Using a Problem/Case-Based Learning Program to Increase First and Second Year Medical Students' Discussions of Health Care Cost Topics.

BACKGROUND: The rising costs of health care in the United States are unsustainable and gaps in physician knowledge of how to provide care at a lower cost remains a contributing factor. It has been suggested that learning about health care costs should be incorporated into existing, already overburdened medical school curricula. OBJECTIVE: To increase the discussion of health care costs among first and second year medical students, we added a component of health care cost education to an existing problem/case-based learning (PBL/CBL) program without adding curricular time. DESIGN: A total of 98 medical students participated in this study throughout the first 2 years of their educational program. Students were charged with researching and discussing health care cost topics as part of their weekly PBL/CBL case conferences. Faculty facilitators tracked each student's participation in discussions of health care cost topics as well as how often students initiated new conversations about health care cost topics during their case conferences. RESULTS: 100% of students engaged in conversations about health care cost topics throughout their first and second year PBL/CBL program. In addition, students increasingly initiated new conversations about health care cost topics as they progressed through their courses from the first to the second year (R 2 = 0.887, P < .01). CONCLUSIONS: Sensitizing medical students early during their educational program to incorporate health care cost topics into their PBL/CBL case conferences proved an effective means for having them engage in conversations related to health care costs. These results offer a new, time-efficient option for incorporating health care cost topics for schools with PBL/CBL programs.

A novel learning approach to pharmaceutical sciences research in a pharmacy research advanced pharmacy practice experience (APPE) elective course.

BACKGROUND AND PURPOSE: This project investigates the use of pharmacy student metacognitive learning in a laboratory-based science research advanced pharmacy practice experience (APPE). EDUCATIONAL ACTIVITY AND SETTING: We describe a five-week research APPE. This course is separated into two parts which run simultaneously. In part 1, students read and discuss papers from primary literature to learn the context of the project and the theory behind each laboratory procedure. In part 2, students perform experiments in the laboratory that contribute to the primary investigator's (PI's) ongoing research project and relate directly to the readings from part 1. Metacognitive processes allow students to better understand and evaluate the primary literature and to connect that information with the hands-on experiments being performed. FINDINGS: Currently, this APPE has run five times with a total of eight students. Student learning was assessed by several written and oral assignments graded with rubrics. Students' perceptions of their own learning and metacognitive development following the course was assessed using a survey. SUMMARY: This APPE seems to be a useful experience for both faculty and students. Students obtain laboratory and metacognitive skill development, while the collaborating laboratory is supplied with material required for further experiments. Importantly, the APPE preceptor is not the PI, so the preceptor is able to focus on the learning skills (both metacognition and hands-on) portion of the APPE.

Assessment of medical students' leadership traits in a problem/case-based learning program.

BACKGROUND: Healthcare delivery is shifting to team-based care and physicians are increasingly relied upon to lead and participate in healthcare teams. Educational programs to foster the development of leadership qualities in medical students are needed to prepare future physicians for these roles. OBJECTIVE: Evaluate the development of leadership attributes in medical students during their first 2 years of medical school while participating in leadership training integrated into a problem/case-based learning program utilizing the Leadership Traits Questionnaire assessment tool. DESIGN: Ninety-eight students enrolled at Zucker School of Medicine participated in Patient-Centered Explorations in Active Reasoning, Learning and Synthesis (PEARLS), a hybrid problem/case-based learning program, during the first and second years of medical school. The Leadership Traits Questionnaire, designed to measure 14 distinct leadership traits, was utilized. It was administered to students, peers in students' PEARLS groups and their faculty facilitators. Participants completed questionnaires at three-time points during the study. Likert scale data obtained from the questionnaire was analyzed using a two-level Hierarchal Linear Model. RESULTS: Complete data sets were available for 84 students. Four traits, including self-assured, persistent, determined, and outgoing, significantly increased over time by measurements of both peer and facilitator-rated assessments. Six additional traits significantly increased over time by measurement of facilitator-rated assessment. By contrast, a majority of student self-rated assessments trended downward during the study. CONCLUSIONS: Medical students demonstrated development of several important leadership traits during the first 2 years of medical school. This was accomplished while participating in the PEARLS program and without the addition of curricular time. Future work will examine the impact of third year clerkships on leadership traits.

Integration of leadership training into a problem/case-based learning program for first- and second-year medical students.

PURPOSE: The evolution of health care systems in response to societal and financial pressures has changed care delivery models, which presents new challenges for physicians. Leadership training is increasingly being recognized as an essential component of medical education training to prepare physicians to meet these needs. Unfortunately, most medical schools do not include leadership training. It has been suggested that a longitudinal and integrated approach to leadership training should be sought. We hypothesized that integration of leadership training into our hybrid problem-based learning (PBL)/case-based learning (CBL) program, Patient-Centered Explorations in Active Reasoning, Learning and Synthesis (PEARLS), would be an effective way for medical students to develop leadership skills without the addition of curricular time. METHODS: We designed a unique leadership program in PEARLS in which 98 medical students participated during each of their six courses throughout the first 2 years of school. A program director and trained faculty facilitators educated students and coached them on leadership development throughout this time. Students were assessed by their facilitator at the end of every course on development of leadership skills related to teamwork, meaningful self-assessment, process improvement, and thinking outside the box. RESULTS: Students consistently improved their performance from the first to the final course in all four leadership parameters evaluated. The skills that demonstrated the greatest change were those pertaining to thinking outside the box and process improvement. CONCLUSION: Incorporation of a longitudinal and integrated approach to leadership training into an existing PBL/CBL program is an effective way for medical students to improve their leadership skills without the addition of curricular time. These results offer a new, time-efficient option for leadership development in schools with existing PBL/CBL programs.

Cardiovascular disease and its association with histological changes of the left stellate ganglion.

Mounting evidence has demonstrated that the autonomic system plays a role in the morbidity and mortality of certain cardiovascular disease states. Ventricular arrhythmias have been associated with the level of sympathetic activation. We attempted to determine if the presence of fibrosis, a marker for previous ischemic events, correlates with an increase in the number of left stellate ganglion nerve cell bodies which is indicative of hypersympathetic stimulation to the myocardial tissue. Left stellate ganglia were removed, sectioned and prepared using hematoxylin and eosin and Masson's trichrome stain. The interventricular septum of the heart corresponding to the stellate ganglion samples were removed, serially sectioned, and stained with hematoxylin and eosin and Masson's trichrome stain. The samples were described using a grading scale to quantify the percentage of fibrosis. Ganglion nerve cell bodies were then individually counted in three separate high-powered fields. A student's T-test was used to statistically evaluate the data. Stellate ganglions were sampled from 32 cadavers. Fibrosis was present within 72% (23/32) of the interventricular septums that were sampled. Nine interventricular septums were found to be free of fibrosis. For those interventricular septums that were positive for the presence of fibrosis, the mean left stellate ganglion nerve cell bodies was 39.8 (Range: 26-51). For those interventricular septums that were negative for the presence of fibrosis, the mean left stellate ganglion nerve cell bodies was 34.3 (Range: 27-46). The difference between the mean nerve cell bodies for interventricular septums with fibrosis and without fibrosis was found to be statistically significant (P = 0.048). Histological changes in terms of the number of left stellate ganglion nerve cell bodies seem to be dependent upon the presence of fibrosis within the interventricular septum. Considering fibrosis of the interventricular septum is a marker for previous ischemic events, an increase in the number of nerve cell bodies of the left stellate ganglion in the presence of fibrosis suggests an association does exist between hypersympathetic stimulation to the myocardial tissue and myocardial infarction. Further research into this association is warranted in order to determine if left stellate ganglion blockade is a viable treatment option for arrhythmias following myocardial infarctions.

Arterio-arterial malformation between a high origin radial artery and brachial artery within the cubital fossa - its clinical and embryological significance: a case report.

INTRODUCTION: Arterial variations of the upper extremity are commonly seen in the radial and ulnar arteries. Arterial variations can be damaged through iatrogenic means if not properly documented. CASE PRESENTATION: A rare arterial anomaly was found in a 61-year-old female cadaver consisting of an arterio-arterial malformation between a high-origin radial artery and the brachial artery within the cubital fossa. The high-origin radial artery arose from the axillary artery, deep to the pectoralis minor muscle. It coursed superficially through the anterior compartment of the arm, converging with the more deeply placed brachial artery in the cubital fossa. CONCLUSION: Our finding demonstrates the still vast array of possible arterial varieties and the need for awareness in order to prevent iatrogenic injury. We also provide supportive evidence of intussusceptive angiogenesis' involvement in the formation of larger vessels.

Bartholin's abscess arising within hidradenoma papilliferum of the vulva: a case report.

BACKGROUND: Hidradenoma papilliferum is an uncommon, benign, cystic, papillary tumor that occurs almost exclusively in the female anogenital region. Bartholin's abscess is also an anogenital cystic lesion caused by obstruction of Bartholin's duct with an overlying infection. Concomitant presentation of Bartholin's abscess and Hidradenoma papilliferum is unique. CASE PRESENTATION: A 43-year-old African American woman presented with a painful cystic mass on the left labia majora. A preoperative diagnosis of Bartholin's abscess was made. During excision and draining, an additional tan-brown dermal nodule was removed which demonstrated histological features of Hidradenoma papilliferum. CONCLUSION: We present what we believe to be the first case of Bartholin's abscess arising in hidradenoma papilliferum and its clinical significance.

Surgical treatment for acromioclavicular joint osteoarthritis: patient selection, surgical options, complications, and outcome.

Osteoarthritis is one of the most common causes of pain originating from the acromioclavicular (AC) joint. An awareness of appropriate diagnostic techniques is necessary in order to localize clinical symptoms to the AC joint. Initial treatments for AC joint osteoarthritis, which include non-steroidal anti-inflammatory drugs (NSAIDS) and corticosteroids, are recommended prior to surgical interventions. Distal clavicle excision, the main surgical treatment option, can be performed by various surgical approaches, such as open procedures, direct arthroscopic, and indirect arthroscopic techniques. When choosing the best surgical option, factors such as avoidance of AC ligament damage, clavicular instability, and post-operative pain must be considered. This article examines patient selection, complications, and outcomes of surgical treatment options for AC joint osteoarthritis.

Pathology-dependent histological changes of the left stellate Ganglia: a cadaveric study.

Sympathetic hyperinnervation due to nerve sprouting generated by the left stellate ganglion has been noted following cardiopulmonary disease processes. Sympathetic hyperinnervation seems to be limited to cardiopulmonary diseases in the experimental and clinical settings. However, histological changes of the left stellate ganglion following cardiopulmonary diseases in humans have vet to be observed. This study intends to investigate the histological changes of cadaveric sympathetic nervous tissue of left stellate ganglia (n = 32) and their relationship to noted pathology. Our study found fibrotic changes of the left stellate ganglion are not significantly dependent upon pathological processes, however, changes in the number of nerve cell bodies seems to be pathology dependent. A relationship between respiratory (mean = 33.3; P = 0.023) and cardiovascular pathologies (mean = 29.6; P = 0.199) and an increase in nerve cell bodies of the left stellate ganglion was noted when compared to other pathologies (mean = 25.7). The link between cardiopulmonary disease and sympathetic hyperinnervation may be the increase in the number of nerve cell bodies of the left stellate ganglion. Our results are clinically significant considering sympathetic hyperinnervation is associated with arrythmogenesis and an increase in morbidity and mortality in patients with pulmonary disease. Such findings may warrant investigation into the use of ganglion blockade in cardiopulmonary diseases.

Significance of differences in patency among cranial sutures.

OBJECTIVE: To evaluate the gross external characteristics of the coronal, lambdoid, and sagittal sutures in human cadaver skulls and determine if a difference exists in terms of patency, sex, and age. METHODS: The coronal, lambdoid, and sagittal sutures were described using a modified grading scale to quantify sutural patency. An open suture was graded as 0, a fused suture as 1, and an obliterated suture as 2, 3, or 4, depending on the extent of obliteration. RESULTS: Thirty-six skulls were examined, including 17 female and 19 male (age range, 56-101 y). When compared with the sagittal suture, the lambdoid suture was significantly more likely to be patent and least likely to be obliterated. No significant difference in suture grades was found between female and male skulls, and no significant difference was found between age and suture grade. CONCLUSION: The prolonged patency of the lambdoid suture may be due to external forces, such as the greater number of muscles affecting the lambdoid suture when compared with the sagittal suture.