Near peer-assisted learning to improve confidence for medical students' situational judgment tests.

BACKGROUND: The situational judgment test (SJT) was introduced for all graduating United Kingdom medical students in 2013. Students have anxiety over time pressures and heavy weighting of a single examination. AIMS: This study aimed to examine formal SJT preparation available, perceptions of a near peer-delivered course, and to measure improvement in students' confidence. INNOVATION: Foundation doctors ( first 2 years of postgraduate training) produced a "Situational Judgment Test Preparation Course" in November 2015. METHODS: Feedback was collected via Likert scores rating teaching, a mock examination, and pre- and post-course confidence along with free-text responses. Delayed feedback was collected via an online survey. RESULTS: Forty-four students completed the feedback. Seventy percent reported <2 h of university SJT preparation. There were significant post-course improvements in familiarity with structure, scoring system, knowledge and content, and overall SJT confidence (P < 0.05). Delayed feedback showed sustained improvement in familiarity with knowledge and content (P < 0.05). Qualitative analysis revealed themes of improved confidence, approachable tutors, and identifying question strategies. DISCUSSION: Students perceived a lack of formal SJT preparation which was reflected in low pre-course confidence. Improvements in confidence may reflect a unique insight into how to approach the examination from those having recently undertaken it.

Associations between inflammatory and immune response genes and adverse respiratory outcomes following exposure to outdoor air pollution: a HuGE systematic review.

Variants of inflammatory and immune response genes have been associated with adverse respiratory outcomes following exposure to air pollution. However, the genes involved and their associations are not well characterized, and there has been no systematic review. Thus, we conducted a review following the guidelines of the Human Genome Epidemiology Network. Six observational studies and 2 intervention studies with 14,903 participants were included (2001-2010). Six studies showed at least 1 significant gene-pollutant interaction. Meta-analysis was not possible due to variations in genes, pollutants, exposure estimates, and reported outcomes. The most commonly studied genes were tumor necrosis factor α (TNFA) (n = 6) and toll-like receptor 4 (TLR4) (n = 3). TNFA -308G>A modified the action of ozone and nitrogen dioxide on lung function, asthma risk, and symptoms; however, the direction of association varied between studies. The TLR4 single-nucleotide polymorphisms rs1927911, rs10759931, and rs6478317 modified the association of particulate matter and nitrogen dioxide with asthma. The transforming growth factor ß1 (TGFB1) polymorphism -509C>T also modified the association of pollutants with asthma. This review indicates that genes controlling innate immune recognition of foreign material (TLR4) and the subsequent inflammatory response (TGFB1, TLR4) modify the associations of exposure to air pollution with respiratory function. The associations observed have biological plausibility; however, larger studies with improved reporting are needed to confirm these findings.