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The following are purported to be common-sense features of the world: time’s passage, the unreality of the future, the existence of ‘genuine’ change. All of these common-sense features are accommod...

It is taken as obvious that there is a conflict between objective temporal passage and relativistic physics. The traditional formulation of temporal passage is the movement of a universe-wide set o...

Background Lack of transparency and meaningful assessment in surgical residency has led to inconsistent intraoperative entrustment and highly variable trainee competence at graduation. The relationship between faculty entrustment and resident entrustability on clinical competency remains unclear. We sought to evaluate the dynamic between entrustment/entrustability and clinical competency in general surgery residency. Methods Intraoperative observations were conducted across a 22-month period at an academic tertiary center. Entrustment/entrustability were measured using OpTrust. Clinical competencies were appraised via ACGME Milestones and Objective Structured Assessment of Technical Skill (OSATS) scores. Mixed effects linear regression was used to investigate the relationship among overall ACGME Milestone scores, OSATS domain scores, and overall OpTrust scores. Results Overall OpTrust scores significantly correlated with overall Milestone scores and multiple OSATS score domains. Conclusions OpTrust demonstrated a positive association between ACGME general surgery Milestones and OSATS scores. Overall, OpTrust may help optimize intraoperative faculty entrustment and resident entrustability, facilitating surgical trainee success during residency.

Severe antisocial behavior in girls, best exemplified by conduct disorder (CD), is a serious clinical and public health problem. Treatment is difficult, particularly in girls with comorbid internalizing disorders. Identifying biological correlates may help to develop new treatments or diagnostic, prognostic, or treatment response biomarkers. Based on our earlier work and research from others occurring primarily in boys with severe antisocial behavior, it is possible that abnormalities in the hypothalamic pituitary adrenal (HPA) axis circadian cortisol cycle may be associated with female CD. Additionally, research suggests that the presence of comorbid internalizing disorders may be related to differences in cortisol secretion, compared to subjects who only have CD. Our study aimed: 1) to compare the circadian cortisol cycle in 98 girls with CD, 15-16 years of age to 47 girls without any psychiatric disorder (ND) and 2) to compare the cycle in girls with CD and comorbid internalizing disorders (CD + INT) to those without such comorbidity (CD Only). Salivary cortisol was collected over 24 h during weekdays at scheduled times, with protocol adherence measures in place. Unstructured covariance pattern modeling, controlling for effects of age, social class, IQ, and awakening time was used to analyze cortisol data. CD was associated with overall lower cortisol secretion (p = 0.03), but this difference was due to a lower volume of cortisol secreted 30 min after awakening (area under the curve with respect to ground, p = 0.01). Circadian cortisol secretion was no different in the CD+INT group compared to the CD Only group (p = 0.52). Our findings need to be replicated using current consensus guidelines for the assessment of the CAR. We also suggest two new avenues of research in this field.

Background There is limited data on deliberate teaching of residents in the clinic setting; we sought to investigate the clinic experience at our institution and improve education through creation of a novel “Resident-Optimized Clinic” (ROC). Methods An online survey was sent separately to residents and faculty. Based on the results of this survey a modified ROC was developed to try to improve the obstacles to learning in clinic. Results Qualitative analysis revealed the barriers in clinic were inconsistencies in expectations, lack of autonomy, time, and facility limitations. The modified ROC was rated positively with 100% of participants expressing they had sufficient time and autonomy; and 90% felt the environment was optimized for teaching. Conclusions Multiple themes have been identified as problematic for the clinic education experience. The ROC was rated positively by trainees suggesting thoughtful intervention to improve clinic results in a better clinic experience and more educational gain from the clinic environment.

Presentism is held by most to be the intuitive theory of time, due in large part to the view's supposed preservation of time's passage. In this paper, I strike a blow against presentism's intuitive pull by showing how the presentist, contrary to overwhelming popular belief, is unable to establish temporal change upon which the passage of time is based. I begin by arguing that the presentist's two central ontological commitments, the Present Thesis and the Change Thesis, are incompatible. The main problem is that satisfying the Change Thesis to establish passage requires the existence of more than one moment. This conflicts with the Present Thesis that only the present moment exists. The presentist's response is to appeal to surrogates to stand proxy for the past, so as to account for the difference between what does exist and what did exist. I argue that, for this surrogate strategy to be successful, the proposed surrogates must track what actually happened. I demonstrate that there is no guarantee that t...

Objective Feedback is critical to the development of medical students. To enhance feedback, we created a web application, the Minute Feedback System (MFS). This app allows students to request precise, timely, written feedback from residents and staff without the burden of vague, end-of-rotation surveys. In this study, we investigate variations in response rates and feedback fatigue based on sex and rank (resident/fellow vs. faculty). Design Data were collected from May 2015-October 2016. The MFS stores student requests for feedback along with faculty responses allowing for analysis of feedback response rate as well as sex and rank identification. Variation in response rate was analyzed using Chi-square and log-rank testing. Feedback fatigue was assessed using Cox regression modeling. Setting University Affiliated, Tertiary Care Center. Participants Medical Students, Residents and Faculty. Results About 98.6% of students (138 women, 140 men) used the MFS on their surgery clerkship. They requested feedback from 159 trainees (residents or fellows) and 114 surgical faculty. Feedback was requested more from faculty (26.3 requests per individual) compared to trainees (16.4 requests per individual). The overall evaluator response rate was 60%. Male students were 13% less likely to receive feedback than female students. There was a higher prevalence of feedback fatigue among female faculty (11% less likely to respond) and residents (23% less likely to respond). Regression analysis showed that the overall hazard of nonresponse over time was 1.05, indicative of overall feedback fatigue among all respondents. Conclusions The MFS is a novel tool for feedback used by nearly all M3 students during their surgery clerkship at our institution. Evaluation of response rates demonstrated feedback fatigue, especially among women faculty and residents. Feedback fatigue was more likely to affect male students, although the reason for this is unclear. Further analysis is necessary to understand this sex-associated response disparity and its effect on student feedback in the learning environment.

Background Medical students often report dissatisfaction with the feedback they receive on their clerkships. This study evaluates the performance of the Minute Feedback System (MFS), a web-based tool designed to facilitate medical student acquisition of same day written feedback from surgery residents and faculty. Methods System-generated data, targeted surveys, and end of clerkship questionnaires were used to evaluate MFS performance over a one-year period. Results 170 students made 3190 feedback requests and received 1978 responses (62% response rate). Students felt the system was easy to use (90%), provided useful feedback (74%), and allowed them to obtain more feedback than they would have in its absence (81%). Concerns were raised regarding the quality of electronic feedback and whether the data generated would be used for summative assessment. Conclusions The MFS encourages same-day assessment and increases documented medical student feedback. Further development is required to improve feedback quality, response rates, and feedback application.

Background The feedback medical students receive during clinical rotations, traditionally verbal and not formally captured, plays a critical role in student development. This study evaluates written daily feedback given to students through a novel web-based feedback system. Methods A Minute Feedback System was used to collect feedback given to medical students during their surgery clerkship from May 2015-April 2016. Using qualitative content analysis, feedback comments were categorized as: encouraging, corrective, specific, and nonspecific. Effective feedback was a combination of specific and either corrective or encouraging feedback; ineffective feedback contained only nonspecific comments; mediocre feedback contained elements of both effective and ineffective comments. Results 3191 feedback requests were sent by medical students and 2029 faculty/resident feedback responses were received. The overall response rate was 62%. Nonspecific feedback comprised 80% of faculty, 83% of senior resident, and 78% of junior resident comments. Specific feedback was given by only 35% of faculty, 17% of senior residents, and 26% of junior residents. Faculty provided Effective feedback in only 16% of comments, senior residents 8%, and junior residents 17%. Mediocre feedback comprised 13% of faculty, 9% of senior resident, and 7% of junior resident comments. Ineffective feedback comprised 67% of all feedback: 60% of faculty, 72% of senior resident, and 68% of junior resident feedback. Conclusions The majority of resident and faculty feedback to medical students using an electronic, email-based application during their surgery clerkship was nonspecific and encouraging and therefore of limited effectiveness. This presents an opportunity for resident/faculty development and education regarding optimal feedback techniques.

Background Medical students often report a lack of timely, useful feedback during clerkship rotations. The purpose of this study was to develop a novel Minute Feedback System and determine whether it would generate frequent, high quality, documented feedback for students during the third year surgery clerkship. Methods The Minute Feedback System was created using the Qualtrics © survey software platform and piloted with surgery clerkship students. These students were surveyed about the frequency and quality of feedback and their overall rating of the surgery clerkship and compared to students who did not use the feedback system. Results The initial pilot of the Minute Feedback System involved 6/34 M3 surgery clerkship students and generated a total of 70 unique comments from faculty and residents over 3 weeks. When the 6 pilot students were compared to the 28 students without access to the Minute Feedback System , they respectively rated the frequency of feedback 4.50 vs 2.83 (p The system was then made available to all students on the M3 surgery clerkship (n = 31) over the subsequent 2 month rotation. 354 unique feedback comments were generated from 399 student requests (89% response rate). Students using the Minute Feedback System (n = 31) compared to students in the previous academic year without (n = 170) rated the quality of feedback (3.76 vs 3.4, p Conclusion The novel Minute Feedback System allows for frequent, timely, useful and documented feedback to medical students.

Asperger syndrome (AS) is a pervasive developmental disorder generally regarded as a variant of autism. While it has been included in the ICD-10 and DSM-IV as a distinct diagnostic entity, it is still unclear to what extent it differs from high-functioning autism (HFA). Persons with HFA have been reported to show a variety of deficits of thought processes. Abnormalities such as poor reality testing, perceptual distortions, and areas of cognitive slippage have been described using the Rorschach inkblot test (Dykens, Volkmar, & Glick, 1991). Since AS has been conceptualized as a mild variant of autism, we hypothesized that persons with AS will have fewer abnormalities on the Rorschach test compared to persons with HFA. To test this hypothesis, we compared 12 subjects with AS (ICD-10, 10 male, mean age = 12.2 +/- 3.3 years, mean full-scale IQ = 99.6) with 8 subjects with HFA (ICD-10/DSM-III-R, 7 male, mean age = 12.2 +/- 3.8 years, mean full-scale IQ = 83.4) on the Rorschach test. AS subjects demonstrated a trend towards greater levels of disorganized thinking than the HFA group. They were also more likely to be classified as "Introversive" suggesting that AS subjects may have more complex inner lives involving elaborate fantasies, Also, AS subjects tended to be more focused on their internal experiences. However, overall, the Rorschach test was not found to differentiate the two diagnostic groups on the majority of structural variables. Implications of these findings are discussed with regard to the diagnostic validity of Asperger syndrome.

Objectives Conduct disorder (CD) in adolescent girls is a significant problem, but few data exist on the neuropsychological function of girls with this disorder. We investigated whether girls with CD have poorer neuropsychological function than girls without any psychiatric disorder, whether these differences remained significant after adjusting for demographics, and whether psychiatric comorbidity, age at onset of CD symptoms, or aggressive CD behaviors were differentially associated with neuropsychological function within the CD group. Method Ninety-three girls, ages 15 to 17 years, from the community (52 CD; 41 without any disorder [normal controls]) received a neuropsychological battery examining motor/laterality, general intelligence, language, visuospatial, visual-motor, executive function, and academic achievement domains. Results Girls with CD had lower general intelligence and poorer performance on visuospatial, executive function, and academic achievement domains. After adjusting for demographic factors, scores in the CD group were worse for general intelligence and in the visuospatial and academic achievement domains. Comorbid substance use disorder was negatively correlated with motor/laterality; no other intra-CD group comparisons were statistically significant. Conclusions Girls with CD had deficits in several domains of neuropsychological function. Possible explanations for the findings and clinical implications are discussed.

Impaired recognition of facial affect has been reported in youths and adults with antisocial behavior. However, few of these studies have examined subjects with the psychiatric disorders associated with antisocial behavior, and there are virtually no data on females. Our goal was to determine if facial affect recognition was impaired in adolescent girls with conduct disorder (CD). Performance on the Ekman Pictures of Facial Affect (POFA) task was compared in 35 girls with CD (mean age of 17.9 years ± 0.95; 38.9% African-American) and 30 girls who had no lifetime history of psychiatric disorder (mean age of 17.6 years ± 0.77; 30% African-American). Forty-five slides representing the six emotions in the POFA were presented one at a time; stimulus duration was 5 s. Multivariate analyses indicated that CD vs. control status was not significantly associated with the total number of correct answers nor the number of correct answers for any specific emotion. Effect sizes were all considered small. Within-CD analyses did not demonstrate a significant effect for aggressive antisocial behavior on facial affect recognition. Our findings suggest that girls with CD are not impaired in facial affect recognition. However, we did find that girls with a history of trauma/neglect made a greater number of errors in recognizing fearful faces. Explanations for these findings are discussed and implications for future research presented.

Children/adolescents 1. Walker (1981) 60 patients; 15 CD 12± 2 years ? 6 Clinical diagnosis Single photos; forced choice: 4 min CD=controls No covariates tested; no data on girls 2. Cadesky et al. (2000) 200; 87 CD or CD+ ADHD 9± 1 year ? 13 Research diagnosis; parent/teacher DANVA forced choice: 2 s CD