Virtual Adaptation of an International Exchange Program in Medical Education.

Medical education has drastically transformed during the COVID-19 pandemic. Measures such as adopting telemedicine visits, minimizing the number of trainees on service, discontinuing external rotations, and converting in-person to online didactics have been broadly and swiftly implemented. While these innovations have promoted greater interconnectivity amongst institutions and made continuing medical education possible, international exchange programs in medical education are still largely disrupted. In response to the changing guidelines and restrictions necessitated by the COVID-19 pandemic, the authors used Kern's six-step approach to design and implement a virtual curriculum to replace the in-person activities of the 2020-2021 Neurology Peru-Rochester exchange program (NeuroPro). Twenty-seven trainees participated in this virtual adaptation. The average daily attendance was ≥85% and the program was rated 9/10 on average in a feedback survey (63% response rate). The median percentage of correct answers during the pre-test was 64% and it increased to 79% during the post-test (P = 0.003). Virtual adaptation of international exchange programs in medical education is feasible to safely continue international collaborative efforts to promote symbiotic building of local expertise and cross-cultural exchange during the ongoing COVID-19 pandemic and beyond.

Neural correlates of intertemporal choice in aggressive behavior.

People often have to make decisions between immediate rewards and more long-term goals. Such intertemporal judgments are often investigated in the context of monetary choice or drug use, yet not in regard to aggressive behavior. We combined a novel intertemporal aggression paradigm with functional neuroimaging to examine the role of temporal delay in aggressive behavior and the neural correlates thereof. Sixty-one participants (aged 18-22 years; 37 females) exhibited substantial variability in the extent to which they selected immediate acts of lesser aggression versus delayed acts of greater aggression against a same-sex opponent. Choosing delayed-yet-more-severe aggression was increased by provocation and associated with greater self-control. Preferences for delayed aggression were associated with greater activity in the ventromedial prefrontal cortex (VMPFC) during such choices, and reduced functional connectivity between the VMPFC and brain regions implicated in motor impulsivity. Preferences for immediate aggression were associated with reduced functional connectivity between the VMPFC and the frontoparietal control network. Dispositionally aggressive participants exhibited reduced VMPFC activity, which partially explained and suppressed their preferences for delayed aggression. Blunted VMPFC activity may thus be a neural mechanism that promotes reactive aggression towards provocateurs among dispositionally aggressive individuals. These findings demonstrate the utility of an intertemporal framework for investigating aggression and provide further evidence for the similar underlying neurobiology between aggression and other rewarding behaviors.