Improving Integration of Basic Science into Clinical Medicine: Vertical Integration into Clinical Education (VICE) Activity.

The integration of basic science into clinical clerkships continues to be a challenge in medical curricula. We developed an integrated session for 3rd year medical students enrolled in OB-Gyn/Pediatric Block. The session focused on transplacental and perinatal infections, and consisted of a student-driven pedagogy activity in which students were required to explain the basic science principles behind the pathophysiology of the clinical presentations, the work-up, and the treatment of the infections. This approach helps students understand how basic science knowledge informs clinical practice and potential increase clerkship-level students' confidence as it makes them serve as leaders of active learning modules. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40670-021-01485-7.

Giant cell tumor of the talus: A case report.

Giant cell tumor is a benign primary bone neoplasm which most often occurs in a periarticular location. Involvement of the bones of the foot and ankle is rare, and there have been a limited number of previous case reports involving the talus. Here we report a case of giant cell tumor of the talus, which was initially radiographically occult in a 43-year-old female, with emphasis on MRI imaging characteristics. The patient underwent surgical excision and curettage. Histological examination revealed the presence of spindle cells admixed with giant cells, confirming GCT. We further provide an overview of the radiological findings of GCT. Giant cell tumor is a benign bone neoplasm of mesenchymal origin, identified by multinucleated giant cells [1]. GCT is locally aggressive and can destroy adjacent bone and articulations. The most commonly affected bones are the distal femur, proximal tibia, and distal radius, with an epiphyseal predominance in 90% of cases [2]. Presentations are mostly mono-ostotic, however multicentricity may occur in younger patients [3]. Very few cases have been reported in the bones of the feet, an incidence of 1%-2% have been previously reported [4]. GCT is seen between ages 20 and 40 years, with a 56% predominance in females [3]. Although benign, 1%-9% cases may "metastasize" to the lungs. The initial treatment is surgical removal, either en bloc, or more commonly intralesional curettage and the use of adjuvants. Even after resection, GCT has a high recurrence rate [2]. The trigger for GCT is currently unknown. However, a majority of cases have cytogenetic abnormalities of telomeric associations (tas). Involvement of the RANK pathway is also believed to contribute to the pathogenesis of GCT [2].

Evaluating the performance of a low-cost mobile phone attachable microscope in cervical cytology.

BACKGROUND: Cervical cancer remains a global health problem especially in remote areas of developing countries which have limited resources for cervical cancer screening. In this study, we evaluated the performance of a low-cost, smartphone attachable paper-based microscope when used for classifying images of cervical cytology. METHODS: Cervical cytology samples included: 10 Normal, 10 Low-grade squamous intraepithelial lesion (LSIL), 10 High-grade squamous intraepithelial lesion (HSIL), and 10 Malignant Pap Smears. The agreement between conventional microscopy vs. Foldscope imaging was calculated using a weighted kappa coefficient. A confusion matrix was created with three classes: Normal, LSIL, and HSIL/malignant, to evaluate the performance of the Foldscope by calculating the accuracy, sensitivity, and specificity. RESULTS: We observed a kappa statistic of 0.68 for the agreement. This translates into a substantial agreement between the cytological classifications by the Foldscope vs. conventional microscopy. The accuracy of the Foldscope was 80%, with a sensitivity and specificity of 85 and 90% for the HSIL/Mal category, 80 and 83.3%, for LSIL, and 70 and 96.7% for Normal. CONCLUSIONS: This study highlights the usefulness of the Foldscope in cervical cytology, demonstrating it has substantial agreement with conventional microscopy. Its use could improve cytologic interpretations in underserved areas and, thus, improve the quality of cervical cancer screening. Improvements in existing limitations of the device, such as ability to focus, could potentially increase its accuracy.

Innate and Adaptive Immune Response to a Virus: An Integrated Learning Module.

Introduction: Medical schools must expand their teaching strategies to address a new generation of medical students and ensure their growth into lifelong, self-directed learners. Integration across basic science disciplines packaged together with clinical medicine produces learning materials that better enable medical students to achieve these goals. Methods: We created a narrated audiovisual learning module illustrating the foundational sciences and clinical presentation surrounding immune responses to viral infections. We integrated immunology, microbiology, histology, pathology, and clinical medicine and included a self-assessment quiz and clinical vignette with questions to test students' understanding of the material. We published the module on our school's learning management system and tracked student usage, which was followed by an in-class survey to assess student perceptions of the usefulness of the module. Results: Sixty-four (59%) of the first-year medical students used the module. Thirty-seven students completed the in-class survey assessing their perceptions of the module. Over 95% of responders reported that the module helped them learn the new material, identify areas of weakness, understand the big picture for this immune response, and apply the material in a clinical context. Discussion: This module illustrates an approach to integrating basic science disciplines in order to facilitate students' understanding of the mechanisms underlying patients' clinical presentations. Survey results indicated that students valued the module as a self-directed learning component that integrated essential clinical concepts. The module was a helpful tool for students to evaluate their comprehension of immunology in a clinical context and can be used as required or optional material.

Immune Response in Allergic Contact Dermatitis: An Integrated Learning Module.

Introduction: Medical students are introduced to skin rashes during their preclinical years and often express difficulty in differentiating the underlying mechanisms. The preclinical lessons regarding immunologically mediated skin rashes are largely forgotten by the time the students begin diagnosing and treating skin rashes during clinical rotations. This module aims to enhance student understanding of immunologic concepts by integrating material across disciplines, contextualizing within a clinical scenario, and providing opportunity for self-testing. Methods: A diagram illustrating immune responses in allergic contact dermatitis was used in the Texas Tech University Paul L. Foster School of Medicine preclinical curriculum. This diagram was updated as an audiovisual learning module that traced the immune mechanisms and pathogenesis of contact dermatitis from allergen exposure to skin-rash development. A self-assessment quiz and a clinical vignette with questions were included in the module. Student usage was monitored, and an in-class survey evaluating student perception was administered. Results: Sixty-four (58%) first-year medical students used this module. Twenty-eight students completed the in-class survey. Over 95% of respondents felt that the module helped them learn the new material, identify areas of weakness, and both understand the underlying pathology and big picture for this immune response. Discussion: Student survey results indicate the module is clinically relevant and enhances learning. The module may be used as a component of self-directed learning in any immunology curriculum or may be used in any basic immunology course to exemplify the role of the immune system in disease.

Immune Response to Bacteria: An Integrated Learning Module to Enhance Preclinical Students' Competency in Immunology.

INTRODUCTION: Medical students express frustration that they cannot assemble a comprehensive big picture of how the immune system responds to a microbe and that integration of basic science knowledge, especially across disciplines, with clinical knowledge is difficult. Yet medical student competency requires application of knowledge of immune mechanisms to inform diagnosis and treatment. METHODS: A diagram for immune response to extracellular microbes was previously published by MedEdPORTAL in 2011. This diagram has been updated here as a narrated audiovisual module with integrated histopathology. It contains a self-assessment quiz that tests students' understanding of the module followed by a clinical vignette that tests students' ability to apply the concepts in a clinical context. The module was published and usage was tracked via our learning management system. An in-class survey was conducted to gauge students' perceptions of the module. RESULTS: Eighty-two out of 102 (76%) first-year medical students used the module. Over 85% of survey participants felt that the module was a useful resource for learning and reviewing. More than 90% felt that the module helped them to understand the big picture and identify areas for further study. DISCUSSION: This module assembles a big picture of the immunologic mechanisms involved in a bacterial infection. It was created in response to requests and suggestions by preclinical medical students and used for first-year students during the first few weeks of their training in the basic sciences. This approach integrates multiple disciplines and facilitates students' learning and application of difficult concepts in immunology and pathology.