Pamela Veale

A systematic review and quantitative analysis of neurocognitive outcomes in children with four chronic illnesses

Concern has been expressed that infants and children exposed to uneventful surgery and anesthesia may incur neurological injury that becomes manifest in poor scholastic performance or future learning difficulties. A recent meta‐analysis of seven clinical studies examined the relationship between learning or behavior difficulties and pediatric exposure to anesthesia/surgery and reported an odds ratio of 1.4; however, the level of association and causal factors remain unclear. The purpose of our study is to provide context to the pediatric anesthesia neurotoxicity question by reviewing the evidence linking four childhood illnesses with neurocognitive development. In the present review, we have sought to quantify the magnitude of the impact of chronic illness on neurocognitive development through a systematic review of publications that report the developmental trajectory of patients with four childhood diseases: cystic fibrosis (CF), hemophilia A, end‐stage renal disease (ESRD) and end‐stage liver disease (ESLD).

A practical approach to mentoring students with repeated performance deficiencies

BackgroundWith the increasing use of competency-based evaluations we now have more and better ways to identify performance deficiencies in our learners. Yet the emphasis placed on identifying deficiencies appears to exceed that given to improving these deficiencies.AimsHere we describe the program at the University of Calgary for mentoring students with repeated performance deficiencies. We focus primarily on the key steps of mentoring and remediation, and establishing a program that provides consistency and accountability to this process.ConclusionsA small cohort of trainees with persistent performance deficiencies may need intensive remediation to reach the expected level of performance. Ultimately, not all learners will be successful in their remediation, but we feel that it is the responsibility of training programs to provide mentorship and an organized approach to remediation in order to maximize the chances of successful remediation.

Quantitative analysis of the fine vascular anatomy of articular ligaments

An image analysis technique has been developed to quantitatively describe the fine vascular patterns observed in ligament tissue. The longitudinal orientational distribution and total vessel volume of India-ink-perfused blood vessel segments in normal and healing ligaments were determined. The methods involved special vascular preparation of adult rabbit knee medial collateral ligaments (MCLs) by India-ink perfusion. Black and white microscope images of ink-perfused tissue sections were subjected to a thresholding procedure to binarize digitized ligament images, which were then skeletonized and analyzed for directional distribution based on the least-squares technique. Analysis of medial collateral ligaments in New Zealand White rabbits using this method has shown that scarred tissue is more vascular and has a more chaotic angular distribution of blood-vessel segments than normal ligament tissue.<<ETX>>

Prospective comparison of student-generated learning issues and resources accessed in a problem-based learning course

Background: Multiple factors can contribute to variability in content coverage and student study activities between problem-based learning (PBL) groups. Aims: The purpose of this study was to analyse the student learning issues to answer three questions: 1. How do the student-generated learning issues compare to faculty-developed ‘key feature’ objectives for each case? 2. Is there stability in choice of student learning issues over a four-year period? 3. What resources do the students access and has this changed over a four-year period? Methods: Student-generated learning issues were collected during a course that follows a PBL design using standardized patient cases. Between 2002 and 2005, 407 students in 74 groups completed the course. The student-generated learning issues were compared with faculty-developed learning objectives to identify content covered. Students also recorded resources accessed and time spent researching the learning issues. Results: Learning issues regarding medical content had moderate correspondence to faculty objectives. However, ‘key feature’ objectives that included other content such as communication challenges, ethics issues, psychosocial stressors, etc. were identified less frequently in student learning issues. Student study time was constant across cases, groups and years. A trend toward increased use of electronic resources over time was identified, and student choice of resource material did not necessarily match the references listed in the case materials. Conclusion: Despite similarity in student study time between groups, significant variability in content of learning issues and resources accessed was apparent.

Sickness presenteeism in clinical clerks: Negatively reinforced behavior or an issue of patient safety?

BACKGROUND The purpose of this study was to investigate sickness presenteeism in medical students and to understand the factors that may promote this behavior. METHODS All 178 final year medical students (clinical clerks) at the University of Calgary, Class of 2014 were invited to complete an online, anonymous, cross-sectional survey. After completing each mandatory rotation, students were sent a link to the online survey. Students were asked to report days of illness and whether they attended clinical or educational activities while ill. Students were also asked about consequences of missed days and reasons for attending while ill. RESULTS Out of a possible 1,068 surveys, 549 surveys were returned, reflecting a 51% response rate. Overall, 37.0% ± 11.8% of the respondents reported attending while experiencing symptoms suggestive of a contagious illness. Overall, the odds of presenteeism (ie, attending while ill/absent while ill) for all clerkship rotations were 4.92. The most frequent reasons (56%) were concerns regarding evaluation or the impact that missing time from the rotation would have on their learning. CONCLUSIONS Sickness presenteeism is common among medical students. Relevant factors may be different for students than other health care workers. Medical educators should be aware of these factors when developing policies to help promote professionalism and patient safety.

Making progress in the ethical treatment of medical trainees

There is an inherent conflict within clinician educators as we balance the roles of healthcare provider to patients in need of care with that of educator of learners in need of teaching. In this essay we use Beauchamp and Childress’ principles of biomedical ethics as a framework to compare the relationship that clinician educators have with their patients and their learners, and suggest that while we typically apply ethical principles when addressing the needs of our patients, these principles are frequently lacking in our interactions with learners. This dichotomy reflects a person-by-situation interaction that may be partly explained by the expectations of the regulatory bodies that define how clinicians should interact with patients and how educators should interact with learners. The result is that we may fall short in applying respect for autonomy, beneficence/nonmaleficence, and justice when addressing the needs of our learners. Fortunately there are ways in which we can incorporate these ethical principles into our interactions with learners while still adhering to accreditation standards and institutional policy. These include flipped classrooms and simulated learning experiences, incorporating aspects of instructional design that have been shown to improve learning outcomes, providing additional resources to learners with greater needs, and organizing training curricula around entrustable professional activities. Although the consistent application of ethical principles with all learners during all learning experiences is likely unachievable, we can, and should, move towards more ethical treatment of our learners.

How teachers can help learners build storage and retrieval strength

Abstract Aim: To be an effective teacher, content expertise is necessary but alone does not guarantee optimal learning outcomes for students. In this article, the authors discuss ways in which medical teachers can shape the learning of their students and enable them to become more efficient and effective learners. Methods: Using Bjork and Bjorks new theory of disuse as their framework, the authors discuss strategies to improve storage strength of to-be-learned information and strategies to improve retrieval strength of learned information. Results: Strategies to improve storage strength include optimizing cognitive load, providing causal explanations, and giving effective feedback. Strategies to improve retrieval strength include situated cognition and various types of retrieval practice. Conclusions: Adopting these teaching strategies should hopefully help teachers improve the learning outcomes of their students, but there is still a need for further research into the science of learning and the science of instruction, including comparative effectiveness of different teaching strategies and how best to translate findings from the psychology literature into medical education.