A qualitative study of Canadian resident experiences with Competency-Based Medical Education.

Background: Competency-based medical education (CBME) is an outcomes-based curricular paradigm focused on ensuring that graduates are competent to meet the needs of patients. Although resident engagement is key to CBME's success, few studies have explored how trainees have experienced CBME implementation. We explored the experiences of residents in Canadian training programs that had implemented CBME. Methods: We conducted semi-structured interviews with 16 residents in seven Canadian postgraduate training programs, exploring their experiences with CBME. Participants were equally divided between family medicine and specialty programs. Themes were identified using principles of constructivist grounded theory. Results: Residents were receptive to the goals of CBME, but in practice, described several drawbacks primarily related to assessment and feedback. For many residents, the significant administrative burden and focus on assessment led to performance anxiety. At times, residents felt that assessments lacked meaning as supervisors focused on "checking-boxes" or provided overly broad, non-specific comments. Furthermore, they commonly expressed frustration with the perceived subjectivity and inconsistency of judgments on assessments, especially if assessments were used to delay progression to greater independence, contributing to attempts to "game the system." Faculty engagement and support improved resident experiences with CBME. Conclusion: Although residents value the potential for CBME to improve the quality of education, assessment and feedback, the current operationalization of CBME may not be consistently achieving these objectives. The authors suggest several initiatives to improve how residents experience assessment and feedback processes in CBME.

Contexte: La formation médicale axée sur les compétences (FMFC) est un paradigme d'apprentissage axé sur les résultats et visant à garantir que les diplômés aient les compétences nécessaires pour répondre aux besoins des patients. Bien que l'engagement des résidents soit la clé du succès de la FMFC, peu d'études ont exploré comment ils vivent son introduction. Nous nous sommes penchés sur l'expérience des résidents dans les programmes de formation canadiens qui ont mis en œuvre la FMFC. Méthodes: Nous avons mené des entrevues semi-structurées avec 16 résidents de sept programmes de formation postdoctorale canadiens, afin de sonder leur expérience de la FMFC. Les participants provenaient de façon égale de la médecine familiale et de programmes de spécialité. Les thèmes ont été dégagés en appliquant les principes de la théorie enracinée constructiviste. Résultats: Bien que réceptifs aux objectifs de la FMFC, les résidents décrivent des inconvénients de sa mise en pratique, notamment sur le plan de l'évaluation et de la rétroaction. Pour beaucoup d'entre eux, la focalisation sur l'évaluation et le fardeau administratif qui y est lié ont été une source d'anxiété de performance. Les résidents ont l'impression que les évaluations manquent parfois de pertinence, car les superviseurs, se sentant contraints de « cocher des cases ¼, font des commentaires trop généraux et peu ciblés. De plus, un sentiment de frustration a été fréquemment exprimé face à la subjectivité et à l'incohérence perçues des jugements dans les évaluations, surtout lorsque ces dernières sont utilisées pour retarder le cheminement vers une plus grande indépendance, ce qui contribue à des tentatives de « déjouer le système ¼. L'implication et le soutien du corps professoral ont aidé à bonifier l'expérience des résidents. Conclusion: Bien que les résidents apprécient le potentiel de la FMFC pour rehausser la qualité de la formation, de l'évaluation et de la rétroaction, son opérationnalisation actuelle ne permet pas d'atteindre ces objectifs de façon systématique. Les auteurs proposent quelques initiatives pour améliorer la façon dont les résidents vivent les processus d'évaluation et de rétroaction dans le cadre de la FMFC.

Oxysterol-binding protein (OSBP)-related protein 4 (ORP4) is essential for cell proliferation and survival.

Oxysterol-binding protein (OSBP) and OSBP-related proteins (ORPs) comprise a large gene family with sterol/lipid transport and regulatory activities. ORP4 (OSBP2) is a closely related paralogue of OSBP, but its function is unknown. Here we show that ORP4 binds similar sterol and lipid ligands as OSBP and other ORPs but is uniquely required for the proliferation and survival of cultured cells. Recombinant ORP4L and a variant without a pleckstrin homology (PH) domain (ORP4S) bind 25-hydroxycholesterol and extract and transfer cholesterol between liposomes. Two conserved histidine residues in the OSBP homology domain ORP4 are essential for binding phosphatidylinositol 4-phosphate but not sterols. The PH domain of ORP4L also binds phosphatidylinositol 4-phosphate in the Golgi apparatus. However, in the context of ORP4L, the PH domain is required for normal organization of the vimentin network. Unlike OSBP, RNAi silencing of all ORP4 variants (including a partial PH domain truncation termed ORP4M) in HEK293 and HeLa cells resulted in growth arrest but not cell death. ORP4 silencing in non-transformed intestinal epithelial cells (IEC)-18 caused apoptosis characterized by caspase 3 and poly(ADP-ribose) polymerase processing, DNA cleavage, and JNK phosphorylation. IEC-18 transformed with oncogenic H-Ras have increased expression of ORP4L and ORP4S proteins and are resistant to the growth-inhibitory effects of ORP4 silencing. Results suggest that ORP4 promotes the survival of rapidly proliferating cells.

Functional implications of sterol transport by the oxysterol-binding protein gene family.

Cholesterol and its numerous oxygenated derivatives (oxysterols) profoundly affect the biophysical properties of membranes, and positively and negatively regulate sterol homoeostasis through interaction with effector proteins. As the bulk of cellular sterols are segregated from the sensory machinery that controls homoeostatic responses, an important regulatory step involves sterol transport or signalling between membrane compartments. Evidence for rapid, energy-independent transport between organelles has implicated transport proteins, such as the eukaryotic family of OSBP (oxysterol-binding protein)/ORPs (OSBP-related proteins). Since the founding member of this family was identified more than 25 years ago, accumulated evidence has implicated OSBP/ORPs in sterol signalling and/or sterol transport functions. However, recent evidence of sterol transfer activity by OSBP/ORPs suggests that other seemingly disparate functions could be the result of alterations in membrane sterol distribution or ancillary to this primary activity.

Electric field induced assembly of vimentin microscaffolds around metallic electrodes.

The self-assembly properties of fibrous proteins such as collagen are frequently used to form three-dimensional scaffolds. In this study we investigated the effect of nonuniform alternating and static electric-fields on the self-assembly properties of a dilute solution of vimentin. In the presence of both types of fields at the same time, vimentin was observed to accumulate at the positive electrode and to form microscaffolds bridging the two electrodes in 20-30 min. Atomic force microscopy of the surface of dried microscaffolds revealed the presence of dense 8-12 nm diameter vimentin filament meshworks as well as bundles with typical diameters of 100-200 nm. Stretching of the scaffolds revealed that either the bundles or drawn meshworks could be extended to at least 6-fold and the presence fibers with a width of several µm.