The SUMO protease SENP1 promotes aggressive behaviors of high HIF2α expressing renal cell carcinoma cells.

While an important role for the SUMO protease SENP1 is recognized in multiple solid cancers, its role in renal cell carcinoma (RCC) pathogenesis, particularly the most dominant subtype, clear cell RCC (ccRCC), is poorly understood. Here we show that a combination of high HIF2α and SENP1 expression in ccRCC samples predicts poor patient survival. Using ccRCC cell models that express high HIF2α but low SENP1, we show that overexpression of SENP1 reduces sumoylation and ubiquitination of HIF2α, increases HIF2α transcriptional activity, and enhances expression of genes associated with cancer cell invasion, stemness and epithelial-mesenchymal transition. Accordingly, ccRCC cells with high HIF2α and SENP1 showed increased invasion and sphere formation in vitro, and local invasion and metastasis in vivo. Finally, SENP1 overexpression caused high HIF2α ccRCC cells to acquire resistance to a clinical mTOR inhibitor, everolimus. These results reveal a combination of high SENP1 and HIF2α expression gives particularly poor prognosis for ccRCC patients and suggest that SENP1 may be an attractive new target for treating metastatic RCC (mRCC).

The Exceptional Teacher Initiative: Finding a Silver Lining in Addressing Medical Student Mistreatment.

PROBLEM: The Penn State College of Medicine (PSCOM) faced escalating reports of learner mistreatment in 2013-2017. As systems were implemented to gather and respond to student reports, faculty members expressed concern that these were creating a culture that focused on negative behaviors to the exclusion of acknowledging outstanding teaching that was also occurring. APPROACH: The Exceptional Teacher Initiative was introduced in August 2017 to attempt to shift the institutional conversation around learner mistreatment by balancing reports of mistreatment with reports highlighting examples of excellent teaching considered in-line with organizational values. The primary goals of the program were to make it easy for students to submit narratives describing outstanding teaching experiences and to capture the nuances of what the teacher did that were notable to the student. Students were invited to write about teachers who challenged and changed them. Narratives were sent to the named teachers and their educational and clinical leaders. OUTCOMES: Over the first 12 months of the Exceptional Teacher Initiative, learners submitted 553 narratives naming 253 different individuals across 37 departments. Faculty members and students expressed appreciation for this effort to highlight the positive. A monthly Exceptional Moments in Teaching feature was introduced in 2018, in which a named educator is featured prominently across the PSCOM. NEXT STEPS: Future plans include examining the impact of being named an exceptional teacher, ways exceptional teachers create respectful teaching interactions, and common threads within student narratives that illuminate specific techniques, behaviors, and attitudes that create exceptional teaching experiences.

Creativity in Medical Education: The Value of Having Medical Students Make Stuff.

What is the value of having medical students engage in creative production as part of their learning? Creating something new requires medical students to take risks and even to fail--something they tend to be neither accustomed to nor comfortable with doing. "Making stuff" can help students prepare for such failures in a controlled environment that doesn't threaten their professional identities. Furthermore, doing so can facilitate students becoming resilient and creative problem-solvers who strive to find new ways to address vexing questions. Though creating something new can be fun, this is not the main outcome of interest. Rather, the principle reason we recommend devoting precious curricular time to creative endeavors is because it helps medical students become better doctors.

The emotions of graduating medical students about prior patient care experiences.

OBJECTIVES: To determine the emotional responses to patient care activities described by fourth year medical students. METHODS: Qualitative content analysis for emerging themes in letters written by graduating medical students to patients during a Capstone Course. The patient need not be alive and the letter would never be sent. RESULTS: Six themes emerged from student letters: (1) Sorrow for the depths of patient suffering; (2) Gratitude towards patients and their families; (3) Personal responsibility for care provided to patients; (4) Regret for poor care provided by the student or student's team; (5) Shattered expectations about medicine and training; and (6) Anger towards patients. Students expressed sensitivity to vulnerable patients, including those who were alone, unable to communicate, or for whom care was biased. Students' expressed powerlessness (inability to cure, managing a work-life balance, and challenges with hierarchy) in some essays. CONCLUSION: At graduation, medical students describe strong emotions about previous patient care experiences, including difficulty witnessing suffering, disappointment with medicine, and gratitude to patients and their families PRACTICE IMPLICATIONS: Providing regular opportunities for writing throughout medical education would allow students to recognize their emotions, reflect upon them and promote wellness that would benefit students and their patients.

Motivational interviewing versus prescriptive advice for smokers who are not ready to quit.

OBJECTIVE: Smokers who are not ready to quit are a very difficult group to treat. Physicians, nurses, and nurse practitioners are in a unique position to encourage patients to quit smoking. However, the best approach to do so is not clear. METHODS: A two-group randomized controlled trial with 218 pack-a-day precontemplative and contemplative smokers recruited from the community. The laboratory-based study was designed to simulate outpatient visits to general practitioners. Participants were randomized to a 15-min intervention to compare the effectiveness of brief motivational or prescriptive counseling by a health professional. Thirteen outcome variables included intentions to quit and verbal reports at 1 and 6 months with biological verification. A composite outcome measure was constructed to provide greater power to detect study differences. RESULTS: Approximately 33% of the sample reported at least one 24-h quit period during the 6 months they were followed after the trial. Results suggest that while neither treatment was superior, there were subgroup differences. Participants in the motivational condition were also more likely to respond to follow-up calls. CONCLUSIONS AND PRACTICE IMPLICATIONS: Motivational interviewing and prescriptive advice were equally effective for precontemplative and contemplative smokers. Practitioners should use the method that appeals to them.

Patients as teachers, medical students as filmmakers: the video slam, a pilot study.

In 2006-2007 and 2007-2008, the authors pilot-tested a filmmaking project, (medical students filmed patients) to assess the project's potential to teach about the challenges of living with serious chronic illness. Two years of second-year medical students (N = 32) from The University of Arizona, working in groups of two or three, were paired with patients and filmed multiple home visits during eight months. Students edited their films to 7 to 10 minutes and added transitions, titles, and music. A mixed audience of students and faculty viewed the resulting 12 films in a "Video Slam." Faculty also used the films in the formal curriculum to illustrate teaching points related to chronic illness. Student filmmakers, on average, made 4.4 visits, collected 5.6 hours of film, and edited for 26.6 hours. Students reported that the project affected what they planned to cover in clinic visits, increased their plans to involve patients in care, enhanced their appreciation for patient-centered care, improved their knowledge of community resources, improved their understanding of allied health professionals' roles, and taught them about patients' innovative adaptations. Overall, students rated the project highly for its impact on their education (mean = 4.52 of 5). Student and faculty viewers of the films (N = 74) found the films compelling (mean = 4.95 of 5) and informative (mean = 4.93 of 5). The authors encountered the ethical dilemmas of deciding who controls the patients' recorded stories and navigating between patient anonymity/confidentiality and allowing patients to use their stories to teach.

Measuring progress toward smoking cessation.

Measuring the effect of behavioral interventions is often limited to a single outcome variable for ease of analysis. In the case of low probability outcomes, this narrow focus may often result in Type II errors, reducing the likelihood of detecting an effect of an intervention. The development and use of a scale to measure progress toward the ultimate desired change in behavior might result in greater sensitivity to subtle, but important, effects of interventions. That possibility is illustrated by the development and exploratory testing of a scale meant to measure penetration into the process of change with respect to smoking cessation. The scale consists of a set of outcome indicators that are intended to represent the sequential steps that smokers go through in moving toward and ultimately giving up smoking. Rasch analyses indicate that the scale is coherent and merits further development. It seems likely that similar scales might be developed to assess progress toward change for many other behaviors that seem to require a gradual process of change that can be indexed by items representing discrete steps along the way.