Allelic frequencies of the hs1.2 enhancer within the immunoglobulin heavy chain region in Dayton, Ohio patients screened for celiac disease with duodenal biopsy.

BACKGROUND: Genetic and environmental factors contribute to the development of celiac disease (CD), but specific genetic predisposing factors remain poorly understood. One candidate is allele 2 of the hs1.2 enhancer within the immunoglobulin heavy chain region. In humans, there are four possible alleles and a previous study of an Italian cohort demonstrated a significantly increased frequency of allele 2 in patients with CD. AIMS: The purpose of the current study was to determine if a similar association between allele 2 and CD exists in an American population from Dayton, OH. METHODS: Subjects were screened for CD via esophagogastroduodenoscopy with duodenal biopsy. All biopsies were microscopically scored using a modified Marsh-Oberhuber classification. DNA was isolated from patients' buccal cells for hs1.2 genotype analysis using PCR. RESULTS: Unlike the Italian cohort, allele 2 frequency was not significantly different in patients with histopathologic evidence of CD compared to patients without such evidence. However, our patient population as a whole demonstrated a significantly increased allele 2 frequency when compared to that previously reported within diverse ethnic populations. CONCLUSIONS: Since our comparative control patients do not necessarily reflect a healthy control population, an overall increase in allele 2 may reflect an association between allele 2 of the hs1.2 enhancer and a spectrum of gastrointestinal disorders.

Incentive structure in team-based learning: graded versus ungraded Group Application exercises.

PURPOSE: Previous studies on team-based learning (TBL) in medical education demonstrated improved learner engagement, learner satisfaction, and academic performance; however, a paucity of information exists on modifications of the incentive structure of "traditional" TBL practices. The current study investigates the impact of modification to conventional Group Application exercises by examining student preference and student perceptions of TBL outcomes when Group Application exercises are excluded from TBL grades. METHODS: During the 2009-2010 and 2010-2011 academic years, 175 students (95.6% response rate) completed a 22-item multiple choice survey followed by 3 open response questions at the end of their second year of medical school. These students had participated in a TBL supplemented preclinical curriculum with graded Group Application exercises during year one and ungraded Group Application exercises during year two of medical school. RESULTS: Chi-square analyses showed significant differences between grading categories for general assessment of TBL, participation and communication, intra-team discussion, inter-team discussion, student perceptions of their own effort and development of teamwork skills. Furthermore, 83.8% of students polled prefer ungraded Group Application exercises with only 7.2% preferring graded and 9.0% indicating no preference. CONCLUSION: The use of ungraded Group Application exercises appears to be a successful modification of TBL, making it more "student-friendly" while maintaining the goals of active learning and development of teamwork skills.

The impact of team-based learning on medical students' academic performance.

PURPOSE: Since team-based learning (TBL) was introduced as a medical education strategy in 2001, few studies have explored its impact on learning outcomes, particularly as measured by performance on examinations. Educators considering implementing TBL need evidence of its effectiveness. This study was conducted to determine whether student performance on examinations is affected by participation in TBL and whether TBL benefits lower- or higher-performing students. METHOD: The authors analyzed the performance of second-year medical students on 28 comprehensive course examinations over two consecutive academic years (2003-2004, 2004-2005) at the Boonshoft School of Medicine. RESULTS: The 178 students (86 men, 92 women) included in the study achieved 5.9% (standard deviation [SD] 5.5) higher mean scores on examination questions that assessed their knowledge of pathology-based content learned using the TBL strategy compared with questions assessing pathology-based content learned via other methods (P < .001, t test). Students whose overall academic performance placed them in the lowest quartile of the class benefited more from TBL than did those in the highest quartile. Lowest-quartile students' mean scores were 7.9% (SD 6.0) higher on examination questions related to TBL modules than examination questions not related to TBL modules, whereas highest-quartile students' mean scores were 3.8% (SD 5.4) higher (P = .001, two-way analysis of variance). CONCLUSIONS: Medical students' higher performance on examination questions related to course content learned through TBL suggests that TBL enhances mastery of course content. Students in the lowest academic quartile may benefit more than highest-quartile students from the TBL strategy.