as a global signal by donating its phosphoryl group to specific two-component response regulators. This ability derives from its capacity to store energy in the form of a high-energy phosphate bond. This bond, while critical to its function, also destabilizes acetyl-P in cell extracts. This lability has greatly complicated biochemical analysis, leading in part to widely varying acetyl-P measurements. We therefore developed an optimized protocol based on two-dimensional thin layer chromatography that includes metabolic labeling under aerated conditions and careful examination of the integrity of acetyl-P within extracts. This protocol results in greatly improved reproducibility, and thus permits precise measurements of the intracellular concentration of acetyl-P, as well as that of other small phosphorylated molecules

Conceptualization of category-oriented likelihood ratio: a useful tool for clinical diagnostic reasoning

<p>Abstract</p> <p>Background</p> <p>In the diagnostic reasoning process medical students and novice physicians need to be made aware of the diagnostic values of the clinical findings (including history, signs, and symptoms) to make an appropriate diagnostic decision. Diagnostic reasoning has been understood in light of two paradigms on clinical reasoning: <it>problem solving </it>and <it>decision making</it>. They advocate the reasoning strategies used by expert physicians and the statistical models of reasoning, respectively. Evidence-based medicine (EBM) applies <it>decision theory </it>to the clinical diagnosis, which can be a challenging topic in medical education.</p> <p>This theoretical article tries to compare evidence-based diagnosis with expert-based strategies in clinical diagnosis and also defines a novel concept <it>of category-oriented likelihood ratio (LR) </it>to propose a new model combining both aforementioned methods.</p> <p>Discussion</p> <p>Evidence-based medicine advocates the use of quantitative evidence to estimate the probability of diseases more accurately and objectively; however, the published evidence for a given diagnosis cannot practically be utilized in primary care, especially if the patient is complaining of a nonspecific problem such as abdominal pain that could have a long list of differential diagnoses. In this case, expert physicians examine the key clinical findings that could differentiate between broader categories of diseases such as organic and non-organic disease categories to shorten the list of differential diagnoses. To approach nonspecific problems, not only do the experts revise the probability estimate of specific diseases, but also they revise the probability estimate of the <it>categories of diseases </it>by using the available clinical findings.</p> <p>Summary</p> <p>To make this approach analytical and objective, we need to know how much more likely it is for a key clinical finding to be present in patients with one of the diseases of a specific category versus those with a disease not included in that category. In this paper, we call this value <it>category-oriented LR</it>.</p

Discovery and profiling of small RNAs responsive to stress conditions in the plant pathogen <i>Pectobacterium atrosepticum</i>

BACKGROUND: Small RNAs (sRNAs) have emerged as important regulatory molecules and have been studied in several bacteria. However, to date, there have been no whole-transcriptome studies on sRNAs in any of the Soft Rot Enterobacteriaceae (SRE) group of pathogens. Although the main ecological niches for these pathogens are plants, a significant part of their life cycle is undertaken outside their host within adverse soil environment. However, the mechanisms of SRE adaptation to this harsh nutrient-deficient environment are poorly understood. RESULTS: In the study reported herein, by using strand-specific RNA-seq analysis and in silico sRNA predictions, we describe the sRNA pool of Pectobacterium atrosepticum and reveal numerous sRNA candidates, including those that are induced during starvation-activated stress responses. Consequently, strand-specific RNA-seq enabled detection of 137 sRNAs and sRNA candidates under starvation conditions; 25 of these sRNAs were predicted for this bacterium in silico. Functional annotations were computationally assigned to 68 sRNAs. The expression of sRNAs in P. atrosepticum was compared under growth-promoting and starvation conditions: 68 sRNAs were differentially expressed with 47 sRNAs up-regulated under nutrient-deficient conditions. Conservation analysis using BLAST showed that most of the identified sRNAs are conserved within the SRE. Subsequently, we identified 9 novel sRNAs within the P. atrosepticum genome. CONCLUSIONS: Since many of the identified sRNAs are starvation-induced, the results of our study suggests that sRNAs play key roles in bacterial adaptive response. Finally, this work provides a basis for future experimental characterization and validation of sRNAs in plant pathogens. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12864-016-2376-0) contains supplementary material, which is available to authorized users

An Integrated Approach for Finding Overlooked Genes in Shigella

Background: The completion of numerous genome sequences introduced an era of whole-genome study. However, many genes are missed during genome annotation, including small RNAs (sRNAs) and small open reading frames (sORFs). In order to improve genome annotation, we aimed to identify novel sRNAs and sORFs in Shigella, the principal etiologic agents of bacillary dysentery. Methodology/Principal Findings: We identified 64 sRNAs in Shigella, which were experimentally validated in other bacteria based on sequence conservation. We employed computer-based and tiling array-based methods to search for sRNAs, followed by RT-PCR and northern blots, to identify nine sRNAs in Shigella flexneri strain 301 (Sf301) and 256 regions containing possible sRNA genes. We found 29 candidate sORFs using bioinformatic prediction, array hybridization and RT-PCR verification. We experimentally validated 557 (57.9%) DOOR operon predictions in the chromosomes of Sf301 and 46 (76.7%) in virulence plasmid.We found 40 additional co-expressed gene pairs that were not predicted by DOOR. Conclusions/Significance: We provide an updated and comprehensive annotation of the Shigella genome. Our study increased the expected numbers of sORFs and sRNAs, which will impact on future functional genomics and proteomics studies. Our method can be used for large scale reannotation of sRNAs and sORFs in any microbe with a known genom