Recent Publications by CFE Educators

In both 1910 and 2010, The Carnegie Foundation for the Advancement of Teaching used existing educational innovations and learning theory to point the way to the future of medical education. Flexner's transformative report of 1910 was strongly influenced by the innovative curriculum at Johns Hopkins University School of Medicine and by educational principles of the Progressive Era. In 1912, Flexner wrote a similar critique of medical education in Europe. These two reports have powerfully shaped medical education for the past century. Yet much has changed since then, which prompted The Carnegie Foundation for the Advancement of Teaching to commission another report that was published in 2010. Drawing on contemporary educational innovations and research from the learning sciences, the authors make four recommendations for reform: (1) standardize on learning outcomes while individualizing the learning process, (2) integrate formal knowledge with clinical experience, (3) imbue habits of inquiry and improvement to achieve lifelong learning and excellence, and (4) explicitly cultivate the formation of professional identity. In this article, the author describes educational innovations and educational principles relevant to each of these four recommendations.

As we mark the 100th anniversary of the Flexner report which revolutionized the process of medical education, there is again concern that we face a critical need for change in the process of medical education in order to meet the needs of learners, teachers, and patients. In this symposium, panelists shared perspectives on medical education reform from throughout the world, including The Future of Medical Education in Canada, the role of regulators in contributing to reform, the evolution of accreditation standards, the current state of medical education in Southeast Asia, and the perspectives of a medical student on medical education reform. In the "Audience discussion" section, themes emerged surrounding medical education as a social good, the need for governmental support of medical education, the cost of medical education and the rise of for-profit medical schools, and embracing a broader view of health professional education. There remain remarkable parallels in calls for reform in medical education at the turn of the twentieth and twenty-first centuries but education which is patient-centered and actively involves the voices of our patients and our students is likely to be a hallmark.

BACKGROUND/PURPOSE

In recent years, there has been increasing pressure to measure and report quality in health care. However, there has been little focus on quality measurement in the field of neurology for conditions other than stroke and transient ischemic attack. As the number of evidence-based treatments for neurological conditions grows, so will the demand to measure the quality of care delivered. The purpose of this study was to review essential components of hospital performance measures for neurological disease and propose potential quality indicators for commonly encountered inpatient neurological diagnoses.

METHODS

We determined the most common inpatient neurological diagnoses at a major tertiary care medical center by reviewing the billing database. We then searched PubMed and the National Guidelines Clearinghouse to identify treatment guidelines for these conditions. Guideline recommendations with class I/level A evidence were evaluated as possible quality indicators.

RESULTS

We found 94 guidelines for 14 inpatient neurological conditions other than stroke and transient ischemic attack. Of these, 36 guidelines contained at least 1 recommendation with class I evidence. Based on these, potential quality indicators for intracerebral hemorrhage, subarachnoid hemorrhage, pneumococcal meningitis, coma following cardiac arrest, encephalitis, Guillain-Barre syndrome, multiple sclerosis, and benign paroxysmal positional vertigo are proposed.

CONCLUSIONS

There are several inpatient neurological conditions with treatments or diagnostic test routines supported by high levels of evidence that could be used in the future as quality indicators.

BACKGROUND

Many medical schools use patient-encounter logs to track students' clinical experiences, but few have investigated the student-user perspective to understand how students enter, review, and use patient-encounter information.

AIMS

This study examines first-year medical students' use of a web-based tracking system and whether students thought logging patient-encounters was educationally valuable.

METHODS

This mixed-methods study uses data from student encounter log entries, a focus group with first-year students, and a survey. Data analysis involved descriptive statistics for quantitative data, qualitative content analysis of students' free-response entries in the logs, and thematic analysis for focus group and survey responses.

RESULTS

Most students logged at least one encounter (90%), but used the system substantially less than expected. Focus group and survey data indicated that students found minimal educational value in the encounter tracking system as designed, but identified several ways in which the system could be improved to better support their learning. Suggestions included clearer guidelines for use, better integration into the curriculum, a mentoring process, and provision of benchmarks or target number of specific encounter types.

CONCLUSION

Student-user perspectives are crucial in optimizing information collected through patient-encounter tracking systems, and can improve both the functionality and the educational value of such systems.

Interactions of transcriptional activators are difficult to study using transcription-based two-hybrid assays due to potent activation resulting in false positives. Here we report the development of the Golgi two-hybrid (G2H), a method that interrogates protein interactions within the Golgi, where transcriptional activators can be assayed with negligible background. The G2H relies on cell surface glycosylation to report extracellularly on protein-protein interactions occurring within the secretory pathway. In the G2H, protein pairs are fused to modular domains of the reporter glycosyltransferase, Och1p, and proper cell wall formation due to Och1p activity is observed only when a pair of proteins interacts. Cells containing interacting protein pairs are identified by selectable phenotypes associated with Och1p activity and proper cell wall formation: cells that have interacting proteins grow under selective conditions and display weak wheat germ agglutinin (WGA) binding by flow cytometry, whereas cells that lack interacting proteins display stunted growth and strong WGA binding. Using this assay, we detected the interaction between transcription factor MyoD and its binding partner Id2. Interfering mutations along the MyoD:Id2 interaction interface ablated signal in the G2H assay. Furthermore, we used the G2H to detect interactions of the activation domain of Gal4p with a variety of binding partners. Finally, selective conditions were used to enrich for cells encoding interacting partners. The G2H detects protein-protein interactions that cannot be identified via traditional two-hybrid methods and should be broadly useful for probing previously inaccessible subsets of the interactome, including transcriptional activators and proteins that traffic through the secretory pathway.

PURPOSE

Scholarly research is considered by many to be an important component of residency training but little is known about the quantity and types of publications produced by urology residents. To our knowledge whether publication efforts during residency predict future academic publication performance is also unknown. We evaluated resident productivity, as measured by peer reviewed publication output, and determined its relation to future publication output as junior faculty.

MATERIALS AND METHODS

We assembled a list of graduating residents from 2002 to 2004 who were affiliated with the top 50 urology hospitals, as ranked in 2009 by U.S. News&World Report. PubMed® was queried to determine the publication total in the last 3 years of residency of each individual and during years 2 to 4 after residency graduation. Resident publication output was stratified by research time and fellowship training. The relationship between resident productivity and future achievement was assessed.

RESULTS

We assessed the publication output of 251 urologists from a total of 34 training programs affiliated with the top 50 urology hospitals. Subjects published a mean total of 3.5 and a mean of 2.0 first author papers during training. Greater research time during residency was associated with increased productivity during and after residency. Publication during training correlated with publication during the early academic career.

CONCLUSIONS

Publication output correlated with increasing dedicated research time and was associated with the pursuit of fellowship training and an academic career. Publication during residency predicted future academic achievement.