Beyond mistreatment: Learner neglect in the clinical teaching environment.

Medical student mistreatment has been recognized as a deterrent to education as it interferes with the learning process and contributes to student burnout and attrition. Medical schools and leaders in undergraduate medical education have expended tremendous effort in addressing this phenomenon in hopes of eradicating mistreatment. However, there is a spectrum of behaviors that negatively impact the learning environment beyond that which is considered frank mistreatment. In this conceptual article, the authors propose the concept of learner neglect for the consideration by educators and researchers. This is a term for a range of behaviors exhibited intentionally or unintentionally by a supervisor that prevent a learner from reaching his or her potential. While the behaviors may overlap with mistreatment, they do not always fit within the definition of mistreatment. This concept is illustrated in the context of optimal and suboptimal teaching behaviors that commonly occur within the ecosystem of clinical education. Descriptions and examples are provided for both intentional and unintentional learner neglect. The authors hypothesize possible short- and long-term impacts of learner neglect, describe contributors to its prevalence, and offer questions for key stakeholders to consider in an effort to recognize, study, and ameliorate this issue within medical education programs.

Regional medical campuses: a new classification system.

There is burgeoning belief that regional medical campuses (RMCs) are a significant part of the narrative about medical education and the health care workforce in the United States and Canada. Although RMCs are not new, in the recent years of medical education enrollment expansion, they have seen their numbers increase. Class expansion explains the rapid growth of RMCs in the past 10 years, but it does not adequately describe their function. Often, RMCs have missions that differ from their main campus, especially in the areas of rural and community medicine. The absence of an easy-to-use classification system has led to a lack of current research about RMCs as evidenced by the small number of articles in the current literature. The authors describe the process of the Group on Regional Medical Campuses used to develop attributes of a campus separate from the main campus that constitute a "classification" of a campus as an RMC. The system is broken into four models-basic science, clinical, longitudinal, and combined-and is linked to Liaison Committee on Medical Education standards. It is applicable to all schools and can be applied by any medical school dean or medical education researcher. The classification system paves the way for stakeholders to agree on a denominator of RMCs and conduct future research about their impact on medical education.

Match rates into family medicine among regional medical campus graduates, 2007-2009.

BACKGROUND: Regional medical campuses (RMCs) are geographically separate from parent campuses, have administrative ties to deans' offices, and offer at least 4 third-year clerkships. This study sought to describe the match rates into family medicine for graduates of RMCs and non-RMCs. METHODS: The authors obtained the 2007 to 2009 match lists from schools participating in the Association of American Medical College's Group on Regional Medical Campuses. RMC match numbers for family medicine were subtracted from the total number of family medicine matched US seniors as published by the National Residency Match Program. The outcome of interest was the relative frequencies of RMC and non-RMC graduates matching into family medicine. RESULTS: Between 2007 and 2009, 261 graduates from 29 RMCs accounted for 8% of all family medicine matches. During the study period, the match rate into family medicine for RMC graduates was 80% higher than that of non-RMC graduates (14.2% vs 7.9% for all 3 years). In 2009, only 3 of the RMCs had family medicine match rates lower than that of non-RMCs (7.5%). CONCLUSIONS: The RMC match rate into family medicine was nearly twice that of non-RMCs. RMCs may play a role in addressing physician workforce imbalances.

Pistachio nut consumption and serum lipid levels.

OBJECTIVE: Clinical and epidemiological studies have reported the beneficial effects of tree nuts and peanuts on serum lipid levels. We studied the effects of consuming 15% of the daily caloric intake in the form of pistachio nuts on the lipid profiles of free-living human subjects with primary, moderate hypercholesterolemia (serum cholesterol greater than 210 mg/dL). METHODS: design: Randomized crossover trial. setting: Outpatient dietary counseling and blood analysis. subjects: 15 subjects with moderate hypercholesterolemia. intervention: Fours weeks of dietary modification with 15% caloric intake from pistachio nuts. MEASURES OF OUTCOME: Endpoints were serum lipid levels of total cholesterol, HDL-C, LDL-C, VLDL-C, triglycerides and apolipoproteins A-1 and B-100. BMI, blood pressure, and nutrient intake (total energy, fat, protein, and fiber) were also measured at baseline, during, and after dietary intervention. RESULTS: No statistically significant differences were observed for total energy or percent of energy from protein, carbohydrate or fat. On the pistachio nut diet, a statistically significant decrease was seen for percent energy from saturated fat (mean difference, -2.7%; 95% CI, -5.4% to -0.08%; p = 0.04). On the pistachio nut diet, statistically significant increases were seen for percent energy from polyunsaturated fat (mean difference, 6.5%; 95% CI, 4.2% to 8.9%; p<.0001) and fiber intake (mean difference, 15 g; 95% CI, 8.4 g to 22 g; p = 0.0003). On the pistachio diet, statistically significant reductions were seen in TC/HDL-C (mean difference, -0.38; 95% CI, -0.57 to -0.19; p = 0.001), LDL-C/HDL-C (mean difference, -0.40; 95% CI, -0.66 to -0.15; p = 0.004), B-100/A-1 (mean difference, -0.11; 95% CI, -0.19 to -0.03; p = 0.009) and a statistically significant increase was seen in HDL-C (mean difference, 2.3; 95% CI, 0.48 to 4.0; p = 0.02). No statistically significant differences were seen for total cholesterol, triglycerides, LDL-C, VLDL-C, apolipoprotein A-1 or apolipoprotein B-100. No changes were observed in BMI or blood pressure. CONCLUSION: A diet consisting of 15% of calories as pistachio nuts (about 2-3 ounces per day) over a four week period can favorably improve some lipid profiles in subjects with moderate hypercholesterolemia and may reduce risk of coronary disease.