Perceptions of X+Y Scheduling Among Combined Internal Medicine-Pediatrics Residency Trainees: A Qualitative Program Evaluation.

OBJECTIVE: The study aims to elicit perceived benefits and downsides of X+Y scheduling for combined Internal Medicine-Pediatrics (Med-Peds) residents via focus groups. METHODS: Five focus groups were conducted with Med-Peds residents in participating programs which utilized X+Y scheduling. Onefocus group was held per participating institution. Each focus group was facilitated by a chief resident from a different participating institution. Questions were developed by the study team after a review of the literature and local experience with X+Y scheduling and included open-ended questions. Focus groups were recorded and transcribed. Transcripts were reviewed by study team members, and representative themes and quotes were presented. The main outcome was to evaluate the perceived benefits and downsides of X+Y scheduling for Med-Peds. RESULTS: Results from four of the five focus groups were fully reviewed. Themes regarding the benefits of X+Y scheduling included (1) improved inpatient and outpatient experience, (2) predictability in schedule which improved wellness, and (3) longitudinal time for career exploration. Downsides of X+Y scheduling were highlighted as well including (1) condensing too many experiences into Y time and (2) challenges that exist when categorical medicine and pediatrics programs use different block schedules. CONCLUSIONS: X+Y schedules create potential solutions for longstanding barriers to medical education and notably conflict with inpatient and outpatient responsibilities. Our data shows similar benefits to X+Y scheduling for combined residents as for their categorical colleagues and sheds light on some unique considerations for combined programs and trainees. Additional studies should continue to assess the effect of X+Y scheduling on our combined trainees.

Collective intelligence improves probabilistic diagnostic assessments.

OBJECTIVES: Collective intelligence, the "wisdom of the crowd," seeks to improve the quality of judgments by aggregating multiple individual inputs. Here, we evaluate the success of collective intelligence strategies applied to probabilistic diagnostic judgments. METHODS: We compared the performance of individual and collective intelligence judgments on two series of clinical cases requiring probabilistic diagnostic assessments, or "forecasts". We assessed the quality of forecasts using Brier scores, which compare forecasts to observed outcomes. RESULTS: On both sets of cases, the collective intelligence answers outperformed nearly every individual forecaster or team. The improved performance by collective intelligence was mediated by both improved resolution and calibration of probabilistic assessments. In a secondary analysis looking at the effect of varying number of individual inputs in collective intelligence answers from two different data sources, nearly identical curves were found in the two data sets showing 11-12% improvement when averaging two independent inputs, 15% improvement averaging four independent inputs, and small incremental improvements with further increases in number of individual inputs. CONCLUSIONS: Our results suggest that the application of collective intelligence strategies to probabilistic diagnostic forecasts is a promising approach to improve diagnostic accuracy and reduce diagnostic error.

The Implementation of X + Y Scheduling in Combined Internal Medicine-Pediatrics Residency Programs: Practical Considerations for Program Leadership.

The X + Y scheduling approach, or block scheduling, is common among internal medicine residency programs. With the beginning of a pilot program through the American College of Graduate Medical Education in 2018, pediatrics and internal medicine-pediatrics (Med-Peds) residency programs have been able to adopt X + Y scheduling as well. The X + Y scheduling approach presents unique challenges and opportunities for combined Med-Peds residencies. This paper describes an early experience with X + Y scheduling in Med-Peds residencies and describes practical considerations for Med-Peds programs considering or planning a transition to the X + Y schedule. These considerations include strategies for gaining stakeholder support; selecting the appropriate block structure; opportunities for designing the ambulatory curriculum; and maximizing the clinical benefit in the residency continuity clinic.

Quercetin inhibits glucose transport by binding to an exofacial site on GLUT1.

Quercetin, a common dietary flavone, is a competitive inhibitor of glucose uptake and is also thought to be transported into cells by GLUT1. In this study, we confirm that quercetin is a competitive inhibitor of GLUT1 and also demonstrate that newly synthesized compounds, WZB-117 and BAY-876 are robust inhibitors of GLUT1 in L929 cells. To measure quercetin interaction with L929 cells, we develop a new fluorescent assay using flow cytometry. The binding of quercetin and its inhibitory effects on 2-deoxyglucose (2DG) uptake showed nearly identical dose dependent effects, with both having maximum effects between 50 and 100 µM and similar half maximum effects at 8.9 and 8.5 µM respectively. The interaction of quercetin was rapid with t1/2 of 54 s and the onset and loss of its inhibitory effects on 2DG uptake were equally fast. This suggests that either quercetin is simply binding to surface GLUT1 or its transport in and out of the cell reaches equilibrium very quickly. If quercetin is transported, the co-incubation of quercetin with other glucose inhibitors should block quercetin uptake. However, we observed that WZB-117, an exofacial binding inhibitor of GLUT1 reduced quercetin interaction, while cytochalasin B, an endofacial binding inhibitor, enhanced quercetin interaction, and BAY-876 had no effect on quercetin interaction. Taken together, these data are more consistent with quercetin simply binding to GLUT1, but not actually being transported into L929 cells via the glucose channel in GLUT1.