Luba Dumenco

Introduction of a murine p53 mutation corresponding to human codon 249 into a murine hepatocyte cell line results in growth advantage, but not in transformation

The p53 gene is frequently mutated in human tumors; in hepatocellular carcinomas, there is a high frequency of a specific mutation at codon 249 in regions with significant aflatoxin exposure. To assess the role of this p53 mutation in the development of hepatocellular carcinoma, a mutant murine p53 gene, p53ser246, which corresponds to human codon 249, was transfected into a differentiated, nontransformed hepatocyte cell line AML12. Expression of p53ser246 in this line resulted in a growth advantage when compared with either a control vector (which contains a large p53 deletion) or with a different p53 mutant, val135, not found in hepatocellular carcinoma. Overall, there was a threefold increase in colony formation after transfection with p53ser246 as compared with the control or p53val135 vectors, and the p53ser246 plates developed consistently larger colonies. Whereas clones expressing the control or p53val135 constructs showed no significant morphological changes, clones expressing p53ser246 showed increased heterogeneity (large multinucleated cells and areas of small crowded cells) without focus formation. In addition, the ser246 mutation imparted a growth advantage in serum‐free media, suggesting less dependence on specific factors present in serum. None of the mutant p53 or control lines were capable of growth in soft agar or tumor formation in nude mice. Thus in this model, in which endogenous wild‐type p53 expression is retained, a high level of mutant p53 expression is not sufficient to transform hepatocytes. Our findings indicate that p53ser246 has effects on hepatocytes that may result in a clonal growth advantage and suggest that additional factors are required for the development of hepatocellular carcinoma. (HEPATOLOGY 1995; 22:1279–1288.).

Incorporating iPads into a preclinical curriculum: A pilot study

Background: The incorporation of technology into medical education is critical for learners. Little is known about the effect of integrating iPad technology into undergraduate medical education. Aims: We introduced iPads into the first-year curriculum in 2011–2012. We aimed to evaluate students’ use of, and attitudes toward, the iPad. Methods: We administered two surveys to students during the 2011–2012 academic year. Additionally, we conducted focus groups to further evaluate the effectiveness of iPad integration into the curriculum. Results: Survey data reflect mixed attitudes toward the use of the iPad in the preclinical curriculum. While a vast majority of students agree “the iPad has value in the medical curriculum” (79% in the first survey; 65% in the second survey), there was a decrease over time in the view that “the iPad is a positive addition to the curriculum” (75% in the first survey; 49% in the second survey). Focus group data indicate students appreciate certain aspects of iPad use in the curriculum, including improved curriculum interactivity, but the majority believe it cannot replace printed handouts at this time. Discussion: The iPad provides some benefits in undergraduate medical education. More studies are necessary to determine how the iPad is best incorporated into medical education.

Introducing technology into medical education: Two pilot studies

OBJECTIVES Educators are integrating new technology into medical curriculum. The impact of newer technology on educational outcomes remains unclear. We aimed to determine if two pilot interventions, (1) introducing iPads into problem-based learning (PBL) sessions and (2) online tutoring would improve the educational experience of our learners. METHODS We voluntarily assigned 26 second-year medical students to iPad-based PBL sessions. Five students were assigned to Skype for exam remediation. We performed a mixed-method evaluation to determine efficacy. RESULTS Pilot 1: Seventeen students completed a survey following their use of an iPad during the second-year PBL curriculum. Students noted the iPad allows for researching information in real time, annotating lecture notes, and viewing sharper images. Data indicate that iPads have value in medical education and are a positive addition to the curriculum. Pilot 2: Students agreed that online tutoring is at least or more effective than in-person tutoring. CONCLUSIONS In our pilot studies, students experienced that iPads and Skype are beneficial in medical education and can be successfully employed in areas such as PBL and remediation. PRACTICE IMPLICATIONS Educators should continue to further examine innovative opportunities for introducing technology into medical education.

A Cross-Sectional Analysis of Perceptions of Interprofessional Education in Medical Students

Background and Objectives: With the recent paradigm shift in medicine away from traditional hierarchies and patient-physician dyads, there is increased interest in training students to work interprofessionally. A primary focus for improving collaboration in health care is increasing exposure to formalized interprofessional education (IPE) across health professions during training. This study focuses on the effect of formal and informal curricula on medical student attitudes toward IPE. Methods: A cross-sectional survey of all undergraduate medical students was conducted using the Readiness for Interprofessional Learning Scale (RIPLS). Results: Throughout all years of medical school, students agreed with the importance of interprofessional education. Fourth-year medical students had higher total RIPLS scores (64.29 versus 61.0; p=0.007), as well as higher scores on multiple individual RIPLS questions than first-year students. Conclusions: Medical students become more enthusiastic about IPE as their training progresses. Both formal and informal educational opportunities contribute to this effect.

Expanding Group Peer Review: A Proposal for Medical Education Scholarship

After participating in a group peer-review exercise at a workshop presented by Academic Medicine and MedEdPORTAL editors at the 2015 Association of American Medical Colleges Medical Education Meeting, the authors realized that the way their work group reviewed a manuscript was very different from the way by which they each would have reviewed the paper as an individual. Further, the group peer-review process yielded more robust feedback for the manuscripts authors than did the traditional individual peer-review process. This realization motivated the authors to reconvene and collaborate to write this Commentary to share their experience and propose the expanded use of group peer review in medical education scholarship.The authors consider the benefits of a peer-review process for reviewers, including learning how to improve their own manuscripts. They suggest that the benefits of a team review model may be similar to those of teamwork and team-based learning in medicine and medical education. They call for research to investigate this, to provide evidence to support group review, and to determine whether specific paper types would benefit most from team review (e.g., particularly complex manuscripts, those receiving widely disparate initial individual reviews). In addition, the authors propose ways in which a team-based approach to peer review could be expanded by journals and institutions. They believe that exploring the use of group peer review potentially could create a new methodology for skill development in research and scholarly writing and could enhance the quality of medical education scholarship.

The importance of quality improvement education for medical students.

tional responses before (when the code blue was announced overhead), during and after the event. The facilitator from spiritual care used the focused conversation method as a model for reflection upon which trainees could subsequently draw to provide a framework for conversations immediately after future code blues. What lessons were learned? A survey conducted 2 weeks after the session revealed that 81% of respondents felt more comfortable discussing their emotions following a code blue, 88% felt better prepared to deal with the stress and emotions associated with code blues, and 94% felt that they were more likely to debrief immediately following a code blue in the future. In the supportive environment of our debriefing session, trainees were comfortable in sharing a range of emotions related to code blues. Although many trainees were saddened or upset by them, some described feelings of detachment or indifference following a cardiac arrest. This was associated with guilt or a feeling that something may be wrong with them. In the follow-up survey, one trainee stated that it was helpful to know that he was not alone in feeling this way. Whereas the expression of emotions by practitioners is often undermined by medical education’s hidden curriculum, we learned that our trainees are engaged and fulfilled by these reflective activities when they are legitimised in the formal curriculum.

Substance Use Disorder Training Workshop for Future Interprofessional Health Care Providers

Introduction Rates of substance use disorders, including opioid misuse, continue to rise despite national initiatives. Because of this, health professional schools from Rhode Island joined together to design and implement a single-day interprofessional education workshop on substance use disorder training. Methods This workshop consists of four sessions. The first is a patient panel featuring both patients recovering from substance use disorders and their health care providers. Next is a naloxone administration training session. This is followed by a standardized patient session featuring an individual who requires nonopioid options for chronic pain treatment and in which health professional students work together to take a history, perform a physical examination, and develop a treatment plan. Finally, the last session is a complex paper-based case study focusing on a homeless individual with diverse medical problems requiring multifaceted care. Results A total of 540 students from a variety of health care professions participated in the workshop. Students were asked to evaluate each component of the workshop, as well as the workshop overall, on a 6-point Likert scale (1 = poor, 6 = outstanding). Students rated the overall workshop at 76% (4.54 out of 6), and the sessions received ratings ranging from 67% (4.01 out of 6 for the case study) to 83% (4.96 out of 6 for the patient/provider panel). Discussion This curriculum can be adapted and implemented at other medical schools to provide opportunities for future health care professionals to learn how to work effectively in interprofessional teams to manage substance use disorders.

Predicting United States Medical Licensure Examination Step 2 clinical knowledge scores from previous academic indicators

The use of multiple academic indicators to identify students at risk of experiencing difficulty completing licensure requirements provides an opportunity to increase support services prior to high-stakes licensure examinations, including the United States Medical Licensure Examination (USMLE) Step 2 clinical knowledge (CK). Step 2 CK is becoming increasingly important in decision-making by residency directors because of increasing undergraduate medical enrollment and limited available residency vacancies. We created and validated a regression equation to predict students’ Step 2 CK scores from previous academic indicators to identify students at risk, with sufficient time to intervene with additional support services as necessary. Data from three cohorts of students (N=218) with preclinical mean course exam score, National Board of Medical Examination subject examinations, and USMLE Step 1 and Step 2 CK between 2011 and 2013 were used in analyses. The authors created models capable of predicting Step 2 CK scores from academic indicators to identify at-risk students. In model 1, preclinical mean course exam score and Step 1 score accounted for 56% of the variance in Step 2 CK score. The second series of models included mean preclinical course exam score, Step 1 score, and scores on three NBME subject exams, and accounted for 67%–69% of the variance in Step 2 CK score. The authors validated the findings on the most recent cohort of graduating students (N=89) and predicted Step 2 CK score within a mean of four points (SD=8). The authors suggest using the first model as a needs assessment to gauge the level of future support required after completion of preclinical course requirements, and rescreening after three of six clerkships to identify students who might benefit from additional support before taking USMLE Step 2 CK.

The Warren Alpert Medical School of Brown University.

The present structure (Figure 1) evolved since 2005. It was developed to support a comprehensive redesign of the curriculum. The Medical Curriculum Committee (MDCC), the membership of which is meant to represent the diversity of stakeholders, is responsible for approving all curriculum changes. It is the core curriculum redesign group. The group is presently organized into subdivisions (working groups) that are responsible for the redesign of the clinical curriculum (e.g., content, the learning environment, assessment, and so on). Working group leaders are members of the MDCC. Working group membership extends well beyond the MDCC roster. Separate infrastructure exists to support implementation of the preclinical curriculum, the clinical curriculum, and the Scholarly Concentrations Program.