Clinician Educator Milestones: Assessing and Improving Educators' Skills.

ABSTRACT: The importance of the clinician educator (CE) role in delivery of competency-based medical education is well recognized. There is, however, no formal mechanism to identify when faculty have the knowledge, skills, and attitudes to be successful CEs. In 2020, the Accreditation Council for Graduate Medical Education, Accreditation Council for Continuing Medical Education, Association of American Medical Colleges, and American Association of Colleges of Osteopathic Medicine convened a workgroup of 18 individuals representing multiple medical specialties and diverse institutions in the United States, including nonphysician educators, a medical student, and a resident, to develop a set of competencies, subcompetencies, and milestones for CEs.A 5-step process was used to create the Clinician Educator Milestones (CEMs). In step 1, the workgroup developed an initial CEM draft. Through brainstorming, 141 potential education-related CE tasks were identified. Descriptive statements for each competency and developmental trajectories for each subcompetency were developed and confirmed by consensus. The workgroup then created a supplemental guide, assessment tools, and additional resources. In step 2, a diverse group of CEs were surveyed in 2021 and provided feedback on the CEMs. In step 3, this feedback was used by the workgroup to refine the CEMs. In step 4, the second draft of the CEMs was submitted for public comment, and the CEMs were finalized. In step 5, final CEMs were released for public use in 2022.The CEMs consist of 1 foundational domain that focuses on commitment to lifelong learning, 4 additional domains of competence for CEs in the learning environment, and 20 subcompetencies. These milestones have many potential uses for CEs, including self-assessment, constructing learning and improvement plans, and designing systematic faculty development efforts. The CEMs will continue to evolve as they are applied in practice and as the role of CEs continues to grow and develop.

Assistive technologies are central to the realization of the Convention on the Rights of Persons with Disabilities.

PURPOSE: In this paper, we highlight examples of how AT may play a role in realizing each of the fundamental rights affirmed in the UNCRPD. MATERIALS AND METHODS: We conducted an indicative literature search for relevant literature to each of the substantive articles of the CRPD. RESULTS: Assistive technology plays a critical role in achieving the rights affirmed by the Convention on the Rights of Persons with Disabilities. CONCLUSIONS: Ensuring adequate provision of AT by states parties is critical to the progressive realization of the rights of persons with disabilities and to fulfilling commitments made by states parties upon ratification of the CRPD.Implications for rehabilitationAssistive technology (AT) is critical to enable full participation of persons with disability in society and the achievement of rights affirmed by the Convention on the Rights of Persons with Disabilities.Governments and other key stakeholders should endeavour to improve access to AT through inclusive, evidence-informed programs and services.Advocacy is required to improve access to AT through universal health coverage.

Fixation, flexibility, and creativity: The dynamics of mind wandering.

The mind-wandering literature is long on results and short on theory. One notable exception is the Dynamic Framework, a theoretical framework that characterizes mind wandering as thoughts that are relatively unconstrained from deliberate and automatic sources, or "freely moving." Critically, this framework makes numerous testable predictions, including (a) a positive association between freely moving thought and ADHD, (b) negative associations between freely moving thought and depression, anxiety, and OCD, and (c) a positive association between freely moving thought and divergent thinking ability. In Study 1, to test these predictions, we measured participants' reports of freely moving thoughts during a cognitive task and assessed divergent thinking and various psychopathological symptoms. Results failed to support any of the Dynamic Framework's predictions. In Study 2, we assessed the predicted relations between freely moving thought and divergent-thinking performance by manipulating thought constraint during a creative-incubation interval that preceded a divergent-thinking task. Here, we found some evidence (albeit very weak) to support the Dynamic Framework's prediction. Finally, in Study 3, we examined the possibility that indexing freely moving thought during a divergent-thinking task would yield the predicted associations but failed to find support for these associations. These results, most of which are at odds with the predictions of the Dynamic Framework, suggest either the need to revise the framework and/or that current methods are inadequate to properly test these predictions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Rare presentation of acute pancreatitis in mild COVID-19.

Viral-induced pancreatitis has been well-defined; however, there are limited data regarding COVID-19 and pancreatitis. Most cases are commonly in conjunction with severe COVID-19 as well as lipase elevation. We describe a unique case of mild SARS-CoV-2 infection resulting in acute pancreatitis in the absence of lipase elevation. A 39-year-old patient with no medical history, presented with epigastric pain. Vital signs were unremarkable. Patient was positive for COVID-19. Liver function panel, calcium, triglyceride and lipase levels were all unremarkable. CT of the abdomen demonstrated acute pancreatitis without gallstones. Our case may indicate that pancreatic injury in SARS-CoV-2 infection is due to a direct impact on the pancreas by the virus, given the absence of lipase elevation and mild presentation. This case highlights the importance of suspecting pancreatitis in mild COVID-19 that present with atypical symptoms such as epigastric pain, even without lipase elevation.

The Impact of Temporally Coherent Visual Cues on Speech Perception in Complex Auditory Environments.

Speech perception often takes place in noisy environments, where multiple auditory signals compete with one another. The addition of visual cues such as talkers' faces or lip movements to an auditory signal can help improve the intelligibility of speech in those suboptimal listening environments. This is referred to as audiovisual benefits. The current study aimed to delineate the signal-to-noise ratio (SNR) conditions under which visual presentations of the acoustic amplitude envelopes have their most significant impact on speech perception. Seventeen adults with normal hearing were recruited. Participants were presented with spoken sentences in babble noise either in auditory-only or auditory-visual conditions with various SNRs at -7, -5, -3, -1, and 1 dB. The visual stimulus applied in this study was a sphere that varied in size syncing with the amplitude envelope of the target speech signals. Participants were asked to transcribe the sentences they heard. Results showed that a significant improvement in accuracy in the auditory-visual condition versus the audio-only condition was obtained at the SNRs of -3 and -1 dB, but no improvement was observed in other SNRs. These results showed that dynamic temporal visual information can benefit speech perception in noise, and the optimal facilitative effects of visual amplitude envelope can be observed under an intermediate SNR range.

Ancient Use of Ig Variable Domains Contributes Significantly to the TCRδ Repertoire.

The loci encoding B and T cell Ag receptors are generally distinct in commonly studied mammals, with each receptor's gene segments limited to intralocus, cis chromosomal rearrangements. The nurse shark (Ginglymostoma cirratum) represents the oldest vertebrate class, the cartilaginous fish, with adaptive immunity provided via Ig and TCR lineages, and is one species among a growing number of taxa employing Ig-TCRδ rearrangements that blend these distinct lineages. Analysis of the nurse shark Ig-TCRδ repertoire found that these rearrangements possess CDR3 characteristics highly similar to canonical TCRδ rearrangements. Furthermore, the Ig-TCRδ rearrangements are expressed with TCRγ, canonically found in the TCRδ heterodimer. We also quantified BCR and TCR transcripts in the thymus for BCR (IgHV-IgHC), chimeric (IgHV-TCRδC), and canonical (TCRδV-TCRδC) transcripts, finding equivalent expression levels in both thymus and spleen. We also characterized the nurse shark TCRαδ locus with a targeted bacterial artifical chromosome sequencing approach and found that the TCRδ locus houses a complex of V segments from multiple lineages. An IgH-like V segment, nestled within the nurse shark TCRδ translocus, grouped with IgHV-like rearrangements we found expressed with TCRδ (but not IgH) rearrangements in our phylogenetic analysis. This distinct lineage of TCRδ-associated IgH-like V segments was termed "TAILVs." Our data illustrate a dynamic TCRδ repertoire employing TCRδVs, NARTCRVs, bona fide trans-rearrangements from shark IgH clusters, and a novel lineage in the TCRδ-associated Ig-like V segments.

Migration of a fractured inferior vena cava filter strut to the right ventricle of the heart.

Inferior vena cava (IVC) filters are increasingly used in patients with recurrent venous thromboembolism in whom anticoagulation is contraindicated or intolerable. Migration of fragments is a known complication of IVC filter use. We present a case of a 32-year-old man, who presented with right-sided chest pain believed to be caused by a migrated IVC fragment to the right ventricle. The filter was removed by an endovascular cook forceps with the assistance of intracardiac echocardiography. This case serves as an addition to the existing reports of successful removal of intracardiac fragments via minimally invasive endovascular approach, amid a larger number of intracardiac fragments that have been removed by an open-heart approach.

Peritoneal tuberculosis mimicking peritoneal carcinomatosis.

A 67-year-old male presented with fatigue, abdominal pain , and 30-pound weight loss over 3 months. Computerized tomography (CT) abdomen displayed ascites with thickening and enhancement of the peritoneum and mottled nodular appearing as soft tissue consistent with omental caking worrisome for peritoneal carcinomatosis. A paracentesis revealed white blood cell count of 2,500 with 98% lymphocytes and serum ascites albumin gradient of 0.9 g/L. No acid-fast bacilli were seen by microscopic exam and culture was negative. Purified protein derivative skin test (PPD) was negative and CXR did not reveal any infiltrates. Esophagogastroduodenoscopy (EGD) and colonoscopy were unrevealing. The patient underwent exploratory laparotomy with round ligament and peritoneal biopsies that revealed numerous necrotizing granulomas. Acid-fast bacteria Ziehl-Neelsen stain (AFB) of the biopsy specimen revealed single acid-fast bacilli. Treatment for M. tuberculosis was initiated and final culture revealed that mycobacterium tuberculosis was sensitive to Isoniazid, Rifampin, Ethambutol, and Pyrazinamide. After 6 months of treatment, the ascites and peritoneal carcinomatosis resolved.

Monitoring Osteoarthritis: A Cross-sectional Survey in General Practice.

BACKGROUND: Despite being a highly prevalent chronic condition managed predominantly in primary care and unlike other chronic conditions, osteoarthritis (OA) care is delivered on an ad hoc basis rather than through routine structured review. Evidence suggests current levels of OA care are suboptimal, but little is known about what general practitioners' (GPs) consider important in OA care, and, thus, the scope to improve inconsistency or poor practice is, at present, limited. OBJECTIVES: We investigated GPs' views on and practice of monitoring OA. METHODS: This was a cross-sectional postal survey of 2500 practicing UK GPs randomly selected from the Binley's database. Respondents were asked if monitoring OA patients was important and how monitoring should be undertaken. RESULTS: Responses were received from 768 GPs of whom 70.8% were male and 89.5% were principals within their practices. Despite 55.4% (n = 405) indicating monitoring patients with OA was important and 78.3% (n = 596) considering GPs the appropriate professionals to monitor OA, only 15.2% (n = 114) did so routinely, and 45% (n = 337) did not monitor any OA patients at all. In total, 61.4% (n = 463) reported that patients should self-monitor. Respondents favored monitoring physical function, pain, and analgesia use over monitoring measures of BMI, self management plans, and exercise advice. CONCLUSIONS: The majority of respondents felt that monitoring OA was important, but this was not reflected in their reported current practice. Much of what they favored for monitoring was in line with published guidance, suggesting provision of suboptimal care does not result from lack of knowledge and interventions to improve OA care must address barriers to GPs engaging in optimal care provision.

Should there be a Quality and Outcomes Framework domain for osteoarthritis? A cross-sectional survey in general practice.

BACKGROUND: Despite being a chronic condition with a high prevalence and significant associated morbidity that is managed predominantly in primary care, osteoarthritis (OA) does not feature in the Quality and Outcomes Framework (QOF) component of the UK general practice contract. The aim of this study was to determine whether general practitioners (GPs) thought OA should be added as a QOF domain, and the potential items for inclusion. METHODS: A cross-sectional postal survey of 2500 UK GPs randomly selected from Binley's database of currently practising GPs was conducted. The survey asked if OA should be added as a domain to QOF, how many points should be allocated to it and what indicators should be included. RESULTS: Responses were received from 768 GPs, of whom 70.4% were male and 89.1% were partners in their practice. The majority (82.6%; n = 602) felt that OA should not be included as a QOF domain. Significant predictors of support for the addition of an OA domain to QOF included having a special interest in musculoskeletal disease (odds ratio [OR] 1.95, 95% confidence interval [CI] 1.26-3.03), a higher research degree (OR 3.98, 95% CI 1.31-12.10) and having read the National Institute for Health and Clinical Excellence (NICE) guidance on the management of OA (OR 1.62, 95% CI 1.04-2.54). Being a GP principal was the only negative association (OR 0.48, 95% CI 0.23-0.99). Preferred potential indicators for an OA QOF were analgesia review, exercise advice and patient education. CONCLUSIONS: The majority of respondents felt that OA should not be included as a QOF domain, although it is unclear whether this reflected views particular to OA, or on the addition of any new domain to QOF. Those supporting an OA QOF domain tended to prefer potential indicators that are in line with current published guidance, despite a significant proportion reporting that they had not read the NICE guidelines on the management of OA.

There is no association between a measure of clinical care and the response rate of GPs to postal surveys: a methodological study.

BACKGROUND: There has been much research into factors that can be modified to improve the response rates of general practitioners to surveys and to the demographic characteristics of those who do and do not respond. However, response is yet to be considered with respect to the quality of clinical care provided by GPs. In the UK, one measure of quality of care is the Quality and Outcomes Framework (QOF) score achieved by a general practice. OBJECTIVE: This study considers the association of QOF score with response to self-completion postal surveys of general practitioners. METHODS: Data are taken from two postal surveys of general practitioners (GPs) in the UK regarding their attitudes to osteoarthritis (OA) and sickness certification respectively. Logistic regression was used to assess the association between survey response and QOF score (as a proxy for quality of clinical care), adjusting for other characteristics of GPs and their practices (list size, number of partners, geographical region). RESULTS: There was no significant association of QOF score with survey response in either study, before or after adjustment for the other characteristics. CONCLUSION: There is no evidence of an association between QOF score and the response of GPs to postal surveys. This gives reassurance that samples for studies of GP attitudes and practices should not suffer from response bias in relation to this core characteristic that represents the clinical achievement of their practice.