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Educational change in higher education is challenging and complex, requiring engagement with a multitude of perspectives and contextual factors. In this paper, we present a case study based on our experiences of enacting a fundamental educational change in a medical program; namely, the steps taken in the transition to programmatic assessment. Specifically, we reflect on the successes and failures in embedding a coaching culture into programmatic assessment. To do this, we refer to the principles of programmatic assessment as they apply to this case and conclude with some key lessons that we have learnt from engaging in this change process. Fostering a culture of programmatic assessment that supports learners to thrive through coaching has required compromise and adaptability, particularly in light of the changes to teaching and learning necessitated by the global pandemic. We continue to inculcate this culture and enact the principles of programmatic assessment with a focus on continuous quality improvement.

We are 52 Black scientists. Here, we establish the context of Juneteenth in STEMM and discuss the barriers Black scientists face, the struggles they endure, and the lack of recognition they receive. We review racism's history in science and provide institutional-level solutions to reduce the burdens on Black scientists.

BackgroundCeramide kinase-like protein (CERKL) was originally described in retinal tissue. CERKL has been shown to protect cells from oxidative stress, and mutations in CERKL underlie the inherited disease retinitis pigmentosa. CERKL expression maintains cellular sphingolipids via an unknown mechanism.ObjectivesTo determine whether CERKL is expressed in epidermis and cutaneous squamous cell carcinoma (cSCC) and whether CERKL expression affects cSCC sphingolipid metabolism and susceptibility to oxidative stress.MethodsCERKL expression was determined by RNA-Seq, quantitative polymerase chain reaction and immunohistochemistry. CERKL was knocked down in cSCC cells using small interfering RNA. Sphingolipid content was analysed by liquid chromatography-mass spectrometry. Oxidative stress was induced by treatment with H2 O2 , and apoptosis was measured using flow cytometry to determine annexin V binding.ResultsCERKL mRNA and protein are highly expressed in actinic keratosis and cSCC in comparison with normal epidermis. CERKL is also expressed in metabolically active epithelial cells in normal hair bulbs and sebaceous glands. CERKL knockdown in cultured cSCC cells reduces cellular sphingolipid content and enhances susceptibility to oxidative stress.ConclusionsThese findings suggest that CERKL may be important in cSCC progression and could lead to novel strategies for prevention and treatment of cSCC.

BackgroundCeramide Kinase-Like Protein (CERKL) was originally described in retinal tissue. CERKL has been shown to protect cells from oxidative stress, and mutations in CERKL underlie the inherited disease, retinitis pigmentosa. CERKL expression maintains cellular sphingolipids via an unknown mechanism.ObjectivesTo determine whether CERKL is expressed in epidermis and cutaneous squamous cell carcinoma (cSCC) and whether CERKL expression affects cSCC sphingolipid metabolism and susceptibility to oxidative stress.MethodsCERKL expression was determined by RNA-Seq, qPCR and immunohistochemistry. CERKL was knocked down in cSCC cells using siRNA. Sphingolipid content was analyzed by liquid chromatography-mass spectrometry (LC-MS). Oxidative stress was induced by treatment with H2 O2 , and apoptosis was measured using flow cytometry to determine annexin v binding.ResultsCERKL mRNA and protein are highly expressed in actinic keratosis and cSCC in comparison with normal epidermis. CERKL also is expressed in metabolically active epithelial cells in normal hair bulbs and sebaceous glands. CERKL knockdown in cultured cSCC cells reduces cellular sphingolipid content and enhances susceptibility to oxidative stress.ConclusionsThese findings suggest that CERKL may be important in cSCC progression and could lead to novel strategies for prevention and treatment of cSCC.

Background: As skin cancer is the most common cancer in the U.S., many publications focus on cutaneous malignancies. The objective was to identify and analyze the 100 most-cited articles pertaining to skin cancers to provide clarity on past, and insight for future research. Methods: Using a two-stage search of Thomson Reuters Web of Science database, the 100 most-cited skin cancer articles between 1945 and 2018 were identified and analyzed. Results: The articles were cited an average total of 558.49 times (range: 259 to 3429). There were relatively few significant publications until 1988. Linear correlation revealed that journal impact factor was not correlated with average number of citations per year per article (R2=0.06). Molecular pathogenesis and UV exposure were the most common topics. The topics that received the highest average citations per year per article were prevention (50.44 citations per year), diagnosis (47.32 citations per year), and management (41.37 citations per year). Basic science articles accounted for the most publications, followed by narrative literature reviews. Conclusions: These results may indicate that future publications with similar characteristics are more likely to be cited and thus, more influential.

The way quality of assessment has been perceived and assured has changed considerably in the recent 5 decades. Originally, assessment was mainly seen as a measurement problem with the aim to tell people apart, the competent from the not competent. Logically, reproducibility or reliability and construct validity were seen as necessary and sufficient for assessment quality and the role of human judgement was minimised. Later, assessment moved back into the authentic workplace with various workplace-based assessment (WBA) methods. Although originally approached from the same measurement framework, WBA and other assessments gradually became assessment processes that included or embraced human judgement but based on good support and assessment expertise. Currently, assessment is treated as a whole system problem in which competence is evaluated from an integrated rather than a reductionist perspective. Current research therefore focuses on how to support and improve human judgement, how to triangulate assessment information meaningfully and how to construct fairness, credibility and defensibility from a systems perspective. But, given the rapid changes in society, education and healthcare, yet another evolution in our thinking about good assessment is likely to lurk around the corner.

Arguably, constructive alignment has been the major challenge for assessment in the context of problem-based learning (PBL). PBL focuses on promoting abilities such as clinical reasoning, team skills and metacognition. PBL also aims to foster self-directed learning and deep learning as opposed to rote learning. This has incentivized researchers in assessment to find possible solutions. Originally, these solutions were sought in developing the right instruments to measure these PBL-related skills. The search for these instruments has been accelerated by the emergence of competency-based education. With competency-based education assessment moved away from purely standardized testing, relying more heavily on professional judgment of complex skills. Valuable lessons have been learned that are directly relevant for assessment in PBL. Later, solutions were sought in the development of new assessment strategies, initially again with individual instruments such as progress testing, but later through a more holistic approach to the assessment program as a whole. Programmatic assessment is such an integral approach to assessment. It focuses on optimizing learning through assessment, while at the same gathering rich information that can be used for rigorous decision-making about learner progression. Programmatic assessment comes very close to achieving the desired constructive alignment with PBL, but its wide adoption--just like PBL--will take many years ahead of us.

Programmatic assessment is both a philosophy and a method for assessment. It has been developed in medical education as a response to the limitation of the dominant testing or measurement approaches and to better align with changes in how medical competence was conceptualised. It is based on continual collection of assessment and feedback information which is collected in a portfolio and periodically discussed with a mentor or coach. Students produce reflections in which they analyse the assessment information triangulated across methods to meaningfully--rather than purely numerically-analyse their strengths and weakness in the different competency domains. Decisions about students' progress are made proportionally, in that low-stakes decisions are made when only limited assessment information is available but high-stakes decisions will and can be made on rich information. Quality of the process and credibility of the outcomes is determined by a combination of psychometric methods, qualitative rigour, and through organisational due processes. The method is still young, preliminary results are promising but more empirical justification research is needed.

Objectives Traditionally, evaluation is considered a measurement process that can be performed independently of the cultural context. However, more recently the importance of considering raters’ sense-making, that is, the process by which raters assign meaning to their collective experiences, is being recognised. Thus far, the majority of the discussion on this topic has originated from Western perspectives. Little is known about the potential influence of an Asian culture on raters’ sense-making. This study explored residents’ sense-making associated with evaluating their clinical teachers within an Asian setting to better understand contextual dependency of validity.Design A qualitative study using constructivist grounded theory.Setting The Japanese Ministry of Health, Labour and Welfare has implemented a system to monitor the quality of clinical teaching within its 2-year postgraduate training programme. An evaluation instrument was developed specifically for the Japanese setting through which residents can evaluate their clinical teachers.Participants 30 residents from 10 Japanese teaching hospitals with experience in evaluating their clinical teachers were sampled purposively and theoretically.Methods We conducted in-depth semistructured individual interviews. Sensitising concepts derived from Confucianism and principles of response process informed open, axial and selective coding.Results Two themes and four subthemes were constructed. Japanese residents emphasised the awareness of their relationship with their clinical teachers (1). This awareness was fuelled by their sense of hierarchy (1a) and being part of the collective society (1b). Residents described how the meaning of evaluation (2) was coloured by their perceived role as senior (2a) and their experienced responsibility for future generations (2b).Conclusions Japanese residents’ sense-making while evaluating their clinical teachers appears to be situated and affected by Japanese cultural values. These findings contribute to a better understanding of a culture’s influence on residents’ sense-making of evaluation instruments and the validity argument of evaluation.

Educational change in higher education is challenging and complex, requiring engagement with a multitude of perspectives and contextual factors. In this paper, we present a case study based on our experiences of enacting a fundamental educational change in a medical program; namely, the steps taken in the transition to programmatic assessment. Specifically, we reflect on the successes and failures in embedding a coaching culture into programmatic assessment. To do this, we refer to the principles of programmatic assessment as they apply to this case and conclude with some key lessons that we have learnt from engaging in this change process. Fostering a culture of programmatic assessment that supports learners to thrive through coaching has required compromise and adaptability, particularly in light of the changes to teaching and learning necessitated by the global pandemic. We continue to inculcate this culture and enact the principles of programmatic assessment with a focus on continuous quality improvement.