The Clumsy Horse: A Professional Development Tool for Facilitators of Self-Directed, Case-Based Learning.

Introduction: With the constant evolution of science and advancing technology, future physicians must learn to navigate an ever-changing health care environment by continuous learning throughout their professional careers. Lifelong, self-directed learning is a critical component of medical education to ensure future physicians are adept at identifying knowledge gaps and seeking, analyzing, and communicating new information. To train faculty who teach case-based, self-directed learning, we designed the Clumsy Horse Case. Methods: The Clumsy Horse Case was created as part of a faculty development program for facilitators of a new case-based, self-directed curriculum known as Patient-Centered Education (PaCE) Cases. An unfamiliar veterinary medicine case was designed to level the playing field for faculty from different specialty areas in order to provide an authentic self-directed learning experience. To determine effectiveness, faculty participants completed a standardized eight-question evaluation survey after the Clumsy Horse Case session, and facilitators received student feedback at the end of each semester via a standard faculty evaluation form. Results: Student ratings indicated that faculty were adequately prepared to be effective facilitators. The Clumsy Horse Case was an integral part of facilitator preparation and provided an engaging learning experience for over 60 faculty. Survey ratings and comments from faculty participants indicated a high level of engagement and satisfaction with the learning experience. Discussion: The Clumsy Horse Case is generalizable for developing faculty in any curriculum with a case-based, self-directed learning component. It can be modified to fit any school's curriculum and integrated into a professional development program.

Does micropractice lead to macrosatisfaction?

BACKGROUND: Physician quality of work life is a key factor in career choice, satisfaction, and retention. The majority of physicians are currently employed by large health care organizations where physician loss of autonomy is common, yet some physicians have opened micropractices. There have been no previous studies comparing physician satisfaction between employed physicians and micropractice physicians. METHODS: A previously validated survey of physician satisfaction was sent to 72 physicians practicing in a residency setting, 111 physicians in community, nonresidency setting, and 42 physicians in a micropractice setting. RESULTS: Physicians in micropractices had the lowest satisfaction with income, but the highest satisfaction with family time and the ability to provide continuity of care. Micropractice physicians rated the overall quality of medical care they provide higher than employed physicians. Micropractice physicians reported a much smaller scope of practice. CONCLUSIONS: Overall, physicians in micropractices found more satisfaction in their work at the cost of decreased income and a narrower scope of practice.

Radiation risks: critical analysis and commentary.

OBJECTIVES: 1) To review and summarize what is known about the health risks of radiation. 2) To compare risks from medical imaging to background radiation and to exposure from nuclear accidents. METHODS: Literature review and summative critical analysis. RESULTS: Over the past several years, physicians and patients have become increasingly aware of the potential risks of radiation exposure from medical imaging. The Fukushima disaster further heightened public awareness of hazards associated with radiation and radioactivity. In the case of medical imaging, small but real risks of cancer and other radiation-induced disease must be balanced against potential benefits of improved diagnostic accuracy. The ethical principle of autonomy tells us that patients should be informed of potential benefits and harms of radiation imaging, and should participate in shared decision making. In the case of nuclear power, benefits and especially harms are exceptionally difficult to estimate accurately. Nevertheless, we know that hazards from today's nuclear power plants will persist for many years, affecting future generations not benefiting from electrical power generated today. CONCLUSIONS: A deeper and more widespread understanding of potential benefits and harms of personal and societal choices relating to radiation exposure may lead to improved medical and societal decision-making.

Gynecologic issues in geriatric women.

The number of women over the age of 65 is projected to almost double in the next 20 years, and clinicians need to be comfortable treating conditions common to this cohort. This review covers several common gynecologic conditions seen in older women, including atrophic vaginitis, lichen sclerosis, pelvic floor disorders, and postmenopausal bleeding. We conclude with evidence-based screening recommendations for gynecologic cancers in older women and tips on doing a pelvic examination.

What a fair and rational health system would look like.

The costs and consequences of America's fragmented and profit-driven health system have reached unsustainable levels. Far too much is spent on redundant bureaucracy, and on medical interventions that are either unproven or have been shown to be ineffective, while millions of people lack coverage for basic cost-effective health care. The current level of corporate influence on research, education, and dissemination of scholarly work is unacceptable. It is high time that we design and deliver government-mandated health insurance that makes evidence-based cost-effective health care universally accessible. All comparable nations achieve better outcomes with fewer resources using this model. We can too.

Low-proline environments impair growth, proline transport and in vivo survival of Staphylococcus aureus strain-specific putP mutants.

Staphylococcus aureus is a common cause of disease in humans, particularly in hospitalized patients. This species needs to import several amino acids to survive, including proline. Previously, it was shown that an insertion mutation in the high-affinity proline uptake gene putP in strain RN6390 affected proline uptake by the bacteria as well as reducing their ability to survive in vivo. To further delineate the effect of the putP mutation on growth of S. aureus strain RN6390, a proline uptake assay that spanned less than 1 min was done to measure transport. An eightfold difference in proline levels was observed between the wild-type strain and the high-affinity proline transport mutant strain after 15 s, indicating that the defect was only in proline transport and not a combination of proline transport, metabolism and accumulation that would have been assessed with longer assays. A putP mutant of S. aureus strain RN4220 was then grown in minimal medium with different concentrations of proline. When compared to the wild-type strain, the putP mutant strain was significantly growth impaired when the level of proline was decreased to 1.74 microM. An assessment of proline concentrations in mouse livers and spleens showed proline concentrations of 7.5 micromol per spleen and 88.4 micromol per liver. To verify that the effects on proline transport and bacterial survival were indeed caused solely by a mutation in putP, the putP mutation was complemented by cloning a full-length putP gene on a plasmid that replicates in S. aureus. Complementation of the putP mutant strains restored proline transport, in vitro growth in low-proline medium, and in vivo survival within mice. These results show that the mutation in putP led to attenuated growth in low-proline media and by corollary low-proline murine organ tissues due to less efficient transport of proline into the bacteria.