A Qualitative Analysis on the Effectiveness of Peer Feedback in Team-Based Learning.

Introduction: There is limited information on medical students' perceptions of peer feedback in team-based learning (TBL), both in terms of its value and how it has affected them as they move forward in their careers. The primary goals of this study were to examine students' perceptions about their peer feedback experiences throughout medical school and into residency and to identify areas for improvement to develop a more valuable experience. Materials and Methods: This study utilized exploratory qualitative research. A total of six focus group sessions were conducted, in which each group consisted of medical students or residents. All participants were asked for their thoughts about peer feedback using semi-structured interviews. The sessions were transcribed and thematic analysis of student responses was completed by independent reviewers. Results: A total of 11 first-year, 12 second-year, 12 rising third-year, and 10 rising fourth-year medical students participated in the focus groups. In addition, three graduates participated in the study. Overall, four key themes were identified regarding the peer feedback experience. These included (1) preparation and training, (2) procedure and implementation, (3) evaluation of student feedback, and (4) student considerations. Discussion: The participants indicated that the idea of providing and receiving effective peer feedback throughout the medical school curriculum was a valuable experience. This analysis raised awareness about several potential areas of difficulty for students in regard to the peer feedback process used in TBL. Quality improvement initiatives may include educating students about the use of constructive feedback, adding self-reflection, or using oral instead of written feedback.

Vascular function curve: confusion, clarification and new insights.

The vascular function curve (VFC) in cardiovascular physiology describes the relationship between the steady state venous return (VR in L/min, in the Y-axis) and the steady state right atrial pressure (RAP in mmHg, in the X-axis). However, in some literature, the RAP is considered the independent variable (IV) and the VR the dependent variable (DV), whereas in other literature, the VR is the IV and the RAP the DV. Because of this confusion, when the VFC is combined with the cardiac function curve (CFC), which describes the relationship between the steady state cardiac output and the RAP, it is not strange that the interpretations of the combination are problematic. Hence, in this article, we will trace the origin of the inconsistency, differentiate the VFC into two types based on who created them, and differentiate the RAP into RAP as the IV and DV respectively. Through these in-depth analyses, the confusion will be clarified and new insights into the combination of a VFC with the CFC will develop.

Teaching in Uncertain Times: Expanding the Scope of Extraneous Cognitive Load in the Cognitive Load Theory.

The COVID-19 pandemic caused an unprecedented and highly threatening, constrained, and confusing social and educational environment, we decided to expand the traditional focus of the extraneous load in Cognitive Load Theory (CLT) acknowledging the psychological environment in which learning occurs. We therefore adapted and implemented principles of the CLT to reduce extraneous load for our students by facilitating their educational activities. Given previous empirical support for the principles of CLT, it was expected that the adoption of these principles might enable our students to cultivate attitudes and skills across multiple domains such as online learning and presentation technologies, implementing and maintaining a "classroom atmosphere" in a virtual environment, participating in discussions among large online groups of students, facilitating group work, providing virtual office hours for students, and proactively planning for upcoming semesters.

Threshold Concepts in Preclinical Medical Education: Students' Perceptions.

Threshold concepts are those ideas that learners often find difficult, but must understand in order to master a discipline. Nearly all research into threshold concepts has been from the perspective of teachers. We argue that the students' perspectives can also be helpful. In this commentary, we explore this issue and inform the debate by drawing on insights from a pilot study in which medical students articulated their own views on what constituted threshold concepts from recent learning experiences in physiology. Combining insights, from teachers and students, into candidate threshold concepts could be used to improve the medical curriculum.

Suicide Assessment and Management Team-Based Learning Module.

Introduction: Suicide is a global health problem that health care providers must feel comfortable addressing. Unfortunately, many health care providers are not equipped to assess and treat patients at risk for suicide due to lack of training and education. Interactive resources are needed to educate health professions students about the management of suicidal patients. Methods: The suicide assessment and management team-based learning (TBL) module was developed to address the gap in suicide education. After completing the module, students were able to identify key elements for a comprehensive assessment of a patient's risk for suicide and to discuss clinical management for a suicidal patient. The activity was designed for second-year medical students during a psychopathology course, the last organ-system course prior to clerkships. This module could also be used or modified to meet the educational requirements for other health professions, including medical residents, nurse practitioner students, and physician assistant students. Results: A total of 342 students among 62 teams participated in the TBL over a period of 3 consecutive years. The class averages for the individual Readiness Assurance Test ranged from 80% to 88%. The class averages for the team Readiness Assurance Test and application questions were comparable across all 3 years. Course evaluations showed the TBL helped students think critically and integrate information to prepare them for their future careers. Discussion: Overall, this TBL was an effective educational tool that stimulated high-quality discussion, in which students remained engaged and asked thought-provoking questions.

Effects of different therapeutic modalities for postacne scars on circulating collagen III.

BACKGROUND: Therapies for postacne scarring act through modulation of elastin and collagen, and collagen III might therefore represent a biomarker of treatment effectiveness. PATIENTS AND METHODS: Patients (n = 70) with postacne scars and individuals without scars (n = 56) were included in this case-control study. Patients were treated with Dermaroller microneedling, trichloroacetic acid chemical reconstruction, punch excision, or scar subcision. Scar severity was graded immediately before and after treatment with a photographic quartile scale and the ECCA scale. Serum levels of collagen III were measured in control individuals and in patients, before treatment, 1 month after the first treatment session, and 4 months after the final session. RESULTS: Circulating levels of collagen III were significantly higher in patients with postacne scarring (24.1 ± 12.5) before treatment than in control individuals (2.6 ± 0.8). Circulating levels of collagen in patients were significantly lower 4 months posttreatment (14.3 ± 8.1) than at baseline. The mean percentage change in serum collagen III was positively correlated with both the mean percentage improvement by photographic evaluation (r = .530, P < .000) and the mean percentage change in the ECCA scale (r = .632, P < .000). CONCLUSION: Circulating collagen III is a biomarker for improvement of postacne scarring following different therapies.

How to Receive Criticism: Theory and Practice from Cognitive and Cultural Approaches.

Mistakes in clinical practice may have life-or-death consequences for patients. Training in how to give and receive feedback has been emphasized in medical education for decades, yet medical practitioners continue to struggle with these practices. Giving feedback is difficult because it is not easy for a receiver to receive feedback. Current training programs lack an in-depth understanding of the causes of why receiving feedback is not easy. The purposes of this article are to (1) fill this gap by identifying the shared weaknesses in human nature as the causes underlying the difficulty in receiving feedback, especially criticism, using a cognitive approach; (2) develop logical principles to treat the identified causes; (3) show the shared common wisdom of how to receive criticism through a multicultural approach; and finally, (4) address how these cognitive and multicultural approaches may facilitate receiving criticism in the field of medical education.

Novel approaches for two and three dimensional multiplexed imaging of osteocytes.

Although osteocytes have historically been viewed as quiescent cells, it is now clear that they are highly active cells in bone and play key regulatory roles in diverse skeletal functions, including mechanotransduction, phosphate homeostasis and regulation of osteoblast and osteoclast activity. Three dimensional imaging of embedded osteocytes and their dendritic connections within intact bone specimens can be quite challenging and many of the currently available methods are actually imaging the lacunocanalicular network rather than the osteocytes themselves. With the explosion of interest in the field of osteocyte biology, there is an increased need for reliable ways to image these cells in live and fixed bone specimens. Here we report the development of reproducible methods for 2D and 3D imaging of osteocytes in situ using multiplexed imaging approaches in which the osteocyte cell membrane, nucleus, cytoskeleton and extracellular matrix can be imaged simultaneously in various combinations. We also present a new transgenic mouse line expressing a membrane targeted-GFP variant selectively in osteocytes as a novel tool for in situ imaging of osteocytes and their dendrites in fixed or living bone specimens. These methods have been multiplexed with a novel method for labeling of the lacunocanalicular network using fixable dextran, which enables aspects of the osteocyte cell structure and lacunocanalicular system to be simultaneously imaged. The application of these comprehensive approaches for imaging of osteocytes in situ should advance research into osteocyte biology and function in health and disease.