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Background: Most incorrect diagnoses involve at least one cognitive error, of which premature closure is the most prevalent. While metacognitive strategies can mitigate premature closure in inexperienced learners, these are rarely studied in experienced physicians. Our objective here was to evaluate the effect of analytic information processing on diagnostic performance of nephrologists and nephrology residents. Methods: We asked nine nephrologists and six nephrology residents at the University of Calgary and Glasgow University to diagnose ten nephrology cases. We provided presenting features along with contextual information, after which we asked for an initial diagnosis. We then primed participants to use either hypothetico-deductive reasoning or scheme-inductive reasoning to analyze the remaining case data and generate a final diagnosis. Results: After analyzing initial hypotheses, both nephrologists and residents improved the accuracy of final diagnoses (31.1% vs. 65.6%, p < 0.001, and 40.0% vs. 70.0%, p < 0.001, respectively). We found a significant interaction between experience and analytic processing strategy ( p = 0.002): nephrology residents had significantly increased odds of diagnostic success when using scheme-inductive reasoning (odds ratio [95% confidence interval] 5.69 [1.59, 20.33], p = 0.007), whereas the performance of experienced nephrologists did not differ between strategies (odds ratio 0.57 [0.23, 1.39], p = 0.2). Discussion: Experienced nephrologists and nephrology residents can improve their performance by analyzing initial diagnostic hypotheses. The explanation of the interaction between experience and the effect of different reasoning strategies is unclear, but may relate to preferences in reasoning strategy, or the changes in knowledge structure with experience.

This article describes an optically-based technology, barcoded videodisc, being used innovatively to augment the teaching and learning of a biological process. Mitosis was chosen as the example to illustrate the interactive video system at work because it is often difficult to demonstrate clearly and in its entirety in a school laboratory. An interactive worksheet is presented as a means of using sequences moving pictures from the videodisc for teaching the topic. A procedure for writing such supporting teaching material is described, and an evaluation, by undergraduate biology education students, of the worksheet exemplar is presented and discussed.

To date, an examination of the longitudinal relationship between perceived stress and C-reactive protein (CRP) is limited. We explored the relationship between perceived stress and CRP concurrently and across 2 and 4 years in 383 men and women. Multiple linear regressions examined the cross-sectional and longitudinal relationships between baseline stress and counter-stress scores with CRP at baseline, 2 years after baseline and 4 years after baseline, while controlling for covariates (age, smoking status, anti-inflammatory use, oral contraceptive use, physical activity, menopausal status, years since onset of menopause, post-menopausal hormone use and body mass index). Results indicate that stress and counter-stress were not related to CRP in either men or women at study baseline or 2 years later. Across a 4-year time frame, higher stress values were related to higher CRP values in women, but not men. Counter-stress was not related to CRP values in men or women across the 4 years. This study highlights the importance of examining the cross-sectional and longitudinal relationship between perceived stress and inflammation separately in men and women.

The increasing number of digital anatomy teaching software packages challenges anatomy educators on how to best integrate these tools for teaching and learning. Realistically, there exists a complex interplay of design, implementation, politics, and learning needs in the development and integration of software for education, each of which may be further amplified by the somewhat siloed roles of programmers, faculty, and students. LINDSAY Presenter is newly designed software that permits faculty and students to model and manipulate three-dimensional anatomy presentations and images, while including embedded quizzes, links, and text-based content. A validated tool measuring impact across pedagogy, resources, interactivity, freedom, granularity, and factors outside the immediate learning event was used in conjunction with observation, field notes, and focus groups to critically examine the impact of attitudes and perceptions of all stakeholders in the early implementation of LINDSAY Presenter before and after a three-week trial period with the software. Results demonstrate that external, personal media usage, along with students' awareness of the need to apply anatomy to clinical professional situations drove expectations of LINDSAY Presenter. A focus on the software over learning, which can be expected during initial orientation, surprisingly remained after three weeks of use. The time-intensive investment required to create learning content is a detractor from user-generated content and may reflect the consumption nature of other forms of digital learning. Early excitement over new technologies needs to be tempered with clear understanding of what learning is afforded, and how these constructively support future application and integration into professional practice.

Retroactive interference occurs when newly acquired information inhibits recall of previously learned information. This has been shown to influence recall of sounds, tastes and word associations, and is typically seen when learners receive training on one area of content and are then exposed to new content before being evaluated on the original content. Thus far, retroactive interference has received little attention in medical education and has not been studied during simulation training. Our objective was to evaluate whether retroactive interference occurs during simulation training.We randomised 167 Year 1 medical students to one of two training protocols. After training on a cardiac murmur, participants were tested either on the same cardiac murmur followed by a novel murmur (the non-interference protocol), or on the novel murmur followed by the training murmur (the interference protocol). We evaluated performance on both murmurs at 1 hour and 6 weeks post-training.We found a significant interaction between training protocol and diagnostic performance on training versus novel murmurs at both testing time-points. Students in the non-interference protocol had increased odds of achieving success on the training murmur relative to the novel murmur at 1 hour (odds ratio [OR] 4.96; p0.001) and at 6 weeks (OR 4.23; p = 0.001) after training. By comparison, students in the interference protocol did not demonstrate improved performance on the training murmur relative to the novel murmur at either evaluation (1 hour post-training: OR 0.56 [p = 0.08]; 6 weeks post-training: OR 0.66 [p = 0.23]).Consistent with the theory of retroactive interference, students who encountered a novel murmur between training and evaluation on the murmur on which they had been trained showed no improvement in diagnostic performance following simulation training. These findings should serve to warn educators to consider retroactive interference when designing simulation training sessions.

Measurement invariance of the 2-factor model of the Perceived Stress Scale--10-item version (CohenWilliamson, 1988) was tested across men and women at two time points and in the combined total sample over a 2-year time frame (n = 871). Measurement invariance results indicated that the scale measured the latent factors, stress and counter-stress, equivalently in men and women and over time. With measurement invariance demonstrated, differences in latent means were tested. Results indicated that men had lower levels of frequencies of stressors, and at one time point, higher levels of counter-stress, when compared with women. When examining change in frequencies of stressors and counter-stress over 2 years with the combined male and female sample, stressors remained stable, yet counter-stress increased over time. These findings may aid in the interpretation of results when examining stressors and counter-stress in clinical samples where one would expect stress to increase, whereas positive psychological states decrease.

We are developing LINDSAY Virtual Human, a 3-dimensional, interactive computer model of male and female anatomy and physiology. LINDSAY is designed to be used for medical education. One key characteristic of LINDSAY is the integration of computational models across a range of spatial and temporal scales. We simulate physiological processes in an integrative fashion: from the body level to the level of organs, tissues, cells, and sub-cellular structures. For use in the classroom, we have built LINDSAY Presenter, a 3D slide-based visualization and exploration environment that presents different scenarios within the simulated human body. We are developing LINDSAY Composer to create complex scenes for demonstration, exploration and investigation of physiological scenarios. At LINDSAY Composer′s core is a graphical programming environment, which facilitates the composition of complex, interactive educational modules around the human body.

Aleutian/Pribilof Islands Association, Inc. (APIA) hired three part-time local community members that desire to be Energy Technicians. The energy technicians were trained in methods of weatherization assistance, energy conservation and home safety. They developed a listing of homes in the region that required weatherization, and conducted on-site weatherization and energy conservation education and a home energy and safety reviews in the communities of Akutan, False Pass, King Cove and Nelson Lagoon. Priority was given to these smaller communities as they tend to have the residences most in need of weatherization and energy conservation measures. Local residents were trained to provide all three aspects of the project: weatherization, energy conservation education and a home energy and safety review. If the total energy saved by installing these products is a 25% reduction (electrical and heating, both of which are usually produced by combustion of diesel fuel), and the average Alaska home produces 32,000 pounds of CO2 each year, so we have saved about: 66 homes x 16 tons of CO2 each year x .25 = 264 tons of CO2 each year.

Advocates of holistic assessment consider the ITER a more authentic way to assess performance. But this assessment format is subjective and, therefore, susceptible to rater bias. Here our objective was to study the association between rater variables and ITER ratings. In this observational study our participants were clerks at the University of Calgary and preceptors who completed online ITERs between February 2008 and July 2009. Our outcome variable was global rating on the ITER (rated 1–5), and we used a generalized estimating equation model to identify variables associated with this rating. Students were rated “above expected level” or “outstanding” on 66.4 % of 1050 online ITERs completed during the study period. Two rater variables attenuated ITER ratings: the log transformed time taken to complete the ITER [β = −0.06, 95 % confidence interval (−0.10, −0.02), p = 0.002], and the number of ITERs that a preceptor completed over the time period of the study [β = −0.008 (−0.02, −0.001), p = 0.02]. In this study we found evidence of leniency bias that resulted in two thirds of students being rated above expected level of performance. This leniency bias appeared to be attenuated by delay in ITER completion, and was also blunted in preceptors who rated more students. As all biases threaten the internal validity of the assessment process, further research is needed to confirm these and other sources of rater bias in ITER ratings, and to explore ways of limiting their impact.

Student choice is an important determinant of the specialty mix of practicing physicians in Canada. Understanding student characteristics at medical school entry that are associated with a student choosing a residency in surgery can assist surgical educators in supporting medical students interested in surgery and in serving health human resources needs.From 2002 to 2004, data was collected from entering students in 15 classes at eight of 16 Canadian medical schools. Surveys included questions on career choice, attitudes to practice, and socio-demographics. Students were followed prospectively with survey data linked to their residency choice. Multiple logistic regression analysis was used to identify entry characteristics that predicted a student's ultimate choice of a surgical career.Eight entry variables predicted whether a student named surgery (including obstetrics) as their top residency choice: having surgery as their top career choice, having a relative or friend in a surgical career, having undertaken volunteer work with sports teams, an interest in narrow scope of practice, greater interest in medical the social patient problems, an interest in urgent care, and younger age were identified as predictors of a surgical career choice.Surgical educators may wish to attend to the factors that we found that predicted students selecting a surgical residency as their top career choice at medical school exit in order to foster and support students interested in the surgical disciplines during medical school. In addition, these factors could be used to identify students interested in a surgical career at medical school entry.

Background : Medical students encounter a variety of experiences that have an impact on their emerging professional identity. Clerkship, in particular, presents opportunities for students to consider their career options and decide upon a career path. The process of developing their professional identity begins well before clerkship, however. Anecdotal evidence suggests that interests in medicine begin as early as childhood. This study retrospectively examines the decision-making process clerks make in choosing medicine as a career. Methods: A total of 76 clerks (36 male, 34 female, 6 not reported) responded to four open-ended and two follow-up questions that measure career interests and pursuits. Questions addressed when and how students developed interests in medicine and alternate careers before beginning medical school. An additional eight closed questions drawn from the Ego Status Extended Objective Measure of Ego Identity Status II (EOM-EIS-II) were administered. Content analyses and inter-rater reliability analyses were conducted to classify students according to Marcia’s 1 four ego identity statuses. Results: Having obtained high inter-rater consistency (Cohen’s Kappa coefficient of 0.92), responses to the open-ended questions resulted in the classification of three identity statuses. In total, 49.3% of students were in the ‘achieved’ (high exploration and commitment to choices) status and 48.1% were in the ‘foreclosed’ (low exploration but high commitment to choices) status. A small percentage (1.3%) of students were in the ‘moratorium’category (high exploration but low commitment to choices), while none of the students were in the ‘diffused’ (low exploration and low commitment to choices) category. Conclusions: With approximately half of the students demonstrating a ‘foreclosed’ status, this study reveals that despite exposure to a variety of careers when attending university, only half of the students had seriously pursued a career outside of medicine. The majority of students, moreover, developed an interest in medicine before adulthood, and did so independently from parental influence.

PURPOSE Medical students are typically asked to complete course evaluations, but little is known about how students decide to rate courses. This study sought to examine the student feedback process by exploring the dimensionality of a course evaluation tool and examining the relationship between resulting factors and the overall rating of a course. METHOD During the 2007-2008 academic year, all first- and second-year students were asked to provide feedback on various aspects of curricular content, delivery, and assessment for seven courses taught in the first two years of a clinical presentation curriculum. The authors examined the structure of the evaluation instrument using principal component factor analysis and used multiple linear regression to study the relationship between factors and overall course ratings. RESULTS Four stable and reliable factors were identified (assessment of students, small-group learning, basic science teaching, and teaching diagnostic approaches) that accounted for about 50% of the total variance in overall course ratings. Student assessment displayed the strongest association with overall course ratings, and for second-year students it was the only variable associated with overall course ratings. CONCLUSIONS Of the four factors, student assessment was by far the strongest predictor of overall course ratings, and this association strengthened over time. These results are consistent with the "peak-end rule" and "negativity dominance" for rating emotional experiences.

We sought to examine the financial state of medical students from rural backgrounds during a time of tuition fee deregulation.We surveyed incoming classes from 2007 to 2011 at the University of Calgary. Community background, expected educational debt at graduation, educational debt at entry to medical school and parental income were collected for analysis. Data were analyzed using the Χ² test, analysis of variance and the Newman-Keuls multiple comparison test.The overall response rate was 95.3%. Of the 571 (93.5%) respondents who supplied data on their background and debt, 94.4% expected to have educational debt at graduation. The mean projected educational debt at graduation by medical students from both rural ($107 226 [95% confidence interval (CI) $98 030-$116 423]) and regional ($99 456 [95% CI $91 905-$107 006]) backgrounds was significantly greater than the debt projected by students from metropolitan ($88 565 [95% CI $83 607-$93 524]) backgrounds. Medical students who came from rural backgrounds had the highest mean debt at entry to medical school ($33 053 [95% CI $25 715-$40 391]) compared with their peers from regional ($23 253 [95% CI $16 621-$29 885]) and metropolitan ($22 053 [95% CI $17 344-$26 762]) backgrounds. Students of rural origin also had parents whose mean income ($104 024 [95% CI $75 976-$132 173]) was significantly lower than the mean parental income of their peers who originated from regional ($143 167 [95% CI $119 898-$166 435]) and metropolitan ($150 339 [95% CI $135 241-165 438]) centres.Rising tuition and subsequent debt may be affecting the diversity of medical students' backgrounds. Financial programs dedicated to rural-background students and their interest in medicine may become necessary.

Background Training on a cardiopulmonary simulator improves subsequent diagnostic performance on the same simulator. But data are lacking on transfer of learning. The objective of this study was to determine whether training on a cardiorespiratory simulator improves diagnostic performance on a real patient. Methods We randomly allocated first-year medical students at the University of Calgary to simulator training in one of three clinical scenarios of acute-onset chest pain: pulmonary embolism with right ventricular strain but no murmur, symptomatic aortic stenosis, or myocardial ischemia causing mitral regurgitation. Simulation sessions ran for 20 min, after which participants had a standardized debriefing session and reviewed the physical findings. Immediately following the training sessions, students assessed the auscultatory findings of a real patient with mitral regurgitation. Our outcome measures were accuracy of identifying abnormal auscultatory findings and diagnosing the underlying cardiac abnormality (mitral regurgitation). Results Eighty-six students participated in the study. Students trained on mitral regurgitation were more likely to identify and diagnose these findings on a real patient with mitral regurgitation than those who had trained on aortic stenosis or a scenario with no cardiac murmur. The accuracy (SD) of identifying clinical features of mitral regurgitation for these three groups was 74.0 (36.4) vs 56.2 (34.3) vs 36.8 (33.1), respectively (P = .0005), and for diagnosing mitral regurgitation, the accuracy was 68.0 (45.4) vs 51.6 (50.0) vs 29.9 (40.7), respectively (P = .01). Conclusions Simulator training on mitral regurgitation increases the likelihood of diagnosing this abnormality on a real patient

In response to the 2008-2009 AIAA Undergraduate Team Design Competition's R equest for Proposals for an advanced, environmentally compatible, 150 seat commercial transport; Jackson West has designed the Sparrow JS-3. The Sparrow represents the next step in the evolution of commercial aviation. Scheduled to enter service in 2018, The Sparrow will compete directly with the Boeing 737 and Airbus A320. Its improvements in fuel consumption and operating cost, as well as its reduced environmental impact, make The Sparrow the ideal solution to this RFP.

Verde is an environmentally responsible commercial transport seating 150 dual-class passengers, designed in response to the 2008-2009 Request for Proposal from the American Institute of Aeronautics and Astronautics Undergraduate Team Aircraft Design Competition. While the airline industry faces increasing pressures from the cost of fuel and the responsibility of environmental impact, the next generation of this aircraft class must operate more efficiently and address those environmental needs. Therefore, all design decisions for Verde focused first on reducing fuel burn, second on reducing emissions, then noise, and finally on maintaining flyaway cost, airport integration, and passenger comfort. The final design utilizes several green technologies such as an unducted fan engine cycle, biofuel, and use of advanced yet reusable materials to achieve these goals. Much of the design process focused on trying to increase the main wing aspect ratio which required the need to balance structural weight, aerodynamic performance benefits, and airport integration. This fuel-burn-centered philosophy yielded significant improvements, including a fuel block burn for the typical 500 nmi mission of 38.1 lb/seat and an 10% improvement in operating cost compared to current operations.

The challenge of planning a clinical clerkship curriculum is to create order from chaos. Fortunately, the Liaison Committee for Medical Education has thrown clerkship directors a lifeline by recognizing simulated learning experiences--including virtual patients--as equivalents to real-life clinical encounters for accreditation purposes. Although virtual patients offer a more consistent and learner-centered curriculum that provides greater practice opportunities and reduces the demand for busy clinical preceptors, going virtual does involve potential risks. Here, the authors discuss some of the pros and cons of virtual patients, especially the concerns that virtual learning experiences may not produce effective feedback and that learning may not transfer from the virtual to the clinical environment. To match teaching to different learning needs, the authors propose "adaptive feedback" whereby learners choose from three levels of feedback: seeing the correct diagnosis and patient outcomes, seeing an expert "trace," and/or meeting with their preceptor to discuss the case. Medical educators can facilitate automatic transfer of learning from the virtual to the clinical setting by making all aspects of the learning and retrieval environments as similar as possible and by integrating the virtual and clinical environments--thus sparing learners the burden of "forward reaching" transfer and providing an anchor for virtual learning experiences. Medical educators can promote intentional transfer of learning if they make the virtual learning environment both the place students practice their skills before clinical encounters and the place to which they return after clinical encounters to reflect on and improve their skills.

Purpose To determine the long-term effects of curriculum length on physician competence, the authors compared the performance of graduates from the University of Calgary (U of C; a school with a three-year curriculum) with matched samples from the University of Alberta (U of A) and from other Canadian schools with a four-year curriculum. Method The authors used data from the College of Physicians and Surgeons of Alberta, Physician Achievement Review (PAR) program to determine curricular outcomes. The authors analyzed PAR program data, comprising reviews from medical colleagues, nonphysician coworkers (e.g., nurses, pharmacists), patients, and the physicians themselves, for 166 physicians from U of C, U of A, and other universities. They compared groups using one-way analysis of covariance (ANCOVA) and multivariate analysis of covariance (MANCOVA), with years since graduation as a covariate, and a Cohen d effect size calculation to assess the magnitude of the differences. Results The authors analyzed review data for 498 physicians. The results of ANCOVA showed that no significant differences existed among schools for the self and the patient aggregate mean questionnaire scores. Aggregate mean questionnaire scores from the medical colleague and coworker surveys were significant, albeit with a small effect size. MANCOVA showed small but significant differences among schools on the aggregate mean factor scores for medical colleague, coworker, and patient questionnaires. Conclusions Although differences among schools exist, they are small. They suggest at least equivalent performance for graduates of three- and four-year medical schools who practice in Alberta.

Objective: The goal was to determine whether young children and their parents prefer physicians wearing clear face shields or surgical masks. Methods: Eighty children (4–10 years of age) and their guardians were recruited from a pediatric emergency department. A survey and color photographs of the same male and female physicians wearing face shields and surgical masks were distributed. The parents were asked to decide which set of physicians they would prefer to care for their children and with which set of physicians they thought their children would be most comfortable. The children then were asked to decide which set of physicians they would prefer to take care of them and why. The children also were asked whether they found any of the physicians frightening and, if so, why. Results: Fifty-one percent of parents preferred the pictures of physicians wearing face shields, and 62% thought that their children would choose the physicians in the face shields because their faces were visible and therefore less frightening. However, 59% of children stated that either set of physicians would be fine and neither was frightening; if given a choice, 49% would choose physicians in face shields. Conclusions: Physicians and parents have a perception that surgical masks are frightening to all children. Our study has shown that this perception is not completely true. Face shields may be a better choice, however, because both parents and children would prefer this option.

Paralytic shellfish poisoning (PSP), a human illness caused by the ingestion of shellfish contaminated with paralytic shellfish toxins (PSTs), has been reported in Alaska for decades. These poisoning incidents have resulted in losses to local economies due to shellfish harvest closures. Thus the development of an effective biotoxin monitoring program designed specifically for the remote regions of Alaska would provide protection for public health and allow for a viable shellfish industry. The present study provides data useful for the development of an effective toxin screening protocol by comparing PST levels quantified in shellfish by many of the currently available PST detection techniques. Seven bivalve species were collected along beaches of the Aleutian Islands from June 2006 to September 2007. The concentration of PSTs was quantified and compared using five different analytical methods: the mouse bioassay, high performance liquid chromatography (HPLC), receptor-binding assay, the commercially available Jellett Rapid PSP Test strips, and an enzyme linked immunosorbent assay technique. The Association of Official Analytical Chemists (AOAC)-approved HPLC method proved to be valuable for characterizing the suite of individual PSTs in each species for research purposes, but was not considered practical for rapid toxin screening in remote Alaskan regions due to its time-consuming nature and requirement of expensive equipment and considerable expertise. In the present study, Jellett test strips were shown to be an effective tool for rapid screening, however due to the high percentage of false positives, subsequent validation via AOAC-approved methods would be required to prevent unnecessary closures.

Background. Given the looming shortage of physicians in Canada, we wished to determine how closely the career preference of students entering Canadian medical schools was aligned with the current physician mix in Canada. Methods Career choice information was collected from a survey of 2,896 Canadian medical students upon their entry to medical school. The distribution of career choices of survey respondents was compared to the current physician speciality mix in Canada. Results We show that there is a clear mismatch between student career choice at medical school entry and the current specialty mix of physicians in Canada. This mismatch is greatest in Urban Family Medicine with far fewer students interested in this career at medical school entry compared to the current proportion of practicing physicians. There are also fewer students interested in Psychiatry than the current proportion of practicing physicians. Conclusion This mismatch between the student interest and the current proportion of practicing physicians in the various specialities in Canada is particularly disturbing in the face of the current sub-optimal distribution of physicians. If nothing is done to correct this mismatch of student interest in certain specialities, shortages and misdistributions of physicians will be further amplified. Studies such as this can give a window into the future health human resources challenges for a nation.

To determine how first-year medical students interested in rural family medicine in Canada differ from their peers.From 2002 to 2004, first-year students (n = 2189) from 16 classes in 8 Canadian medical schools ranked intended career choices and indicated influences on their choices using Likert scales. We used t tests and chi2 tests to determine demographic influences and factor analysis, and we used analysis of variance to examine associated attitudes.Of the 1978 surveys returned (90.3%), 1905 were used in the analysis. Rural family medicine was ranked first by 11.1%, varying from 4.7% to 20.2% among schools. Students interested in rural family medicine were more likely to have grown up rurally, graduated from a rural high school and have family in a rural location than others (p0.001). They were more likely to be older, in a relationship, to have volunteered in a developing nation and less likely to have university-educated parents than those interested in a specialty (p0.008). Attitudes of students choosing family medicine, rural or urban, include social orientation, preference for a varied scope of practice and less of a hospital orientation or interest in prestige, compared with students interested in specialties (p0.001).Medical schools may address the rural physician shortages by considering student demographic factors and attitudes at admission.

This paper describes disc‐based interactive video applications in initial teacher training which have arisen out of materials developed under the Interactive Video in Schools Project and Interactive Video in Education Awareness Scheme, sponsored by the Department of Trade and Industry. Interactive video is examined in the context of applications in five types of learning environment; as a presentation system for conventional lecturing or small‐group teaching, as a vehicle for independent student learning, as a resource for students on teaching practice, as an information source and as a surrogate tutor. In each case development work is described and future possibilities are discussed.

To describe the factors that medical students report influence them to pursue careers in family medicine.Qualitative study using focus groups and interviews and the results of surveys conducted at 3 different points in medical education.Three medical schools in western Canada: the University of British Columbia in Vancouver, the University of Calgary in Alberta, and the University of Alberta in Edmonton.A total of 33 medical students.Students were surveyed during the first 2 weeks of their programs, at the end of their preclinical training, and again at the end of their clinical training on their interest in family medicine or other specialty areas. Focus groups and interviews were conducted to explore the reasons students gave for an emerging or final interest in family medicine as a career choice. A small cohort of students who stayed with another specialty choice or switched to another specialty from family medicine were also interviewed. Thematic content analysis was carried out.Students identified several important influences that were subdivided into pre-medical school, medical school, postgraduate training, and life-in-medicine influences. Many positive and negative aspects of family medicine were reported during the preclinical period. Clinical exposure was critical for demonstrating the positive aspects of family medicine. Postgraduate training, future practice, and nonpractice life considerations also influenced students' career choices.This study provides a qualitative understanding of why students choose careers in family medicine. Medical schools should offer high-quality family medicine clinical experiences, consider the potentially positive influence of rural settings, and provide early and accurate information on family medicine training and career opportunities. These interventions might help students make more informed career decisions and increase the likelihood that they will consider careers in family medicine.

Copyright © 2006 National Rural Health Alliance Inc. The definitive version is available at www.blackwell-synergy.com

Introduction: Course outcomes have been assessed by examining the congruence between statements of commitment to change (CTCs) and course objectives. Other forms of postcourse reflective exercises (for example, impact and unmet-needs statements) have not been examined for congruence with course objectives or their utility in assessing course outcomes. This study assessed the congruence of course objectives and statements of commitment to change, effects on practice, unmet-needs, and the utility of supplementing CTCs with other forms of reflective work in course evaluations. Methods: A 3-module course on Alzheimer's disease and other dementias provided end-of-course CTC statements, follow-up data, and statements of effects on practice and unmet needs. Statements were aligned to module objectives and analyzed descriptively. Results: Of the 932 physicians who registered for 1 of the 3 modules, 404 provided CTCs, 302 provided impact statements, and 265 provided unmet-needs statements. Sixty percent of the CTCs could be assigned to an objective for their module, and between 14% and 25% of CTCs were assigned to objectives for another module. Three-quarters of CTCs were fully or partially implemented. Physicians did not have an opportunity to implement the new content in 70% of nonimplemented CTCs. Fewer impact and unmet-needs statements were congruent with course objectives than CTCs. Conclusions: Commitment-to-change statements had more congruence with objectives than did impact or unmet-needs statements. These latter statements, particularly those that could not be assigned to an objective, may reinforce and supplement the information provided by CTC analyses.

Three container vans (CVs) used to transport and store rations in Operation Desert Shield/Storm (ODS) in 1991 were relocated at the Yuma Proving Ground Yuma, AZ to monitor heat stress occurring in military rations in a desert climate. One of the vans contained Meal-Ready-To-Eat (MRE) Rations one B Rations and one contained Tray Rations. A total of 64 thermocouples were attached throughout the vans and temperatures were recorded hourly. Time-temperature indicators (TTI) were also attached to some cartons and sample MREs inserted for sensory and objective evaluation after storage. Temperatures were analyzed for the period 18 June 1992 to 31 December 1995. Results show that despite the small headspace in the CVs, the maximum temperatures in the most critical top ration cases rarely exceeded 120 deg F (49 deg C), although temperatures four inches below the roof reached 151 deg F (66 deg C). Rations stored for the summer six months in the vans experienced about the same heat stress similar rations stored at a constant temperature of 100 deg F. Temperature dependence of sensory and objective degradation of rations stored in the vans was consistent with an Arrhenius activation energy of 26 kcal/mole. Effective mean constant temperatures computed to represent the degradation caused by the varying van storage temperatures in 1995 were 93 deg F for the year, 100 deg F for the hottest summer six months, 106 deg F for the hottest three months, and 108 deg F for the hottest month. For periods of less than one year, the seasonal effects are extreme, the hottest summer month experiencing about 40 times the degradation rate of the coldest winter month.

This paper describes the pioneering development of flexible‐learning courseware in the teaching and learning of cell biology using a novel optical disk‐based technology — PhotoCD — and its associated computer software. The use of this format in an educational context for the manipulation of, and interaction with, photographic images in electronic form is presented for the first time. Examples of courseware which use PhotoCD, image‐enhancement and image‐management software in biology education are given, and an evaluation by undergraduates in biology education (student teachers) of these teaching and learning strategies is presented

Beim Erhitzen des Allens (I) mit dem Athylen (IIa) in einem Pyrex-Gefas erfolgt Cycloaddition zum Addukt cis- und trans-(IIIa) (Isomerenverhaltnis 47:53).