Slack as a virtual undergraduate dermatology community: a pilot study.

BACKGROUND: Dermatology is under-represented in UK undergraduate curricula, and with a diagnostic and educational toolkit that is heavily centred on face-to-face (F2F) clinical examination, dermatology education has been disproportionately affected by the COVID-19 pandemic. Online channel-based messaging apps such as Slack offer an opportunity to engage students in remote, multimodal collaborative learning by reproducing a classroom environment in the virtual space. AIM: To determine the feasibility, acceptability and proof of concept for an online Slack community in undergraduate dermatology education. METHODS: Undergraduate medical students participated in an online classroom for a 6-week programme encompassing case-based discussions, seminars and journal clubs. The platform was facilitated by junior doctors (n = 10) and patient educators (n = 6). Students and faculty completed a post-course evaluation. Students additionally completed a pre- and post-intervention dermatology quiz. Mixed methods analyses included quantitative analyses to explore data trends and qualitative phenomenographic analyses to assimilate key underlying themes. RESULTS: Students (n = 65) were enrolled to join the platform. The evaluation was completed by students (n = 52) from UK universities (n = 27). The majority of students (n = 27) interacted with the platform as passive observers (≤ 5 active interactions with the channel), with a small group (n = 4) of 'super-users' (≥ 100 active interactions). The overall quality of the course was described as 'excellent' by 96% of participants and 100% of faculty. CONCLUSION: A community-based online classroom can act as an enjoyable, acceptable and collaborative means of delivering dermatology education to undergraduate medical students. Its ease of use and supportive nature may also facilitate patient involvement. Such advances may provide vital safeguards against the reduction in F2F learning that has accompanied the COVID-19 pandemic.

'I saw it on Facebook!' Assessing the influence of social media on patient presentation to a melanoma screening clinic.

BACKGROUND: The motivations for patients presenting to melanoma screening clinics (MSCs) with concerning skin lesions are poorly understood. Social media (SoMe) refers to online platforms designed to facilitate sharing of information with billions of users worldwide. There is evidence of patients posting skin lesion 'selfies' on SoMe, influencing internet searches. Interventions through SoMe may have positive impacts on health seeking behaviour. AIM: To identify the influence of SoMe on patients presenting to an MSC service, and to establish whether patients have been exposed to SoMe posts on skin cancer, from medical authorities or the public. METHOD: For this pilot study, qualitative data were collected from patient questionnaires over 7 consecutive weeks at MSCs in Newcastle upon Tyne hospitals. Questions involved demographics, factors influencing attendance, use of SoMe and exposure to content on skin lesions on SoMe. RESULTS: Questionnaires were collected from 249 patients across a range of ages. Self-examination of lesions was the most common driver. One person in the study population described SoMe as having motivated their attendance, while 30 patients recalled seeing posts from health authorities regarding skin cancer. Qualitative data indicated that patients could be influenced by targeted public health campaigns on SoMe. CONCLUSIONS: This study suggests that SoMe is not currently a major conscious driver to attend an MSC, even among SoMe-familiar populations. However, the fact that SoMe is ubiquitous in society, in conjunction with our qualitative data, may suggest that current strategies for SoMe melanoma information delivery are not of requisite quality to break through to target populations.

Exploring the perspectives of dermatology undergraduates with an escape room game.

BACKGROUND: A UK dermatology curricula review has suggested that undergraduate delivery relies on lectures and is subject to clinical and staffing pressures. Many UK undergraduate students feel less than adequately prepared to manage dermatological conditions, and misconceptions about dermatology are common. Educators have called for innovative solutions, including small group teaching. Escape rooms are games requiring teams to solve puzzles to escape from a room. AIM: To assess the impact of an escape room game on perceptions of dermatology among undergraduate medical students. METHODS: Students were invited to an escape room to consolidate lessons taught in a previous lecture. Students were first asked to complete a questionnaire about their preferred learning environments, perceptions of dermatology and confidence in content. Following the escape room event, these questions were revisited. Focus groups were then held to explore themes raised. RESULTS: In total, 16 students took part in the escape room sessions and in 3 focus groups. Feedback was strongly positive, with 100% of students expressing 'strongly agree' on whether they enjoyed the session. Qualitative data were coded for themes of accessibility, variety of taught content and awareness. The majority (94%) of students stated the escape room made them want to experience more dermatology. CONCLUSION: Prejudices about dermatology exist among medical students, and may act as a barrier to perceived accessibility to the specialty. Escape rooms can provide a shift to a more learner-centred approach, which may aid in combating these negative perceptions. They may act as an enjoyable means of consolidating lecture-based and clinical teaching, and require minimal resources.

Physician work force in Texas: planning for the future.

A number of proposals have been advanced to solve the shortage of primary care physicians in the United States. We analyzed the supply of primary care and nonprimary care physicians in Texas and contrasted work force supply with projected need. Texas has a serious shortage of primary care physicians and an adequate supply of nonprimary care specialists only in major urban areas. We also analyzed attitudes of medical students in and graduates of The University of Texas medical schools to assess factors that influenced their career choices. The most influential factors were remarkably similar among all groups and were related primarily to personal attributes and experience. This study assesses the current physician work force in Texas and suggests means by which policy can be decided to affect the supply and distribution of physicians in Texas.

Analysis of humoral and phagocytic defenses against Streptococcus pneumoniae serotypes 1 and 3.

To better define relationships among pneumococcal anticapsular antibodies, opsonophagocytosis, and in vivo mouse protection, we measured these functions in sera from healthy individuals who had not received pneumococcal vaccine. For serotype 1 pneumococci, the level of antibody measured by radioimmunoassay did not predict mouse protection, as has been noted by others. For some sera, opsonic requirements for antibody and complement could be clearly demonstrated and a strong correlation obtained between concentration of antibody and degree of phagocytic killing. However, for most sera, antibody concentration did not correlate with opsonic activity, as measured by phagocytic bactericidal assay or uptake of radiolabeled bacteria. Sera with high concentrations of anticapsular antibody did not always support in vitro bacterial killing by leukocytes. Conversely, highly opsonic sera did not necessarily have substantial levels of measurable antibody. Moreover, in vitro opsonophagocytic activity failed to predict in vivo protection; sera could be opsonic in vitro but not protective in vivo and vice versa. For serotype 3 pneumococci, antibody concentrations correlated strongly with mouse protective titers, as has been noted by others for type 3. Opsonophagocytosis, as measured by leukocyte bactericidal activity, required both complement and heat-stable substance(s) present in high-antibody sera, presumably antibody. Furthermore, increasing concentrations of serum enhanced phagocytic killing in a fashion that could be correlated with anticapsular antibody content. However, correlation with opsonophagocytosis was not so strong as with mouse protection, and there was no correlation between antibody concentration and opsonization as measured by uptake of radiolabeled bacteria. These observations suggest that opsonophagocytosis (with the definitive end point of bacterial killing) cannot be the standard against which to measure antibody concentrations. Furthermore, host protective mechanisms against pneumococci remain to be clearly defined. Even if opsonization by anticapsular antibody is the primary mechanism, there is need for development of improved functional assays of protection.

An objective measure of clinical performance.

Studies repeatedly have shown the clinical performance of students and residents to be less than expected by faculty. Because evaluation methods substantially influence education, poor performance can be improved with better clinical evaluation methods. This study evaluated a standardized method to measure clinical performance in which trained actual and simulated patients were organized in a multiple-station format for efficient testing of examinees on 17 cases in less than four hours. Specific checklists completed by patients and predetermined scoring protocols yielded reliable data and reduced faculty time. Data from 204 students in three clerkships were consistent with previous research showing case specificity and substantial case-to-case variability. As a group however, the students' overall total scores were very similar. This suggests that clinical education is inconsistent and that a profile of an examinee's performance is more accurate than a single overall score. Validity of this standardized clinical examination was supported by significant but moderate correlations with faculty ratings of ward performance and the medicine subtest of the National Board of Medical Examiners test, part II. Direct per-student costs were $21.00. This standardized objective examination of clinical skills is feasible for use in training programs and will provide reliable and valid data on clinical performance not available through typical methods.

A comparative evaluation of text formats in a medical school course.

Information mapping, a system of instruction design for categorizing, sequencing and graphically presenting printed information for highly technical communication in business, seemed ideally suited for presenting the technical procedures of the general screening physical examination to medical students. To evaluate the impact of this new text format one half of the class received a conventional text for those procedures and the other half used an information mapped text. Cognitive test scores were not significantly different. However, the information mapped text was rated significantly more favorably on six dimensions. Students using the mapped text also spent significantly more time studying it than those using the conventional text.

Opsonization of pneumococci. II. Metabolic effects of a "third" human serum activity that mediates intracellular killing.

We investigated the mechanisms by which a serum activity, neither complement nor immunoglobulin, mediates killing of pneumococci by polymorphonuclear leukocytes (PMN). Electron microscopy revealed type 25 pneumococci to be within PMN when incubated in normal serum, in serum absorbed twice at 0 degrees C with type 25 pneumococci, or in absorbed plus heat-inactivated serum. Uptake of radiolabeled bacteria, and activation of oxygen consumption and of the hexose monophosphate shunt by PMN with pneumococci, were similar in normal serum, absorbed serum, or the combination of absorbed and heat-activated serum. Reduction of nitroblue tetrazolium (NBT) and of cytochrome c by PMN in the presence of type 25 pneumococci and absorbed serum, with or without heat-inactivated serum were one-third and one-half, respectively, of those in normal serum. Likewise, protein iodination was one-half that in normal serum. Reduction of cytochrome c by cytochalasin B-treated PMN was the same in normal, absorbed, or absorbed plus heat-inactivated serum. Furthermore, release of beta-glucuronidase from PMN after ingestion of pneumococci in 10% normal, absorbed, or absorbed plus heat-inactivated serum was identical. These data indicate that the "third" serum activity is not necessary for attachment of pneumococci to or ingestion by PMN, nor is it necessary for stimulation of the plasma membrane oxidase. Rather, it functions somehow in intracellular killing.

Trypan blue inhibition of complement receptor function on various cells.

Trypan blue has previously been shown to inhibit complement-mediated phagocytosis by interaction with the C3 receptor but not with the Fc receptor. In studies reported here, trypan blue inhibited EAC3 rosette formation with human polymorphonuclear leucocytes (PMN) and mononuclear cells, rabbit alveolar macrophages (AM) and peritoneal PMN, and guinea-pig spleen cells. Trypan blue also inhibited C3-mediated bacterial adherence to the same receptor-bearing cells and to human glomerular cells. EAC3bi rosette formation was also inhibited, but EAC3d rosettes were not detected in our assay system. Although the precise molecular nature of C3b fragments deposited on antibody-sensitized erythrocytes has not been fully determined, trypan blue probably inhibits all C3 receptors from different species and may prove useful in vivo and in vitro for the definition of C3-receptor function in various aspects of the immune response.

A mechanism for the amelioration by hyperbaric oxygen of experimental staphylococcal osteomyelitis in rabbits.

Although hyperbaric oxygen (HBO) is as effective as cephalothin against osteomyelitis due to Staphylococcus aureus in the rabbit, the effect is not by directing killing. To investigate the mechanism, argon washouts (perfusion) and oxygen tensions were measured by intramedullary probes placed in the metaphyses of infected and uninfected tibias. In vitro phagocytic killing activity for S. aureus was determined at oxygen tensions found in these bones under ambient and HBO conditions. Mean tibial oxygen tensions (mm Hg) under ambient conditions were 21 (infected) and 45 (uninfected); under HBO conditions, 104 (infected) and 321 (uninfected). Perfusion was decreased in osteomyelitic bone and was not acutely increased by HBO in either normal or infected bone. Phagocytic killing of S. aureus was markedly decreased at 23 mm Hg of O2, significantly improved at 45 and 109 mm Hg, and most effective at 150 mm Hg. Thus, in osteomyelitic bone, HBO increased intramedullary oxygen to tensions consistent with normal phagocytic function.

Complement-independent adherence of Escherichia coli to complement receptors in vitro.

We studied adherence to human cells by a strain of Escherichia coli. Adherence to erythrocytes was assessed directly by phase-contrast microscopy and indirectly by hemagglutination; adherence to peripheral blood leukocytes, using radiolabeled bacteria and subsequent determination of leukocyte-associated radioactivity; and adherence to renal glomeruli, by microscopy of fluoresceinated bacteria and of Gram-stained nonfluoresceinated bacteria. In serum-free systems, E. coli of this strain adhered to human erythrocytes, which have surface receptors for the third component of complement (C3), but not to erythrocytes from species lacking this receptor. 1 mM trypan blue, a reagent that inhibits complement receptor function, inhibited adherence to human erythrocytes, as well as adherence to leukocytes and glomeruli. Preincubation of erythrocytes and leukocytes with complement-coated zymosan particles partially blocked subsequent bacterial adherence. Incubation of human erythrocytes with aging human serum, with trypsin-cleaved C3, or with C3 cleaved by the classical pathway convertase (EAC142)-all of which treatments deposited C3 on the erythrocyte surface, presumably at C3 receptors-inhibited subsequent E. coli adherence. Finally, incubation of E. coli with rabbit antiserum to human C3 blocked adherence to erythrocytes.Bacterial hemagglutination and erythrocyte adherence were not inhibited by mannose in concentrations up to 2.5%. And this strain of E. coli did not adhere to or agglutinate guinea pig erythrocytes, the usual test particle used for demonstration of common pili. Finally, electron microscopy of adherent bacteria showed only rare surface pili. In contrast, adherence to and agglutination of guinea pig erythrocytes by a stock piliated E. coli was inhibited by mannose but not by trypan blue. We conclude that organisms of this strain of E. coli adhere to human erythrocytes, leukocytes, and glomeruli at complement receptors. Complement is not required for this interaction. Adherence apparently involves a C3-like structure on the bacterial surface, but bacterial surface pili play no role. The physiological or pathological role of this adherence is not apparent, but study of this phenomenon may elucidate functions of complement receptors on various cells.