Reflective Writing: A Potential Tool to Improve Interprofessional Teamwork with Radiologists.

RATIONALE AND OBJECTIVES: Studies show that problems with interprofessional collaboration can result in adverse patient outcomes. These problems are common in the field of radiology, where technology has decreased opportunities for direct communication and collaboration with referring physicians. To our knowledge, critical reflection has not been studied as an intervention to better understand one's own and/or others' roles in the context of an interprofessional team, or more specifically, to improve interprofessional collaboration between radiologists and other physicians. MATERIALS AND METHODS: We trialed a reflective journaling assignment in our fourth year medical student general radiology elective. Student journal content was scored by percentage of comments reflecting on elective experiences versus recounting events. Content was categorized as "reflection" using an established measurement tool. Reflective content was evaluated to identify common themes. RESULTS: A total of 31 journals (178 entries and 26,749 words) were analyzed. Reflective content accounted for 43% of overall content and was subdivided into three categories: insight into one's own role and responsibilities as an ordering physician (20%), insight into a radiologist's role and responsibilities (12%), and thoughts on improving interprofessional collaboration with radiologists (11%). CONCLUSIONS: Reflective writing allows students to explore their own role and responsibilities in the context of an interprofessional team and may improve interprofessional teamwork with radiologists.

Self-organizing human cardiac microchambers mediated by geometric confinement.

Tissue morphogenesis and organ formation are the consequences of biochemical and biophysical cues that lead to cellular spatial patterning in development. To model such events in vitro, we use PEG-patterned substrates to geometrically confine human pluripotent stem cell colonies and spatially present mechanical stress. Modulation of the WNT/ß-catenin pathway promotes spatial patterning via geometric confinement of the cell condensation process during epithelial-mesenchymal transition, forcing cells at the perimeter to express an OCT4+ annulus, which is coincident with a region of higher cell density and E-cadherin expression. The biochemical and biophysical cues synergistically induce self-organizing lineage specification and creation of a beating human cardiac microchamber confined by the pattern geometry. These highly defined human cardiac microchambers can be used to study aspects of embryonic spatial patterning, early cardiac development and drug-induced developmental toxicity.

Development of single retinofugal axon arbors in normal and ß2 knock-out mice.

The maturation of retinal ganglion cell (RGC) axon projections in the dorsal lateral geniculate nucleus (dLGN) and the superior colliculus (SC) relies on both molecular and activity-dependent mechanisms. Despite the increasing popularity of the mouse as a mammalian visual system model, little is known in this species about the normal development of individual RGC axon arbors or the role of activity in this process. We used a novel in vivo single RGC labeling technique to quantitatively characterize the elaboration and refinement of RGC axon arbors in the dLGN and SC in wild-type (WT) and ß2-nicotinic acetylcholine receptors mutant (ß2(-/-)) mice, which have perturbed retinal waves, during the developmental period when eye-specific lamination and retinotopic refinement occurs. Our results suggest that eye-specific segregation and retinotopic refinement in WT mice are not the result of refinement of richly exuberant arbors but rather the elaboration of arbors prepositioned in the proper location combined with the elimination of inappropriately targeted sparse branches. We found that retinocollicular arbors mature ∼1 week earlier than retinogeniculate arbors, although RGC axons reach the dLGN and SC at roughly the same age. We also observed striking differences between contralateral and ipsilateral RGC axon arbors in the SC but not in the LGN. These data suggest a strong influence of target specific cues during arbor maturation. In ß2(-/-) mice, we found that retinofugal single axon arbors are well ramified but enlarged, particularly in the SC, indicating that activity-dependent visual map development occurs through the refinement of individual RGC arbors.