Peter H. Lenz

Practical strategies for effective lectures

Lecturing is an essential teaching skill for scientists and health care professionals in pulmonary, critical care, and sleep medicine. However, few medical or scientific educators have received training in contemporary techniques or technology for large audience presentation. Interactive lecturing outperforms traditional, passive-style lecturing in educational outcomes, and is being increasingly incorporated into large group presentations. Evidence-based techniques range from the very simple, such as inserting pauses for audience discussion, to more technologically advanced approaches such as electronic audience response systems. Alternative software platforms such as Prezi can overcome some of the visual limits that the ubiquitous PowerPoint imposes on complex scientific narratives, and newer technology formats can help foster the interactive learning environment. Regardless of the technology, adherence to good principles of instructional design, multimedia learning, visualization of quantitative data, and informational public speaking can improve any lecture. The storyline must be clear, logical, and simplified compared with how it might be prepared for scientific publication. Succinct outline and summary slides can provide a roadmap for the audience. Changes of pace, and summaries or other cognitive breaks inserted every 15-20 minutes can renew attention. Graphics that emphasize clear, digestible data graphs or images over tables, and simple, focused tables over text slides, are more readily absorbed. Text slides should minimize words, using simple fonts in colors that contrast to a plain background. Adherence to these well-established principles and addition of some new approaches and technologies will yield an engaging lecture worth attending.

Chronic traffic pollution exposure is associated with eosinophilic, but not neutrophilic inflammation in older adult asthmatics

Abstract Objective: Airway inflammatory patterns in older asthmatics are poorly understood despite high asthma-related morbidity and mortality. In this study, we sought to define the relationship between exposure to traffic pollutants, biomarkers in induced sputum, and asthma control in older adults. Methods: Induced sputum was collected from 35 non-smoking adults ≥65 years with a physician’s diagnosis of asthma and reversibility with a bronchodilator or a positive methacholine challenge. Patients completed the Asthma Control Questionnaire (ACQ), and Elemental Carbon Attributable to Traffic (ECAT), a surrogate for chronic diesel particulate exposure, was determined. Equal numbers of subjects with high (≥0.39 µg/m3) versus low (<0.39 µg/m3) ECAT were included. Differential cell counts were performed on induced sputum, and myeloperoxidase (MPO) and eosinophil peroxidase (EPO) were measured in supernatants. Regression analyses were used to evaluate the relationship between sputum findings, ACQ scores, and ECAT. Results: After adjustment for potential confounders, subjects with poorly controlled asthma based on ACQ ≥ 1.5 (n = 7) had significantly higher sputum eosinophils (median = 4.4%) than those with ACQ < 1.5 (n = 28; eosinophils = 2.6%; β = 10.1 [95% CI = 0.1–21.0]; p = 0.05). Subjects with ACQ ≥ 1.5 also had significantly higher sputum neutrophils (84.2% versus 65.2%; β = 7.1 [0.2–14.6]; p = 0.05). Poorly controlled asthma was associated with higher sputum EPO (β = 2.4 [0.2–4.5], p = 0.04), but not MPO (p = 0.9). High ECAT was associated with higher eosinophils (β = 10.1 [1.8–18.4], p = 0.02) but not higher neutrophils (p = 0.6). Conclusions: Poorly controlled asthma in older adults is associated with eosinophilic and neutrophilic inflammation. Chronic residential traffic pollution exposure may be associated with eosinophilic, but not neutrophilic inflammation in older asthmatics.

Strategies for Success in Fellowship

Internal Medicine subspecialty fellows across the continuum of their training should be aware of key strategies to gain the most out of their fellowship training. More than during any other time in a physician’s training, subspecialty fellows are expected to be proactive, self-motivated, and self-directed in their own education and career development. Training programs provide unique opportunities to individualize a fellow’s experiences with the goal of preparing each fellow for a specific career path. Identifying the optimal career path for a given fellow requires self-reflection and good mentoring. The successful launching of a career at the end of fellowship requires planning and time to ensure that individualized career-focused objectives and resources are provided during fellowship. Understanding key strategies for successful fellowship training is essential and can increase the likelihood of a successful and rewarding career.