Strategies to support self-regulated learning in integrated, student-centered curricula.

PURPOSE: With undergraduate medical education shifting to an integrated, student-centered approach, self-regulated learning (SRL) skills are critical for student success. Educational research holds that learning strategy effectiveness is context dependent. Our study aims to explore what strategies medical students use to support SRL when engaged in the specific context of an integrated, student-centered curriculum. APPROACH: This study took place in two medical schools with integrated, student-centered curricula. Semi-structured interviews were conducted with first-year medical students from both schools, asking them to reflect on the learning strategies they used throughout their first year of medical school. Interview data was analyzed first deductively using the SRL framework and then inductively to understand the specific strategies being used. FINDINGS: Students engaged in strategies to support SRL in ways that were unique to the integrated, student-centered context. We found that medical students developed strategies to plan for integration and building connections across material during all three phases of self-regulated learning. INSIGHTS: By identifying specific tasks and behaviors students utilized during their first year of medical school, this study provides a roadmap that students and educators can use to help students become self-regulated learners.

Community, Coaching, and Action Research: Promoting Ambitious Teaching in Medical Education.

Ambitious teaching is an instructional approach enacted through central tasks of teaching that involves a fundamental shift in mindset and practice. In this approach, the teacher facilitates student learning in the context of authentic, interactive experiences by eliciting student thinking and adapting instruction accordingly. We designed the Medical Educator-Excellence in Teaching (MEET) program to promote ambitious teaching in medical education. Here, we describe the structure of MEET, the framework that informed our work, and program evaluation data. We propose MEET as a model of educator development that promotes ambitious teaching through development of educator community, focused coaching, and inquiry into practice.

"I might not fit that doctor image": Ideal worker norms and women medical students.

Despite the increasing numbers of women students in medical schools, focused attention on their perceptions about medical school and the medical profession remain underexamined. These perceptions are important to understand, particularly since women students are likely burdened with a host of gender norms related to work, family, and their future roles as physicians. Early experiences in medical school offer important insights into the larger student experience and are tied to academic outcomes and feelings of belonging. To examine early experiences of women medical students, this qualitative study used sensemaking theory to describe the current context and "story" of ideal worker norms. Critical qualitative interviews of 38 women students were performed during their first 2 months of medical school and explored both how the students perceived and experienced ideal worker norms, and how they made sense of the "story" of ideal worker norms. The participants described ways they encountered gendering and ideal worker norms through displays of nurturing behaviour, expectations to balance a future family, and whether they looked or acted the part of a doctor. This article highlights the challenges women medical students are already aware they will face, the opportunities they look forward to, and the strengths they anticipate leaning on to navigate their profession. Results from this study have implications for women medical students' learning experiences and transitions into medical school and for faculty, staff, and scholars concerned with challenging gendering norms that shape medical education.

Is the incidence of infantile esotropia declining?: a population-based study from Olmsted County, Minnesota, 1965 to 1994.

OBJECTIVE: To investigate the incidence of infantile esotropia from a defined population in the United States over a 30-year period. Recent reports from the United Kingdom have suggested that strabismus or strabismus surgery is occurring less frequently today than in previous years. METHODS: The medical records of all patients diagnosed with infantile esotropia within Olmsted County, Minnesota, from January 1, 1965, through December 31, 1994, were retrospectively reviewed. RESULTS: The birth prevalence of infantile esotropia during the 30-year period was 25 (95% confidence interval, 21-29) per 10 000, or 1 in 403 live births. Although there were slightly more cases of infantile esotropia in the earlier years (45 from 1965-1974, 51 from 1975-1984, and 34 from 1985-1994), the change in incidence over time was not statistically significant (P = .32). The mean number of surgeries performed on each patient in this cohort was similar during the 30-year study: 1.8 for those diagnosed from 1965 to 1974, 1.9 for 1975 to 1984, and 1.6 for 1985 to 1994. CONCLUSIONS: The incidence of infantile esotropia in this population has not significantly changed from 1965 through 1994. Moreover, the rate of surgical intervention over these years is similar for this patient population.

Long-term follow-up of congenital esotropia in a population-based cohort.

PURPOSE: To report the long-term outcomes of a population-based cohort of children diagnosed with congenital esotropia during a 30-year period. METHODS: The medical records of all patients diagnosed with congenital esotropia as residents of Olmsted County, MN, from January 1, 1965, through December 31, 1994, were retrospectively reviewed. RESULTS: A total of 130 children were diagnosed during the 30-year period at a median age of 7.4 months with a mean deviation of 30(Delta). During a median follow-up of 11.9 years, 126 patients underwent a mean of 1.8 strabismus surgeries. The risk for undergoing a second surgery was significantly greater in patients with a larger presenting angle (p = 0.017) and a younger age at first surgery (p = 0.006). The Kaplan-Meier rate of having a second surgery was 51% at 10 years and 66% at 20 years. For those with 6 weeks or more of follow-up from the final surgery, last examined at a mean age of 15.1 years, 42 of 94 (45%) were within 8(Delta) of orthotropia and 30 of 98 had some level of stereopsis (

Age at strabismus diagnosis in an incidence cohort of children.

PURPOSE: To compare the age at diagnosis of children with esotropia, exotropia, and hypertropia. DESIGN: Retrospective, population-based cohort study. METHODS: The medical records of all Olmsted County, Minnesota, residents < 19 years diagnosed with esotropia, exotropia, or hypertropia from January 1, 1985 through December 31, 1994 were reviewed. RESULTS: The median age at diagnosis of esotropia (n = 380), exotropia (n = 205), and hypertropia (n = 42) was 3.1 years, 7.2 years, and 6.1 years, respectively (P = .001). In the first six years of life, esotropia had the highest incidence and was more likely to occur than either exotropia or hypertropia; exotropia predominated between age seven and 12 years; and each form was similarly likely to occur between 13 and 18 years of age (P = .001). CONCLUSIONS: The age at diagnosis was significantly different for the various forms of strabismus in this population. Esotropia is the most common form in the first six years of life; beyond this age exotropia predominates until the teenage years when the three forms have a similar but decreased incidence.

Incidence and types of childhood esotropia: a population-based study.

OBJECTIVE: To describe the incidence and types of childhood esotropia in a defined population. DESIGN: Retrospective population-based cohort. PARTICIPANTS: All pediatric (<19 years of age) residents of Olmsted County, Minnesota, diagnosed with an esodeviation (> or =10 prism diopters) from January 1, 1985, through December 31, 1994. METHODS: The medical records of all potential patients identified by the resources of the Rochester Epidemiology Project were reviewed. MAIN OUTCOME MEASURES: Incidence and types of childhood esotropia. RESULTS: Three hundred eighty-five cases of childhood esotropia were identified during the 10-year period, yielding an annual age- and gender-adjusted incidence of 111.0 (95% confidence interval, 99.9-122.1) per 100,000 patients younger than 19 years of age. This rate corresponds to a cumulative prevalence of approximately 2.0% of all children younger than 6 years, with a significant decrease in older ages (P<0.0001). Of the 385 study children, the specific forms and percentages of esotropia diagnosed were as follows: fully accommodative, 140 (36.4%); acquired nonaccommodative, 64 (16.6%); esotropia associated with an abnormal central nervous system, 44 (11.4%); partially accommodative, 39 (10.1%); congenital, 31 (8.1%); sensory, 25 (6.5%); paralytic, 25 (6.5%); undetermined, 13 (3.4%); and other, 4 (1.0%). CONCLUSIONS: The incidence of childhood esotropia from this self-referred population-based study is comparable with prevalence rates reported among Western populations. Esotropia is most common during the first decade of life, with the accommodative and acquired nonaccommodative forms occurring most frequently. The congenital, sensory, and paralytic forms of childhood esotropia were less common in this population.