Defining Student-as-Teacher Curricula in the Absence of National Guidelines: An Innovative Model.

Teaching is a critical skill in the medical profession, yet has only recently gained recognition as a core skill for medical students and trainees. Student-as-teacher (SAT) programs provide medical students formal teaching instruction with opportunities for practice. While efforts to determine how SAT courses should be taught are ongoing, the authors' review of SAT programs in medical schools' curricula shows they are diverse and often developed by faculty and trainees who advocate for formal teacher training at their institutions, rather than by medical school leadership. Consequently, there is significant heterogeneity among known SAT programs with regard to content, format, and evaluation methods. As efforts are underway to create guidelines and competency frameworks for SAT programs, medical educators must engage in open and critical discussion about the optimal content and organization for SAT educational experiences, emphasizing outcomes-based value and curricular and experiential consistency across programs. The authors describe an innovative SAT elective at Harvard Medical School (HMS), discuss research supporting curricular content and decisions, and emphasize potential implications for the conception and implementation of SAT programs at other institutions. The HMS SAT course is a year-long, elective, longitudinal curriculum built on a community of practice model and comprising 5 key components: Fundamentals of Medical Education seminar series, teaching field experiences, teaching observations, final educational product, and self-reflection. This 5-component theoretically justified model covers essential topics of SAT programming, providing students a comprehensive educational skills training curriculum. Medical educators developing SAT courses must identify common core competencies and curricular activities to implement SAT programs informed by the perspective of local stakeholders and institutional needs. Further growth of SAT programs in medical education offers opportunities for collaboration and coordination among medical educators, institutions, and licensing and accreditation bodies, to further develop consistent guidelines for teaching medical education skills to future medical educators.

Anal Cancer Screening for HIV-Negative Men Who Have Sex with Men: Making Clinical Decisions with Limited Data.

Anal cancer is a rare disease that disproportionately affects people living with HIV and men who have sex with men (MSM). Although screening of MSM living with HIV occurs in the absence of consistent national guidelines, less research exists on screening HIV-negative MSM. In this article, we discuss patient-, clinician-, and systems-level factors that may influence decisions to screen HIV-negative MSM. Randomized controlled trials with MSM living with HIV and those at high risk are in progress, yet more research is needed to address clinical uncertainty around screening additional at-risk groups.

Sugar-sweetened beverage intake and cancer recurrence and survival in CALGB 89803 (Alliance).

BACKGROUND: In colon cancer patients, obesity, sedentary lifestyle, and high dietary glycemic load have been associated with increased risk of cancer recurrence. High sugar-sweetened beverage intake has been associated with obesity, diabetes, and cardio-metabolic diseases, but the influence on colon cancer survival is unknown. METHODS: We assessed the association between sugar-sweetened beverage consumption on cancer recurrence and mortality in 1,011 stage III colon cancer patients who completed food frequency questionnaires as part of a U.S. National Cancer Institute-sponsored adjuvant chemotherapy trial. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated with Cox proportional hazard models. RESULTS: Patients consuming ≥ 2 servings of sugar-sweetened beverages per day experienced an adjusted HR for disease recurrence or mortality of 1.67 (95% CI, 1.04-2.68), compared with those consuming <2 servings per month (P(trend) = 0.02). The association of sugar-sweetened beverages on cancer recurrence or mortality appeared greater among patients who were both overweight (body mass index ≥ 2 5 kg/m(2)) and less physically active (metabolic equivalent task-hours per week <18) (HR = 2.22; 95% CI, 1.29-3.81, P(trend) = 0.0025). CONCLUSION: Higher sugar-sweetened beverage intake was associated with a significantly increased risk of cancer recurrence and mortality in stage III colon cancer patients.