Identification of Health Systems Science in a Problem-Based Learning Clinical Reasoning Exercise.

The creation of developmentally appropriate and meaningfully complex clinical reasoning exercises in the pre-clerkship curriculum is a common challenge for many medical schools. We provide an overview of one component of the pre-clerkship clinical reasoning curriculum at Case Western Reserve University School of Medicine, and present evidence that inclusion of Health Systems Science in this exercise facilitates integrated thinking in a Problem-Based Learning curriculum.

Students perceive skills learned in pre-clerkship PBL valuable in core clinical rotations.

Purpose: Problem-based learning (PBL) is an instructional method widely used by medical educators that promotes an environment in which students effectively learn the foundational knowledge and skills that are prerequisites for graduation. This study evaluated medical students' perceptions of the helpfulness of skills acquired in PBL to core clerkship rotations.Methods: A 25-item survey was designed to assess students' perceptions of skills learned in PBL that were helpful on core clerkships and transferable to the clinical setting. A random sample of students with at least 8 months of clerkship experience were invited to complete the survey.Results: Of 68 students, 35 (52%) returned questionnaires. Results suggest a clustering of themes based on their perceived value. Skills learned in PBL that students rated most highly as helpful or very helpful during core clinical rotations include: comfort discussing concepts, identifying key information, presentation skills, interpersonal skills, diagnostic thinking, finding information, self-awareness, and organizing information. Other items rated highly included: forming questions, time management, primary literature (engaging with published original research articles), and leadership. The skills acquired in PBL were associated with multiple competency domains.Conclusions: Although conditions of the pre-clerkship curriculum are substantially different from the learning environment of clerkship rotations, skills learned in PBL are perceived as applicable to authentic clinical training.

Scholarship in Teaching: An Approach to Enhancing the Value and Academic Standing of Teaching.

BACKGROUND: In our effort to increase the value and academic standing of teaching, we implemented an initiative focused on scholarship in teaching. Our program was narrowly focused, project-based, peer-reviewed, resource-neutral, and open to all faculty. Faculty members are invited annually to submit a description of their educational projects in keeping with Glassick's criteria. Our purpose was to assess the effects of this award program. METHOD: We reviewed the distribution of applications over a 3-year period and determined the academic departments, academic rank of applicants, and focus of projects. A questionnaire assessed applicants' perceptions of the value of participation, its contribution to promotion and advancement, and its role in subsequent dissemination activities. RESULTS: Slightly fewer than half (60 of 124, 48%) of the applications submitted during 2016 through 2018 were judged by peer review to meet Glassick's criteria for scholarship and received the award. Most applicants were junior faculty, and most applications were from the department of medicine though all departments who taught students in core clinical rotations were represented during the years studied. The projects that were awarded were more likely to be disseminated when compared with those who were not awarded. LESSONS LEARNED: Our scholarship in teaching program seemingly advanced educational scholarship among teaching faculty and provided a way of recognizing projects that advanced educational initiatives. Further efforts are required to promote support from departmental leadership, to enhance faculty participation, and to encourage success through mentoring and assistance in project preparation.

RhoGDI-binding-defective mutant of Cdc42Hs targets to membranes and activates filopodia formation but does not cycle with the cytosol of mammalian cells.

We have identified a mutant of the human G-protein Cdc42Hs, R66E, that fails to form a detectable complex with the GDP-dissociation inhibitor RhoGDI in cell-free systems or in intact cells. This point mutant is prenylated, binds guanine nucleotide and interacts with GTPase-activating protein in a manner indistinguishable from wild-type Cdc42Hs. Immunofluorescence localization studies revealed that this RhoGDI-binding-defective mutant is found predominantly in the Golgi apparatus, with a staining pattern similar to that of the wild-type protein. However, unlike wild-type Cdc42Hs, which is distributed in both the microsomal membrane and cytosolic fractions, studies using differential centrifugation show that prenylated R66E Cdc42Hs is found exclusively in association with lipid bilayers. Additionally, whereas the overexpression of RhoGDI results in an apparent translocation of wild-type Cdc42Hs from the Golgi apparatus into the cytosol, identical RhoGDI-overexpression conditions do not alter the Golgi localization of the R66E mutant. Furthermore, overexpression of this RhoGDI-binding-defective mutant of Cdc42Hs seems to activate redistribution of the actin cytoskeleton and filopodia formation in fibroblasts in a manner indistinguishable from the wild-type protein. Taken together, these results suggest that the interaction of Cdc42Hs with RhoGDI is not essential for proper membrane targeting of nascent prenylated Cdc42Hs in mammalian cells; neither is this interaction an essential part of the mechanism by which Cdc42Hs activates filopodia formation. However, it does seem that redistribution of Cdc42Hs to the cytosolic compartment is absolutely dependent on RhoGDI interaction.