Assessing Videoconference Etiquette in Academia: Determining Positive and Negative Associations With Online Interactions.

INTRODUCTION: The lack of guidelines for videoconferencing etiquette elucidated frustrations during the COVID-19 pandemic. The authors aimed to assess the perceptions of faculty educators and residents regarding videoconferencing etiquette. METHODS: In 2021, a survey assessing perceptions regarding the formality of various meeting types and the importance of various videoconferencing etiquette practices (Likert scale of 1-5) was created and disseminated to all faculty educators and residents at a single institution. Responses of faculty versus residents were analyzed in general and by procedural and mixed/nonprocedural subspecialties. RESULTS: The faculty response rate was 53.5% (38/71). The resident response rate was 7.3% (115/1569). A total of 19 departments were represented. Faculty respondents reported having significantly more hours of weekly formal meetings than residents, 4 (3-10) versus 2 (1-4) h (P < 0.05), and no difference in informal meeting hours, with 3 (2-6) versus 3 (1.6-5) h (P = 0.210). Faculty and residents concurred on the formality of all meeting types except for didactics, which residents regarded more frequently as informal (80.9% versus 57.9%; P < 0.01). Faculty rated wearing professional attire and keeping one's video on as mattering more, and that videoconferencing from bed was more inappropriate (P < 0.05). Furthermore, faculty and residents in mixed/nonprocedural specialties had more significantly discordant perceptions between them than did those in procedural specialties. CONCLUSIONS: The data demonstrated that faculty educators and residents have differing perceptions regarding the formality of meeting types and etiquette practices. These should be addressed to prevent future frustrations and improve engagement in ongoing virtual conferencing education.

The Role of Breast Cancer Stem Cells in Chemoresistance and Metastasis in Triple-Negative Breast Cancer.

Triple negative breast cancer (TNBC) remains an aggressive disease due to the lack of targeted therapies and low rate of response to chemotherapy that is currently the main treatment modality for TNBC. Breast cancer stem cells (BCSCs) are a small subpopulation of breast tumors and recognized as drivers of tumorigenesis. TNBC tumors are characterized as being enriched for BCSCs. Studies have demonstrated the role of BCSCs as the source of metastatic disease and chemoresistance in TNBC. Multiple targets against BCSCs are now under investigation, with the considerations of either selectively targeting BCSCs or co-targeting BCSCs and non-BCSCs (majority of tumor cells). This review article provides a comprehensive overview of recent advances in the role of BCSCs in TNBC and the identification of cancer stem cell biomarkers, paving the way for the development of new targeted therapies. The review also highlights the resultant discovery of cancer stem cell targets in TNBC and the ongoing clinical trials treating chemoresistant breast cancer. We aim to provide insights into better understanding the mutational landscape of BCSCs and exploring potential molecular signaling pathways targeting BCSCs to overcome chemoresistance and prevent metastasis in TNBC, ultimately to improve the overall survival of patients with this devastating disease.

Smart Glasses as a Surgical Pathology Grossing Tool.

CONTEXT.­: Smart glasses are a wearable technology that enable hands-free data acquisition and entry. OBJECTIVE.­: To develop a surgical pathology grossing application on a smart glass platform. DESIGN.­: An existing logistics software for the Google Glass Enterprise smart glass platform was used to create surgical pathology grossing protocols. The 2 grossing protocols were developed to simulate grossing a complex (heart) and a simple (kidney) specimen. For both protocols, users were visually prompted by the smart glass device to perform each task, record measurements, or document the field of view. In addition to measuring the total time of the protocol performance, each substep within the protocol was automatically recorded. Subsequently, a report was generated that contained the dictation, images, voice recordings, and the timing of each step. The application was tested by 3 users using the 2 grossing protocols. The users were tracked across 3 grossing procedures for each protocol. RESULTS.­: For the complex specimen grossing the average time across repeated procedures was not significantly different between users (P > .99). However, when grossing times of the complex specimen were compared for repeated performances of the same user, a significant reduction in grossing times was observed with each repetition (P = .002). For the simple specimen, the average grossing time across multiple attempts was different among users (P = .03); however, no improvement in grossing time was observed with repeated performance (P = .499). CONCLUSIONS.­: Augmented reality based grossing applications can provide automated data collection to track the changes in grossing performance over time.

Using the NAM diagnostic process framework to teach clinical reasoning in computerized case presentations to 251 medical students.

OBJECTIVES: Explicit education on diagnostic reasoning is underrepresented relative to the burden of diagnostic errors. Medical educators report curricular time is a major barrier to implementing new curricula. The authors propose using concise student-identified educational opportunities -- differential diagnosis and summary statement writing -- to justify curriculum development in diagnostic reasoning. METHODS: Eighteen clerkship and 235 preclinical medical students participated in a 1 h computerized case presentation and facilitated discussion. Students were surveyed on their attitudes toward the case. RESULTS: All 18 (100% response) clerkship students and 121 of the 235 preclinical students completed the survey. Students felt the module was effective and relevant. They proposed medical schools consider longitudinal computerized case presentations as an educational strategy. CONCLUSIONS: A computerized case presentation is a concise instructional strategy to teach critical points in diagnosis to clerkship and preclinical medical students.

Empirical comparison of three assessment instruments of clinical reasoning capability in 230 medical students.

BACKGROUND: Several instruments intend to measure clinical reasoning capability, yet we lack evidence contextualizing their scores. The authors compared three clinical reasoning instruments [Clinical Reasoning Task (CRT), Patient Note Scoring rubric (PNS), and Summary Statement Assessment Rubric (SSAR)] using Messick's convergent validity framework in pre-clinical medical students. Scores were compared to a validated clinical reasoning instrument, Clinical Data Interpretation (CDI). METHOD: Authors administered CDI and the first clinical case to 235 students. Sixteen randomly selected students (four from each CDI quartile) wrote a note on a second clinical case. Each note was scored with CRT, PNS, and SSAR. Final scores were compared to CDI. RESULTS: CDI scores did not significantly correlate with any other instrument. A large, significant correlation between PNS and CRT was seen (r = 0.71; p = 0.002). CONCLUSIONS: None of the tested instruments outperformed the others when using CDI as a standard measure of clinical reasoning. Differing strengths of association between clinical reasoning instruments suggest they each measure different components of the clinical reasoning construct. The large correlation between CRT and PNS scoring suggests areas of novice clinical reasoning capability, which may not be yet captured in CDI or SSAR, which are weighted toward knowledge synthesis and hypothesis testing.

Convergent Validity of a Novel Clinical Reasoning Tool in Clerkship Medical Students: Pilot Study.

Medical student educators have limited tools for standardized clinical reasoning assessment. The clinical reasoning task (CRT) checklist has been shown to identify specific tasks in the diagnostic process among residents and faculty. Authors assessed a novel student think aloud protocol strategy, the CRT, compared with the validated clinical data interpretation (CDI) test in six third-year medical students. The CRT was scored by two independent reviewers (kappa = 0.88). CRT and CDI scores were strongly positively correlated (r = 0.768, p = 0.074, df = 4). CRT provides both a global assessment of clinical reasoning and specific clinical reasoning deficits.