Optimal timing of faculty teaching when combined with near-peer teaching: A mixed methods analysis.

BACKGROUND: Near-peer teaching is increasingly used in medical education, supporting or replacing faculty teaching. It has positive aspects for learners and tutors, some of which are explained by higher social and cognitive congruence between learners and near-peer tutors (NPTs). This study investigates the optimal combination of faculty tutors (FTs) and NPTs in an abdominal ultrasound course. METHODS: Sixty-four third-year medical students underwent a basic ultrasound course, with 75% of lessons taught by NPTs and 25% by FTs. Each of four groups had a different faculty teaching timing. A mixed methods approach used a survey and semi-structured interviews at the course end to elicit learners' preferences, and end-of-course examination scores to look for differences in outcomes. RESULTS: Most learners preferred having faculty teaching in the second half of the course, saying it would be overwhelming to start with FTs. Learners preferred between a quarter and a third of the teaching to be from FTs, with NPTs rated better at teaching basics, and FTs contributing unique, helpful clinical knowledge. There was no significant between-group difference in examination scores. CONCLUSIONS: Medical students preferred most of their teaching to be from NPTs, with some faculty input in the second half of the course.

Near-peer compared to faculty teaching of abdominal ultrasound for medical students - A randomized-controlled trial.

PURPOSE: Medical schools increasingly rely on near-peer tutors for ultrasound teaching. We set out to compare the efficacy of a blended near-peer ultrasound teaching program to that of a faculty course in a randomized controlled trial. METHODS: 152 medical students received 21 hours of ultrasound teaching either by near-peer teachers or medical doctors. The near-peer course consisted of blended learning that included spaced repetition. The faculty-led course was the European common course for abdominal sonography. The primary outcome measurement was the students' ultrasound knowledge at month 6, assessed by structured examination (score 0 to 50). Secondary outcomes included scores at month 0 and changes in scores after the course. RESULTS: Students in the near-peer group scored 37 points, and students in the faculty group scored 31 points six months after course completion. The difference of 5.99 points (95% CI 4.48;7.49) in favor of the near-peer group was significant (p<0.001). Scores immediately after the course were 3.8 points higher in the near-peer group (2.35; 5.25, p<0.001). Ultrasound skills decreased significantly in the six months after course completion in the faculty group (-2.41 points, [-3.39; -1.42], p<0.001]) but barely decreased in the near-peer group (-0.22 points, [-1.19; 0.75, p=0.66]). CONCLUSION: The near-peer course that combined blended learning and spaced repetition outperformed standard faculty teaching in basic ultrasound education. This study encourages medical schools to use peer teaching combined with e-learning and spaced repetition as an effective means to meet the increasing demand for ultrasound training.

[Revision of the Young Sonographers Basic e-Learning Abdomen Course]. / Revision des e-Learnings zum Grundkurs Abdomen der Young Sonographers.

Revision of the Young Sonographers Basic e-Learning Abdomen Course Abstract. Current situation: The Young Sonographers e-learning was created in 2017 and contains the theoretical content and the procedure for the practical examination technique of the basic course on abdominal ultrasound. In order to provide an optimal teaching tool for ultrasound training in Switzerland in the future, this e-learning material has now been revised. Methodology: The feedback from various experts as well as from participants, tutors and examiners served as the basis for the revision. Results and discussion: The feedback revealed five categories that needed adaptation: the structure of the examination procedures, the coherence between text and video, the reasonable use of video versus written text, the accurate naming of acts and tools and the quantitative balance of the module structures. After revision of these weak points, new scripts were written and filmed as video recordings. The digitally optimized implementation on the website is still under construction at the time of publication.

[Rare Incidental Finding during a Student Ultrasonography Course - A Case Report]. / Seltener Zufallsbefund in einem studentischen Sonografiekurs ­ ein Fallbericht.

Rare Incidental Finding during a Student Ultrasonography Course - A Case Report Abstract. During a sonography class in medical school, a large fluid-filled mass was discovered in the center of the lower abdomen in a healthy, asymptomatic female student; an overflow bladder was suspected. Despite various interdisciplinary investigations, the etiology of the cystic formation could not be clarified. Three months after discovery of the incidental finding, the increasingly symptomatic patient was diagnosed with a cystic tumor in the lower abdomen with secondary urinary retention, and surgical cyst excision was performed. A large, serous Paratubular cyst was found on the left side with torsion of the tube without signs of ischemia and without malignancy. Incidental findings in ultrasound teaching are not uncommon. Course participants, tutors, and course instructors must be aware of this and have a clear procedure at hand in order to deal with it.

[Five Tips for Practical Ultrasound Teaching from the Perspective of Peer Tutors]. / Fünf Tipps für den praktischen Ultraschall-Unterricht aus der Perspektive von Peer-Tutorinnen und -Tutoren.

Five Tips for Practical Ultrasound Teaching from the Perspective of Peer Tutors Abstract. Abtract: When learning diagnostic ultrasound, practical teaching in small groups is of particular importance. In this article, we present five tips that we consider particularly important for successful and effective ultrasound teaching from the perspective of peer tutors.

[Emergency Ultrasound Training for and with Medical Students]. / Notfallsonografie für Studierende.

Emergency Ultrasound Training for and with Medical Students Abstract. Practical basic skills in sonography are a mandatory part of Swiss medical schools since 2018. The universities of Basel and Bern teach students the content of the POCUS component "Basic Emergency Sonography" of the SGUM and have developed the e-learning tool "POCUS Emergency Sonography" for this purpose in cooperation. By using this innovative blend- ed learning concept, students acquire basic skills in sonography and can build upon this know-how in their further education.

[Near-Peers First, Physician Tutors Last. Interim Report of a Mixed-Methods Study Exploring Optimal Timing in Undergraduate Ultrasound Teaching]. / Near-Peers zuerst, ärztliche Tutorierende am Schluss. Zwischenbericht einer Mixed-Method-Studie zum Timing im Ultraschallunterricht.

Near-Peers First, Physician Tutors Last. Interim Report of a Mixed-Methods Study Exploring Optimal Timing in Undergraduate Ultrasound Teaching Abstract. While many medical undergraduate ultrasound teaching programmes combine teaching from both physician and student ('near-peer') tutors, there has been little research on how these can be optimally combined. In this study, four groups of 16 medical undergraduates each received twelve lessons from student tutors and four lessons from physician tutors as part of their basic ultrasound course. Each group's physician tutor lessons took place in a different quarter of the course timetable. Quantitative and qualitative data were then collected through an online questionnaire, and 15 participants had 1:1 interviews. This interim analysis shows that, when designing combined ultrasound teaching for medical undergraduates, student tutors should be used at the start and physician tutors in the second half of the programme.

Managing Incidental Findings Reported by Medical, Sonography and Other Students Performing Educational Ultrasound Examinations.

The evolution of ultrasound imaging into a key technology for diagnostic practice has resulted in its incorporation into the education of medical students worldwide. Although the introduction of ultrasound into medical schools' curricula is relatively recent, training of sonographers and other ultrasound users is mature. Ultrasound is being used in a variety of learning environments and clinical settings, from courses in anatomy and physiology to clinical rotations where medical and other students may scan healthy volunteers or patients, sometimes with little to no supervision. Educators may be apprehensive about a perceived high likelihood that students will encounter unexpected findings during these sessions, which could distress the patient or ultrasound model as well as the student, and result in problems that would be more pronounced if such incidental findings are complex. Policies are needed to address how to manage incidental ultrasound findings that are identified during educational activities. This article summarizes the background and provides a framework for establishing and implementing a well-designed and thoughtful approach for dealing with incidental findings observed in volunteer subjects by medical students during training courses in ultrasound diagnostic scanning. Subject confidentiality should be respected, and review of incidental findings should be transparent without provoking unnecessary anxiety. It is the responsibility of the instructor or supervisor to ensure adequate clinical follow-up if indicated.

[Peer Teaching in Ultrasound Education - A Narrative Review]. / Peer-Teaching in der Ultraschall-Ausbildung ­ Eine Übersichtsarbeit.

Peer Teaching in Ultrasound Education - A Narrative Review Abstract. Learning about ultrasound is becoming an increasingly important component of the undergraduate medical curriculum. However, teaching about this is very time-consuming, which is why many universities use peer teaching in ultrasound training. Peer teaching has various advantages that go beyond reducing specialists' teaching time: students may learn more from their peers because their cognitive schemata are more congruent and they are more likely to be open about their learning deficits. In addition, the process of teaching leads to increased learning and motivation in the peer teachers themselves. Most studies that compare peer teaching with teaching from medically qualified tutors show comparable learning effects, with different advantages for the two settings.

Comparing Blended Learning with Faculty-Led Ultrasound Training: Protocol for a Randomised Controlled Trial (The SIGNATURE Trial).

Background: Ultrasound is increasingly used in clinical practice as a bedside tool. As medical graduates first encounter the technique in early residency, ultrasound training needs to be integrated into the undergraduate curriculum. In Switzerland, abdominal ultrasound skills have been taught by a faculty-led, 21-hour course. However, this course does not have sufficient capacity to meet the increasing demand, and there have been doubts about its effectiveness as a teaching method. We therefore developed a 21-hour blended-learning course, comprising five hours of e-learning and 16 hours of near-peer tutoring. This study investigates whether this new teaching format is as good as, or superior to, the faculty-led method. Methods: The SIGNATURE study is an investigator-initiated, two-arm, randomised controlled trial, enrolling 152 medical students at the Universities of Bern, Fribourg and Zurich. Stratified by study site, students are 1:1 randomised to either the blended-learning course or the faculty-led 2.5-day ultrasound course. Students undergo a six-station objective structured clinical examination (OSCE) and complete an online questionnaire immediately after the course and 6 months later. Discussion: If demonstrated to be effective, the blended-learning course would allow an increase in the number of undergraduate medical students that can acquire ultrasound skills before starting their residencies.

Emancipatory Nursing Praxis: A Theory of Social Justice in Nursing.

Emancipatory nursing praxis (ENP) is a middle-range nursing theory of social justice developed from an international, grounded theory study of the critical factors influencing nurses' perceptions of their role in social justice. The ENPs implementing processes (becoming, awakening, engaging, and transforming) and 2 conditional contexts (relational and reflexive) provide an in-depth understanding of the transformative learning process that determines nurse engagement in social justice. Interpretive findings include the voice of Privilege primarily informed ENP theory, the lack of nursing educational and organizational support in social justice role development, and the advocate role should expand to include the role of an ally.

Diminished acute phase response and increased hepatic inflammation of aged rats in response to intraperitoneal injection of lipopolysaccharide.

Aging is associated with a deterioration of the acute phase response to inflammatory challenges. However, the nature of these defects remains poorly defined. We analyzed the hepatic inflammatory response after intraperitoneal administration of lipopolysaccharide (LPS) given to Fisher 344 rats aged 6, 15, and 22-23 months. Induction of the acute phase proteins (APPs), haptoglobin, alpha-1-acid glycoprotein, and T-kininogen was reduced and/or retarded with aging. Initial induction of interleukin-6 in aged rats was normal, but the later response was increased relative to younger counterparts. An exacerbated hepatic injury was observed in aged rats receiving LPS, as evidenced by the presence of multiple microabscesses in portal tracts, confluent necrosis, higher neutrophil accumulation, and elevated serum levels of alanine aminotransferase, relative to younger animals. Our results suggest that aged rats displayed a reduced expression of APPs and increased hepatic injury in response to the inflammatory insult.

T-kininogen: a biomarker of aging in Fisher 344 rats with possible implications for the immune response.

T-kininogen (T-KG) is a reliable biomarker of aging in male Sprague-Dawley rats. Here we confirm, in a longitudinal study, a similar behavior in Fisher 344 rats of both sexes. In males, the increase in serum levels of T-KG follows an exponential curve, whereas in females the increase is best fitted by a linear curve. In both genders, dietary restriction delays the increase in T-KG. We have previously shown that T-KG inhibits T lymphocyte proliferation. Here we show that serum T-KG levels correlate negatively with the ability of splenocytes (most likely B cells) to proliferate in response to lipopolysaccharide. A similar correlation was not observed with other markers of inflammation, including alpha1-acid glycoprotein (AGP), haptoglobin, or interleukin-10. We conclude that the increase in serum T-KG represents a useful biomarker of aging in Fisher 344, and it correlates with decreased lymphocyte proliferation with age, although a cause-effect relationship has not been established.

Serum from aged F344 rats conditions the activation of young macrophages.

There is considerable controversy about the molecular mechanisms responsible for the variations in innate immunity associated with age. While in vivo, aged animals and humans react to an inflammatory signal with an excessive production of pro-inflammatory cytokines, studies in vitro generally show that this response is attenuated in macrophages from old individuals. In an effort to examine possible extrinsic factors that might affect the response of macrophages to lipopolysaccharide (LPS), we have challenged peritoneal macrophages obtained from young rats with sera obtained from rats of different ages. Our results indicate that the serum from aged rats significantly impairs the capacity of young macrophages to induce tumor necrosis factor-alpha (TNF-alpha) production, while at the same time it increases the basal levels of interleukin-6 (IL-6). The effect of serum from aged donors on TNF-alpha secretion requires pre-incubation and is sensitive to heat inactivation. In contrast, the stimulating effect on IL-6 is resistant to heat, and thus should not be due to a protein factor. Therefore, our results indicate that the age-related changes in macrophage activity are not only the consequence of intrinsic changes, but there also appears to be a modulatory effect imparted by the external milieu.

T-kininogen induces endothelial cell proliferation.

Basal proliferation of endothelial cells increases with age, and this might play a role in the etiology of age-related vascular diseases, as well as angiogenesis. Serum kininogen levels increase during aging in rats and humans, and T-kininogen (T-KG) can affect proliferative homeostasis in several cell models. Both kinins and kininogens have been shown previously to be angiogenic through activation of endothelial cell proliferation, and here we show that exposure of endothelial cells to T-KG results in vigorous cell proliferation, accompanied by ERK/AKT activation. In our experiments, the proliferative response requires B1 and B2 kinin receptors, even though kinins are not released from the precursor. We hypothesize that the age-related increase in T-KG could play a significant role in the age-related dysregulation of vascular physiology and function.

T-kininogen, a cystatin-like molecule, inhibits ERK-dependent lymphocyte proliferation.

Plasma levels of kininogens increase with age in both rats and humans. Kininogens are inhibitors of cysteine proteinases, and filarial cysteine proteinase inhibitors (cystatins) reduce the proliferation of T cells. We evaluated whether T-kininogen (T-KG) might mimic this effect, and here we present data indicating that exposure of either rat splenocytes or Jurkat cells to purified T-KG results in inhibition of both ERK activation and [(3)H]-thymidine incorporation, both basal and in response to ConA or PHA. Interestingly, T-KG did not impair [(3)H]-thymidine incorporation in response to IL-2, which requires primarily the activation of the JNK and Jak/STAT pathways. These effects were neither the consequence of increased cell death, nor required the activity of kinin receptors. Furthermore, when T cell receptor proximal events were bypassed by the use of PMA plus Calcium ionophore, T-KG no longer inhibited ERK activation, suggesting that inhibition occurs upstream of these events, possibly at the level of membrane associated signal transduction molecules. We conclude that, like filarial cystatins, T-KG inhibits ERK-dependent T cell proliferation, and these observations suggest a possible role for T-KG in immunosenescence.

Increased kinin levels and decreased responsiveness to kinins during aging.

Kinins are vasoactive peptides released from precursors called kininogens, and serum levels of both T- and K-kininogens increase dramatically as rats age. Kinin release is tightly regulated, and here we show that serum kinin levels also increase with age, from 63 +/- 16 nmol/L in young Fisher 344 rats to 398 +/- 102 nmol/L in old animals. Both K- and T-kininogens contribute sequentially to this increase, with the increase in middle-aged animals being driven primarily by K-kininogen, whereas the further augmentation in older rats occurs by increasing T-kininogen. By measuring ERK activation, we show that aorta endothelial cells from old animals are hyporesponsive to exogenous bradykinin. However, if serum kinin levels are experimentally decreased by lipopolysaccharide treatment, then the endothelial response to bradykinin is re-established. These results indicate that serum levels of kinins increase with age, whereas the responsiveness of target cells to kinins is reduced in these same animals.

T-kininogen inhibits kinin-mediated activation of ERK in endothelial cells.

Serum levels of T-kininogen increase dramatically as rats approach the end of their lifespan. Stable expression of the protein in Balb/c 3T3 fibroblasts leads to a dramatic inhibition of cell proliferation, as well as inhibition of the ERK signaling pathway. T-kininogen is a potent inhibitor of cysteine proteinases, and we have described that the inhibition of ERK activity occurs, at least in part, via stabilization of the MAP kinase phosphatase, MKP-1. Since fibroblasts are not a physiological target of T-kininogen, we have now purified the protein from rat serum, and used it to assess the effect of T-kininogen on endothelial cells. Adding purified T-kininogen to EAhy 926 hybridoma cells resulted in inhibition of basal ERK activity levels, as estimated using appropriate anti-phospho ERK antibodies. Furthermore, exogenously added T-kininogen inhibited the activation of the ERK pathway induced by either bradykinin or T-kinin. We conclude that the age-related increase in hepatic T-kininogen gene expression and serum levels of the protein could have dramatic consequences on endothelial cell physiology, both under steady state conditions, and after activation by cell-specific stimuli. Our results are consistent with T-kininogen being an important modulator of the senescent phenotype in vivo.