Feasibility Study of a Fully Synchronous Virtual Critical Care Elective Focused on Learner Engagement.

BACKGROUND: The COVID-19 pandemic disrupted clinical education for medical students. With the rise of variants, meaningful in-person clinical experiences remain threatened. This report describes the design, implementation, and evaluation of a fully synchronous virtual critical care elective for medical students focused on learner engagement. METHODS: The two-week elective was offered during June and July 2020 in the COVID-19 extracorporeal membrane oxygenation (ECMO) unit. Medical students remotely participated in multidisciplinary rounds with the attending physician connected from the bedside via a head-mounted camera providing the first-person video view. Other team members connected outside the negative pressure area. Learners electronically completed daily intensive care unit (ICU) goals sheet (GS) for each patient. The daily completion percentage of the GS assessed the learner engagement, and the learners evaluated the experience with a five-point Likert scale survey. RESULTS: Nine medical students participated in two separate cohorts. Cohort A had 53 patient encounters, and Cohort B had 45 patient encounters totaling 301.5 total hours of supervised virtual patient interaction. The mean completion percentage of the daily ICU GS for the combined cohorts was 77.8%, (with a standard deviation of 9.6%), with sustained or increased completion from start to finish for all learners. All medical students agreed that the daily ICU GS was helpful for following rounds, organizing patient assessments and plans, and participating in patient care. The majority (88.9%) agreed that the elective increased their comfort in caring for critically ill patients. CONCLUSIONS: During the COVID-19 pandemic, a fully synchronous virtual critical care elective successfully utilized the first-person view and daily ICU GS to promote and assess learner engagement.

Perceptions of Barriers and Facilitators to Becoming a Medical Professional Among Underrepresented Undergraduate and Postbaccalaureate Learners.

OBJECTIVE: To assess underrepresented undergraduate and postbaccalaureate learners' perceptions of (1) the medical field, (2) barriers that might prevent individuals from pursuing professional medical careers, and (3) resources that assist in overcoming these barriers. PARTICIPANTS AND METHODS: A qualitative study with focus groups was designed to achieve the objective. Participants were recruited from a community initiative to provide early exploration of the medical field to disadvantaged and minority individuals. Thirty-five individuals voluntarily participated in semistructured interviews. Audio from the interviews was analyzed using a qualitative descriptive approach and thematic analysis. This study was conducted from October 20, 2018, to April 6, 2019. RESULTS: Participants identified multiple characteristics related to the health care work environment and desirable attributes of health care personnel. The following barriers were identified: financial burden, lacking knowledge of the path to becoming a medical professional, inadequate social support, and lacking the metrics of a competitive candidate. Resources identified by participants to overcome barriers included professional networks and programmatic considerations. CONCLUSION: The study participants discussed negative and positive aspects of the health care environment, such as implicit and explicit biases and attributes that promote or sustain success. Participants expounded on financial, academic, social, and personal factors as barriers to success. In regard to resources that were believed to be helpful to mitigate barriers and promote success, participants commented on activities that simulate a professional medical environment, include networking with medical personnel, support well-being, and provide exposure to structured information on the process of obtaining professional medical training.

Identification of the immunoproteasome as a novel regulator of skeletal muscle differentiation.

While many of the molecular details of myogenesis have been investigated extensively, the function of immunoproteasomes (i-proteasomes) in myogenic differentiation remains unknown. We show here that the mRNA of i-proteasome subunits, the protein levels of constitutive and inducible proteasome subunits, and the proteolytic activities of the 20S and 26S proteasomes were significantly upregulated during differentiation of skeletal muscle C2C12 cells. Knockdown of the i-proteasome catalytic subunit PSMB9 by short hairpin RNA (shRNA) decreased the expression of both PSMB9 and PSMB8 without affecting other catalytic subunits of the proteasome. PSMB9 knockdown and the use of i-proteasome-specific inhibitors both decreased 26S proteasome activities and prevented C2C12 differentiation. Inhibition of the i-proteasome also impaired human skeletal myoblast differentiation. Suppression of the i-proteasome increased protein oxidation, and these oxidized proteins were found to be more susceptible to degradation by exogenous i-proteasomes. Downregulation of the i-proteasome also increased proapoptotic proteins, including Bax, as well as cleaved caspase 3, cleaved caspase 9, and cleaved poly(ADP-ribose) polymerase (PARP), suggesting that impaired differentiation is likely to occur because of significantly increased apoptosis. These results demonstrate for the first time that i-proteasomes, independent of constitutive proteasomes, are critical for skeletal muscle differentiation of mouse C2C12 cells.