A Longitudinal Assessment of Self-directed Learning Readiness and Development in Medical Students.

OBJECTIVES: Self-directed learning (SDL) competency is important for physicians to stay abreast of advances in their field and to provide the best available evidence-based care to their patients. Therefore, an essential responsibility of medical educators is to ensure the development of SDL skills in their students. The first objective of this study was to investigate longitudinally the degree to which medical students were ready to engage in SDL. The second objective was to examine students' perceptions of their SDL development throughout training. METHODS: A 2-part study of preclinical and clinical medical students was carried out at a midwestern U.S. university. In Study A, a longitudinal assessment of preclinical medical students' readiness to engage in SDL was conducted by administering an SDL readiness survey (SDLRS). In Study B, third- and fourth-year medical students were asked to reflect on their SDL development, in addition to completing the SDLRS. RESULTS: After validating the Hendry and Ginns version of the SDLRS in preclinical medical students during Study A, we found that 3 of the 4 subscales remained constant over the 3 iterations of the survey while the self-determination subscale increased significantly between the first and third iteration of the survey. In Study B, an analysis of the clinical medical students' comments indicated a perceived increase in their SDL abilities and a growing appreciation of SDL. However, the SDLRS scores of clinical students did not differ from the results observed in preclinical students in Study A. CONCLUSIONS: The results of the SDLRS indicated that the experience of students in our medical school has a positive influence on self-determination by the end of the preclinical years. Furthermore, analysis of the reflections of clinical students indicated ongoing development of SDL skills throughout their medical school training that were influenced by a wide range of experiences.

Defining Their Own Success: Scholars' Views After a Faculty Development Program.

OBJECTIVE: Educator roles in medicine are expanding yet career paths and definitions of successful careers are not uniformly agreed upon. Educator success from their own perspective has not been broadly explored as these studies usually occur from the institutional or organizational viewpoint. This study examined the impact of a national educational faculty development program (FDP) for academic pediatricians on educators' self-description of their own professional and personal success. METHODS: This was a cross-sectional, qualitative study of FDP alumni between 2019-2021. Interviews explored participants perspectives on their professional success, and supports and barriers. Using an iterative process, thematic analysis of the data identified 6 themes. RESULTS: Fourteen scholars were interviewed. All felt they were successful citing both outcome and impact measures categorized into 6 themes: personal attributes, adequate resources and barriers, foundational skill development, experiencing strong mentoring and networking, engaging, and being connected to a community of practice and self-identifying as a medical educator. To view the data holistically, a model incorporating 3 frameworks was developed. CONCLUSIONS: These educators viewed themselves as successful academic educators. While papers, promotions and positions were important, educators viewed impact in mentoring and collaborations with others, along with acquired expertise and an expanded viewpoint of the field and themselves as equally important. Educators and leaders could use these elements for their own self-assessment and support, FDP development and enhancement, and for investment in programs and faculty educators.

Emergency Critical Skills Training for Pre-clinical Physician Assistant Students: Mixed Method Comparison of Training Method.

Introduction: The fast-paced nature of physician assistant (PA) programs warrants an emphasis on high-fidelity, critical care skills training. Generally, manikins or task trainers are used for training and assessing. Soft-preserved cadavers provide a high-fidelity model to teach high-acuity, low-opportunity procedures; however, their effectiveness in PA pre-clinical training is not well understood. Objective: This study compared procedural competency of task trainer and soft-preserved cadaver trained pre-clinical PA (pcPA) students in completing tube thoracostomy, endotracheal intubation, intraosseous infusion, and needle thoracostomy. Methods: A randomized controlled study was conducted with pcPA students (n = 48) at a midwestern program. Participants were randomly assigned to cadaver trained (CT), task trainer (TT), or control group (CG). We assessed procedural competency using skill-specific rubrics and performed qualitative analysis of student comments regarding skill-specific procedural preparedness. Results: Intervention groups surpassed the control group on all skills. The CT students exhibited significantly higher procedural competency compared to TT-trained students in endotracheal intubation (p = 0.0003) and intraosseous infusion (p = 0.0041). Thematic analysis of student comments revealed pre-training students consistently felt unprepared and lacked confidence to perform needle thoracostomy, tube thoracostomy, and endotracheal intubation. Post-training perceptions, CT/TT, focused on preparedness and confidence. The CT group also consistently described the impact of realistic simulation. Conclusion: High-fidelity training with soft-preserved cadavers may be the most effective way to prepare pcPA students to perform endotracheal intubation and intraosseous infusion. Student perspectives on procedural preparedness highlight the importance of multidimensional, realistic training methods. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-022-01575-0.

Implementation and Evaluation of Virtual Laboratory Tours for Laboratory Diagnosis of Hematologic Disease.

OBJECTIVES: There is often limited time allocated to teaching laboratory medicine to medical students. Without adequate time and context, it can be difficult for students to learn appropriate uses and limitations of laboratory tests. Introducing students to the laboratories and test methods may help them learn these concepts, but physical laboratory tours are difficult to organize for large groups, especially during the coronavirus disease 2019 pandemic. METHODS: We created virtual laboratory tours consisting of short video clips and voiceover PowerPoint slides to teach students about the laboratory tests used to diagnose hematologic malignancies. We assessed the impact on student performance on laboratory medicine-themed quiz questions and surveyed the students to determine their attitudes about the activity. RESULTS: In total, 129 first-year medical students participated in the study. The average score on the preactivity quiz was 59.8%, and the average score on the postactivity quiz was 92.2%. Students were more confident in their ability to answer quiz questions after completing the activity. Postactivity survey data indicated that the students enjoyed the activity and felt it was an effective way to learn the material. CONCLUSIONS: Virtual laboratory tours show promise as a method of incorporating more laboratory medicine content into medical school curricula.

Implementation and evaluation of a self-directed learning activity for first-year medical students.

Background: It is critical that medical students develop self-directed, life-long learning skills to navigate medical school successfully and to become competent healthcare professionals. Moreover, the Liaison Committee on Medical Education (LCME), the USA medical school accrediting body, requires activities designed to help students develop self-directed learning (SDL) skills in the preclinical years.Objective: We evaluated the feasibility and effectiveness of a self-directed learning activity in a 6-week first-year medical student course.Design: The course director assigned infectious disease case studies to teams of first-year medical students who individually assessed their knowledge gaps of the case, identified scholarly sources to fill their knowledge gaps, shared the information with their teammates, and reflected on their ability to guide their own learning. Students were asked to rate workload, team effort, acquisition of new clinical knowledge, and life-long learning skills. Students were also asked to reflect on how this assignment affected their perception of their SDL skills. Descriptive statistics were used to analyze responses to the Likert scale questions. Thematic analysis was applied to the comments.Results: Survey response rate was 80% (131/163). Students strongly or moderately agreed that 1) they spent an appropriate amount of time on the project (94%), 2) the workload was evenly distributed among their teammates (95%), 3) their teammates made significant and timely contributions to the project (97%), 4) the project contributed to learning new clinical knowledge (92%), and 5) the project contributed to the acquisition of life-long learning skills (85%). The analysis team identified four themes from student reflections on their perception of their self-directed learning skills: self-learning skills, collaboration, application, and meta-cognition,Conclusions: Study results demonstrated that we successfully implemented a case-based SDL activity in a first-year medical school course and that students perceived the activity as a valuable learning experience.

Key Studies in Medical Education from 2017: ANarrative Review.

Education, like clinical medicine, should be based on the most current evidence in the field. Despite the overwhelming breadth of literature in medical education, pediatric educators desire and need to incorporate best practices into their educational approaches. This article provides an overview of 18 articles from the literature in 2017 that the authors consider to be key articles in the field of pediatric medical education. The 7 authors, all medical educators with combined leadership experience and expertise across the continuum of pediatric medical education, used an iterative, staged process to review more than 1682 abstracts published in 2017. This process aimed to identify a subset of articles that were most relevant to educational practice and most applicable to pediatric medical education. In the process, pairs of authors independently reviewed and scored abstracts in 13 medical education-related journals and reached consensus to identify the abstracts that best met these criteria. Selected abstracts were discussed using different pairs to select the final articles included in this review. This paper presents summaries of the 18 articles that were selected. The results revealed a cluster of studies related to feedback, coaching, and observation; trainee progression, educator development, trainee entrustment, culture, and climate; and the medical student experience. This narrative review offers a useful tool for educators interested in keeping informed about the most relevant and valuable information in the field of medical education.

How Mentor Identity Evolves: Findings From a 10-Year Follow-up Study of a National Professional Development Program.

PURPOSE: Despite academic medicine's endorsement of professional development and mentoring, little is known about what junior faculty learn about mentoring in implicit curricula of professional development programs, and how their mentor identity evolves in this context. The authors explored what faculty-participants in the Educational Scholars Program implicitly learned about mentoring and how the implicit curriculum affected mentor identity transformation. METHOD: Semistructured interviews with 19 of 36 former faculty-participants were conducted in 2016. Consistent with constructivist grounded theory, data collection and analysis overlapped. The authors created initial codes informed by Ibarra's model for identity transformation, iteratively revised codes based on incoming data patterns, and created visual representations of relationships amongst codes to gain a holistic, shared understanding of the data. RESULTS: In the implicit curriculum, faculty-participants learned the importance of having multiple mentors, the value of peer mentors, and the incremental process of becoming a mentor. The authors used Ibarra's model to understand how the implicit curriculum worked to transform mentor identity: Faculty-participants reported observing mentors, experimenting with different ways to mentor and to be a mentor, and evaluating themselves as mentors. CONCLUSIONS: The Educational Scholars Program's implicit curriculum facilitated faculty-participants taking on mentor identity via opportunities it afforded to watch mentors, experiment with mentoring, and evaluate self as mentor, key ingredients for identity construction. Leaders of professional development programs can develop faculty as mentors by capitalizing on what faculty-participants learn in the implicit curriculum and deliberately structuring postgraduation mentoring opportunities.

Top Medical Education Studies of 2016: A Narrative Review.

Education, like clinical medicine, should be based on the most current evidence in the field. Unfortunately, medical educators can be overwhelmed by the sheer volume and range of resources for this literature. This article provides an overview of 15 articles from 2016 that the authors consider the top articles in the field of pediatric medical education. The 7 authors, all medical educators with combined leadership and expertise across the continuum of pediatric medical education, used an iterative 3-stage process to review more than 6339 abstracts published in 2016. This process was designed to identify a small subset of articles that were most relevant to educational practices and most applicable to pediatric medical education. In the first 2 stages, pairs of authors independently reviewed and scored abstracts in 13 medical education-related journals and reached consensus to identify the articles that best met these criteria. In the final stage, all articles were discussed using a group consensus model to select the final articles included in this review. This article presents summaries of the 15 articles that were selected. The results revealed a cluster of studies related to observed standardized clinical encounters, self-assessment, professionalism, clinical teaching, competencies/milestones, and graduate medical education management strategies. We provide suggestions on how medical educators can apply the findings to their own practice and educational settings. This narrative review offers a useful tool for educators interested in keeping informed about the most relevant and valuable information in the field.

Community Engagement: Why Oklahoma? Why Now?

IMPORTANCE: Oklahoma ranked 43rd in the 2017 America's Health Rankings largely due to health behaviors such as adult obesity, lack of physical activity and smoking. Oklahoma children also suffer from adverse childhood experiences that contribute to poor health outcomes. Community engagement, a process that involves people affiliated by geographic location and shared interest working together to address issues affecting community wellbeing, is a common model that has had some success in Oklahoma communities addressing child health. OBSERVATIONS: Factors that contribute to poor health in Oklahoma include not only health behaviors such as obesity and smoking, but also lack of access to care created by a lack of health insurance and primary care providers, compounded by the largely rural nature of the state. The National Institutes of Health is committed to funding research aimed at improving the health of rural and disadvantaged populations. Historically, these populations are difficult to reach and may not be interested in the national health research initiatives, but rather want to focus on health issues important to their communities. CONCLUSIONS AND RELEVANCE: In this article we discuss some of Oklahoma's most pressing pediatric health needs, community engagement efforts to address these issues and a newly funded NIH grant at OUHSC aimed at supporting and learning from these efforts.

Influence of Genetic Counseling Graduate Program Websites on Student Application Decisions.

This study investigated how genetic counseling educational program websites affect application decisions via an online survey sent to current students and recent graduates. Program leadership: directors, assistant directors, associate directors, were also surveyed to determine where their opinions coincided or differed from those reported by students and recent graduates. Chi square analysis and t-tests were used to determine significance of results. A two-sample t-test was used to compare factors students identified as important on a 5-point Likert scale with those identified by directors. Thematic analysis revealed three major themes students consider important for program websites: easy navigation, website content, and website impression. Directors were interested in how prospective students use their program website and what information they found most useful. Students indicated there were specific programs they chose not to apply to due to the difficulty of using the website for that program. Directors significantly underestimated how important information about application requirements was to students in making application decisions. The information reported herein will help individual genetic counseling graduate programs improve website functionality and retain interested applicants.

Transitioning From Medical Educator to Scholarship in Medical Education.

Clinician educators spend most of their time in clinical practice, educating trainees in all types of care settings. Many are involved in formal teaching, curriculum development and learner assessment while holding educational leadership roles as well. Finding time to engage in scholarly work that can be presented and published is an academic expectation, but also a test of efficiency. Just as clinical research originates from problems related to patients, so should educational research originate from issues related to educating the next generation of doctors. Accrediting bodies challenge medical educators to be innovative while faculty already make the best use of the limited time available. One obvious solution is to turn the already existing education work into scholarly work. With forethought, planning, explicit expectations and use of the framework laid out in this article, clinical educators should be able to turn their everyday work and education challenges into scholarly work.

Photoreceptor development in premetamorphic and metamorphic Xenopus laevis.

Transgenic Xenopus laevis are commonly used to study gene expression in photoreceptors, but only red rods and red cones are known to exist in the pre-metamorphic stages commonly used in transgenic studies. Using RT-PCR, this study shows that violet cones develop in early pre-metamorphic stages (Stage 35) with the red rods and red cones. Green rod development began in Stage 53 with the onset of metamorphosis.

The rat Apg3p/Aut1p homolog is upregulated by ischemic preconditioning in the retina.

PURPOSE: Retinas can be protected from subsequent severe ischemic injury by ischemic preconditioning. Ischemic preconditioning is dependent on gene expression and protein synthesis; however, it is not clear which genes are important in this process. In this study, we have identified and characterized the rat homolog of yeast Apg3p/Aut1p, an important autophagy protein encoded by the autophagy 3-like (APG3L) gene. We have also further characterized the homologous human APG3L gene. METHODS: A fragment of the rat Apg3 cDNA was identified by mRNA differential display from hypoxia-treated E1A-NR3, an immortalized cell line derived from rat retinal cells that manifests phenotypes of retinal neurons. The full length of rat Apg3 (rApg3) cDNA sequence (about 1.4 kb) encoding 341 amino acids was cloned from a rat retinal cDNA library and characterized using Southern and northern blot analysis, and a global GenBank search. Protein expression was determined by western blotting, and immunohistochemistry. Ischemic preconditioning was achieved by ligation of the retinal arteries of the right eye for 5 min followed by 5 h reperfusion. The prolonged retinal ischemia was induced by ligation of the retinal arteries for 45 min followed by 5 h reperfusion. The full-length homologous human APG3L gene was cloned and sequenced from a human genomic DNA library. RESULTS: The combination of genomic Southern blot analysis and a global GenBank search indicated that rat APG3L is a single copy gene. Rat Apg3 mRNA is expressed in the retina at a high level but is also detected in other tissues. In the process of comparing the rat and human APG3L genes we showed that the organization of the human APG3L gene includes a unique transcriptional start site, a coding region with 12 translated exons and 11 introns and is located on human chromosome 3q13.1. Subcellular localization studies showed that recombinant rat autophagocytosis protein (Apg3p) is a cytosolic protein. Rat Apg3 mRNA level was upregulated by ischemic preconditioning but downregulated by prolonged ischemia. CONCLUSIONS: Our results suggest that the upregulation of rApg3 is a specific response to ischemic preconditioning rather than to retina ischemia, and autophagy may contribute to the neuroprotective effect of ischemic preconditioning in the retina.

A novel Xenopus SWS2, P434 visual pigment: structure, cellular location, and spectral analyses.

PURPOSE: The purpose of this study was to clone and characterize the green rod pigment in Xenopus laevis. METHODS: The cDNA for the Xenopus "green rod" pigment was cloned and sequenced from Xenopus retina mRNA by reverse transcription polymerase chain reaction and the 5' end cloned by rapid amplification of the cDNA ends. The cellular localization of the Xenopus opsin was determined by immunolabeling of flat-mounted retinas using a specific antibody against this opsin. Spectral properties of the expressed protein were determined by absorption spectroscopy using recombinant pigment. RESULTS: A novel Xenopus opsin cDNA containing a full-length coding region has been cloned and sequenced. The deduced amino acid sequence predicts a protein of 362 amino acids, forming 7 hydrophobic helices. Sequence analysis indicates that it belongs firmly to the SWS2 class of visual pigments and has 89%, 80%, and 75% amino acid sequence identity with bullfrog, tiger salamander, and newt SWS2 pigments, respectively. Staining of Xenopus retina with a Xenopus SWS2 opsin-specific polyclonal antibody demonstrated that the SWS2 pigment is expressed in green rods. After expression in COS cells, reconstitution with 11-cis retinal, and purification, the SWS2 pigment exhibits an absolute absorption maximum of 434 nm Thus, the name "SWS2, P434" was assigned for this opsin. The pigment decays rapidly in hydroxylamine in the dark, unlike the red rod pigment, rhodopsin. CONCLUSIONS: A novel green rod opsin cDNA has been cloned and sequenced from the retina of adult Xenopus laevis, which encodes a protein belonging to the SWS2 group of opsins. The expressed opsin possesses cone-opsin-like properties although it was identified only in the Xenopus green rod cells.