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BackgroundSelf-management of type 1 diabetes (T1D) requires numerous decisions and actions by people with T1D and their caregivers and poses many daily challenges. For those with T1D and a developmental disorder such as autism spectrum disorder (ASD), more complex challenges arise, though these remain largely unstudied. ObjectiveThis study aimed to better understand the barriers and facilitators of raising a child with T1D and ASD. Secondary analysis of web-based content (phase 1) and telephone interviews (phase 2) were conducted to further expand the existing knowledge on the challenges and successes faced by these families. MethodsPhase 1 involved a qualitative analysis of publicly available online forums and blog posts by caregivers of children with both T1D and ASD. Themes from phase 1 were used to create an interview guide for further in-depth exploration via interviews. In phase 2, caregivers of children with both T1D and ASD were recruited from Penn State Health endocrinology clinics and through the web from social media posts to T1D-focused groups and sites. Interested respondents were directed to a secure web-based eligibility assessment. Information related to T1D and ASD diagnosis, contact information, and demographics were collected. On the basis of survey responses, participants were selected for a follow-up telephone interview and were asked to complete the adaptive behavior assessment system, third edition parent form to assess autism severity and upload a copy of their child’s most recent hemoglobin A1c (HbA1c) result. Interviews were transcribed, imported into NVivo qualitative data management software, and analyzed to determine common themes related to barriers and facilitators of raising a child with both ASD and T1D. ResultsFor phase 1, 398 forum posts and blog posts between 2009 and 2016 were analyzed. Common themes related to a lack of understanding by the separate ASD and T1D caregiver communities, advice on coping techniques, rules and routines, and descriptions of the health care experience. For phase 2, 12 eligible respondents were interviewed. For interviewees, the average age of the child at diagnosis with T1D and ASD was 7.92 years and 5.55 years, respectively. Average self-reported and documented HbA1c levels for children with T1D and ASD were 8.6% (70 mmol/mol) and 8.7% (72 mmol/mol), respectively. Common themes from the interviews related to increased emotional burden, frustration surrounding the amount of information they are expected to learn, and challenges in the school setting. ConclusionsCaregivers of children with both T1D and ASD face unique challenges, distinct from those faced by caregivers of individuals who have either disorder alone. Understanding these challenges may help health care providers in caring for this unique population. Referral to the diabetes online community may be a potential resource to supplement the care received by the medical community.

The anatomy laboratory provides an ideal environment for the integration of clinical contexts as the willed-donor is often regarded as a student's "first patient." This study evaluated an innovative approach to peer teaching in the anatomy laboratory using a clinical handoff context. The authors introduced the "Situation, Background, Assessment, Recommendation" (SBAR) handoff framework within the anatomy laboratory. Study participants included 147 second-year medical students completing the head and neck portion of an anatomy course. The authors used mixed methods to evaluate the impact of the anatomic SBAR on the student anatomy laboratory experience. Qualitative analysis of student evaluations revealed three themes which emerged from students' summaries of their anatomic handoff experiences: "Learning-by-teaching"; "Acquiescing to doing more with less"; and "Distrust of the peer handoff process." All the themes demonstrated that the anatomic handoff encouraged students' focus on the knowledge preparation and reflection. Closed question analysis suggested that that students' perceptions of handoff usefulness were tied to deeper learning strategies. The handoff provided a mechanism for promoting students' focus on anatomical relationships and facilitated students' learning of transferable clinical skills. Together, these results suggest that the introduction of a handoff process in anatomy education provided both a mechanism for learning anatomy and a unique opportunity for early exposure to an essential clinical skill. This clinical and basic science integration may serve as a vertical integration thread which can be woven throughout undergraduate medical education. Future study will focus on exploring the long-term impacts and learning outcomes of this integration.

The arts and humanities (A&H) play a fundamental role in medical education by supporting medical learners' development of core competencies. Like all medical curricula, those integrating the A&H are more likely to achieve the desired outcomes when the learning domains, goals, objectives, activities, and evaluation strategies are well-aligned. Few faculty development programs focus on helping medical educators design A&H curricula in a scholarly manner. The Prism Model, an evidence-based tool, supports educators developing A&H medical curricula in a rigorous way for maximum impact. The model posits that the A&H can serve four pedagogical functions for medical learners: 1) skill mastery, 2) perspective taking, 3) personal insight, and 4) social advocacy. Although this model has been described in the literature, no practical guidance exists for medical educators seeking to apply it to the development of a specific curriculum. This paper provides a step-by-step demonstration of how to use the Prism Model to design an A&H curriculum. Beginning with the first step of selecting a learning domain through the final step of curriculum evaluation, this paper helps medical educators apply the Prism Model to develop A&H curricula with intentionality and rigour to achieve the desired learning outcomes. [ABSTRACT FROM AUTHOR]

Team-based learning, or TBL, is an application-oriented teaching method that combines small- and large-group learning by incorporating multiple small groups into a large group setting. It has been increasingly used in postsecondary and professional education over the past two decades. Given this increasing usage, many faculty wonder about the effects TBL has on learning outcomes. The authors performed a review and synthesis on the educational literature with respect to TBL to examine the quality of their descriptions of core TBL elements, then constructed narrative summaries of these selected articles. Their analysis demonstrated early evidence of positive educational outcomes in terms of knowledge acquisition, participation and engagement, and team performance. The authors conclude that the TBL literature is at an important maturation point, where more rigorous testing and study of additional questions relating to the method are needed, as well as more accurate reporting of TBL implementation.

Phenomenon: Transformative learning is a theory in which individuals construct new or revised interpretations of the meaning of an experience. COVID-19 offers a rare opportunity to better understand how individuals respond to and make meaning within the shared context of an extraordinary event. We aimed to examine if and how residents and fellows engaged in transformative learning when caring for COVID-19 positive patients during the initial peak of the pandemic (Spring 2020). Approach: We conducted an interpretive qualitative study to identify themes pertaining to transformative learning. We used semi-structured interviews of residents and fellows who were directly or indirectly involved in the care of COVID-19 positive patients admitted to the inpatient wards or the intensive care units during the first peak of the pandemic (defined as March 11th – May 28th, 2020) at our Mid-Atlantic academic health system. We used the medium of comics to depict select interviewees' experiences during the pandemic as a novel way to represent themes from the interviews. Findings: Three main themes arose from our qualitative analysis. These included "a sense of guilt," "the impact on training," and "venues and processes for reflection." In comparing their experiences with colleagues and friends at other institutions with higher COVID-19 case volume, trainees reflected on how they felt lucky, and this led to guilt, although not necessarily transformation. The impact of COVID-19 on the training environment had transformative potential. Trainees challenged their previously held assumptions on the necessity of various surgeries, in-person visits, and physical examination maneuvers when COVID-19 posed a barrier. Finally, while trainees recalled multiple situations throughout the pandemic when they believed they were engaging in reflection, such reflection did not appear to reach so deep as to alter participants' underlying assumptions until the research interview itself, suggesting that transformation was incomplete. Insights: Our purposive sample of residents and fellows who cared for COVID-19 positive patients during the initial peak of the pandemic made meaning of their experience in multiple ways. The largest shift in worldview due to the pandemic appeared to be related to the instrumental utility of certain common medical practices or procedures. This, in turn, was the most prominent influence on how these trainees felt they would practice in the future, and translated to a shift in how they appraised evidence. However, lack of opportunity for reflection may have adversely impacted the ability for transformation to take place. Given that multiple trainees showed appreciation for the critical reflection venue that was the research interview, academic leadership should ensure similar venues exist during training, even after the pandemic ends. [ABSTRACT FROM AUTHOR]

Objective: To compare the effects of active and didactic teaching strategies on learning- and process-oriented outcomes. Design: Controlled trial. Setting: After-hours residents' teaching session. Participants: Family and Community Medicine, Internal Medicine, and Pediatrics residents at two academic medical institutions. Interventions: We randomly assigned residents to two groups. One group received a didactic lecture on effective use of diagnostic tests; during this session, the teacher spent a full hour delivering content. The other group received the same content in a session structured to foster resident-to-resident interactions. In the latter session, the teacher spent only 30 minutes directly delivering content to residents. Measures and Main Results: We measured residents' knowledge about and attitudes toward the session content before, immediately after, and one month after each session. We measured residents' perceptions of engagement and session value immediately after each session. We employed blinded observers who used a structured instrument to observe residents' activities during each session. Both teaching methods led to improvements in residents' scores on both knowledge and attitude assessments. The amount of improvement was not statistically different between groups. Residents in the active learning session perceived themselves, and were observed to be, more engaged with the session content and each other than residents in the didactic session. Residents in the didactic session perceived greater educational value from the session compared to residents in the active session. Conclusions: We reduced the amount of time spent in teacher-driven content delivery by 50 percent and covered the same amount of content with no detrimental effects on knowledge acquisition or attitude enhancement. Teaching strategies that foster learner-to-learner interactions will lead to more active engagement among learners, however, these learners may value the session less. Further research is needed to explore learner perceptions of the teaching process and other outcomes of active learning in medical education.