: Medical education programs in the U.S. rely on the aphorism that faculty own the curriculum; that is, the specialized knowledge, skills, and attitudes of a physician are the province of the faculty ...to be delivered to tuition-paying students. From this view, the learner's role is one of passivity and deference. A contrasting approach, termed curriculum co-creation, frames education as a bi-lateral partnership. Co-creation results from learners, in collaboration with instructors, taking an active role in creating the goals and processes of an educational program. Such a partnership requires substantial revision of the expectations for both learners and instructors. In this Observations article, the idea of co-creation is applied to medical education and an aspirational vision for the role and value of faculty-student co-creation is advocated.
: Co-creation partnerships of faculty and students occur in many forms, varying in degree of departure from traditional educational practice. Co-creation principles and partnerships can be deployed for almost all aspects of training including selection and organization of content, effective methods of instruction, and assessment of student learning. The outcomes of co-creation occur at three levels. The most specific outcome of co-creation is characterized by increased student engagement and enhanced learning. Broader outcomes include improved efficacy and value in the educational program and institution while, at the farthest-reaching level, a co-creative process can modify the medical profession itself. Although some specific instructional techniques to promote student involvement and input have historically been deployed in medical education, there is little evidence that students have ever been permitted to share in ownership.
When fully embraced, curricular co-creation will be recognizable through improved student engagement and learning along with a revised understanding of how faculty-student relationships can foment reform in medical education and the culture of the profession. Further scholarship and research will be indispensable to examine how co-creative partnerships can flatten hierarchies within medical education and inspire the medical profession to be more inclusive and effective. Following the model of co-creation is expected to inspire learners by empowering them to participate fully as co-owners of their own education and prepare them to lead medical education in a different direction for the future.
Introduction
Opportunities to learn about education theory underpinning medical education are limited in both undergraduate and graduate medical education and predominantly focus on “student as ...teacher.” Key components of education theory relevant to medical education, including learning theory, curricular design, and assessment design, are rarely included in student-as-teacher training. Opportunities for medical students to co-create curricula with faculty are scarce.
Methods
We present the case study of a month-long, seminar-style course titled,
Applications and Foundations of Education in Medical Education
. We describe the course, report student feedback, and identify the value of curriculum co-creation expressed in student reflections. The course was designed by a faculty member with formal medical education training; students co-created their own learning outcomes through self-selected articles and personal reflections on the topics: How do people learn; what is the best way to teach; what is a curriculum; and how should students be assessed?
Results
Forty-seven post-clinical students completed the course; 28 completed course evaluations. They strongly agreed that the class met its stated goals (4.89/5) and that faculty teaching (4.93/5) and supervision (4.93/5) were appropriate. Themes from student reflections expressed that the co-creation process was insightful about the profession itself, from the perspective of their own participation in learning how to become a member of the profession.
Discussion
This course offered a unique opportunity for medical students to learn medical education beyond the skill of teaching. The course allowed deep immersion into current literature and offered the chance to plan and execute one’s own learning.
Objectives
To investigate the landscape of cognitive impairment (CI) screening for adults with age‐related hearing loss (ARHL) among otolaryngologists and audiologists. To identify provider factors ...and patient characteristics that impact rates of CI screening and referral.
Methods
A 15 question online survey was sent to members of the Georgia Society of Otolaryngology (GSO), Georgia Academy of Audiology (GAA), American Otological Society and American Neurotology Society (AOS/ANS), and posted on the web forum for two hearing disorders special interest groups within the American‐Speech‐Language‐Hearing Association (ASHA). Responses were collected anonymously. Chi‐square tests were used to compare responses.
Results
Of the 66 included respondents, 61% (n = 40) were otolaryngologists and 35% (n = 23) were audiologists. Respondents were significantly more likely to refer patients for CI assessment than to screen (64% vs 21%, respectively, P < .001). The complaint of a neurological symptom, such as memory loss, would prompt screening or referral for only 27.3% (n = 18) and 51.52% (n = 34) of respondents, respectively. Forty‐two percent (n = 28) of respondents suggested CI screening with the MMSE vs 20% (n = 13) with the Montreal Cognitive Assessment.
Conclusions
Despite recommendations for cognitive assessment in high‐risk populations, such as older adults with ARHL, the practice of CI screening and referral is not yet commonplace among otolaryngologists and audiologists. These providers have a unique opportunity to assess adults with ARHL for CI and ensure appropriate referral.
Level of Evidence
5
Introduction
Frequent and severe bleeding events (SBE) in patients with inherited qualitative platelet disorders Bernard‐Soulier Syndrome (BSS) and Glanzmann Thrombasthenia (GT) can lead to secondary ...iron deficiency anemia (IDA). SBE are primarily treated with platelet transfusions or recombinant activated factor VII (rFVIIa) infusions. The impact of IDA on bleeding management and disease outcomes is understudied.
Aim
To evaluate bleeding management, outcomes, and any association with IDA in pediatric patients with BSS and GT.
Methods
Retrospective chart‐review of pediatric patients with BSS or GT followed at a single hemophilia treatment center between 2007 and 2019.
Results
We identified 14 patients with BSS (n = 2) or GT (n = 12). Patients received rFVIIa (7%), platelet transfusions (7%), or a combination of both (57%) for SBE. Eleven patients (79%) had IDA requiring oral and/or intravenous iron replacement and 50% required red blood cell transfusions. Due to recurrent SBE and refractory IDA, three patients (21%) received rFVIIa prophylaxis at 90 μg/kilogram 2‐3 times/week for ≥15 months. Patients initiated on rFVIIa prophylaxis had a median baseline hemoglobin of 9.8 g/dL (min‐max: 8.0–10.7 g/dL) compared to 11.7 g/dL (8.4–13.8 g/dL) for patients treated on‐demand. Following initiation of rFVIIa prophylaxis, median hemoglobin and ferritin increased by 1.3 g/dL (0.7–2.5 g/dL) and 14.6 ng/mL (0.2–42.9 ng/mL), respectively, and bleeding rates were reduced by 7–78%.
Conclusion
IDA is a known complication of recurrent bleeding events in individuals with inherited bleeding disorders. Routine monitoring for IDA may help improve bleeding management and reduce bleed burden in BSS/GT.
Pediatric palliative care (PPC) improves quality of life and end-of-life outcomes for children with cancer, but often occurs late in the disease course. The Supportive Care Clinic (SCC) was launched ...in 2017 to expand outpatient PPC access.
To describe the inaugural four years (2017–2021) of an academic, consultative, embedded SCC within pediatric oncology.
Descriptive statistics (demographic, disease, treatment, visit, and end-of-life) and change over time were calculated.
During the first four years, 248 patients (51.6% male; 58.1% White; 35.5% Black; 13.7% Hispanic/Latino) were seen in SCC, totaling 1,143 clinic visits (median 4, IQR 2,6), including 248 consultations and 895 follow-up visits. Clinic visits grew nearly 300% from year one to four. Primary diagnoses were central nervous system tumor (41.9%), solid tumor (37.5%), and leukemia/lymphoma (17.3%). The first point of PPC contact became SCC (70.6%) for most referred patients. Among the 136 deceased patients (54.8%), 77.9% had a do-not-resuscitate or Physician Orders for Life Sustaining Treatment in place, and 72.8% received hospice care. When known (n = 112), 89.3% died in their preferred location. The time from SCC consultation to death increased from 74 to 226 days over the four years (P < 0.0001). The proportion of SCC consultations that occurred greater than 90 days from death increased from 39.1% in year one to 85.0% in year four.
Embedded SCC clinics can be successful, achieve steady growth, improve referrals and timing of PPC, and enhance end-of-life care for children with cancer. Large pediatric cancer centers should include SCC outpatient services
Interleukin-27 (IL-27) is an immunoregulatory cytokine that suppresses inflammation through multiple mechanisms, including induction of IL-10, but the transcriptional network mediating its diverse ...functions remains unclear. Combining temporal RNA profiling with computational algorithms, we predict 79 transcription factors induced by IL-27 in T cells. We validate 11 known and discover 5 positive (Cebpb, Fosl2, Tbx21, Hlx, and Atf3) and 2 negative (Irf9 and Irf8) Il10 regulators, generating an experimentally refined regulatory network for Il10. We report two central regulators, Prdm1 and Maf, that cooperatively drive the expression of signature genes induced by IL-27 in type 1 regulatory T cells, mediate IL-10 expression in all T helper cells, and determine the regulatory phenotype of colonic Foxp3+ regulatory T cells. Prdm1/Maf double-knockout mice develop spontaneous colitis, phenocopying ll10-deficient mice. Our work provides insights into IL-27-driven transcriptional networks and identifies two shared Il10 regulators that orchestrate immunoregulatory programs across T helper cell subsets.
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•IL-27-driven transcriptional network in CD4 T cells unravels key Il10 regulators•Systematic characterization of the function of 16 Il10 regulators by RNA-seq•Identification of transcription factors associated with Il10 in multiple T cell subsets•Prdm1 and Maf are critical for Il10 production and intestinal immune homeostasis
Zhang et al. construct a transcriptional network for IL-27-mediated Il10 production in CD4 T cells, characterize the function of 16 Il10 regulators, and uncover the role of two transcription factors, Prdm1 and Maf, in driving Il10 production in all T helper cells and in maintaining immune homeostasis in the colon.
Recommender systems, crucial for user engagement on platforms like e-commerce and streaming services, often lag behind users' evolving preferences due to static data reliance. After Temporal Graph ...Networks (TGNs) were proposed, various studies have shown that TGN can significantly improve situations where the features of nodes and edges dynamically change over time. However, despite its promising capabilities, it has not been directly applied in recommender systems to date. Our study bridges this gap by directly implementing Temporal Graph Networks (TGN) in recommender systems, a first in this field. Using real-world datasets and a range of graph and history embedding methods, we show TGN's adaptability, confirming its effectiveness in dynamic recommendation scenarios.
Recent studies have established that the anti-Stokes Raman signal from plasmonic metal nanostructures can be used to determine the two separate temperatures that characterize carriers inside the ...metal -- the temperature of photoexcited "hot carriers" and carriers that are thermalized with the metal lattice. However, the related signal in the Stokes spectral region has historically impeded surface enhanced Raman spectroscopy (SERS), as the vibrational peaks of adsorbed molecules are always accompanied by the broad background of the metal substrate. The fundamental source of the metal signal, and hence its contribution to the spectrum, has been unclear. Here, we outline a unified theoretical model that describes both the temperature-dependent behavior and the broad spectral distribution. We suggest that the majority of the Raman signal is from inelastic scattering directly with non-thermal carriers that have been excited via damping of the surface plasmon. In addition, a significant spectral component (~ 1%) is due to a sub-population of hot carriers in an elevated thermal distribution. We have performed temperature and power-dependent Raman experiments to show how a simple fitting procedure reveals the plasmon dephasing time, as well as the temperatures of the hot carriers and the metal lattice, in order to correlate these parameters with quantitative Raman analysis of chemical species adsorbed on metal surface.
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