Recent Publications by CFE Educators

This study examined the effects of intrathecally (i.t.) administered mu and delta opioid receptor agonists on the flinching behavior and the expression of Fos-like immunoreactivity (Fos-LI) in the spinal cord elicited by s.c. injection of 5% formalin in one hindpaw of the rat. Intrathecal pretreatment with either the delta-1 opioid receptor agonist [D-Pen2,5]enkephalin (DPDPE) or the delta-2 opioid receptor agonist [D-Ala2,Glu4]deltorphin (DELT) produced a dose-dependent inhibition of flinching behavior in phase 1 and phase 2 that was antagonized by coadministration of the delta-1 opioid receptor antagonist 7-benzylidinenaltrexone or the delta-2 opioid receptor antagonist Naltriben, respectively. Although i.t. pretreatment with 60 micrograms of DPDPE produced a small decrease in the numbers of Fos-LI neurons in laminae I, IIi and IIo, as well as laminae V and VI and laminae VII-X, i.t. pretreatment with 30 micrograms of DELT did not decrease the number of Fos-LI neurons in any region of the spinal cord. In contrast, i.t. pretreatment with an equieffective dose of the mu opioid receptor agonist [D-Ala2,NMePhe4,Gly-ol5]enkephalin (DAMGO) not only significantly decreased the number of flinches in phase 1 and phase 2, but also nearly completely prevented the expression of Fos-LI in all regions of the spinal cord. These effects were antagonized by pretreatment with the mu opioid receptor antagonist D-Phe-Cys-Tyr-D-Trp-Arg-Thr-Phe-Thr-NH2. The efficacy of i.t. administered DAMGO suggests that a direct spinal action contributes to the inhibition of noxious stimulus-evoked Fos-LI in the spinal cord produced by systemically administered mu opioid receptor agonists such as morphine. The relative lack of effect of DPDPE or DELT suggests that delta opioid receptors do not modulate the early-immediate gene c-fos. Alternatively, because delta opioid receptor agonists inhibit synaptic transmission in the spinal cord by predominantly presynaptic mechanisms and do not hyperpolarize dorsal horn neurons, the excitatory inputs that persist in the presence of these agonists may be sufficient to activate the c-fos gene. Taken together, these results provide new evidence, at the level of a "third messenger," that the antinociception produced by i.t. administration of delta and mu opioid receptor agonists is mediated by different mechanisms.

Purpose - The purpose of this study was to investigate influences on third-year medical students' specialty preferences.Method - A survey questionnaire was mailed to third-year medical students at two medical schools. The questionnaire asked students to rate the degree to which various aspects of the third-year curriculum and perceived specialty characteristics influenced their specialty preferences.Results - A total of 214 (70%) of eligible students responded, of whom 46% were female and 57% preferred primary care (PC) specialties. The most frequently cited influential clerkship was internal medicine. Most clerkships (72%) had a positive influence on students' preferences. PC clerkships had more positive influences than non-primary care (NPC) clerkships, especially among PC-oriented students. The most influential aspects of clerkships were faculty and residents, especially in PC clerkships. For both PC- and NPS-oriented students, the diagnostic and patient-related characteristics of their preferred specialties were highly influential. PC-oriented students were more likely to be attracted to prevention and biopsychosocial aspects of specialties, and NPC-oriented students to the opportunity to do procedures and intervene in illnesses. Student gender appeared to have little influence on response patterns, except as a proxy for specialty preference, which, for women, was more likely to be a primary care specialty.Conclusion - These findings suggest that the third-year clerkships, especially at non-university sites, play an important role in specialty choice, and that factors attracting students to PC differ significantly from those attracting students to NPC.

The authors surveyed forty-eight distinguished teachers from clinical departments regarding the role of instructional successes in learning to teach. Using qualitative content analysis of comments, the authors identified nine common successes in clinical teaching associated with planning, teaching, and reflection. In anticipatory reflection used for planning, common successes occurred by involving learners, continuously innovating, creating a positive atmosphere for learning, considering the learners, engaging the learners, preparing adequately, and limiting content. When reflecting-in-action, the success experience most commonly mentioned was maintaining flexibility in action. Reflecting-on-action after a successful teaching event, they commented on the importance of thoughtful analysis and choosing an appropriate strategy. These teachers incorporated reflective practice into their teaching as an essential component of professional development and incrementally improved their teaching based upon successful instructional experiences.

PURPOSE

To examine the perceptions of faculty role models to learn whether their perceptions of role models' behaviors are congruent with those of their students.

METHOD

In 1996 a survey was mailed to 210 student-identified faculty role models at the University of Washington School of Medicine and the University of North Carolina at Chapel Hill School of Medicine. The nominees were asked to rate to what extent each of 32 student-identified role model characteristics was representative of their behavior. They were then asked to rank order the characteristics they felt were most important to model for students. The role models were also asked to rate how much influence they perceived themselves to have on their students' specialty choices. A final, open-ended question inquired about the single characteristics they modeled to students that most influenced the students' specialty choices. The role models' specialties were grouped as either primary care (PC) or non-primary care (NPC). Data were analyzed with several statistical methods.

RESULTS

Of the 210 mailed surveys, a total of 177 were returned, for a response rate of 84%. The role models perceived their behaviors much like their students did; the role models' self-ratings were generally high for all of the student-defined characteristics. Although clinical reasoning was considered the most important characteristic to model for students, the role models also believed that enthusiasm and love for their work were the characteristics that most influenced their students' specialty choices. Few differences were found between the PC and the NPC role models.

CONCLUSION

The role models in this study agreed with their students about what is important to model. They did not intentionally try to recruit students to join their specialties but felt that demonstrating enthusiasm and a sincere love for what they did has a strong influence toward this end.