The power of written word: Reflection reduces errors of omission.

BACKGROUND: Medical trainees are expected to perform complex tasks while experiencing interruptions, which increases susceptibility to errors of omission. In our study, we examine whether documentation of clinical encounters increases reflective thinking and reduces errors of omission among novice learners in a simulated setting. METHODS: In 2021, 56 senior medical students participated in a simulated paging curriculum involving urgent inpatient cross-cover scenarios (sepsis and atrial fibrillation). Students responded to pages from standardized registered nurses (SRNs) via telephone, gathered history, and discussed clinical decision-making. Following the phone encounter, students documented a brief note (documentation encounter). A 'phone' score (number of checklist items completed in the phone encounter) and a 'combined' score (number of checklist items completed in the phone and documentation encounters) were calculated. Data were analyzed for differences between the phone scores (control) and combined scores using T-tests and McNemar test of symmetry. FINDINGS: Fifty-four students (96%) participated. Combined scores were higher than phone scores for sepsis (72.8 ± 11.3% vs. 67.9 ± 11.9%, p < 0.001) and atrial fibrillation (74.0 ± 10.1% vs. 67.6 ± 10.0%, p < 0.001) cases. Important items, such as ordering blood cultures for sepsis (p = 0.023) and placing the patient on telemetry for atrial fibrillation (p = 0.013), were more likely to be present when a note was documented. DISCUSSION: This study suggests that documentation provides a mechanism for learners to reflect, which could increase important diagnostic and therapeutic interventions. CONCLUSION: Documentation by novice medical learners may improve patient care by allowing for reflection and reducing errors of omission.

Interprofessional experiences to bridge the medical school to residency transition: a pilot program.

Interprofessional experiences during medical school are often delivered during pre-clinical years, but less is known about the value of clinical students. Our institution implemented a specialty-specific interprofessiona curriculum during Residency Preparation Courses (RPCs) for senior students including didactics, clinical experiences, and a simulated paging curriculum. Our aim was to determine whether this intervention improved perceptions of interprofesiona roles. We distributed anonymous surveys before (pre-survey) and after (post-survey, collected within 2 weeks of course completion) the RPC to 90 students with questions related to interprofessional roles using a 5-point scale (1 = strongly disagree, 5 = strongly agree). Three months after the start of residency, we sent follow-up surveys inquiring about the usefulness of RPC components (1 = not at all useful, 5 = extremely useful). Response rates were 84.4% pre-survey, 63.3% post-survey, and 41.1% follow-up survey. Post-surveys indicated improvement in self-reported ability in all domains: understanding one's contributions to interprofessional teams (3.9 to 4.4, p < .0001), understanding other team members' contributions (3.9 to 4.4, p < .0001), learning from interprofessional team members (4.2 to 4.6, p = .0002), accounting for interprofessional perspectives (4.2 to 4.6, p < .0001), and co-developing effective care plans (3.9 to 4.4, p < .0001). Follow-up surveys rated clinical experiences as slightly-to-moderately useful (2.3 ± 1.0) and paging curriculum very-to-extremely useful (4.3 ± 1.0). This study demonstrates the value of interprofessional education for advanced students.

Inhibition of angiogenesis by interleukin-4 gene therapy in rat adjuvant-induced arthritis.

OBJECTIVE: Interleukin-4 (IL-4) can modulate neovascularization. In this study, we used a gene therapy approach to investigate the role of IL-4 in angiogenesis in rat adjuvant-induced arthritis (AIA), a model for rheumatoid arthritis. METHODS: Rats received an adenovirus producing IL-4 (AxCAIL-4), a control virus without insert, or control vehicle (phosphate buffered saline) intraarticularly before arthritis onset. At peak onset of arthritis, rats were killed. Vascularization was determined in the synovial tissue, and correlations with inflammation were assessed. Ankle homogenates were used in angiogenesis assays in vitro and in vivo, and protein levels of cytokines and growth factors were assessed by enzyme-linked immunosorbent assay. Synovial tissue expression of alphav integrins was determined by immunohistochemistry. RESULTS: IL-4 induced a reduction in synovial tissue vessel density, which was paralleled by a decrease in inflammation. AxCAIL-4 joint homogenates significantly (P < 0.05) inhibited both endothelial cell (EC) migration and tube formation in vitro. Similarly, AxCAIL-4 inhibited capillary sprouting in the rat aortic ring assay, and vessel growth in the in vivo Matrigel plug assay. The angiostatic effect occurred despite high levels of vascular endothelial growth factor (VEGF), and was associated with down-regulation of the proangiogenic cytokines IL-18, CXCL16, and CXCL5 and up-regulation of the angiogenesis inhibitor endostatin. Of interest, AxCAIL-4 also resulted in decreased EC expression of the alphav and beta3 integrin chains. CONCLUSION: In rat AIA, IL-4 reduces synovial tissue vascularization via angiostatic effects, mediates inhibition of angiogenesis via an association with altered pro- and antiangiogenic cytokines, and may inhibit VEGF-mediated angiogenesis and exert its angiostatic role in part via alphavbeta3 integrin. This knowledge of the specific angiostatic effects of IL-4 may help optimize target-oriented treatment of inflammatory arthritis.