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Clinical reasoning is a complex and crucial ability health professions students need to acquire during their education. Despite its importance, explicit clinical reasoning teaching is not yet implemented in most health professions educational programs. Therefore, we carried out an international and interprofessional project to plan and develop a clinical reasoning curriculum with a train-the-trainer course to support educators in teaching this curriculum to students. We developed a framework and curricular blueprint. Then we created 25 student and 7 train-the-trainer learning units and we piloted 11 of these learning units at our institutions. Learners and faculty reported high satisfaction and they also provided helpful suggestions for improvements. One of the main challenges we faced was the heterogeneous understanding of clinical reasoning within and across professions. However, we learned from each other while discussing these different views and perspectives on clinical reasoning and were able to come to a shared understanding as the basis for developing the curriculum. Our curriculum fills an important gap in the availability of explicit clinical reasoning educational materials both for students and faculty and is unique with having specialists from different countries, schools, and professions. Faculty time and time for teaching clinical reasoning in existing curricula remain important barriers for implementation of clinical reasoning teaching.

The epidemiological situation resulting from the SARS-CoV-2 pandemic caused the Polish universities to fully switch to distance education in March 2020. Medical e-learning has not yet been broadly implemented into the education process. Therefore, examples of successful e-learning implementations or the organization of the process of medical e-learning offer a valuable source of knowledge today, which is needed immediately. The article presents e-learning practices at the Polish medical universities during the SARS-CoV-2 epidemic during the period from March to September 2020, covering seven universities in Poland that offer medical and health studies. The organization and implementation of e-learning classes is presented, including knowledge evaluation practices, providing example decisions issued by university rectors, on which the teaching process was based. A detailed presentation of the schools’ organizational units or workgroups that played an important role in the process of coordination of measures supporting e-education is also included. The article also presents a description of the software applications, utilities, and services used at the schools in the course of the process of online education. Below are some examples of specific such implementations in selected university courses.

The purpose of this article is to explore learners’ perceptions of using virtual patients in a behavioral medicine Massive Open Online Course (MOOCs) and thereby describe innovative ways of disseminating knowledge in health-related areas. A 5-week MOOC on behavioral medicine was hosted on the edX platform. The authors developed two branched virtual patients consisting of video recordings of a live standardized patient, with multiple clinical decision points and narration unfolding depending on learners’ choices. Students interacted with the virtual patients to treat stress and sleep problems. Answers to the exit survey and participant comments from the discussion forum were analyzed qualitatively and quantitatively. In total, 19,236 participants enrolled in the MOOC, out of which 740 received the final certificate. The virtual patients were completed by 2317 and 1640 participants respectively. Among survey respondents (n= 442), 83.1% agreed that the virtual patient exercise was helpful. The qualitative analysis resulted in themes covering what it was like to work with the virtual patient, with subthemes on learner-centered education, emotions/eustress, game comparisons, what the participants learned, what surprised them, how confident participants felt about applying interventions in practice, suggestions for improvement, and previous experiences of virtual patients. Students were enthusiastic about interacting with the virtual patients as a means to apply new knowledge about behavioral medicine interventions. The most common suggestion was to incorporate more interactive cases with various levels of complexity. Further research should include patient outcomes and focus on interprofessional aspects of learning with virtual patients in a MOOC.

Background:Massive Open Online Courses (MOOCs) extended with Virtual Patients (VPs) may foster specific medical skills. In particular, three educational use cases have been proposed to enable interactivity and foster clinical reasoning skills training: collective evaluation of decision making in the context of uncertainty, collective repurposing of cases with division of discussion into subgroups, and computational models in short cases for flexible selection and adaptive learning with VPs. The aim of this study was to evaluate the educational strengths and weaknesses of the proposed use cases.

AbstractGraphic organizers are popular tools which support meaningful learning. The aim of this study was to compare the learning outcomes of two educational scenarios involving the use of learner-generated or author-provided flow diagrams. Thirty-six third to fifth year medical students worked in pairs in the ‘Bit Pathways’ computer-aided learning environment. The group using author-provided graphic organizers performed significantly better on a knowledge retention test 1 month after the learning activity, requiring less preparatory time than the group generating their own graphic organizers (Cohen’s d effect size=0.84, p=0.03). Students liked both learning activities; however, the preference for learning-by-viewing was clear. Students’ quality of flow diagrams were correlated positively with the outcomes of the knowledge post-test (Spearman’s R=0.75, p=0.03). The generally poor quality of learner-generated diagrams indicated that better guided instructional designs for the learning-by-doing scenario are needed. This paper outlines further development directions of both tested scenarios.

NaCl treatment of tomato plants in hydroponic culture at concentrations as low as 50 mM resulted in enhanced accumulation of transcripts of TPX1, a full-length cDNA clone that we had isolated from a library of NaCl-treated tomato plants using a peroxidase-specific oligonucleotide probe. Although the overall amino acid sequence identity of TPX1 to other peroxidase genes was less than 45%, there was a very high degree of identity in all of the conserved domains. The deduced amino acid sequence included the presence of a N-terminal signal peptide but not the C-terminal extension present in peroxidases targeted to the vacuole. The mature protein has a theoretical pI value of 7.5. Transcripts that hybridized to TPX1 were detected only in the roots with higher levels of mRNA in epidermal and subepidermal cell layers. Isoelectric focusing of root extracts showed two major bands of peroxidase activity at pI 5.9 and 6.2. Both activities increased with salt treatment. Southern analysis indicated the presence of only a single TPX1 gene in tomato.

The gene encoding the antifungal protein osmotin is induced by several hormonal and environmental signals. In this study, tissue-specific and inducer-mediated expression of the reporter gene β-glucuronidase (uidA) fused to different fragment lengths of the osmotin promoter was evaluated in transgenic tobacco (Nicotiana tabacum). The region of the promoter between −248 to −108 (Fragment A) was found to be essential and sufficient for inducer (abscisic acid (ABA), C2H4and NaCl)-mediated expression of the reporter gene. Expression of the reporter gene was developmentally regulated and increased with maturity of leaves, stem and flowers. Expression also was tissue-specific being most highly expressed in epidermis and vascular parenchyma of the stem. The regulators ABA, C2H4and NaCl exhibited tissue-specific induction of this promoter. The promoter was specifically responsive to C2H4in flowers at virtually all stages of development, but not responsive in these tissues to ABA or NaCl. Conversely, ABA and NaCl were able to induce reporter gene activity using promoter Fragment A in specific tissues of root where C2H4was unable to induce activity. Further dissection of the promoter Fragment A into fragments containing either the conserved GCC element (PR); PR/AT; or G/AT sequences, and subsequent testing of these fragments fused to GUS in transgenic plants was performed. These experiments revealed that the promoter fragment containing PR element alone, although required, was barely able to allow responsiveness to C2H4. However, significant C2H4-induced activity was obtained with a promoter fragment containing the AT and PR elements together.

Summary: Transgenic sorghum plants (Sorghum bicolor L. Moench, cv. SRN39) were obtained by microprojectile-mediated DNA delivery (Bio-Rad PDS 1000/He Biolistic Delivery System) to explants derived from immature inflorescences. Explants were precultured on medium supplemented with 2.5 mg/l (11.31 µM) 2,4-D, 0.5 mg/l (2.32 µM) kinetin, and 60 g/l sucrose for 1 to 2 wk prior to bombardment. Bialaphos selectron pressure was imposed 2 wk after bombardment and maintained throughout all the culture stages leading to plant regeneration. More than 2500 explants from 1.5 to 3.0 cm inflorescences were bombarded and subjected to bialaphos selection. Out of more than 190 regenerated plants, 5 were determined to be Ignite resistant. Southern analyses confirmed the likelihood that the 5 herbicide resistant plants derived from two independent transformation events. The phosphinothricin acetyltransferase gene (bar) was inherited by and functionally expressed in T1 progeny. However, no β-glucuronidase (GUS) activity could be detected in T1 plants that contained uidA restriction fragments. Histological analyses indicated that in the absence of bialaphos morphogenesis was primarily via embryogenesis while organogenesis was more predominant in callus maintained with herbicide selection.

Curriculum mapping is the process of designing a multidimensional model of an educational programme for a complete, more transparent and better-integrated learning experience. Many universities worldwide are building or expanding their technical infrastructure to manage their curricula. Our aim was to deliver a synopsis of current practices and describe the focus of research interest in implementing curriculum mapping tools for medical education. As part of the Building Curriculum Infrastructure in Medical Education (BCIME) project, we conducted a state-of-the-art narrative review of the literature. A systematised search of the PubMed/MEDLINE database for the years 2013–2019 resulted in 352 abstracts, from which 23 full-text papers were included in the final review. From these, we extracted guidance on 12 key characteristics of curriculum mapping tools. The collected experiences formed four thematic categories: visualisations, text descriptions and analysis, the outcome-based approach and adaptability in curriculum mapping. As result of the review, we summarised topics regarding ways of: implementating new competency-based catalogues (like NKLM) in curriculum mapping software (e. g., using dynamic checklists), methods of streamlining the authoring process (e. g., by automatic detection and alignment of action verbs in learning objectives descriptions) and graphical forms of presenting curriculum data (e. g., network visualisations using automatic clustering of related parts of a curriculum based on similarities between textual descriptions). We expect further developments in text-mining methods and visual/learning analytics in curriculum mapping. The collected data informed the design of a new curriculum management system called EduPortfolio, which is currently being implemented by the BCIME project.

A gene encoding staphylokinase from Staphylococcus aureuswas cloned into the plant transformation binary vector pCAMBIA1303. The presence of a CaMV::sak-gusA-mgfpgene in Agrobacteriumwas confirmed by polymerase chain reaction PCR. Tobacco seedlings were used as explants for Agrobacterium tumefaciens-mediated transformation with the pCAMBIA1303sakvector carrying the fusion gene construct CaMV::sak-gusA-mgfpand the expression of the fusion gene was identified in Nicotiana tabacumplants by β-glucuronidas assay.