Mary T. Johnson

Assessment of clinical reasoning: A Script Concordance test designed for pre-clinical medical students

Background: The Script Concordance test (SCT) measures clinical reasoning in the context of uncertainty by comparing the responses of examinees and expert clinicians. It uses the level of agreement with a panel of experts to assign credit for the examinees answers. Aim: This study describes the development and validation of a SCT for pre-clinical medical students. Methods: Faculty from two US medical schools developed SCT items in the domains of anatomy, biochemistry, physiology, and histology. Scoring procedures utilized data from a panel of 30 expert physicians. Validation focused on internal reliability and the ability of the SCT to distinguish between different cohorts. Results: The SCT was administered to an aggregate of 411 second-year and 70 fourth-year students from both schools. Internal consistency for the 75 test items was satisfactory (Cronbachs alpha = 0.73). The SCT successfully differentiated second- from fourth-year students and both student groups from the expert panel in a one-way analysis of variance (F2,508 = 120.4; p < 0.0001). Mean scores for students from the two schools were not significantly different (p = 0.20). Conclusion: This SCT successfully differentiated pre-clinical medical students from fourth-year medical students and both cohorts of medical students from expert clinicians across different institutions and geographic areas. The SCT shows promise as an easy-to-administer measure of “problem-solving” performance in competency evaluation even in the beginning years of medical education.

Th2 Cytokines IL-4 and IL-13 Downregulate Paxillin Expression in Bronchial Airway Epithelial Cells

Asthma is characterized by infiltration and shedding of the bronchial epithelium. The Th2 cytokines IL-4 and IL-13 are involved in the cellular recruitment and infiltration seen in asthma. The effects of IL-4 and IL-13 on cell–matrix interactions and epithelial shedding are unknown. We hypothesize that bronchial airway epithelial cells (BAEC) express paxillin, a structural focal adhesion protein, and downregulation of paxillin by Th2 cytokines lead to BAEC hyperpermeability. We showed by confocal microscopy the presence of paxillin in BAEC. We demonstrated by Western blot analysis that IL-4 and IL-13 stimulation results in downregulation of paxillin production. IL-4 and IL-13 stimulation decreased epithelial cell–matrix attachment as measured by electrical cell–substrate impedance sensing system (ECIS). Our results suggest that Th2 cytokines IL-4 and IL-13 downregulate paxillin production by BAEC, thereby disrupting the cell–matrix interactions. This may help explain the epithelial shedding and epithelial membrane hyperpermeability that occurs in asthma.

Impact of Online Learning Modules on Medical Student Microbiology Examination Scores

Medical students have a limited amount of time in which to acquire working knowledge of an enormous amount of information, and this is especially relevant for microbiology. One large midwestern medical school is unique in having medical microbiology taught at nine regional campuses using a single core curriculum. A committee of statewide course directors writes a licensure board-style final examination that is referenced to the core and used at all campuses. To prepare for the final examination, students traditionally utilize print-based board examination review books. The purpose of the present study was to determine whether students who train using web-based quizzes score differently as a group on this statewide examination than students who do not utilize the materials online for exam preparation. The study included 71 learners from two different campuses who were taught by the same instructor and were admitted to medical school with similar exemplary credentials. Results were aggregated for three consecutive years. A standard medical microbiology textbook was used to assign the same suggested readings for all students and similar laboratory sessions were provided for all learners. The independent variable was use of the web-based quizzes to prepare before examinations, as indicated by student web usage logs. The dependent variable was score on the statewide final examination. Results support the hypothesis that students who use preparation modules online score higher on the final examination than students who do not. Moreover, students who prepared online scored higher on questions designed to test synthesis of knowledge and analysis of data. The significant difference in final examination outcome (P < 0.002 using a two-tailed unpaired t test) indicates that online preparation for high-stakes examinations could improve student performance in medical microbiology.

Proteomics of tendinopathy.

Recent advances in the basic understanding of both human biology and animal models have enabled an unprecedented level of information to be gathered about the genetic regulation of human disease. However, a corresponding insight into functional interactions between genetic information and protein expression has been slower to accumulate. Measuring mRNA transcripts does not yield a complete set of information about the protein dynamics involved in tissue injury and repair. Proteomics methods applied to unravel these relationships rely upon the identification and analysis of the proteins present within selected tissues and cells. Our understanding of complex biological processes can be enhanced by exploring the differences in protein structure and function between normal and injured tissues. This review concentrates on the development and application of proteomics techniques to uncover the specific processes and pathways involved in tendon injury and chronic tendinopathy.