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Andrew Matthews,1 Matthew Hall,2 Jose M Parra,3 Margaret M Hayes,4 Christine P Beltran,3 Brittany L Ranchoff,5 Amy M Sullivan,4 Jeffrey H William2 1Perelman School of Medicine, University of Pennsylvania Health Systems, Department of Medicine, Philadelphia, PA, USA; 2Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA; 3Carl J. Shapiro Institute for Education and Research, Beth Israel Deaconess Medical Center, Boston, MA, USA; 4Harvard Medical School; Carl J. Shapiro Institute for Education and Research, Beth Israel Deaconess Medical Center, Boston, MA, USA; 5Department of Health Promotion and Policy, University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, MA, USACorrespondence: Jeffrey H WilliamHarvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA 02215, USAEmail jhwillia@bidmc.harvard.eduBackground: Many programs designed to improve feedback to students focus on faculty’s ability to provide a safe learning environment, and specific, actionable suggestions for improvement. Little attention has been paid to improving students’ attitudes and skills in accepting and responding to feedback effectively. Effective “real-time” feedback in the clinical setting is dependent on both the skill of the teacher and the learner’s ability to receive the feedback. Medical students entering their clinical clerkships are not formally trained in receiving feedback, despite the significant amount of feedback received during this time.Methods: We developed and implemented a one-hour workshop to teach medical students strategies for effectively receiving and responding to “real-time” (formative) feedback in the clinical environment. Subjective confidence and skill in receiving real-time feedback were assessed in pre- and post-workshop surveys. Objective performance of receiving feedback was evaluated before and after the workshop using a simulated feedback encounter designed to re-create common clinical and cognitive pitfalls for medical students, called an objective structured teaching exercise (OSTE).Results: After a single workshop, students self-reported increased confidence (mean 6.0 to 7.4 out of 10, P< 0.01) and skill (mean 6.0 to 7.0 out of 10, P=0.10). Compared to pre-workshop OSTE scores, post-workshop OSTE scores objectively measuring skill in receiving feedback were also significantly higher (mean 28.8 to 34.5 out of 40, P=0.0131).Conclusion: A one-hour workshop dedicated to strategies in receiving real-time feedback may improve effective feedback reception as well as self-perceived skill and confidence in receiving feedback. Providing strategies to trainees to improve their ability to effectively receive feedback may be a high-yield approach to both strengthen the power of feedback in the clinical environment and enrich the clinical experience of the medical student.Keywords: feedback, OSTE, medical student, learning environment

Morgan I Soffler,1,2 Margaret M Hayes,2–4 C Christopher Smith3–5 1Harvard Combined Pulmonary and Critical Care Fellowship at Massachusetts General Hospital and Beth Israel Deaconess Medical Center, Boston, MA, USA; 2Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; 3Internal Medicine Residency Program, Beth Israel Deaconess Medical Center, Boston, MA, USA; 4Shapiro Institute for Education and Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA; 5Division of General Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA Abstract: Simulation is a popular and effective training modality in medical education across a variety of domains. Central venous catheterization (CVC) is commonly undertaken by trainees, and carries significant risk for patient harm when carried out incorrectly. Multiple studies have evaluated the efficacy of simulation-based training programs, in comparison with traditional training modalities, on learner and patient outcomes. In this review, we discuss relevant adult learning principles that support simulation-based CVC training, review the literature on simulation-based CVC training, and highlight the use of simulation-based CVC training programs at various institutions. Keywords: simulation, central venous catheterization, assessment, competency, central line insertion

The newly recognized pathogenic virus-like infectious agent (VLIA), originally reported in patients with AIDS but also known to be pathogenic in previously healthy non-AIDS patients and in non-human primates, was cultured in cell-free conditions using a modified SP-4 medium and classified as a member of the order Mycoplasmatales, class Mollicutes. The infectious microorganism is tentatively referred to as Mycoplasma incognitus. M. incognitus has the unique biochemical properties of utilizing glucose both aerobically and anaerobically, as well as having the ability to metabolize arginine. Among all known human mycoplasmas, these specific biochemical characteristics were found previously only in a rarely isolated species, M. fermentans. In comparison with M. fermentans, M. incognitus appears to be even more fastidious in cultivation requirements and fails to grow in all tested mycoplasma media other than modified SP-4 medium. In addition, M. incognitus grows much more slowly, has a smaller spherical particle size and occasional filamentous morphology, and forms only irregular and very small colonies with diffuse edges on agar plates. Antigenic analysis using polyclonal and monoclonal antibodies and DNA analysis of sequence homology and restriction enzyme mappings in M. incognitus, M. orale, M. hyorhinis, M. hominis, M. pneumoniae, M. fermentans, M. arginini, M. genitalium, M. salivarium, Ureaplasma urealyticum, and Acholeplasma laidlawii revealed that M. incognitus is distinct from other mycoplasmas, but is most closely related to M. fermentans.

Three cases of carcinoma ex-pleomorphic adenoma of the breast are reported. Patients were 82, 60 and 56 years old and presented with a breast lump. All tumours showed areas of pleomorphic adenoma adjacent to typical areas of malignant transformation. These cases add to the spectrum of tumours shared by breast and salivary gland. The relationship between these neoplasms and metaplastic carcinoma of matrix-producing type is discussed.