Exploring the Quality of Feedback in Entrustable Professional Activity Narratives Across 24 Residency Training Programs.

Background Competency-based medical education (CBME) has been implemented in many residency training programs across Canada. A key component of CBME is documentation of frequent low-stakes workplace-based assessments to track trainee progression over time. Critically, the quality of narrative feedback is imperative for trainees to accumulate a body of evidence of their progress. Suboptimal narrative feedback will challenge accurate decision-making, such as promotion to the next stage of training. Objective To explore the quality of documented feedback provided on workplace-based assessments by examining and scoring narrative comments using a published quality scoring framework. Methods We employed a retrospective cohort secondary analysis of existing data using a sample of 25% of entrustable professional activity (EPA) observations from trainee portfolios from 24 programs in one institution in Canada from July 2019 to June 2020. Statistical analyses explore the variance of scores between programs (Kruskal-Wallis rank sum test) and potential associations between program size, CBME launch year, and medical versus surgical specialties (Spearman's rho). Results Mean quality scores of 5681 narrative comments ranged from 2.0±1.2 to 3.4±1.4 out of 5 across programs. A significant and moderate difference in the quality of feedback across programs was identified (χ2=321.38, P<.001, ε2=0.06). Smaller programs and those with an earlier launch year performed better (P<.001). No significant difference was found in quality score when comparing surgical/procedural and medical programs that transitioned to CBME in this institution (P=.65). Conclusions This study illustrates the complexity of examining the quality of narrative comments provided to trainees through EPA assessments.

One Health, One Hive: A scoping review of honey bees, climate change, pollutants, and antimicrobial resistance.

Anthropogenic climate change and increasing antimicrobial resistance (AMR) together threaten the last 50 years of public health gains. Honey bees are a model One Health organism to investigate interactions between climate change and AMR. The objective of this scoping review was to examine the range, extent, and nature of published literature on the relationship between AMR and honey bees in the context of climate change and environmental pollutants. The review followed systematic search methods and reporting guidelines. A protocol was developed a priori in consultation with a research librarian. Resulting Boolean search strings were used to search Embase® via Ovid®, MEDLINE®, Scopus®, AGRICOLA™ and Web of Science™ databases. Two independent reviewers conducted two-stage screening on retrieved articles. To be included, the article had to examine honey bees, AMR, and either climate change or environmental pollution. Data, in accordance with Joanna Briggs Institute guidelines, were extracted from relevant articles and descriptively synthesized in tables, figures, and narrative form. A total of 22 articles met the inclusion criteria, with half of all articles being published in the last five years (n = 11/22). These articles predominantly investigated hive immunocompetence and multi-drug resistance transporter downregulation (n = 11/22), susceptibility to pests (n = 16/22), especially American foulbrood (n = 9/22), and hive product augmentation (n = 3/22). This review identified key themes and gaps in the literature, including the need for future interdisciplinary research to explore the link between AMR and environmental change evidence streams in honey bees. We identified three potential linkages between pollutive and climatic factors and risk of AMR. These interconnections reaffirm the necessity of a One Health framework to tackle global threats and investigate complex issues that extend beyond honey bee research into the public health sector. It is integral that we view these "wicked" problems through an interdisciplinary lens to explore long-term strategies for change.

It's about time; divergent circadian clocks in livers of mice and naked mole-rats.

Light is the key regulator of circadian clock, the time-keeping system synchronizing organism physiology and behavior with environmental day and night conditions. In its natural habitat, the strictly subterranean naked mole-rat (Heterocephalus glaber) has lived in a light-free environment for millennia. We questioned if this species retains a circadian clock and if the patterns of this clock and concomitant rhythms differed in liver tissue from mice and naked mole-rats. As expected, in mice, the various circadian clock genes peaked at different times of the day; the Period gene (Per) group peaked in the evening, whereas Brain and Muscle ARNT-like1 (Bmal1) gene peaked in the morning; this phase shift is considered to be fundamental for circadian clock function. In sharp contrast, in the naked mole-rat both Per1 and Per2, as well as Bmal1, peaked at the same time in the morning-around ZT2-suggesting the organization of the molecular circadian oscillator was different. Moreover, gene expression rhythms associated with glucose metabolism and mTOR signaling also differed between the species. Although the activity of mTORC1 was lower, while that of mTORC2 was higher in naked mole-rat livers compared to mice, unlike that of mice where the expression profiles of glucose metabolism genes were not synchronized, these were highly synchronized in naked mole-rats and likely linked to their use of feeding times at zeitgebers.