Integrating Concept Maps into a Medical Student Oncology Curriculum.

Expanding frontiers of knowledge have prompted medical schools to reconsider how best to promote learning in the face of information overload. Concept mapping (CM) promotes knowledge retention and integration. Students have perceived CM positively in prior studies, but the feasibility and utility of integrating CM into a medical student oncology curriculum as a learning and assessment tool have not been described. At the University of California, San Francisco, 152 medical students in a second-year hematology/oncology course produced concept maps about a single cancer type over 4 weeks. We collected student evaluations about CM. Two of three graders independently scored each map using a standard rubric. We compared CM scores with USMLE Step 1 scores and clerkship grades using regression. All students produced a concept map. Student perception was mixed, and students provided feedback to improve CM utility as a learning tool. Grading was feasible, and inter-rater reliability was high. CM scores did not predict USMLE Step 1 scores or clerkship grades. CM was feasible as a learning tool, and we present strategies based on student feedback and literature review to improve utility. CM was feasible and reliable as an assessment tool; additional validity evidence may improve utility. Future studies should explore whether CM integrated into medical student oncology curricula early, serially, and collaboratively, with iterative practice and feedback, may predict meaningful learning and performance outcomes.

Participatory Genomic Testing as an Educational Experience.

Several institutions have incorporated participatory genomic testing into their curricula to engage students in experiential learning, and this has raised ethical concerns. We summarize strategies for managing these concerns and review evidence of the influence of this experiential approach on student knowledge and attitudes towards genomics.

Training future physicians in the era of genomic medicine: trends in undergraduate medical genetics education.

PURPOSE: Advances in genomic technologies are transforming medical practice, necessitating the expertise of genomically-literate physicians. This study examined 2013-2014 trends in genetics curricula in US and Canadian medical schools to ascertain whether and how curricula are keeping pace with this rapid evolution. METHODS: Medical genetics course directors received a 60-item electronic questionnaire covering curriculum design, assessment, remediation of failing grades, and inclusion of specific topics. RESULTS: The response rate was 74%. Most schools teach the majority of genetics during the first 2 years, with an increase in the number of integrated curricula. Only 26% reported formal genetics teaching during years 3 and 4, and most respondents felt the amount of time spent on genetics was insufficient preparation for clinical practice. Most participants are using the Association of Professors of Human and Medical Genetics Core Curriculum(1) as a guide. Topics recently added include personalized medicine (21%) and direct-to-consumer testing (18%), whereas eugenics (17%), linkage analysis (16%), and evolutionary genetics (15%) have been recently eliminated. Remediation strategies were heterogeneous across institutions. CONCLUSION: These findings provide an important update on how genetics and genomics is taught at US and Canadian medical schools. Continuous improvement of educational initiatives will aid in producing genomically-literate physicians.

Perfluoroalkyl acid uptake in lettuce (Lactuca sativa) and strawberry (Fragaria ananassa) irrigated with reclaimed water.

Using reclaimed water to irrigate food crops presents an exposure pathway for persistent organic contaminants such as perfluoroalkyl acids (PFAAs) to enter the human food chain. This greenhouse study used reclaimed water augmented with varying concentrations (0.2-40 µg/L) of PFAAs, including perfluorocarboxylates (C3F7COO(-) to C8F17COO(-)) and perfluorosulfonates (C4F9SO2O(-), C6F13SO2O(-), C8F17SO2O(-)), to investigate potential uptake and concentration-response trends in lettuce (Lactuca sativa) and strawberry (Fragaria ananassa). In addition, studies were conducted to evaluate the role of soil organic carbon concentrations on plant uptake of PFAAs. PFAA concentrations in lettuce leaves and strawberry fruit were measured for each aqueous PFAA concentration applied. PFAA plant concentrations increased linearly with the aqueous concentration for all PFAAs, with PFCAs bioaccumulating to a greater degree than PFSAs in the edible portions of the tested plants. Chain-length-dependency trends were evident in both lettuce shoot and strawberry fruit, with decreasing concentrations associated with increasing chain length. Perfluorobutanoate (PFBA) and perfluoropentanoate (PFPeA), both short-chain PFAAs (<8 carbon chain length), accumulated the most compared with other PFAAs tested in the edible parts of both lettuce and strawberry. PFAA concentrations in strawberry root and shoot were also measured at selected PFAA aqueous concentrations (0.4, 4, and 40 µg/L). Short-chain perfluorocarboxylates were the dominant fraction in the strawberry fruit and shoot compartments, whereas a more even distribution of all PFAAs appeared in the root compartment. Lettuce grown in soils with varying organic carbon contents (0.4%, 2%, 6%) was used to assess the impact of organic carbon sorption on PFAA bioaccumulation. The lettuce grown in soil with the 6% organic carbon content had the lowest bioaccumulation of PFAAs. Bioaccumulation factors for lettuce were correlated to carbon chain length of PFAAs, showing approximately a 0.4 to 0.6 log decrease per CF2 group. This study confirms that PFAAs can enter and bioaccumulate in food crops irrigated with reclaimed water. Bioaccumulation potential depends on analyte functional group and chain length, concentration in the reclaimed water, and organic carbon content of the soil.

Professional Identity Formation of Basic Science Medical Educators: A Qualitative Study of Identity Supports and Threats.

PURPOSE: Basic science medical educators (BSME) play a vital role in the training of medical students, yet little is known about the factors that shape their professional identities. This multi-institutional qualitative study investigated factors that support and threaten the professional identity formation (PIF) of these medical educators. METHOD: A qualitative descriptive study was conducted with a purposive sample of 58 BSME from 7 allopathic medical schools in the U.S. In-depth semi-structured interviews of individual BSME were conducted between December 2020 and February 2021 to explore the facilitators and barriers shaping the PIF of BSME. Thematic analysis was conducted. RESULTS: Factors shaping PIF were grouped into 3 broad domains: personal, social, and structural. Interrelated themes described a combination of factors that pushed BSME into teaching (early or positive teaching experiences) and kept them there (satisfaction and rewards of teaching, communities of like-minded people), as well as factors that challenged their PIF (misunderstanding from medical students, clinical, and research faculty, lack of formal training programs, and lack of tenure-track educator positions). The structural environment was reported to be crucial for PIF and determined whether BSME felt that they belonged and were valued. CONCLUSIONS: This study shows that although most BSME derive a sense of fulfillment and meaning from their role as medical educators, they face considerable obstacles during their PIF. Structural change and support are needed to increase recognition, value, promotion, and belonging for BSME to improve the satisfaction and retention of this important group of faculty.

From helices to health: undergraduate medical education in genetics and genomics.

Rapid advances in genomic technologies combined with drastic reductions in cost and a growing number of clinical genomic tests are transforming medical practice. While enthusiasm about applications of precision medicine is high, the existing clinical genetics workforce is insufficient to meet present demands and will fall increasingly short as the use of genetic and genomic testing becomes more routine. To address this shortage, physicians in all areas of medicine will require genomic literacy. Undergraduate medical students, therefore, need a solid foundation in genetics and genomics so they can apply genomic medicine across a range of specialties. Here, we review the current trends and challenges in undergraduate medical genetics education in North America, highlight innovations and offer recommendations.

A Medical Student Inquiry Behavior Assessment Tool: Development and Validity Evidence.

PURPOSE: The University of California, San Francisco (UCSF) School of Medicine's Bridges curriculum is designed to teach inquiry: the process of approaching problems with curiosity, challenging current concepts, and creating new knowledge. The authors aimed to develop and gather validity evidence for a tool to guide development of medical student inquiry behaviors in small groups. METHOD: The authors reviewed the literature to identify inquiry behaviors, verified findings with an expert focus group, and synthesized the results into 40 behaviors. In a modified two-round Delphi survey in 2016, faculty and students rated the behaviors for inclusion in the tool. Feedback from cognitive interviews and a pilot helped refine the tool. In 2016-2017, the authors implemented the final tool for 152 first-year UCSF medical students in inquiry small groups as a faculty assessment and a student self-assessment each quarter. RESULTS: The two-round response rate was 77% (36/47). Five behaviors were selected for inclusion in the tool: select relevant questions to pursue; justify explanations with evidence; critically evaluate his/her explanation in light of alternative possibilities; allow for the possibility that his/her own knowledge may not be completely correct; and collaborate well with peers. During implementation, faculty and student scores increased on most items, indicating skills development over time. Content, response process, internal structure, and consequential validity evidence is presented. CONCLUSIONS: The tool's five items are observable, measurable core inquiry behaviors. The tool is ready for use by small-group facilitators within inquiry-based curricula to promote student self-assessment and guide feedback to students.

Accumulation of contaminants of emerging concern in food crops-part 2: Plant distribution.

Arid agricultural regions often turn to using treated wastewater (reclaimed water) to irrigate food crops. Concerns arise, however, when considering the potential for persistent contaminants of emerging concern to accumulate into plants intended for human consumption. The present study examined the accumulation of a suite of 9 contaminants of emerging concern into 2 representative food crops, lettuce and strawberry, following uptake via the roots and subsequent distribution to other plant tissues. Calculating accumulation metrics (concentration factors) allowed for comparison of the compartmental affinity of each chemical for each plant tissue compartment. The root concentration factor was found to exhibit a positive linear correlation with the pH-adjusted octanol-water partition coefficient (DOW ) for the target contaminants of emerging concern. Coupled with the concentration-dependent accumulation observed in the roots, this result implies that accumulation of these contaminants of emerging concern into plant roots is driven by passive partitioning. Of the contaminants of emerging concern examined, nonionizable contaminants, such as triclocarban, carbamazepine, and organophosphate flame retardants displayed the greatest potential for translocation from the roots to above-ground plant compartments. In particular, the organophosphate flame retardants displayed increasing affinity for shoots and fruits with decreasing size/octanol-water partition coefficient (KOW ). Cationic diphenhydramine and anionic sulfamethoxazole, once transported to the shoots of the strawberry plant, demonstrated the greatest potential of the contaminants examined to be then carried to the edible fruit portion.

Accumulation of contaminants of emerging concern in food crops-part 1: Edible strawberries and lettuce grown in reclaimed water.

Contaminants of emerging concern present in domestic waste streams include a highly diverse group of potentially biologically active compounds that can be detected at trace levels in wastewater. Concerns about potential uptake into crops arise when reclaimed water is used in food crop production. The present study investigated how 9 contaminants of emerging concern in reclaimed water are taken up into edible portions of two food crops. Two flame retardant chemicals, tris(1-chloro-2-propyl) phosphate (TCPP) and tris(2-chloroethyl) phosphate (TCEP) and several polar pharmaceuticals (carbamazepine, diphenhydramine, sulfamethoxazole, and trimethoprim) accumulated in a linear, concentration-dependent manner in lettuce (Lactuca sativa) irrigated with reclaimed water, suggesting passive uptake of both neutral and ionizable chemical contaminants in lettuce. Furthermore, concentration-dependent accumulation of TCEP and TCPP from reclaimed water was also observed in strawberry fruits (Fragaria ananassa). Collectively, these data suggest that highly polar or charged contaminants can be taken up by crops from water bearing contaminants of emerging concern and can be accumulated in the edible portions. Using these data, however, estimates of human exposure to these contaminants from reclaimed water food crop accumulation suggest that exposure to the contaminants of emerging concern examined in the present study is likely substantially lower than current exposure guidelines.

Sorption of ionized and neutral emerging trace organic compounds onto activated sludge from different wastewater treatment configurations.

The objective of this study was to examine sorption of a suite of 19 trace organic contaminants (TOrCs) to activated sludge. Compounds examined in this study included neutral, nonionized TOrCs as well as acidic TOrCs which may carry a negative charge and basic TOrCs which may carry a positive charge at the pH of wastewater. These TOrCs were evaluated to examine how sorptive behavior might differ for TOrCs in different states of charge. Additionally, multiple sludges from geographically and operationally different wastewater treatment plants were studied to elicit how solid-phase characteristics influence TOrC sorption. Characterization of sludge solids from 6 full scale treatment facilities and 3 bench-scale reactors showed no significant difference in fraction organic carbon (f(oc)) and cation exchange capacity (CEC). Sorption experiments demonstrated that sorption of TOrCs also exhibits little variation between these different sludges. Organic carbon normalized partition coefficients (logK(oc)) were determined as a measure of sorption, and were found to correlate well with octanol-water partition coefficients (logK(ow)) for nonionized TOrCs, and logD(ow) for anionic TOrCs where logD(ow) is greater than 2. These data were used to construct a linear free energy relationship (LFER), which was comparable to existing LFERs for sorption onto sludge. No trend in sorption was apparent for the remaining anionic TOrCs or for the cationic TOrCs. These data suggest that predicting sorption to activated sludge based on K(ow) values is a reasonable approach for neutral TOrCs using existing LFERs, but electrostatic (and likely other) interactions may govern the sorptive behavior of the charged organic chemicals to sludge.

Ctf3p, the Mis6 budding yeast homolog, interacts with Mcm22p and Mcm16p at the yeast outer kinetochore.

The budding yeast kinetochore is composed of an inner and outer protein complex, which binds to centromere (CEN) DNA and attaches to microtubules. We performed a genetic synthetic dosage lethality screen to identify novel kinetochore proteins in a collection of chromosome transmission fidelity mutants. Our screen identified several new kinetochore-related proteins including YLR381Wp/Ctf3p, which is a member of a conserved family of centromere-binding proteins. Ctf3p interacts with Mcm22p, Mcm16p, and the outer kinetochore protein Ctf19p. We used chromatin immunoprecipitation to demonstrate that Ctf3p, Mcm22p, and Mcm16p bind to CEN DNA in a Ctf19p-dependent manner. In addition, Ctf3p, Mcm22p, and Mcm16p have a localization pattern similar to other kinetochore proteins. The fission yeast Ctf3p homolog, Mis6, is required for loading of a CENP-A centromere specific histone, Cnp1, onto centromere DNA. We find however that Ctf3p is not required for loading of the budding yeast CENP-A homolog, Cse4p, onto CEN DNA. In contrast, Ctf3p and Ctf19p fail to bind properly to the centromere in a cse4-1 mutant strain. We conclude that the requirements for CENP-A loading onto centromere DNA differ in fission versus budding yeast.