Development and implementation of a longitudinal students as teachers program: participant satisfaction and implications for medical student teaching and learning.

BACKGROUND: Teaching is a key component of medical practice, but medical students receive little formal training to develop their teaching skills. A longitudinal Students as Teachers (SAT) program was created at the University of Toronto to provide medical students with opportunities to acquire an understanding of educational pedagogy and practice teaching early in their medical training. This program was 7-months in duration and consisted of monthly educational modules, practical teaching sessions, feedback, and reflective exercises. METHODS: A mixed methods study design was used to evaluate initial outcomes of the SAT program by obtaining the perspectives of 18 second-year medical students. Participants filled out questionnaires at the beginning and end of the 7-month program to indicate their skill level and confidence in teaching. Differences between pre- and post-intervention scores were further explored in a group interview of 5 participants. RESULTS: Participants expressed a high degree of satisfaction with the SAT program structure and found the educational modules and practical teaching sessions to be particularly beneficial to their learning. Over the course of the program, there were significant increases in students' confidence in teaching, and self-perceived teaching capacity and communication skills. Furthermore, participants discussed improvements in their effectiveness as learners. CONCLUSIONS: Teaching is a skill that requires ongoing practice. Our results suggest that a longitudinal program consisting of theoretical modules, practical teaching sessions, feedback, and reflective exercises for medical students may improve teaching and communication skills, and equip them with improved learning strategies. This program also provides students with insight into the experience of teaching while holding other academic and clinical responsibilities.

cIAP-1 controls innate immunity to C. pneumoniae pulmonary infection.

The resistance of epithelial cells infected with Chlamydophila pneumoniae for apoptosis has been attributed to the induced expression and increased stability of anti-apoptotic proteins called inhibitor of apoptosis proteins (IAPs). The significance of cellular inhibitor of apoptosis protein-1 (cIAP-1) in C. pneumoniae pulmonary infection and innate immune response was investigated in cIAP-1 knockout (KO) mice using a novel non-invasive intra-tracheal infection method. In contrast to wildtype, cIAP-1 knockout mice failed to clear the infection from their lungs. Wildtype mice responded to infection with a strong inflammatory response in the lung. In contrast, the recruitment of macrophages was reduced in cIAP-1 KO mice compared to wildtype mice. The concentration of Interferon gamma (IFN-gamma) was increased whereas that of Tumor Necrosis Factor (TNF-alpha) was reduced in the lungs of infected cIAP-1 KO mice compared to infected wildtype mice. Ex vivo experiments on mouse peritoneal macrophages and splenocytes revealed that cIAP-1 is required for innate immune responses of these cells. Our findings thus suggest a new immunoregulatory role of cIAP-1 in the course of bacterial infection.

Apoptotic sensitivity of murine IAP-deficient cells.

Although numerous studies have implicated the IAPs (inhibitor of apoptosis proteins) in the control of apoptotic cell death, analyses of murine Iap-targeted cells have not revealed significant differences in their susceptibility to apoptosis. In the present study, we show that, under defined conditions, murine cells lacking XIAP (X-linked inhibitor of apoptosis) and c-IAP (cellular IAP) 2, but not c-IAP1, exhibit heightened apoptotic sensitivity to both intrinsic and extrinsic apoptotic stimuli.

Posttranscriptional downregulation of c-IAP2 by the ubiquitin protein ligase c-IAP1 in vivo.

Inhibitor of apoptosis proteins (IAPs) c-IAP1 and c-IAP2 were identified as part of the tumor necrosis factor receptor 2 (TNFR2) signaling complex and have been implicated as intermediaries in tumor necrosis factor alpha signaling. Like all RING domain-containing IAPs, c-IAP1 and c-IAP2 have ubiquitin protein ligase (E3) activity. To explore the function of c-IAP1 in a physiologic setting, c-IAP1-deficient mice were generated by homologous gene recombination. These animals are viable and have no obvious sensitization to proapoptotic stimuli. Cells from c-IAP1(-/-) mice do, however, express markedly elevated levels of c-IAP2 protein in the absence of increased c-IAP2 mRNA. In contrast to reports implicating c-IAPs in the activation of NF-kappaB, resting and cytokine-induced NF-kappaB activation was not impaired in c-IAP1-deficient cells. Transient transfection studies with wild-type and E3-defective c-IAP1 revealed that c-IAP2 is a direct target for c-IAP1-mediated ubiquitination and subsequent degradation, which are potentiated by the adaptor function of TRAF2. Thus, the c-IAPs represent a pair of TNFR-associated ubiquitin protein ligases in which one regulates the expression of the other by a posttranscriptional and E3-dependent mechanism.