Lepidoptera (Crambidae, Noctuidae, and Pyralidae) Injury to Corn Containing Single and Pyramided Bt Traits, and Blended or Block Refuge, in the Southern United States.

Fall armyworm, Spodoptera frugiperda (J. E. Smith) (Lepidoptera: Noctuidae); corn earworm, Helicoverpa zea Boddie (Lepidoptera: Noctuidae); southwestern corn borer, Diatraea grandiosella Dyar (Lepidoptera: Crambidae); sugarcane borer, Diatraea saccharalis F. (Lepidoptera: Crambidae); and lesser cornstalk borer, Elasmopalpus lignosellus Zeller (Lepidoptera: Pyralidae), are lepidopteran pests of corn, Zea mays L., in the southern United States. Blended refuge for transgenic plants expressing the insecticidal protein derivative from Bacillus thuringiensis (Bt) has recently been approved as an alternative resistance management strategy in the northern United States. We conducted a two-year study with 39 experiments across 12 states in the southern United States to evaluate plant injury from these five species of Lepidoptera to corn expressing Cry1F and Cry1Ab, as both single and pyramided traits, a pyramid of Cry1Ab×Vip3Aa20, and a pyramid of Cry1F×Cry1Ab plus non-Bt in a blended refuge. Leaf injury and kernel damage from corn earworm and fall armyworm, and stalking tunneling by southwestern corn borer, were similar in Cry1F×Cry1Ab plants compared with the Cry1F×Cry1Ab plus non-Bt blended refuge averaged across five-plant clusters. When measured on an individual plant basis, leaf injury, kernel damage, stalk tunneling (southwestern corn borer), and dead or injured plants (lesser cornstalk borer) were greater in the blended non-Bt refuge plants compared to Cry1F×Cry1Ab plants in the non-Bt and pyramided Cry1F×Cry1Ab blended refuge treatment. When non-Bt blended refuge plants were compared to a structured refuge of non-Bt plants, no significant difference was detected in leaf injury, kernel damage, or stalk tunneling (southwestern corn borer). Plant stands in the non-Bt and pyramided Cry1F×Cry1Ab blended refuge treatment had more stalk tunneling from sugarcane borer and plant death from lesser cornstalk borer compared to a pyramided Cry1F×Cry1Ab structured refuge treatment. Hybrid plants containing Cry1F×Cry1Ab within the pyramided Cry1F×Cry1Ab blended refuge treatment had significantly less kernel damage than non-Bt structured refuge treatments. Both single and pyramided Bt traits were effective against southwestern corn borer, sugarcane borer, and lesser cornstalk borer.

The evolution of faculty development in Canada since the 1980s: coming of age or time for a change?

AIM: To determine the current status of university based faculty development at Canadian Medical Schools. BACKGROUND: The roles and responsibilities of faculty members at Canadian medical schools are changing significantly as a consequence of influences such as the competency dictates outlined in the CanMEDS roles. One result of the changes is an increased need for faculty development to assist faculty members in carrying out their new and expanded roles. METHODS: The changing climate in medical schools, and the enhanced performance expectations of academic faculty, led us to conduct a survey of current faculty development practices in Canadian medical schools to determine what is being done to address the new and expanded expectations of faculty members. We used an on-line survey instrument based on surveys of faculty development conducted in 1987 and 1997. RESULTS: We received responses from faculty development directors at all 17 Canadian medical schools. Among the principal findings are a continued emphasis on faculty members' teaching roles, increased funding of faculty development activities at most schools, and a broadened emphasis on faculty roles other than teaching. Among these are research and scholarship, and management and administrative roles. The survey revealed a mismatch between what faculty development directors consider to be effective development practices and which practices are actually used in their schools. Another notable finding is the absence of credible faculty development impact studies. CONCLUSION: The 2007 survey of faculty development practices in Canadian medical schools indicates that teaching is still the number one priority for faculty members and the main focus of faculty development programs. There are notable efforts to help faculty members deal with their newly identified roles including those outlined in the CanMEDS framework. In looking forward, Canadian faculty development directors should continue their efforts to devise credible program evaluation methods. Furthermore, they should expand their thinking beyond Canada's borders. It is time to aggressively explore and understand the approaches and experiences which have proven successful internationally in the United States and Europe.

A pilot study designed to acquaint medical educators with basic pedagogic principles.

BACKGROUND: Faculty development activities in medical schools regularly target teaching behaviours but rarely address basic pedagogic principles underlying those behaviours. Although many teachers have an intuitive or tacit knowledge of basic pedagogic principles, overt knowledge of fundamental educational principles is rare. AIMS: We conducted a short-term pilot study designed to transform teachers' tacit knowledge into explicit knowledge of pedagogic principles. We hypothesized that conscious awareness of these principles will positively influence their teaching effectiveness. METHODS: The intervention included a workshop, provision of a workbook on pedagogic principles and free access to educational consultants. For the intervention, we chose a purposive sample of experienced teachers at our medical school. RESULTS AND CONCLUSIONS: Evaluation of the impact of the intervention using questionnaires and semi-structured interviews revealed three notable findings; 1. Participants were surprised to discover the existence of an extensive body of pedagogic science underlying teaching and learning. 2. They were enthusiastic about the intervention and expressed interest in learning more about basic pedagogic principles. 3. The knowledge acquired had an immediate impact on their teaching.

The acquisition of tacit knowledge in medical education: learning by doing.

AIM: This study was designed to assess medical school teachers' tacit knowledge of basic pedagogic principles and to explore the specific character of the knowledge base. METHODS: We developed a 50-item, multiple-choice question test based on important pedagogic principles, and classified all questions as requiring either declarative or procedural knowledge. A total of 72 medical teachers representing 5 different groups of clinicians and educators agreed to sit the test. RESULTS: Teachers in all 5 groups performed well on the test of tacit pedagogic knowledge but those with advanced education degrees, or local recognition as experts, performed best. All test takers performed best on questions requiring procedural knowledge. CONCLUSION: Medical teachers possess tacit knowledge of basic pedagogic principles. Superior test performance on questions requiring procedural knowledge is consistent with their working in a clinical environment characterised by repeated procedural activities.

First Report of Powdery Mildew Caused by Leveillula taurica on Tomato and Pepper in Bolivia.

Chlorotic and necrotic lesions typical of powdery mildew caused by L. taurica were observed in several tomato (Lycopersicon esculentum) and pepper (Capsicum annuum) fields in Santa Cruz State, Bolivia near the town of Mairana during September 2004. The tomato cultivars affected were Santa Clara, Superman, and Cool 45. Symptoms included bright yellow chlorotic lesions or brown necrotic lesions on different age leaves. Examination of samples collected from several fields revealed sporulation of L. taurica on abaxial leaf surfaces. The fungus had branched conidiophores, a tapered or pyriform apical conidium, with other conidia being more cylindrical (1,2). Conidial size was approximately 60 × 18 µm. Only the Oidiopsis stage was observed. Disease severity was high and caused a significant amount of leaf necrosis and partial defoliation on tomato. Only sporadic lesions were observed on pepper cv. YoloWonder and no significant foliar damage was observed. The growing region receives approximately 75 mm of rainfall annually with most of the rainfall occurring between October and April. Thus, powdery mildew was observed near the end of the normal 5-month dry season. It is likely that the disease has been in the region for some time based on observations from field personnel. Although reported from several other South American countries, to our knowledge, this is the first report of this disease in Bolivia. References: (1) H. J. Boesewinkel. Bot. Rev. 46:167, 1980; (2) J. C. Correll et al. Plant Dis. 71:248, 1987.

If formal CME is ineffective, why do physicians still participate?

Formal or traditional CME can be criticized because organizers often ignore adult learning principles when designing courses. Critics also suggest that formal CME courses have limited impact on attendees' behaviors and practices. The authors agree that attention must be paid to pedagogic principles to assure success of educational courses, but feel that the extant negative evidence related to the impact of formal CME is narrow in scope and of inadequate strength to seriously damn formal approaches. Survey responses were received from 853 practicing physicians who say they still regularly attend formal CME courses. They are motivated to attend to satisfy specific professional needs and for personal reasons. Formal CME is still popular despite what its critics say. The authors are convinced that attention to physicians' perceived needs, effective use of social marketing strategies, and adherence to adult learning principles can assure successful delivery of CME and that formal CME is a useful complement to physician-driven informal CME.

Clinical teachers' tacit knowledge of basic pedagogic principles.

Academic faculty members in medical schools rarely receive formal instruction in basic pedagogic principles; nevertheless many develop into competent teachers. Perhaps they acquire tacit knowledge of these principles with teaching experience. This study was designed to assess clinical teachers' tacit knowledge of basic pedagogic principles and concepts. The authors developed a multiple-choice question (MCQ) exam based on 20 pedagogic principles judged by a panel of education experts to be important for clinical teaching. Three groups of clinician-educators sat the test: (1) clinicians with advanced education training and experience; (2) internal medicine specialists; (3) surgical specialists. All four groups of clinicians-educators passed the test, indicating that they possess a reasonable tacit knowledge of basic pedagogic principles. Those with advanced education training performed much better than members of the other two groups while specialists and residents working in teaching hospitals outperformed specialists from non-teaching hospitals. It is possible that converting this tacit knowledge to explicit knowledge may improve individual teaching effectiveness.

Seven principles for teaching procedural and technical skills.

The authors developed a cognitive-theory-based checklist of seven important principles for teaching technical skills. They then used the checklist in a workshop for doctors who teach procedural and technical skills. Participants in the workshop found the principle-based approach to be more effective than the traditional "see one, do one, teach one" approach.

Educational benefits of blinding students to information acquired and management plans generated by other physicians.

At our university, Internal Medicine clerks are members of a team responsible for the care of patients hospitalized on a teaching ward. Clerks first encounter their patients after the latter have been fully worked up by other physicians who have examined them and initiated investigations and management. Clerks are thus deprived of the opportunity to practice information acquisition, hypothesis generation and problem solving. We therefore undertook a 'blinding' initiative wherein each clerk was required to work up at least one hospitalized patient per week without access to the patient chart and without knowledge of information acquired and hypotheses generated by other physicians. Weekly data collection during the 8-week experiment with 40 clinical clerks revealed that work up of 'blinded' patients was more time-consuming and more difficult than work up of unblinded patients. Clerks were appreciative of the educational value of blinding. Teaching faculty felt clerk 'blinding' to be a practical approach to approximating the true conduct of medical practice and as such was useful for student learning.

Using focus groups to design a valid questionnaire.

The authors planned to study the roles and concerns of senior faculty members at their institutions. To elaborate the aims of their study and to help them design a valid questionnaire, they conducted focus groups with senior faculty. The authors describe how the information gleaned from the focus groups helped them develop their questionnaire.

Coding accuracy of hospital discharge data for elderly survivors of myocardial infarction.

OBJECTIVE: To assess the coding accuracy of primary and secondary discharge diagnoses in the Quebec hospital discharge database for elderly persons with myocardial infarction (MI). DESIGN: Retrospective chart review in a convenience sample of six Montreal hospitals. The diagnoses listed in the medical chart were compared with those listed in the hospital discharge database. For each subject, the Charlson comorbidity index was calculated twice, once based on the medical chart and again based on the hospital discharge database. PATIENTS: Subjects aged 65 years and over who had an MI coded as the primary discharge diagnosis in the hospital discharge database and who were discharged alive. MAIN RESULTS: For 234 MI survivors, the positive predictive value (ie, probability that a patient with MI reported in the hospital discharge database had an MI diagnosed by the discharging physician) for coding MI was 0.96 (95% CI 0.94, 0.98). Comorbid medical conditions and complications of the MI were under-reported in the hospital discharge database, which meant that the Charlson index based on the hospital discharge database was an average of 0.71 units lower than the Charlson index based on the medical chart. CONCLUSIONS: When studying survivors of MI by using hospital discharge databases, the advantages must be weighed against potential drawbacks in the quality of the information. Hospital discharge databases are almost as reliable as medical charts for identifying MI patients, but there is substantial under-reporting of comorbid medical conditions.

Program design and delivery in Canadian CME drug therapy courses.

OBJECTIVE: To examine how drug therapy course directors design and deliver drug therapy courses, and whether they employ adult education principles to assure effective education. DESIGN: Analysis of a three-part questionnaire sent to directors of drug therapy courses in Canada. PARTICIPANTS: The questionnaire was sent to all seven directors of drug therapy courses at medical schools that are accredited continuing medical education providers. RESULTS: All directors completed and returned the questionnaires. To decide on course content, most use feedback from previous course attendees, peer consultations, course committee member discussions and their own perceptions of learners' needs. Courses generally use conventional teacher-dominated technology rather than methods that emphasize active learner participation. CONCLUSION: Directors of Canadian continuing medical education drug therapy courses reasonably employ adult education principles when deciding learner needs and designing teaching vehicles.

Use of standardized patients to assess between-physician variations in resource utilization.

CONTEXT: As medical costs are increasingly being scrutinized, there is heightened interest in defining variations in physician behavior in clinical settings. OBJECTIVE: To evaluate if standardized patient (SP) technology is a reliable and feasible method of studying interphysician variations in test ordering, referral requests, prescribing behavior, and visit costs. DESIGN: The study was conducted with blinded SP visits to family medicine and internal medicine residents, university-affiliated family physicians, and community-based family physicians. Resource utilization and visit costs were assessed using test requisitions, consult requests, and prescriptions that were collected by the SPs. SETTING: Physicians' offices in ambulatory care, hospital-based clinics and in the community. PARTICIPANTS: Four persons (aged 57-77 years) trained to simulate having osteoarthritis of the hip. In one simulation, the patient had gastropathy due to nonsteroidal anti-inflammatory drug use, and in the other, the patient sought therapy for hip discomfort. MAIN OUTCOME MEASURES: Reliability of cost estimates of physician services, tests, consultations, prescriptions, and total visits and test-ordering behavior for nonsteroidal anti-inflammatory gastropathy. RESULTS: Overall, 112 (63%) of the physicians who were sent invitations to the study agreed to participate. Of 312 total SP visits conducted over a 1-year period, unblinding due to SP detection occurred on 36 occasions (11.5%). Reliable cost estimates of physician services, tests, and consultations, and moderately reliable estimates of total visit costs, were obtained with 4 visits per practicing physician and with 2 visits per resident. There were extreme variations in total visit costs generated by the study physicians. A small number of physicians had a major impact on this variability. CONCLUSION: Standardized patient technology provides a reliable, feasible method to assess variations in resource utilization between physicians.

Faculty development in Canadian medical schools: a 10-year update.

OBJECTIVE: To compare the current status of faculty development practices in Canadian medical schools with the status of such practices in 1986. DESIGN: Mail survey. SETTING: All 16 Canadian medical schools. PARTICIPANTS: Faculty development coordinators at the medical schools. OUTCOME MEASURES: Existence of faculty development committees, funding for faculty development activities, types of activities and recognition of faculty participation in such activities. RESULTS: Completed responses were received from all schools. They indicated a significant, positive evolution in faculty development since the previous survey, conducted in 1986. Most schools have established a faculty development committee and provide funds for such activities as workshops, sabbatical leaves and conference attendance. Although traditional development practices are prevalent, there is now widespread emphasis on computer technology, information retrieval, management skills and research. Experienced faculty and other experts are more widely used for consultation on teaching. Very little has been done to evaluate the impact of faculty development. CONCLUSION: Faculty development in Canadian medical schools has undergone a major, positive transition during the last 10 years.

Characteristics of physicians who frequently prescribe long-acting benzodiazepines for the elderly.

Long-acting benzodiazepines (LABZs) are relatively contraindicated for elderly patients because they increase the risk of impaired cognitive function, falls, and hip fractures. The purpose of this study was to identify the characteristics of physicians who frequently prescribe LABZs for elderly patients. The authors examined the prescribing profile of 4,976 physicians who saw at least 20 elderly Quebec medicare registrants in 1990. Physicians who frequently prescribed LABZs for their elderly patients were more likely to have graduated before 1979, to be general practitioners as opposed to specialists, to practice in long-term care settings, and to have graduated from a medical school in Quebec as opposed to other schools in Quebec, in other provinces, or in other countries. The authors have identified several characteristics of physicians who frequently prescribed LABZs for the elderly. Strategies to improve prescribing in this field should target this group of physicians.

[Characteristics of physicians prescribing more psychotropic drugs to women than to men]. / Caractéristiques des médecins prescrivant des psychotropes davantage aux femmes qu'aux hommes.

In industrialized countries, gender differences observed in health condition and the use of medical services appear insufficient to explain a greater consumption of psychotropic drugs in women than men. The authors have tested the hypothesis that physician prescribing patterns largely explains this observation. They demonstrate, using data from the Régie de l'assurance maladie du Québec for people aged 65 and over, that physicians' sociodemographic and practice characteristics are significantly associated with the percentage of men and women who receive a psychotropic drug prescription in their practice.

Does knowledge of drug prescribing predict drug management of standardized patients in office practice?

Drug prescribing for the elderly is an important area of medical knowledge since inappropriate prescribing may lead to significant adverse drug events. The objective of this study was to evaluate the association between knowledge of drug use and quality of drug management by general practitioners in practice. A cross-sectional study design was used to evaluate a sample of 37 GPs in practice. A set of common musculoskeletal problems was chosen to evaluate doctors' knowledge of non-steroidal anti-inflammatory drug use, while performance in practice was assessed using elderly standardized patients. The reliability of knowledge test scores was evaluated using measures of internal consistency. The relationship between knowledge of drug use and quality of therapeutic management in practice was evaluated by rank order and linear correlation analysis. Demographic characteristics of participating and non-participating doctors were similar. The reliability of the knowledge test was 0.55. The reliability of performance scores was 0.66. The correlation between overall performance on the standardized patient cases and total knowledge test score was 0.22 (95% confidence interval = 0-0.63). Knowledge test scores were poorly correlated with quality of therapeutic management in office practice. This indicates that knowledge tests alone cannot predict quality of performance with regard to drug prescribing for the elderly in primary care office practice.