Professional identity formation (PIF) is increasingly recognized as a core element of medical education. The use of narrative reflection is traditionally the most common means to explore PIF. We ...explored the use of mask-making as a process of reflective expression to encourage iterative exploration of professional identity in medical students. This project focused on elements of personal and professional identity in a cohort of entering students.
One hundred fifty entering students at the Pennsylvania State University College of Medicine created a mask to use descriptive words to express their perceptions of an ideal physician (external face of the mask) and their sense of self (internal face of the mask). Responses were compared to established domains of professional identity.
Students most commonly listed elements in the domain of personal characteristics to describe both their sense of self and of an ideal physician. Students were more likely to list emotional elements when describing self and more likely to use elements in the domains of relationships, attitudes, and duties/responsibilities when describing an ideal physician.
The beginning of medical school is a time of significant transition. Mask making can blend visual and narrative arts to provide a complementary tool to examine professional identity formation.
PURPOSETo describe the breadth of strategies U.S. medical schools use to promote medical student well-being.
METHODIn October 2016, 32 U.S. medical schools were surveyed about their student ...well-being initiatives, resources, and infrastructure; grading in preclinical courses; and learning communities.
RESULTSTwenty-seven schools (84%) responded. Sixteen (59%) had a student well-being curriculum, with content scheduled during regular curricular hours at most (13/16; 81%). These sessions were held at least monthly (12/16; 75%), and there was a combination of optional and mandatory attendance (9/16; 56%). Most responding schools offered a variety of emotional/spiritual, physical, financial, and social well-being activities. Nearly one-quarter had a specific well-being competency (6/27; 22%). Most schools relied on participation rates (26/27; 96%) and student satisfaction (22/27; 81%) to evaluate effectiveness. Sixteen (59%) assessed student well-being from survey data, and 7 (26%) offered students access to self-assessment tools. Other common elements included an individual dedicated to overseeing student well-being (22/27; 82%), a student well-being committee (22/27; 82%), pass/fail grading in preclinical courses (20/27; 74%), and the presence of learning communities (22/27; 81%).
CONCLUSIONSSchools have implemented a broad range of well-being curricula and activities intended to promote self-care, reduce stress, and build social support for medical students, with variable resources, infrastructure, and evaluation. Implementing dedicated well-being competencies and rigorously evaluating their impact would help ensure appropriate allocation of time and resources and determine if well-being strategies are making a difference. Strengthening evaluation is an important next step in alleviating learner distress and ultimately improving student well-being.
Cardiac rehabilitation is a comprehensive multidisciplinary program individually tailored to the needs of patients with cardiovascular disease. The overall goals focus on improving daily function and ...reducing cardiovascular risk factors. Cardiac rehabilitation includes interventions aimed at lowering blood pressure and improving lipid and diabetes mellitus control, with tobacco cessation, behavioral counseling, and graded physical activity. The physical activity component typically involves 36 sessions over 12 weeks, during which patients participate in supervised exercise under cardiac monitoring. There are also intensive programs that include up to 72 sessions lasting up to 18 weeks, although these programs are not widely available. Additional components of cardiac rehabilitation include counseling on nutrition, screening for and managing depression, and assuring up-to-date immunizations. Cardiac rehabilitation is covered by Medicare and recommended for patients following myocardial infarction, bypass surgery, and stent placement, and for patients with heart failure, stable angina, and several other conditions. Despite proven benefits in mortality rates, depression, functional capacity, and medication adherence, rates of referral for cardiac rehabilitation are suboptimal. Groups less likely to be referred are older adults, women, patients who do not speak English, and persons living in areas where cardiac rehabilitation is not locally available. Additionally, primary care physicians refer patients less often than cardiologists and cardiothoracic surgeons.
Although Christianity is the world's largest religion, there is confusion over what it means to be Christian within contemporary society. For individuals it is difficult to find, form, or receive a ...Christian identity, let alone maintain one within a secular world. Within organizations such as the church and professions there is often a disconnection between public and private identities and the reality of being Christian in our culture. For society there is the problem of disparate portrayals of Christianity, the marginalized status of Christianity with an associated lack of influence of Christians on our society, and the ongoing shaping of Christian identity by the public arena itself. Associated questions are: should Christians try to engage in, and even shape, the public arena and if so, how?This volume examines the problem of confused and misunderstood Christian identity in a post-Christian age. It suggests ways of shaping Christian identity for the benefit of individuals and for the common good. The importance of well-formed Christian identities is illustrated by research and analysis of selected professions so that the public life of Christians can be more fulfilling and effective.This book will be valuable for all those who are interested in religious identity within a secular society. People of faith and religious organizations will benefit from a penetrating analysis of what it means to be Christian today. Similarly, those whose work involves the church, counseling, education and the performing arts will find specific applications that address concerns about faith in the workplace.
Dental Problems in Primary Care Stephens, Mark B; Wiedemer, Joseph P; Kushner, George M
American family physician,
12/2018, Letnik:
98, Številka:
11
Journal Article
Recenzirano
Oral health directly affects overall health and quality of life. More Americans lack dental insurance than medical insurance. Patients with poor oral health are more likely to have respiratory and ...cardiovascular diseases, adverse pregnancy outcomes, and diabetes mellitus. Early childhood caries is the most common chronic condition in American children. Certain illicit and prescription drugs increase the risk of enamel erosion and caries formation in adults. Incision and drainage is the treatment of choice for dental abscess. Risk factors for periodontal disease include smoking, diabetes, human immunodeficiency virus infection, use of certain medications, and genetic susceptibility. Patients with gingivitis typically present with swollen, erythematous gum tissue that bleeds easily with brushing or flossing. One in three children will have an injury to the primary teeth, and one in five 12-year-old children will have an injury to the permanent teeth. All dental fractures should be evaluated with imaging and managed in conjunction with a dental professional. Immediate reimplantation is the preferred treatment for avulsed permanent teeth. Primary care clinicians are well positioned to reduce rates of oral disease. Family physicians can incorporate oral health into routine practice through counseling about diet, oral hygiene, smoking cessation, and fluoride supplementation; application of fluoride varnish; and screening for dental disease.
The distributions of iodate and iodide were measured along the GEOTRACES GP15 meridional transect at 152°W from the shelf of Alaska to Papeete, Tahiti. The transect included oxygenated waters near ...the shelf of Alaska, the full water column in the central basin in the North Pacific Basin, the upper water column spanning across seasonally mixed regimes in the north, oligotrophic regimes in the central gyre, and the equatorial upwelling. Iodide concentrations are highest in the permanently stratified tropical mixed layers, which reflect accumulation due to light‐dependent biological processes, and decline rapidly below the euphotic zone. Vertical mixing coefficients (Kz), derived from complementary 7Be data, enabled iodide oxidation rates to be estimated at two stations. Iodide half‐lives of 3–4 years show the importance of seasonal mixing processes in explaining north‐south differences in the transect, and also contribute to the decrease in iodide concentrations with depth below the mixed layer. These estimated half‐lives are consistent with a recent global iodine model. No evidence was found for significant inputs of iodine from the Alaskan continental margin, but there is a significant enrichment of iodide in bottom waters overlying deep sea sediments from the interior of the basin.
Plain Language Summary
Iodine is an important element in the oceans' biology and chemistry. The two principal forms are iodate and iodide, which were measured on a surface to seafloor survey from Alaska to Tahiti in 2018 as part of the international GEOTRACES program. Iodate, the stable form in the presence of oxygen, was predominant throughout the transect, but iodide was present at the boundaries, including the Alaskan margin, the abyssal plain, and surface waters. A "hot zone” of high iodide comprising up to 50% of the total iodine concentration was detected in tropical surface waters centered on the equator. It reflects accumulation from biological reduction of iodate by phytoplankton coupled with re‐oxidation of iodide by a non‐light‐dependent process. Iodate reduction probably occurs throughout the transect, but winter mixing of surface waters during storms probably smears out this feature in northern waters. This suggests that the turnover between iodide and iodate is longer than seasonal timescales. Indeed, estimates of iodide half‐life in the range of 3–4 years were calculated from complimentary shipboard measurements of a short‐lived radioisotope, beryllium‐7. High iodide in equatorial surface waters is important for atmospheric chemistry as it has a big impact on the global ozone budget.
Key Points
Iodate is the predominant form of iodine in deep waters, but iodide strongly accumulates in the tropical mixed layer
Iodide oxidation rates were estimated using complimentary Be‐7 data, indicating a half‐life in the lower euphotic zone of 3–4 years
Sediments on the abyssal plain are a modest source of iodide to bottom waters
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