Susan M. Viselli

Interprofessional workshop to improve mutual understanding between pharmacy and medical students.

Objective. To measure changes in pharmacy and medical students’ physician-pharmacist collaboration scores resulting from a workshop designed to promote understanding of the others’ roles in health care. Methods. More than 88% of first-year pharmacy (n = 215) and medical (n = 205) students completed the Scale of Attitudes Toward Physician-Pharmacist Collaboration on 3 occasions in order to establish a baseline of median scores and to determine whether the scores were influenced by an interprofessional workshop. Results. Participation in the interprofessional workshop increased pharmacy students’ collaboration scores above baseline (p=0.02) and raised the scores of medical students on the education component of the collaboration survey instrument (p=0.015). The collaboration scores of pharmacy students greatly exceeded those of medical students (p<0.0001). Conclusion. A workshop designed to foster interprofessional understanding between pharmacy and medical students raised the physician-pharmacist collaboration scores of both. Crucial practical goals for the future include raising the collaboration scores of medical students to those of pharmacy students.

Effect of androgens and glucocorticoids on microbial growth and antimicrobial susceptibility.

The effects of androgens, testosterone and dihydrotestosterone (DHT), of an environmental anti-androgen, 2,2-bis(4-chlorophenyl)-1,1-dichloroethylene (DDE), and of glucocorticoids, hydrocortisone and dexamethasone, on growth kinetics and antibiotic susceptibility of E. faecalis, E. coli, P. aeurginosa, and S. aureus were measured. For P. aeurginosa, the presence of either DHT or DDE caused at least a fourfold shift in the minimum inhibitory concentration (MIC) of cefepime and tobramycin. DHT and DDE also affected the response of E. faecalis to meropenem and norfloxacin, resulting in a shift from sensitive to intermediate resistance (four-fold increase in MIC). Hydrocortisone (2 μM) induced an increase in the sensitivity of S. aureus to erythromycin, as compared to hormone-free control (from 0.5 to 0.06 μg/mL). The susceptibility pattern of E. coli was unaffected by the hormones tested. These changes in susceptibility to antibiotics were unrelated to alterations in growth kinetics. For all organisms tested, the alterations in MICs occurred only in the presence of hormone, indicative of changes in the phenotype of these stable quality control strains.

Effect of insulin on microbial growth

The ability of insulin to affect the growth kinetics of Escherichia coli, Staphylococcus aureus, Enterococcus faecalis, and Pseudomonas aeruginosa was measured. For all organisms, insulin, in the absence of a metabolizable sugar source, i.e., glucose or starch in Mueller-Hinton medium, had no effect on generation time as compared with a homologous control. Response to insulin, in the form of increased or decreased generation times, for both Gram-positive and Gram-negative bacteria, was dependent on the concentration of insulin, the concentration of glucose present, and the initial concentration of bacteria exposed to the glucose and insulin.

Critical Thinking and Reflection Exercises in a Biochemistry Course to Improve Prospective Health Professions Students’ Attitudes Toward Physician-Pharmacist Collaboration

Objective. To determine the impact of performing critical-thinking and reflection assignments within interdisciplinary learning teams in a biochemistry course on pharmacy students’ and prospective health professions students’ collaboration scores. Design. Pharmacy students and prospective medical, dental, and other health professions students enrolled in a sequence of 2 required biochemistry courses. They were randomly assigned to interdisciplinary learning teams in which they were required to complete case assignments, thinking and reflection exercises, and a team service-learning project. Assessment. Students were asked to complete the Scale of Attitudes Toward Physician-Pharmacist Collaboration prior to the first course, following the first course, and following the second course. The physician-pharmacist collaboration scores of prospective health professions students increased significantly (p<0.001). Conclusions. Having prospective health professions students work in teams with pharmacy students to think and reflect in and outside the classroom improves their attitudes toward physician-pharmacist collaboration.

Challenging Medical Students to Confront their Biases: A Case Study Simulation Approach

We used three approaches to determine whether first-year medical students would begin to confront their biases in response to a simulated encounter with an incarcerated, African-American patient. The patient presented with fatigue in a Biochemistry course workshop. Two hundred five students watched and helped a classmate conduct a simulated interview with the patient who had been imprisoned for attempted murder. We then studied whether the students confronted their biases against the patient using (a) a survey of individual students regarding these biases, (b) one of a number of questions on a formal assignment concerning the case completed in a team format, and (c) an unprompted extra-credit opportunity to reflect as a team on issues of their choice. On the survey, eighty five percent of students confronted their biases against the patient, and they began to reflect critically about these biases. Critical reflection on teams occurred more frequently outside the formally assigned exercise (Effect Size = 0.75, crucial practical importance). Thus, most first-year medical students can be led, even in basic sciences courses, to confront their biases. In this way, they may also begin to mitigate their biases against patients. Such self-regulation of biases by health care professionals on a regular basis should help to decrease health care disparities.

Does Critical Reflection by Biochemistry Learning Teams Foster Patient-centered Beliefs among Medical Students?

The authors measured patient-centered orientation scores of first-year osteopathic medical students before vs. after implementing exercises to foster critical reflection by learning teams. In the 2008–09 academic year, 60 of a total of 130 classroom hours were devoted to team-based learning (TBL) in a sequence of three Biochemistry courses (1500, 1501 and 1502). TBL was modified to include required and extra-credit team critical reflection assignments. Index questions were used to compare student learning on their own using modified TBL to learning facilitated by instructors in the preceding year. Individual student performances on index questions improved using modified TBL as the sequence of three courses progressed from 8% lower than in the prior year for the first course (p<0.001) to 7% higher than in the prior year for the third course (p<0.005). Moreover, team members cooperated more on team tests as they progressed from Biochemistry 1500 through Biochemistry 1502 (p<0.01). Finally, students became more patient-centered and caring (p<0.0001) using modified TBL, whereas the reverse was observed (p<0.01) prior to implementing exercises to foster critical reflection by team-based learning teams. Thus, TBL, modified to include opportunities for team critical reflection, fostered both cooperation and patient-centered orientations in first-year medical students.

Sex-Related Immune Changes in Young Mice

Here we describe changes in selected immune parameters related to age and sex in young mice. We focused on the T cell compartment and studied thymuses and spleens from mice 3 to 9 weeks of age in order to bracket the time period around murine puberty. With regard to distribution of immune cells, no significant sex-related changes were seen in thymocyte expression of CD3, CD4, CD8, or CD4/CD8 or splenocyte expression of CD3, CD4, CD8, or CD45R/B220, a pan B cell marker. For splenocytes, significantly more cells were positive for CD3 in older (6-9 week old) compared with younger (3-4 week old) mice. Splenocyte and thymocyte cell proliferation as measured by DNA synthesis in response to in vitro mitogens was compared for cells from male and female mice over the ages studied. Thymocyte proliferation was not related to age or sex of the mice. For splenocytes of the youngest mice (3 weeks old), the response to a cell surface-receptor-independent mitogenic combination of phorbol ester and ionomycin induced a significantly greater response in cells from female mice compared with male mice. This trend was reversed for mice of 4-6 weeks of age, where the response by splenocytes from males was significantly greater than that by cells from females. For mice 7-8 weeks of age, splenocytes from female mice responded significantly less to stimulation by antibody to CD3, a component of the T-cell receptor. Our results demonstrate that depending on the assays employed, sexual dimorphism in the immune system may be demonstrated prior to puberty.

#91 Immune and autoimmune effects of the environmental antiandrogen, DDE

Androgens have long been theorized to influence the immune system and to play a role in the female predominance of autoimmune diseases such as systemic lupus erythematosus (SLE). Environmental antiandrogens, specifically a derivative of the pesticide, DDT, known as p,p 0-DDE (1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene), may also influence immunity and the development of autoimmunity. DDE suppresses androgen binding to the androgen receptor, functioning as an androgen receptor antagonist. Our studies have used castrate male C57BL/6 mice. These mice have enlarged thymuses; androgen treatment rapidly induces thymic involution, by inducing thymocyte apoptosis. Somewhat surprisingly, we found treatment with DDE, an androgen receptor antagonist, also induces thymocyte apoptosis. We investigated thymus expression of death related proteins, including Fas and TRAIL, that are both implicated as important regulators of apoptosis. Since previous studies in our laboratory show both Fas and TRAIL to be androgen regulated in the thymus, we assessed whether DDE regulates their expression. Immunoblot and FACS analyses were done and revealed that while Fas appears to be regulated by DDE, TRAIL does not. Our study also utilized FACS analysis to examine subpopulations of immune cells in thymuses and spleens of mice treated with DDE, with regard to CD4/CD8, CD3/ B220. DDE treatment did not alter percentages of cells within those subpopulations. We are also evaluating CD4CD25 regulatory T (Treg) cells that are essential for the maintenance of immunologic self-tolerance, and Forkhead box transcription factor (Foxp3) that is important in the development and function of Treg cells. By FACS analysis, more cells express Foxp3 in thymuses treated with DDE than control. We are also using NZB/ NZW F1 mice that spontaneously develop disease comparable to human SLE. The disease is more prevalent in female NZB/NZW F1 mice than males, and androgens effectively treat the disease. We are currently investigating the effects of both androgens and DDE on the expression of Fas and Foxp3 in this model of autoimmunity.