The Teacher-Learner Contract (TLC): An Objectives-Based Checklist for Surgical Shadowing.

OBJECTIVE: A lack of structure and communication in physician shadowing experiences may prevent medical students from accruing its potential benefits. In this study, we evaluated the use of an objectives-based surgical shadowing teacher-learner contract (TLC) on the outcomes of shadowing experiences. DESIGN: Cross-sectional study with 30 unique student-surgeon pairs who participated in a 1-time shadowing experience between December 2016 and May 2017. SETTING: Eight hospitals and clinics in Metro Vancouver, British Columbia, Canada. PARTICIPANTS: A convenience sample of preclinical medical students attending University of British Columbia and local surgeons from a variety of specialties were recruited by email. A random sample of 30 students was selected from a pool of interested students. RESULTS: Twenty-eight students and 18 surgeons completed the study. In general, students and surgeons reported that the TLC focused learning and improved communication between teachers and learners. Students also commented that using the TLC prompted them to reflect on their goals and consider how the shadowing experience might contribute to their overall medical education. Both students and surgeons found benefit in using the checklist (mean 3.5 ± 0.75 and mean 3.8 ± 1.1, respectively, where 1 was not useful and 5 was very useful). All participants rated the TLC as easy to use (mean 1.429 ± 1.271 and mean 1.333 ± 0.686, respectively, where 1 was not difficult and 5 was very difficult), and 80% of respondents said they would use the tool again. Participants who benefited the most were students with limited surgical shadowing experience and surgeons with less experience teaching preclerkship students. CONCLUSIONS: This study demonstrates that an objectives-based learning contract like the TLC can facilitate meaningful shadowing experiences for teachers and learners and may have longitudinal educational benefits. However, widespread implementation will require institutional support of this concept.

The Transcriptional Repressor Polycomb Group Factor 6, PCGF6, Negatively Regulates Dendritic Cell Activation and Promotes Quiescence.

Pro-inflammatory signals provided by the microenvironment are critical to activate dendritic cells (DCs), components of the innate immune system that shape both innate and adaptive immunity. However, to prevent inappropriate immune activation, mechanisms must be in place to restrain DC activation to ensure DCs are activated only once sufficient stimuli have been received. Here, we report that DC activation and immunogenicity are regulated by the transcriptional repressor Polycomb group factor 6 (PCGF6). Pcgf6 is rapidly downregulated upon stimulation, and this downregulation is necessary to permit full DC activation. Silencing PCGF6 expression enhanced both spontaneous and stimulated DC activation. We show that PCGF6 associates with the H3K4me3 demethylase JARID1c, and together, they negatively regulate H3K4me3 levels in DCs. Our results identify two key regulators, PCGF6 and JARID1c that temper DC activation and implicate active transcriptional silencing via histone demethylation as a previously unappreciated mechanism for regulating DC activation and quiescence.