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The prevalence of Autism Spectrum Disorder (ASD) is growing rapidly, affecting 1 in 59 children in the United States in 2018. Individuals with ASD currently receive fragmented care that threatens their health and well-being. Challenges of autism care include disconnections between the medical system and school supports, poor care coordination between primary care and specialists, and saturation of neuropsychiatry-based centers' capacity to care for the ASD population. ASD treatment also lacks of a coordinated system of care for patients' multi-system comorbidities. Families are calling for an ASD care delivery system to meet their needs and the needs of their children. To serve people with ASD and their medical and other providers, we propose a coordinated approach to care grounded in primary care. We call the model the "Systematic Network of Autism Primary Care Services (SYNAPSE)." We develop the model by applying the frameworks of "coproduction" of care and chronic disease management. In this Commentary we discuss the model's rationale, underpinnings, and the implications for clinical practice. We advance these ideas to align with policy makers' recognition of the importance of primary care for ASD, as reflected by the most recent Interagency Autism Coordinating Committee (IACC) meeting at the National Institute of Mental Health.

This study investigates the vocabulary learning opportunities in an ELT course book designed for upper-intermediate learners. All the words appearing in the 12 chapters of the text were analyzed. The results suggest that the text would provide opportunities to deepen knowledge of the second 1,000 most frequent words in English, and would provide a context for pre-teaching of academic words met in the text for learners on an academic pathway. The results also suggest that the text would provide minimal opportunities for learners to develop vocabulary knowledge beyond high frequency and academic words. The findings demonstrate a need to supplement use of such texts with an extensive reading program and other forms of language rich input to promote vocabulary development. (Contains 5 tables.)

The problem: Medical schools require highly skilled and committed clinical faculty to teach, assess, supervise and mentor students' clinical care. Medical education is facing a crisis in recruiting and sustaining these clinical teachers. Faced with multiple demands and responsibilities in fast‐paced clinical environments, teachers may not have the time, resources or stamina to sustain these critical roles. Medical school leaders must commit to and provide structures and processes to attract, sustain and retain clinical teachers. Conceptual framework: The authors use the lens of self‐determination theory to frame approaches to support teacher sustainability. Self‐determination theory describes sources of human motivation. The theory and its evidence base characterise three human psychological needs: autonomy, competence, and relatedness. This theory can bridge individual psychological and institutional leadership perspectives to help medical school leaders anticipate and respond to their clinical teachers' needs. The authors propose three practical steps: practices to advance employee‐centredness, processes to align individual and institutional values, and restructuring education to support clinical teachers' needs alongside student and patient needs. The authors describe limitations to this relational approach that focuses on leadership actions and consider individual agency as another key factor for sustainability. Discussion: Medical school leaders can develop and apply theory‐driven approaches to advance sustainability. Sustainability now and in the future requires careful attention to the needs of clinical teachers and to their relationships with and within medical schools. Addressing the faculty crisis, self‐determination theory is used as a lens to address teacher sustainability, leading the authors to emphasize employee‐centered practices, values alignment, and education restructuring. [ABSTRACT FROM AUTHOR]

Achievement goal theory links goal setting, motivation, and learning and describes three orientations: 'mastery' (seeking learning), 'performance' (seeking positive judgments), and 'performance-avoidance' (avoiding negative judgments). Mastery orientation is considered most adaptive. The authors investigated goal orientations of traditional block clerkship (TBC) and longitudinal integrated clerkship (LIC) students. This was an exploratory study conducted at one US medical school. Three hundred and twenty students completed an anonymous survey consisting of three tools with validation evidence: Patterns of Adaptive Learning Survey, Task-choice Goal Measures, and Questionnaire Goal Choice Items. The authors analyzed the data using regression analyses, Chi-square, and Wilcoxon's rank-sum tests. While all students rated mastery items most highly on the five-point Likert scale (mean 4.58/5.00), LIC students rated performance-orientation lower (β = −0.36, p =.04), chose personal mastery-orientation items more frequently (92% vs. 64.4%, p =.005), and perceived their learning environment as promoting less performance (β = −0.60, p =.002) and performance-avoidance (β = −0.78, p <.001) compared to TBC students. LIC and TBC students differed in their report of personal and clerkship goal orientations. These differences may inform educational design and future research to promote students' mastery orientation. [ABSTRACT FROM AUTHOR]