Aim: To examine differences in the types of teaching activities performed during rounds between the most effective and least effective inpatient teaching attendings.
Methods: Participants included 56 ...attending physicians supervising 279 trainees. Trained observers accompanied teams during rounds and recorded the frequencies of educational activities that occurred. Students and residents then rated their satisfaction with the teaching on rounds.
Results: Attending physicians with the highest learner satisfaction scores performed significantly more teaching activities per patient than attending physicians who were rated as average or less-effective (2.1 vs. 1.4 vs. 1.5; p = .03). There were significant differences in the frequencies of 3 out of the 9 specific teaching activities observed, including answering specific patient-care related questions (77% vs. 66% vs. 47%; p = .003), teaching on learner chosen topics (8% vs. 2% vs. 2%; p = .02), and providing feedback (31% vs. 10% vs. 0.1%; p = .001).
Conclusions: Specific categories of teaching activities-patient-specific teaching, teaching on learner-identified topics, and providing real-time feedback-are performed more frequently by the highest-rated attending physicians, which can guide faculty development.
Mycobacterium chimaera, a member of the Mycobacterium avium complex, is a slow-growing, nontuberculous mycobacterium associated with outbreaks in cardiac-surgery patients supported on heart-lung ...machines. We report a case of an elderly woman on chronic prednisone who presented with a six-month history of worsening chronic back pain, recurrent low-grade fevers, and weight loss. Imaging identified multilevel vertebral osteomyelitis and lumbar soft-tissue abscess. Abscess culture identified M. chimaera.
Using leaf epidermis from Vicia faba, we tested whether auxin-induced stomatal opening was initiated by auxin-induced ethylene synthesis. Epidermis was dark-incubated in buffered KNO3 containing 0.1 ...mM alpha-naptha-lene acetic acid or 1 mM indole-3-acetic acid. Maximum net opening was ca. 4 micro m after 6 h. Opening was reversed by 20 micro M ABA, 0.1 mM CaCl2. 1-Anrinocyclopropane carboxylic acid (ACC) synthase catalyzes synthesis of ACC, the immediate precursor to ethylene. Auxin-induced stomatal opening was fully inhibited by 10 micro M 1-aminoethoxyvinylglycine (AVG), an ACC synthase inhibitor. In solutions containing AVG auxin-induced opening was restored in a concentration-dependent manner by exogenous ACC, but not in control solutions lacking an auxin. ACC-mediated reversal of AVG-inhibition of stomatal opening was inhibited by alpha-aminoisobutyric acid (AIB), an inhibitor of ACC oxidase, the last enzyme in the ethylene biosynthetic pathway, by 10 micro M silver thiosulfate (STS), an inhibitor of ethylene action, and by 20 micro M ABA, 0.1 mM CaCl2. CoCl2, an inhibitor of ethylene synthesis, also inhibited auxininduced opening. Both STS and CoCl2 inhibited opening induced by light or by fusicoccin, but neither light- nor fusicoccin-induced opening was inhibited by AVG. These results support the hypothesis that auxin-induced stomatal opening is mediated through auxin-induced ethylene production by guard cells.
As technological advancements challenge the current roles healthcare workers fill, curiosity and lifelong learning are becoming increasingly important. However, descriptions of specific curricular ...interventions that successfully develop these attitudes and skills remain limited.EDUCATIONAL CHALLENGEAs technological advancements challenge the current roles healthcare workers fill, curiosity and lifelong learning are becoming increasingly important. However, descriptions of specific curricular interventions that successfully develop these attitudes and skills remain limited.We aimed to promote curiosity and advance practical application of evidenced-based medicine through a longitudinal, gamified learning activity within a longitudinal integrated clerkship (LIC). Thirty-seven students across two inquiry-themed LICs based at a university hospital and a community-based integrated healthcare delivery system used BINGO cards containing various assignments designed to develop the skill of asking and answering clinical questions. Assignments included: engaging experts, using evidence-based medical resources, attending education events, utilizing medical library resources, and Phone-a-Scientist. Students shared their experiences in a group setting and wrote a reflection for each assignment that was qualitatively analyzed to determine the perceived educational outcomes according to the Kirkpatrick Evaluation Model.PROPOSED SOLUTIONWe aimed to promote curiosity and advance practical application of evidenced-based medicine through a longitudinal, gamified learning activity within a longitudinal integrated clerkship (LIC). Thirty-seven students across two inquiry-themed LICs based at a university hospital and a community-based integrated healthcare delivery system used BINGO cards containing various assignments designed to develop the skill of asking and answering clinical questions. Assignments included: engaging experts, using evidence-based medical resources, attending education events, utilizing medical library resources, and Phone-a-Scientist. Students shared their experiences in a group setting and wrote a reflection for each assignment that was qualitatively analyzed to determine the perceived educational outcomes according to the Kirkpatrick Evaluation Model.Results suggest that Inquiry BINGO fosters curiosity and builds skill in applied evidenced-based medicine early in clinical training. Most assignments prompted students to engage in opportunities they might not have otherwise explored. All but three students reported a change in behavior as a result of the assignment and 57% reported positive clinical or research results.LESSONS LEARNEDResults suggest that Inquiry BINGO fosters curiosity and builds skill in applied evidenced-based medicine early in clinical training. Most assignments prompted students to engage in opportunities they might not have otherwise explored. All but three students reported a change in behavior as a result of the assignment and 57% reported positive clinical or research results.Future iterations of this activity should be evaluated by obtaining patient and/or preceptor feedback as well as longitudinal evaluations of student behavior to ensure higher level educational outcomes are being met.NEXT STEPSFuture iterations of this activity should be evaluated by obtaining patient and/or preceptor feedback as well as longitudinal evaluations of student behavior to ensure higher level educational outcomes are being met.
Background
Medical educators need valid, reliable, and efficient tools to assess evidence-based medicine (EBM) knowledge and skills. Available EBM assessment tools either do not assess skills or are ...laborious to grade.
Objective
To validate a multiple-choice–based EBM test—the Resident EBM Skills Evaluation Tool (RESET).
Design
Cross-sectional study.
Participants
A total of 304 medicine residents from five training programs and 33 EBM experts comprised the validation cohort.
Main Measures
Internal reliability, item difficulty, and item discrimination were assessed. Construct validity was assessed by comparing mean total scores of trainees to experts. Experts were also asked to rate importance of each test item to assess content validity.
Key Results
Experts had higher total scores than trainees (35.6 vs. 29.4,
P
< 0.001) and also scored significantly higher than residents on 11/18 items. Cronbach’s alpha was 0.6 (acceptable), and no items had a low item-total correlation. Item difficulty ranged from 7 to 86%. All items were deemed “important” by > 50% of experts.
Conclusions
The proposed EBM assessment tool is a reliable and valid instrument to assess competence in EBM. It is easy to administer and grade and could be used to guide and assess interventions in EBM education.
Guard cell protoplasts isolated from leaves of Nicotiana glauca (Graham) were cultured. Conditions were sought that would maximize survival and maintain cells in their differentiated state. ...Temperature was an important determinant of survival, growth, and differentiation. As temperatures were increased from 24 to 32 degrees C, survival for 1 week in culture increased from approximately 20% to approximately 80% of cells used to initiate cultures. At all of these temperatures, approximately 90% of surviving cells divided to form callus tissue. "Footprint" areas of cells cultured for 1 week at 32 degrees C increased almost 30-fold. Cells cultured for 1 week at 34 to 40 degrees C also survived in high percentages (approximately 80%), but they retained a morphology similar to that of guard cells and they did not divide. Footprint areas of cells cultured for 1 week at 38 degrees C increased 6-fold. Cells cultured at 36 to 40 degrees C in media containing 0.1 or 1.0 micromolar abscisic acid survived in high percentages and did not divide. At 38 degrees C their footprint areas did not increase, but cells so cultured increased in diameter when treated with fusicoccin. Morphologies and electrophoretic profiles of total sodium dodecyl sulfate-extractable proteins suggest that cells cultured at 38 degrees C in media containing abscisic acid remain differentiated. L-alpha-(2-Aminoethexyvinyl)-glycine reduced survival to 1% at 26 or 32 degrees C but had no effect at 38 degrees C. At lower temperatures, cell growth and survival appear to be ethylene dependent
According to the Luria-Das information-processing theory, impaired planning ability is the source of more generalized cognitive deficits in mentally retarded populations. Also, the model suggests the ...possibility of relative independence between unit 2 (planning) and unit 3 (coding) abilities for mentally retarded individuals. Consequently, it was predicted that 26 educable mentally retarded (EMR) children would score significantly less well on relatively pure measures of planning ability than 13 younger average-ability children after the children were matched on cognitive processing ability (Mental Age of the Kaufman Assessment Battery for Children). Moreover, it was predicted that teaching an optimal planning strategy to randomly selected individuals of both groups would improve the EMR group's scores relative to the average-ability group. Neither prediction was supported. The results are not inconsistent with the model, but can be explained parsimoniously by neurodevelopmental stage theories also.
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