Applying the Lean Startup Method to Structure Project-Based, Student-Driven Curricular Enhancements.

PROBLEM: Formal medical student engagement in curricular evaluation provides significant value through identification of opportunities for curricular change. Students provide diverse perspectives and have a unique vantage point, which allows them to see aspects of the curriculum that educators and administrators might not recognize. Current descriptions of student engagement are focused largely on collection, analysis, and presentation of summative feedback in the pre-clerkship curriculum. However, medical students could potentially contribute to curricular improvement in ways extending beyond post hoc curricular evaluation. Student teams focused on identification of specific needs and project-based implementation of solutions represent one means of doing so but require a structured, organizing method in order to succeed. INTERVENTION: We describe a novel, project-based, student-driven medical education initiative, the Special Projects Team, which is focused on identifying opportunities for forward-looking curricular enhancements beyond single courses or rotations. We adapted and implemented the lean startup method, a model for project management, in order to address the need for organization and accountability in the Special Projects Team. Members of the Special Projects Team were recruited from the first- and second-year medical school classes in the 2018-2020 academic years and provided with training on the lean startup method. Team members selected and pursued projects according to the principles of lean startup method, reporting their progress to the chair of the Special Projects Team and other team members at monthly meetings with pre-defined structure. CONTEXT: The Special Projects Team is part of the local Student Curricular Board at the Chicago campus of the University of Illinois College of Medicine. The Student Curricular Board is responsible for conducting curricular evaluation and improvement, operating under the local medical student council with financial support from the Office of Curricular Affairs. Direct supervision of the Special Projects Team is provided by a student chair, the executive board of the Student Curricular Board, and the curricular dean. IMPACT: The projects initiated as part of the Special Projects Team covered a broad range of themes, including curricular evaluation, technology, and student experiences. Lean startup method contributed to sustained project success and frequent reassessment across the two years of our experience, with aggregate project success or continuation rate of 68.4% (13/19 projects). We further demonstrate how lean startup method increased productivity while providing structure and accountability for a student-led medical education team. LESSONS LEARNED: Lean startup method can be used to structure student-driven, project-based curricular enhancements. This approach is broadly applicable to other medical schools with implementation requiring only a motivated student team, faculty advisor, and basic knowledge of the lean startup method.

The effects of rumination on internalising symptoms in the context of the COVID-19 pandemic among mothers and their offspring: a brief report.

As a result of the novel coronavirus (COVID-19) pandemic, anxiety and depressive symptoms have risen among children and adults. However, it remains unclear why the effects of the pandemic are so salient for certain individuals. This study examined rumination, a well-established risk factor for internalising disorders, as a predictor of prospective increases in anxiety and depression symptoms in mothers and their offspring. Change in rumination during the pandemic was also examined as a predictor of symptom transmission at the dyadic level. Fifty-three biological mother-child dyads were recruited from two longitudinal studies that had completed their respective baselines prior to the COVID-19 pandemic. Mothers and youth (ages 9-15 years, 77.4% female) completed measures of depression and anxiety symptoms and rumination before and during the pandemic. Results revealed baseline rumination was positively associated with internalising symptom changes for mothers, but not youth. Moreover, pre-to-peri pandemic changes in rumination were associated with prospective increases in mother and youth internalising symptoms. Finally, results revealed a significant correlation for pre-to-peri pandemic depressive symptom change among mothers and youth; however, rumination did not mediate this association. Findings highlight changes in rumination as a potential mechanism for internalising symptom risk during the COVID-19 pandemic across development.

Neural reward responsiveness and daily positive affect functioning in adolescent girls.

Deficits in reward processing have been implicated in the development of many forms of psychopathology, especially major depressive disorder (MDD). One facet of reward processing, known as reward responsivity, has been associated with the development and maintenance of depression across development. The reward positivity (RewP) is an event-related potential derived from electroencephalogram (EEG), which is thought to reflect reward responsivity. An attenuated RewP has been observed in both currently depressed individuals and youth at risk for depression, suggesting it may represent a biomarker of depression. Despite this, little is known about how the RewP translates to behavior and affect in the real world. In the current study, we examined how the RewP relates to real world emotional functioning, measured using ecological momentary assessment (EMA). Thirty-eight female adolescents (ages 11-16, Mage = 13.9 years) participated in the study; approximately half of the sample were considered high risk due to maternal lifetime history of MDD. Adolescents completed a monetary reward task while EEG was recorded, followed by a 10-day period of EMA assessing daily affect and emotion regulation strategy use following positive events. Results revealed that the RewP was positively associated with subjective reports of positive, but not negative, daily affect. Results also revealed that the RewP was positively associated with focusing on positive feelings following a positive event (e.g., savoring). Findings from this preliminary study highlight how neural responses to reward in the lab relate to daily life emotional functioning, supporting the RewP as an ecologically valid marker of positive affect functioning among youth.

Neuromodulatory effects of transcranial electrical stimulation on emotion regulation in internalizing psychopathologies.

OBJECTIVE: We hypothesize offset theta-tACS (transcranial alternating current stimulation) improves emotion regulation (ER) and psychopathology more than transcranial direct current stimulation (tDCS) in participants with internalizing psychopathologies (IPs). METHODS: This pilot study utilized a double-blind, pseudo-counterbalanced, sham-controlled design with participants with IPs. Participants were assigned to receive tDCS or tACS, underwent four stimulation sessions (two sham), and completed an emotion regulation task (ERT) during or after stimulation. Participants completed the Beck Depression Inventory before/after the study, the Spielberger State and Trait Anxiety Index after each ERT, and rated their arousal, valence, and perceived reappraisal ability during the ERT. RESULTS: Participants receiving either stimulation type showed a reduction in anxiety, depression, and valence and arousal ratings. We additionally discovered an effect demonstrating those who received sham stimulation first displayed little-to-no change in any score across the study, but tACS participants who received verum stimulation first showed significant improvements in each metric. CONCLUSIONS: Improving ER capabilities via theta tACS has the potential to yield beneficial clinical effects. SIGNIFICANCE: This study adds validity to the use of non-invasive neuromodulatory methods, especially tACS, to alleviate IPs. Additional research is needed to better understand the effects of sham stimulation. Careful consideration of sham incorporation should be made in future studies.

Differential effects of transcranial current type on heart rate variability during emotion regulation in internalizing psychopathologies.

BACKGROUND: Internalizing psychopathologies (IPs) are characterized by disruptions in emotion regulation (ER). A potential target for ER modulation in individuals with IPs is the theta band. We hypothesized that offset theta-tACS (transcranial alternating current stimulation) would result in more enhanced ER, indexed by greater increase in heart rate variability (HRV), than transcranial direct current stimulation (tDCS) in participants with IPs. METHODS: This pilot study utilized a double-blind, pseudo-counterbalanced design. Participants with internalizing psychopathologies (anxiety and depression) were randomly assigned to receive either offset theta-tACS (n = 14) or tDCS (n = 15) and underwent four sessions of stimulation (two sham). In both arms, there were alternating iterations of an emotion regulation task (ERT) during or immediately after stimulation and rest. Heart rate data were collected during each ERT and rest iteration, and analyses were completed using high-frequency (HF) and root mean square of successive differences (RMSSD) HRV metrics. RESULTS: tACS participants consistently displayed increases in both HRV metrics from Time 1 to Time 4. Participants receiving tDCS displayed few significant changes in HF-HRV and no significant changes in RMSSD-HRV. LIMITATIONS: Due to the small sample size, analyses were limited. Additionally, the lack of a baseline ERT makes it difficult to determine overall ER improvement. CONCLUSIONS: tACS appears to increase ER capacity as reflected in increased HRV in individuals with internalizing psychopathologies, particularly after two sessions of stimulation. This study adds validity to the use of tACS as a neuromodulatory technique in cognitive and clinical research. Additional research is required to better understand potential carry-over effects of multiple sessions of stimulation.

Anterior cingulate cortex activity during attentional control corresponds with rumination in depression and social anxiety.

Rumination and worry are transdiagnostic perseverative cognitions that have overlapping and distinct characteristics. While the mechanisms of perseverative cognitions remain incomplete, limited data indicate anterior cingulate cortex (ACC) as it relates to top-down functions contributes to perseverative cognitions in internalizing conditions. The current study extends this work in patients with major depression (n = 39) or social anxiety (n = 42). During fMRI, participants viewed images comprising letter strings superimposed on task-irrelevant threatening or neutral faces. To moderate task difficulty, there was a low perceptual load condition where the target letter was in a string of identical letters and high load condition with the target letter in a mixed letter string increasing task difficulty. Regions of interest (ROI) comprised dorsal ACC and rostral ACC. Bilateral amygdala was also examined. Results showed diagnostic groups had similar levels of rumination and worry. Exploratory hierarchical regression analysis comprising clinical measures, task performance, and the 4 ROIs revealed significantly less dorsal ACC engagement during low (vs. high) load to task-irrelevant faces corresponded with more rumination, but not worry, regardless of diagnostic status. However, the ACC finding did not survive Bonferroni correction. Preliminary results suggest dorsal ACC response during attentional control may serve as a transdiagnostic mechanism of rumination.

Relaxation Techniques for People with Chronic Obstructive Pulmonary Disease: A Systematic Review and a Meta-Analysis.

Introduction. Chronic Obstructive Pulmonary Disease (COPD) people suffer from severe physical impairments, which often elicit significant psychological distress and impact their quality of life. This meta-analysis aimed to assess evidence from the scientific literature on the effects of relaxation techniques. Methods. We investigated 9 databases to select 25 RCTs. Studies included both inpatients and outpatients with COPD. Both respiratory and psychological outcomes were considered. Results. Relaxation techniques showed a little positive effect on the value of the percentage of predicted FEV1 (d = 0.20; 95% Cl: 0.40--0.01) as well as a slight effect on levels of both the anxiety (d = 0.26; 95% Cl: 0.42-0.10) and depression (d = 0.33; 95% Cl: 0.53-0.13). The higher effect size was found in the quality of life value (d = 0.38; 95% Cl: 0.51-0.24). The assessed quality of the studies, based on the PEDro Scale, was generally medium/high. Conclusion. Relaxation training can have a moderate impact on both psychological well-being and respiratory function, resulting in noticeable improvements in both. Although higher quality research is required, our results sustain the importance of relaxation techniques as a tool to manage COPD.