Residency Program Directors' Views on Research Conducted During Medical School: A National Survey.

PURPOSE: With the United States Medical Licensing Examination Step 1 transition to pass/fail in 2022, uncertainty exists regarding how other residency application components, including research conducted during medical school, will inform interview and ranking decisions. The authors explore program director (PD) views on medical student research, the importance of disseminating that work, and the translatable skill set of research participation. METHOD: Surveys were distributed to all U.S. residency PDs and remained open from August to November 2021 to query the importance of research participation in assessing applicants, whether certain types of research were more valued, productivity measures that reflect meaningful research participation, and traits for which research serves as a proxy. The survey also queried whether research would be more important without a numeric Step 1 score and the importance of research vs other application components. RESULTS: A total of 885 responses from 393 institutions were received. Ten PDs indicated that research is not considered when reviewing applicants, leaving 875 responses for analysis. Among 873 PDs (2 nonrespondents), 358 (41.0%) replied that meaningful research participation will be more important in offering interviews. A total of 164 of 304 most competitive specialties (53.9%) reported increased research importance compared with 99 of 282 competitive (35.1%) and 95 of 287 least competitive (33.1%) specialties. PDs reported that meaningful research participation demonstrated intellectual curiosity (545 [62.3%]), critical and analytical thinking skills (482 [55.1%]), and self-directed learning skills (455 [52.0%]). PDs from the most competitive specialties were significantly more likely to indicate that they value basic science research vs PDs from the least competitive specialties. CONCLUSIONS: This study demonstrates how PDs value research in their review of applicants, what they perceive research represents in an applicant, and how these views are shifting as the Step 1 exam transitions to pass/fail.

Academic Management in Uncertain Times: Shifting and Expanding the Focus of Cognitive Load Theory During COVID-19 Pandemic Education.

Globally, the COVID-19 pandemic has forced medical education toward more "online education" approaches, causing specific implications to arise for medical educators and learners. Considering an unprecedented and highly threatening, constrained, and confusing social and educational environment caused by the COVID-19 pandemic, we decided to shift the traditional focus of the Cognitive Load Theory (CLT) from students to instructors. In this process, we considered recent suggestions to acknowledge the psychological environment in which learning happens. According to this fundamental fact, "Learning and instructional procedures do not occur in a situational vacuum." Following this assertion, we adapted and implemented principles of CLT to reduce the extraneous load for our faculty to facilitate continued scholarly activity and support the overall wellbeing of our faculty during these trying times. The adoption of these principles enabled our team to cultivate attitudes and skills across multiple domains, such as online presentation technologies, implementing and maintaining a "classroom atmosphere" in a virtual environment, encouraging discussion among large online groups of students, facilitating group work, providing virtual office hours, and proactively planning for subsequent sessions.

Fostering Early Preclinical Experiences for Developing Knowledge, Skills, and Confidence in Key Residency Competencies Through Participation in a Medical Student Research Training Program.

Periods of academic transition are challenging and require medical students to adjust to new environments and expectations. Commonly cited areas of struggle include integrating into the interprofessional health care team, communication, organization and time management, and self-regulated learning. Consciously designing opportunities early in the preclinical curriculum to help students gradually build these competencies can be achieved within existing research training programs or projects. This perspective article reflects on how the medical student research training program at the Oakland University William Beaumont School of Medicine supports student growth in these areas beginning in the first year, so that students can directly apply these skills as they progress to the clinical years and beyond.

Adapting Strategically to Changing Times in Health Professions Education: A Generational Workshop for Educators.

Introduction: Health professions classrooms are filled with a new generation of students: iGen/generation Z. Much is known about millennials' educational needs, but they no longer comprise the majority of student populations. Research indicates that curricular strategies once useful for millennials may be ineffective for iGen. Due to multiple and surprising generational differences including ubiquitous technology, verbal/social/reading skills, and attention spans, educators might struggle to reach iGen members and are encouraged to re-examine instructional methods with iGen in mind. Methods: We designed this 90-minute workshop to give educators an informed understanding of iGen and discuss curricular adaptations intended to maintain educational quality through a literature-based presentation, self-assessment activities, and case discussions. We delivered the session to multiple diverse groups of health professions educators and staff. The attendees evaluated the workshop's quality and its longitudinal impact using 5-point Likert-style agreement surveys. Results: Respondents deemed the topic crucial to professional development and rated the content highly relevant (100% agreement/strong agreement). Longitudinal respondents could recognize iGen and personal characteristics (79% agreement or strong agreement) and the majority (58%) agreed/strongly agreed they were able to implement new instructional strategies. Discussion: Although educators are aware of typical generational differences, many are surprised to learn the unique attributes of their iGen student population. Workshop participation allowed educators to better understand both iGen students as well as how their own generational characteristics might relate to iGen members. Gaining this perspective allows educators to more adeptly create and deliver content to current health professions students.

Twelve tips for interfacing with the new generation of medical students: iGen.

iGen, or Generation Z, is the newest generation of health professions students to enter the classroom. This generation represents the first cohort of students in which technology has been present in all aspects of their lives. Since birth, they have been influenced by the boom of social media and wide-spread internet availability, leading to decreased face-to-face interactions and a desire for immediate access to information. Health professions educators should recognize the unique attributes of iGen students in order to foster student success and create a more positive learning environment. The following twelve tips examine the research-based distinctive characteristics of iGen students and highlight important concepts to consider when modifying current pedagogy to better support their needs. Incorporating these tips as an educator can promote lifelong learning and skill development for iGen students and empower this generation to thrive.

A Foundational Science Department's Transition to an Online Community.

Like many medical school department's around the world, we needed to pivot, almost instantly to an online community. As a large and diverse foundational science department, grounded in a culture of collegiality and collaboration, we faced a host of challenges beyond immediate remote teaching. Of paramount concern to departmental leadership was-how do we maintain our culture while working remotely?

Utilization of an online module bank for a research training curriculum: development, implementation, evolution, evaluation, and lessons learned.

BACKGROUND: Students enter Oakland University William Beaumont School of Medicine's required research program, Embark, with variable levels of experience. Recognizing this, Embark allows for progression through the individual research project with flexibility. Since 2014, student self-directed curriculum personalization is promoted through a menu of online modules. OBJECTIVE: This evaluation sought to understand student usage of the modules, identified strengths of the modules and preferred attributes of the modules. Gaining this evidence will provide information on how to best meet students' needs in a just-in-time format. METHODS: A retrospective mixed methods analysis of the module library was conducted. The library was constructed using best practices as an educational tool. The retrospective evaluation included analysis of students' viewing patterns and answers to required course evaluations during the fall semesters of 2014 to 2017. Students' preference for modules was determined by viewing records and conjoint analysis. RESULTS: Students' milestone preparation was not negatively impacted by relocation of curricular content from lecture to modules. Changes in module implementation within the course (2016) resulted in an increase of students viewing modules beyond only the minimum course requirements (71% (2016) from 10% (2014)). Data from both quantitative and qualitative evaluation questions show an increase in students' identifying the modules as a strength to individualize the course. The identified module strengths include content individualization, just-in-time access, while identified needs included a desire for additional modules. Students preferred modules that were animated, shorter in duration and curated from an external source. CONCLUSIONS: Online modules provide students with a rich set of resources allowing for individualized learning. Lessons learned in the implementation of the online modules may be transferable to many educational topics. When implementing similar technology projects, usage rates, learner feedback, and effect on appreciation of the content are important to frequently monitor.

Embarking on a Journey of Discovery: Developing Transitional Skill Sets through a Scholarly Concentration Program.

PROBLEM: Medical student participation in research enhances appreciation of the scientific literature and the conduct of investigation, and may lead to an interest in academic medicine. Independent medical student research offers frequently overlooked opportunities to develop and assess professional practice abilities, including project design and implementation, interprofessional team communication, and time management. These skills, useful to physicians, are often challenging for medical students to master as they transition into clinical careers. To address this challenge, we designed and embedded interventional modalities into a highly mentored and longitudinal scholarly concentration component of the curriculum. INTERVENTION: The Embark scholarly concentration program incorporates traditional research training with the development of professional practice skills essential for transitioning to clinical practice. The program includes individualized and just-in-time components enabling student access to information and feedback specific to their projects and development of professional practice skills. CONTEXT: The Embark program is a required longitudinal component of the Oakland University William Beaumont School of Medicine undergraduate medical curriculum. The Embark program consists of courses that inform and facilitate a required longitudinal independent research project. OUTCOME: A retrospective evaluation of the Embark program's success with development of professional practice skills through the lens of both faculty and student perceptions included analysis of project records and course evaluation feedback. Evaluation of individual student development of transitional skill ability is possible through both quantitative and qualitative analysis of data collected from student project records. More than 80% of course evaluation commentary on strengths of the program addressed activities related to professional practice skills. To systematize the evaluation of these data sources, we have piloted a framework, iSAIL, designed to assess student development in these skills during the planning and conduct of a research project. LESSONS LEARNED: By developing professional practice skills in the context of a scholarly concentration program, medical students can build a foundation for future engagement in research while they develop skills to overcome challenges that they are likely to encounter in their clinical careers. Modalities designed to evaluate individualized student development of professional practice skills through research participation define program successes and may lead to the identification of additional resources needed by students. By offering medical students opportunities to develop professional practice skills within the protected environment of an independent research project, this scholarly concentration program provides a valuable opportunity to influence the early development of skills necessary throughout their clinical careers.

Setting Students Up for Success: A Short Interactive Workshop Designed to Increase Effective Study Habits.

INTRODUCTION: Research shows that students generally utilize ineffective learning techniques such as massed practice and rereading. We developed an interactive workshop to teach first-year medical students highly effective learning techniques. Students often believe they know what works best for themselves. To impart effective strategies, we must disprove any current ineffective strategies. During the workshop, we employ activities designed to keep students engaged and reveal flaws in common study practices. METHODS: The workshop occurred during the first week of an integrated basic science course that provides a foundation for our integrated curriculum. In addition to presenting evidence supporting effective techniques, we also realized a practical aspect that needed to be addressed-the limited time available to medical students. Thus, we concluded the workshop by distilling principles into approaches they could immediately put into practice-before, during, and after lecture. Focusing on the most effective techniques made the approaches more palatable to students facing vast quantities of preparatory material. RESULTS: A postworkshop survey requested feedback for improvement and also included a table allowing students to indicate their interest and help needed for implementing each technique. This gave our Director of Academic Success invaluable insight as she developed additional workshops for first-year students. DISCUSSION: Although study skills workshops are commonplace, this module is distinct in that it forces students to evaluate the effectiveness of their learning strategies and provides scaffolding for adopting highly effective study techniques. Ultimately, the goal was to educate our new students on implementing effective study techniques.

An outbreak of Pseudomonas aeruginosa respiratory tract infections associated with intrinsically contaminated ultrasound transmission gel.

We describe an outbreak of Pseudomonas aeruginosa respiratory tract infections related to intrinsically contaminated ultrasound gel used for intraoperative transesophageal echocardiograms in cardiovascular surgery patients. This investigation led to a product safety alert by the Food and Drug Administration and the development of guidelines for appropriate use of ultrasound gel.

Yeast IME2 functions early in meiosis upstream of cell cycle-regulated SBF and MBF targets.

BACKGROUND: In Saccharomyces cerevisiae, the G1 cyclin/cyclin-dependent kinase (CDK) complexes Cln1,-2,-3/Cdk1 promote S phase entry during the mitotic cell cycle but do not function during meiosis. It has been proposed that the meiosis-specific protein kinase Ime2, which is required for normal timing of pre-meiotic DNA replication, is equivalent to Cln1,-2/Cdk1. These two CDK complexes directly catalyze phosphorylation of the B-type cyclin/CDK inhibitor Sic1 during the cell cycle to enable its destruction. As a result, Clb5,-6/Cdk1 become activated and facilitate initiation of DNA replication. While Ime2 is required for Sic1 destruction during meiosis, evidence now suggests that Ime2 does not directly catalyze Sic1 phosphorylation to target it for destabilization as Cln1,-2/Cdk1 do during the cell cycle. METHODOLOGY/PRINCIPAL FINDINGS: We demonstrated that Sic1 is eventually degraded in meiotic cells lacking the IME2 gene (ime2Δ), supporting an indirect role of Ime2 in Sic1 destruction. We further examined global RNA expression comparing wild type and ime2Δ cells. Analysis of these expression data has provided evidence that Ime2 is required early in meiosis for normal transcription of many genes that are also periodically expressed during late G1 of the cell cycle. CONCLUSIONS/SIGNIFICANCE: Our results place Ime2 at a position in the early meiotic pathway that lies upstream of the position occupied by Cln1,-2/Cdk1 in the analogous cell cycle pathway. Thus, Ime2 may functionally resemble Cln3/Cdk1 in promoting S phase entry, or it could play a role even further upstream in the corresponding meiotic cascade.

Is there a clinical association of vancomycin MIC creep, agr group II locus, and treatment failure in MRSA bacteremia?

BACKGROUND: The association of vancomycin treatment failure with minimum inhibitory concentration (MIC) creep is concerning, as most isolates are still considered to be in the susceptible range. Several studies have suggested that the accessory gene regulator (agr) group II polymorphism is predictive of vancomycin treatment failure. We assessed the associations between increased vancomycin MIC, agr group II locus, and vancomycin treatment failure in Methicillin-resistant Staphylococcus aureus (MRSA) bacteremias. METHODS: MRSA isolates from 99 inpatient bacteremias were studied. Susceptibility testing was conducted by an automated method (MicroScan) and by the gradient diffusion method (E-test). Vancomycin MICs were stratified into 3 groups for analysis: MIC ≤ 1, MIC > 1 but ≤ 2, and MIC >2 µg/mL. Strains were typed by repetitive-polymerase chain reaction analysis and the agr locus was identified by multiplex polymerase chain reaction. Failure of vancomycin treatment was defined as persistent bacteremia after 72 hours, death at 30 days, or treatment change due to clinical failure. RESULTS: Among 99 bacteremic patients, there were 82 agr group II and 15 agr group I isolates. There was no relationship between higher vancomycin MICs and isolate agr II loci (42 of 82) (P=0.59). Earlier vancomycin exposure was significantly associated with increased MIC (P=0.03). Vancomycin treatment failure was observed in 12 patients: 3 required an alternate regimen, 4 had persistent positive cultures, and 5 whose deaths were attributable to MRSA infection. Survival in agr group II was 57 of 82 (69%) versus agr group I in which it was 14 of 15 (93%), (P=0.06). CONCLUSIONS: We did not identify any significant association between MIC creep and vancomycin failure or between higher vancomycin MICs and agr group II. However, a higher mortality was seen in agr group II than agr group I.

Sic1-induced DNA rereplication during meiosis.

Orderly progression through meiosis requires strict regulation of DNA metabolic events, so that a single round of DNA replication is systematically followed by a recombination phase and 2 rounds of chromosome segregation. We report here the disruption of this sequence of events in Saccharomyces cerevisiae through meiosis-specific induction of the cyclin-dependent kinase (CDK) inhibitor Sic1 mutated at multiple phosphorylation sites. Accumulation of this stabilized version of Sic1 led to significant DNA rereplication in the absence of normal chromosome segregation. Deletion of DMC1 abolished DNA rereplication, but additional deletion of RAD17 restored the original phenotype. Therefore, activation of the meiotic recombination checkpoint, which arrests meiotic progression at pachytene, suppressed DNA rereplication resulting from Sic1 stabilization. In contrast to deletion of DMC1, deletion of NDT80, which encodes a transcription factor required for pachytene exit, did not inhibit DNA rereplication. Our results provide strong evidence that CDK activity is required to prevent inappropriate initiation of DNA synthesis before the meiotic divisions.

Distinct activities of the related protein kinases Cdk1 and Ime2.

In budding yeast, commitment to DNA replication during the normal cell cycle requires degradation of the cyclin-dependent kinase (CDK) inhibitor Sic1. The G1 cyclin-CDK complexes Cln1-Cdk1 and Cln2-Cdk1 initiate the process of Sic1 removal by directly catalyzing Sic1 phosphorylation at multiple sites. Commitment to DNA replication during meiosis also appears to require Sic1 degradation, but the G1 cyclin-CDK complexes are not involved. It has been proposed that the meiosis-specific protein kinase Ime2 functionally replaces the G1 cyclin-CDK complexes to promote Sic1 destruction. To investigate this possibility, we compared Cln2-Cdk1 and Ime2 protein kinase activities in vitro. Both enzyme preparations were capable of catalyzing phosphorylation of a GST-Sic1 fusion protein, but the phosphoisomers generated by the two activities had significantly different electrophoretic mobilities. Furthermore, mutation of consensus CDK phosphorylation sites in Sic1 affected Cln2-Cdk1- but not Ime2-dependent phosphorylation. Phosphoamino acid analysis and phosphopeptide mapping provided additional evidence that Cln2-Cdk1 and Ime2 targeted different residues within Sic1. Examination of other substrates both in vitro and in vivo also revealed differing specificities. These results indicate that Ime2 does not simply replace G1 cyclin-CDK complexes in promoting Sic1 degradation during meiosis.