Overnight Hospital Experiences for Medical Students: Results of the 2014 Clerkship Directors in Internal Medicine National Survey.

BACKGROUND: Since the 2011 Accreditation Council of Graduate Medical Education (ACGME) work hour rules for residents were implemented, 24-30 h call for interns has been replaced by shift work, including night-float. The impact of these changes on undergraduate medical education experiences in internal medicine has not been described. OBJECTIVE: We aimed to determine the current status of medical students' overnight experiences in Internal Medicine clerkships and sub-internships, and to assess internal medicine educators' perceptions of the importance of overnight work during internal medicine rotations. DESIGN AND PARTICIPANTS: In May 2014, the Clerkship Directors in Internal Medicine (CDIM) conducted its annual survey. Twenty-eight questions about student participation in overnight work and perceptions of the importance of overnight work (rated on 1-5 Likert scale, 1 = very unimportant and 5 = ery important) were included. Descriptive statistics were used to summarize responses. Free text results were analyzed qualitatively. KEY RESULTS: The response rate was 78 %. A minority of respondents reported students having any overnight experience during the clerkship (38.7 %) or the sub-internship (40.7 %). Only 5 % of respondents reported having students assigned to night-float rotations outside of clerkships or sub-internships. Respondents agreed that overnight experiences were more important during the sub-internship than the clerkship, 4.0 ± 1.1 vs. 3.2 ± 1.2, p < 0.001. Admitting new patients, following their course and responding to emergencies were rated as important overnight tasks for both clerkship and sub-internship students. CONCLUSIONS: Overnight experiences offer students additional educational opportunities. Clerkship directors felt that the overnight experience for the sub-intern in particular was an important chance to practice providing emergency cross coverage and other intern roles. In the era of ACGME duty hours, there is a need to further examine whether there is a role for increased overnight hospital experiences for medical students.

Development of a Multifaceted Antimicrobial Stewardship Curriculum for Undergraduate Medical Education: The Antibiotic Stewardship, Safety, Utilization, Resistance, and Evaluation (ASSURE) Elective.

To address the growing need for dedicated stewardship training in undergraduate medical education, we developed an antimicrobial stewardship curriculum for medical students with the objectives of increasing expertise in antimicrobial prescribing, introducing antimicrobial stewardship fundamentals, and enhancing comfort with engagement in interprofessional antimicrobial stewardship activities.

Loose protein packing around the extracellular half of the GABA(A) receptor beta1 subunit M2 channel-lining segment.

GABA(A) receptors are ligand-gated ion channels formed by the pseudosymmetrical assembly of five homologous subunits around the central channel axis. The five M2 membrane-spanning segments largely line the channel. In the present work we probed the water surface accessibility of the beta(1) subunit M2 segment using the substituted cysteine accessibility method. We assayed the reaction of the negatively charged sulfhydryl-specific reagent, p-chloromercuribenzenesulfonate (pCMBS(-)), by its effect on subsequent currents elicited by EC(50) and saturating GABA concentrations. pCMBS(-), applied with GABA, reacted with 14 of the 19 residues tested. At the M2 cytoplasmic end from 2' to 6' only beta(1)A252C (2') and beta(1)T256C (6') were pCMBS(-)-reactive in the presence of GABA. We infer that the M2 segments are tightly packed in this region. Toward the extracellular half of M2 all residues from beta(1)T262C (12') through beta(1)E270C (20') reacted with pCMBS(-) applied with GABA. We infer that this region is highly mobile and loosely packed against the rest of the protein. Based on differences in pCMBS(-) reaction rates two domains can be distinguished on the putative channel-lining side of M2. A faster reacting domain includes the 2', 9', 12', 13', and 16' residues. The slower reacting face contains the 6', 10', and 14' residues. We hypothesize that these may represent the channel-lining faces in the closed and open states and that gating involves an 80-100 degrees rotation of the M2 segments. These results are consistent with the loose packing of the M2 segments inferred from the structure of the homologous Torpedo nicotinic acetylcholine receptor.