Notes

Continual Psychological Anxiety Attenuates the particular Usefulness associated with anti-PD-L1 Immunotherapy for Vesica Cancer malignancy in Immunocompetent Rats.
Though musculoskeletal complaints account for roughly one-quarter of primary care and emergency department visits, only 2% of US medical school curriculum is devoted to musculoskeletal disease. Many graduating students demonstrate poor knowledge and report low confidence in treating musculoskeletal disorders. This study defines the current state of musculoskeletal curriculum of medical schools in detail to identify variations and potential shortcomings.

All eleven medical schools in California were invited to participate in an in-depth survey detailing the design and content of their musculoskeletal curriculum.

A response rate of 100% was achieved. Overall, schools devoted an average of 58.7h to musculoskeletal medicine, of which more than half was spent covering anatomy. The primary instructor for musculoskeletal medicine was a clinician in four schools (36.4%). Six schools offered a dedicated musculoskeletal physical exam course. No schools required students to complete a clinical rotation in musculoskeletal medicine. There was high variability among institutions when evaluating core subject coverage.

There is large variation in the content and structure of musculoskeletal instruction among California medical schools. Increased curricular time, integration of preclinical and clinical experiences, greater specialist participation, and standardized objectives may provide more consistent and comprehensive musculoskeletal education.

The online version contains supplementary material available at 10.1007/s40670-020-01144-3.
The online version contains supplementary material available at 10.1007/s40670-020-01144-3.
Self-efficacy, academic motivation, and self-regulation have been identified as important factors contributing to students' learning success in general education. In the field of medical education, however, few studies have examined these variables or their interrelationships as predictors of undergraduate medical students' learning outcomes, especially in the context of flipped learning.

Using structural equation modeling (SEM), this study explored the impact of self-efficacy on 146 first- and second-year medical students' academic achievement in a flipped-learning environment, and whether such impact (if any) was mediated by academic motivation and self-regulated learning (SRL) strategies.

On average, students scored highest on self-efficacy (mean = 5 out of a possible 7), followed by intrinsic motivation (mean = 4.59), resource-management strategies (mean = 4.48), metacognitive strategies (mean = 4.46), extrinsic motivation (mean = 4.24), and cognitive strategies (mean = 4.17). Our SEM results suggest that, while there was a direct effect of self-efficacy on learning outcomes, academic motivation and SRL strategies did not mediate it.

By unpacking the structural relationships among self-efficacy, academic motivation, SRL strategies, and learning outcomes, this study provides evidence-based support for the importance of promoting students' self-efficacy in undergraduate medical flipped-learning environments. Strategies for increasing students' self-efficacy are also discussed.
By unpacking the structural relationships among self-efficacy, academic motivation, SRL strategies, and learning outcomes, this study provides evidence-based support for the importance of promoting students' self-efficacy in undergraduate medical flipped-learning environments. Strategies for increasing students' self-efficacy are also discussed.
There is limited data assessing simulation and virtual reality training as a standardized tool in medical education. This feasibility study aimed to evaluate the effectiveness of virtual reality training and a student-led simulation module in preparing medical students to perform a lumbar puncture.

Twenty-five medical students completed a pre-intervention survey, and a baseline video recorded lumbar puncture procedure on a task trainer. selleckchem Students were randomly distributed into the virtual reality group, or the curriculum's standard student-led procedural instruction group. Participants were then given 45min to practice the lumbar puncture procedure. After the intervention, all participants were video recorded again as they performed a post-intervention lumbar puncture and completed a post-intervention survey. Pre- and post-intervention videos were scored using a critical action checklist in conjunction with time needed to complete the procedure to evaluate proficiency.

At baseline, there were no major statistically significant differences between groups. Assessing overall post-intervention performance, both groups showed improvement in aggregate score (
 < 0.001) and time required to complete (
 = 0.002) the lumbar puncture. Following interventions, the student-led group improved over the virtual reality group in a variety of metrics. The student-led group increased their aggregate score by 3.49 and decreased their time to completion by 34s over the VR group when controlling for baseline measures.

Both virtual reality and student-led simulation training were useful training modalities, with hands-on simulation showing better results versus virtual reality training in this setting.

The online version contains supplementary material available at 10.1007/s40670-020-01141-6.
The online version contains supplementary material available at 10.1007/s40670-020-01141-6.
Reflective writing is used throughout medical education to help students navigate their transformation into medical professionals. Assessment of reflective writing, however, is challenging; each available methodology of assessment has distinct advantages and disadvantages. We tested if combining two independent assessment mechanisms-a faculty-designed rubric and Academic Writing Analytics (AWA), an automated technique-could be used together to form a more robust form of evaluation.

We obtained reflective essays written by first year medical students as part of a clinical skills course. Faculty scored essays using a rubric designed to evaluate Integration, Depth, and Writing. The same essays were subjected to AWA analysis, which counted the number of reflective phrases indicative of Context, Challenge, or Change.

Faculty scored the essays uniformly high, indicating that most students met the standard for reflection as described by the rubric. AWA identified over 1400 instances of reflective behavior within the essays, and there was significant variability in how often different types of reflective phrases were used by individual students.

While data from faculty assessment or AWA alone is sufficient to evaluate reflective essays, combining these methods offer a richer and more valuable understanding of the student's reflection.
While data from faculty assessment or AWA alone is sufficient to evaluate reflective essays, combining these methods offer a richer and more valuable understanding of the student's reflection.
Leadership is important for organisational teams and patient safety. We aimed to identify leadership behaviours that medical students are developing and consider whether these prepare new graduates to become leaders.

We conducted a mixed methods study using an online questionnaire comprising the Clinical Leadership Survey and additional free-text questions. All New Zealand fifth-year medical students and junior doctors (postgraduate year one) were invited to participate. Our analysis used non-parametric testing and general thematic analysis.

Seventy-five students and 43 doctors participated. Participants neither agreed nor disagreed that they were clinical leaders (3 vs 3,
). Students were less sure they used clinical leadership behaviours than doctors (4 vs 3,
0.014), but all were using transformational leadership behaviours in clinical environments (60 vs 63 out of a maximum of 75,
). Thirty percent could not give an example of acting as clinical leaders, but 97% described using leadership-type behaviours. Thematic analysis yielded four clinical leadership themes advocacy, collaboration, leading the way and individualism.

Undergraduates appear to be developing and practicing transformational leadership behaviours and junior doctors associate leadership with their role. Participants were unaware of several important leadership behaviours, which could be further developed within an explicit structured curriculum.
Undergraduates appear to be developing and practicing transformational leadership behaviours and junior doctors associate leadership with their role. Participants were unaware of several important leadership behaviours, which could be further developed within an explicit structured curriculum.
Effective use of nontechnical skills (NTS) contributes to the provision of safe, quality care in the fast-paced, dynamic setting of the operating room (OR). Inter-professional education of NTS to OR team members can improve performance. Such training requires the accurate measurement of NTS in order to identify gaps in their utilization by OR teams. Although several instruments for measuring OR NTS exist in the literature, each tool tends to define specific NTS differently.

We aimed to determine commonalities in defined measurements among existing OR NTS tools.

We undertook a comprehensive literature review of assessment tools for OR NTS to determine the critical components common to these instruments. A PubMed search of the literature from May 2009 to May 2019 combined various combinations of keywords and Medical Subject Headings (MeSH) related to the following subjects teamwork, teams, assessment, debriefing, surgery, operating room, nontechnical, communication. From this start, articles were selectedinical environment.
NTS OR assessment tools in the literature have a variety of kin constructs related to the specific measured components within the instruments. Such kin constructs contain thematic cohesion across six primary NTS groupings with some variation in scale and scope. Future plans include using this information to develop an easy-to-use assessment tool to assist with debriefing in the clinical environment.
Family medicine (FM), a discipline that eschewed worshiping the ivory tower of research in favor of patient care, has struggled with its role in the world of scholarly activity. FM residencies mirror this conflict despite the Accreditation Council for Graduate Medical Education's requirements for creating an environment of inquiry and scholarship. Because of this, the faculty within the Department of Family and Community Health (dFCH) at Marshall University changed its culture of scholarship.

A faculty-driven needs-based assessment of the department's strengths and deficiencies for enhancing scholarship was conducted. A three-pronged approach of creating motivation, developing an infrastructure, and consolidating resources was created. This process was periodically re-evaluated and augmented. Departmental scholarly activity, defined as both publications and presentations, was tracked for an eight year period.

Scholarly output increased by 483% (6 to 29) in year 1 and 10-fold by year 8 (6 to 60) from the pre-culture change baseline. This represents one- and eight-year increases for both publications (4 to 6 and 4 to 18 respectively) and presentations (2 to 23 and 2 to 42 respectively). Scholarly involvement became more widespread among faculty (
= 30) and increased linearly for residents (
= 19) and students (
= 13).

Through a series of needs-based interventions with consistent reanalysis, the dFCH changed its culture of scholarship. Understanding that other departments have similar competing interests to negotiate, the principles of creating motivation, developing research infrastructure, and consolidating resources could be successfully applied elsewhere.
Through a series of needs-based interventions with consistent reanalysis, the dFCH changed its culture of scholarship. Understanding that other departments have similar competing interests to negotiate, the principles of creating motivation, developing research infrastructure, and consolidating resources could be successfully applied elsewhere.
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