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Abstract Purpose Transdisciplinarity has been described as a fusion of theories, methods, and expertise across disciplinary boundaries to address complex, global problems. This approach has coincided with an increase in US medical schools offering masters degrees along with an MD degree to equip medical students to practice in complex, interconnected health systems. This study focused on medical schools that graduate the most dual degree students per year and explored the alignment of such programs with a transdisciplinary approach. Methods We identified 19 allopathic medical schools that annually graduated an average of 10 or more dual-degree students from 2015–2020. We surveyed these schools and asked participants to describe the reason(s) their institutions offered dual-degree programs. Two authors coded the narrative responses from the survey. Results Responses were received from 17 of the 19 schools. The analysis of participants’ responses regarding their institutions’ purpose for offering dual programs revealed several themes associated with a transdisciplinary approach to training. The most common themes were expand skill sets beyond a medical degree (73%), provide opportunity for interdisciplinary collaboration (67%), expand career interest and goals (60%), develop leaders (53%), enhance residency applications (47%) and further the institution’s vision and mission (45%). Conclusions This study is the first comprehensive evaluation of MD/Masters programs in the United States that includes a summary of the medical schools with the largest dual degree programs and their reasons for offering them. The findings support the hypothesis that allopathic medical schools recognize the need for a transdisciplinary approach to prepare students for the complexities in healthcare. These programs provide students with opportunities for additional areas of expertise, leadership development, enhancement of competitiveness for residency application, and interdisciplinary collaboration. Medical schools without dual-degree programs may consider developing these programs to provide benefits to students and institutions.

When uncertain, medical trainees often seek to co-regulate their learning with supervisors and peers. Evidence suggests they may enact self-regulated learning (SRL) strategies differently when engaged in self- versus co-regulated learning (Co-RL). We compared the impacts of SRL and Co-RL on trainees' acquisition, retention, and preparation for future learning (PFL) of cardiac auscultation skills during simulation-based training. In our two-arm, prospective, non-inferiority trial, we randomly assigned first- and second-year medical students to the SRL (N = 16) or Co-RL conditions (N = 16). Across two learning sessions separated by two-weeks, participants practiced and were assessed in diagnosing simulated cardiac murmurs. We examined diagnostic accuracy and learning trace data across sessions, and conducted semi-structured interviews to explore participants' understandings of their underlying choices and learning strategies. SRL participants' outcomes were non-inferior to Co-RL participants on the immediate post-test and retention test, but not on the PFL assessment (i.e., inconclusive). Analyzing interview transcripts (N = 31) generated three themes: perceived utility of initial learning supports for future learning; SRL strategies and sequencing of murmurs; and perceived control over learning across sessions. Co-RL participants regularly described relinquishing control of learning to supervisors and regaining it when on their own. For some trainees, Co-RL seemed to interfere with their situated and future SRL. We posit that transient clinical training sessions, typical in simulation-based and workplace-based settings, may not allow the ideal processes of Co-RL to unfold between supervisor and trainee. Future research must examine how supervisors and trainees can share accountability to develop the shared mental models that underlie effective Co-RL.

This article aims to show that the Old Testament concept of the year of jubilee is neither an anachronistic, nor a peripheral de- tail of Scripture. It is an integral part of it and indeed one her- meneutical tool for interpreting and applying it to social and mo- ral transformation in South Africa. Israel, liberated from slavery and returning to God, became a paradigm for the liberated slave to return to his inheritance in the year of jubilee celebrated every 50th year. Its underlying concerns are: justice, freedom, human dignity and rights. Jesus clearly understood his mission in terms of the proclama- tion of “the year of the Lord’s favour” (Luke 4:14-21), and de- monstrated this by preaching good news to the poor, freeing the prisoners, restoring sight to the blind, and releasing the op- pressed. He linked the mission of his followers with his own and with the promise and gift of the Holy Spirit. Pentecost, seen as fulfilment and announcement of God’s promise, demonstrates that the kingdom of God is already here and still to come. The Book of Revelation gathers together this scriptural theme and presents the jubilee as good news for now and the future. Indeed, God’s future is presented as the ultimate jubilee. Although these institutions cannot be imposed on a secular democracy, there are implications here for holistic evangelism and mission as well as for social and moral transformation in South Africa. These implications, it is argued, should include a reference to the ‘missio Dei’ as Jesus expressed it: holistic evangelism; a commitment to the values and practices of restorative justice; restoration, healing and hope; economic justice and land re- form; ecological responsibility; and moral restoration.

At the conclusion of the TRC, Desmond Tutu stated that the Commission’s task was to promote, not to achieve, reconci- liation. Reconciliation, he maintained, is the responsibility of all South Africans, and expressed the hope that the Christian churches would be in the forefront of this healing process. This article explores how the Christian church can be in the forefront of binding up the wounds, facilitating the healing pro- cess, and living as a people and a sign of hope. The answers it seeks to offer fall under three interrelated themes, namely the church’s: • spirituality of reconciliation; • ministry and mission of reconciliation; and • resources for its ministry and mission of reconciliation. Cultivating a spirituality of reconciliation would mean making reconciliation a lifestyle, rather than a series of strategies, pro- grammes or initiatives, yet remaining concrete, practical, mea- surable and accountable. The church’s mission is primarily to proclaim the good news of God’s Kingdom that is already here, but not yet fully here and therefore still to come. This proclamation is the message of reconciliation between God, others and the self, and anticipates the unity of all creation in Jesus Christ. The resources given to the church to fulfil this apostolic ministry include prophecy, evangelism, pastoral care and teaching, as well as its liturgical and sacramental life, its ministry of pre- sence, its people and its commitment to social justice.

International experience has shown that addressing past human rights violations is a necessary step in the process of reconciliation and nation building. How was post-apartheid, democratic South Africa to deal with its past human rights violations? Would it go the way of retribution in order to settle the scores of the past? Would it go the way of blanket amnesty in the name of political expediency and ignore the fate of its victims? The Promotion of National Unity and Reconciliation, Act 34 of 1995, which established the TRC envisaged that national unity and reconciliation could be promoted by determining the extent, and the fate and whereabouts of the victims, of such human rights violations; giving opportunity for story-telling; recommending reparations and measures to prevent future violations; and by providing a full report. In order to do so the Commission had the power to grant amnesty to those making such disclosures. This article, while not uncritical of the Commission, is generally positive about its contribution both in attempting to deal with the past, and in building a democratic, human rights and restorative justice culture based on the rule of law. It examines the definitions of reconciliation that emerged during the Commission in the light of a Christian definition where reconciliation is seen to be between God, others and self, and involves integration with the human community. This integration involves taking responsibility for the past, confession and repentance, forgiving and being forgiven, making restitution where possible, ongoing transformation in the present and hope for the future.

Background: Immersive virtual reality (IVR) is utilized as an adjunct to anesthesia to distract patients from their intraoperative environment, thereby potentially reducing sedative and narcotic medication usage. This study evaluated intraoperative and acute postoperative results of patients undergoing primary total hip (THA) and total knee arthroplasty (TKA) with and without IVR. Methods: Utilizing IVR as an adjunct to spinal anesthesia, 18 primary THAs (n = 8) and TKAs (n = 10) were performed. These cases were 1:2 matched based on procedure type, age, sex, and body mass index to those performed without IVR. Intraoperative and postanesthesia care unit sedative/narcotic usage, vital signs, and pain scores were compared. Acute perioperative outcomes, including 24-hour oral morphine equivalent (OME), first ambulation distance, length of stay, and 30-day complications, were also analyzed. Pearson Chi-square and Wilcoxon-Mann-Whitney tests evaluated categorical and continuous variables, respectively. Results: When compared to non-IVR primary THAs and TKAs, those performed with IVR utilized significantly less intraoperative sedation (48 mg vs 708 mg of propofol; P < .001) and trended toward less narcotic usage (13 mcg vs 39 mcg of fentanyl; P = .07). In the postanesthesia care unit, IVR and non-IVR patients showed no significant differences (P > .3) in vital signs, pain scores, or OME received. Additionally, similar (P > .3) postoperative outcomes were noted in both cohorts’ 24-hour OME use, distance at first ambulation, length of stay, and 30-day complications. Conclusions: The use of spinal anesthesia with the IVR adjunct to perform primary THAs and TKAs appears to be well-tolerated and associated with less intraoperative sedative medication usage than spinal anesthesia alone.

Context: Like many other African countries, medicinal plants are widely used in Guinea to manage hypertension, which is a highly prevalent health problem. Aims: To identify the plants used in the traditional management of hypertension in Guinea. Methods: From May to November 2018, three hundred and forty-nine Traditional Health Practitioners (THPs) respondents, including 244 traditional healers and 105 herbalists, were contacted. Through semi-structured interviews, ethnobotanical information on medicinal plants were collected. Voucher specimens were authenticated by the department of Botany of the IRDPMAG and deposited in the Herbarium of this Institute. Results: Among the traditional anti-hypertensive recipes, a total of 97 plant species from 85 genera belonging to 43 families have been identified. Combretum micranthum, Hymenocardia acida, Anacardium occidentale, Spondias mombin and Alchornea cordifolia were the most frequently cited. The traditional recipes included one plant species (23 recipes), a combination of two species (18 recipes) or more (47 recipes). Conclusions: A large number of medicinal plants are used for the management of arterial hypertension in Guinea. Further biological and phytochemical investigations are needed to validate the traditional uses of these plants.

Cytochrome P450s drive the structural diversity of plant alkaloids, many of which have biotechnological uses. Here the authors use reverse genetics and metabolomics to identify two Atropa belladonna cytochrome P450s that synthesize pseudotropine-derived alkaloids.

The COVID-19 pandemic resulted in an unanticipated, near-universal shift from in-person to virtual instruction in the spring of 2020. During the 2020–21 school year, schools began to reopen, and families were faced with decisions regarding the instructional mode for their children. We leverage administrative, survey, and virtual-learning data to examine the determinants of family learning-mode choice and associations between virtual education, student engagement, and academic achievement. Family preference for virtual (versus face-to-face) instruction was highly associated with subsequent school-level infection rates and appeared relatively uniform within schools. We find that students assigned to a higher proportion of instructional days in virtual mode experienced higher rates of attendance but negative achievement growth compared to students who were assigned a higher proportion of instructional days in face-to-face mode. Insights from this study can be used to better understand family preferences as well as to target and refine virtual learning in a post-COVID-19 society.

AbstractIntroductionMethodResultsDiscussionSharing mental models is essential for high-performance teams, and speaking up is key for exchanging critical insights, especially during medical errors. Understanding how health providers and trainees voice their concerns is crucial for improving speaking-up behavior. This study aims to fill a gap in the literature by examining how medical students speak up when they encounter medical errors and assessing the impact of training on their speaking-up patterns.A quasi-experimental study involving 146 students, who were divided into two groups, was conducted in Northern Taiwan. One group of students encountered life-threatening scenario before intervention, followed by a faculty-led personalized debriefing session, then a non-life-threatening scenario after the intervention. Another group of students underwent these sessions in the reverse order. Students’ Speaking-up patterns, including expression style, form and attitude, and their speaking-up confidence were assessed at pre- and post-intervention scenarios.During pre-intervention scenario, in expression style, 50 students (34.5%) addressed their concerns to medical errors with direct expression and 14 students (9.7%) utilized indirect hint to express their concerns. In expression form, 31 students (21.4%) addressed their concerns to medical errors with affirmative sentences and 33 students (22.8%) asked questions to express their concerns. In speaking-up attitude, 47 students (32.4%) used unoffensive words, while 17 students (11.7%) used offensive words. After intervention, significantly change of speaking-up styles, forms, and attitude were observed along with their speaking-up confidence (p < 0.001).Medical students are inclined to speak up in the event of medical errors using more direct expression and affirmative sentences, along with increased speaking-up confidence after simulation scenario learning and faculty-led personalized debriefing. Healthcare educators can focus more on discussing with students the advantages and disadvantages of various approaches of speaking-up in medical errors, helping them to develop effective speaking-up behaviors in a variety of medical contexts. [ABSTRACT FROM AUTHOR]

Background and Purpose: An education program to improve the delirium care competency of nurses is important as they play an integral role in caring for patients with delirium. This study aimed to examine the effects of a standardized patient (SP)-based delirium care education program on new graduate nurses' performance and self-confidence. Methods: A waitlist control group with a crossover design was adopted. The SP-based delirium care education program was designed, implemented, and evaluated. Generalized estimating equations were used to analyze differences in performance and self-confidence scores between the intervention and waitlist control groups. Results: The education program was found to significantly affect rater-assessed performance, SP-assessed performance, and self-confidence when controlled for gender and age. Implications for Practice: An SP-based delirium care education program improved new graduate nurses' performance and self-confidence in caring for patients with delirium. Nurse educators should provide experiential learning opportunities to ensure that recent nurse graduates have achieved optimal delirium care competency. [ABSTRACT FROM AUTHOR]

Background: Although reflective thinking is regarded as an important learning aspect of debriefing, the factors that can affect reflective thinking during simulation debriefing remain unclear. Purpose: This study aimed to identify factors affecting reflective thinking during simulation debriefing among nursing students. Methods: This study used a cross-sectional descriptive survey design with a convenience sample of 198 Korean nursing students. Participants completed a structured web-based self-administered questionnaire regarding the reflective learning continuum, psychological safety, learner communications skills, and debriefing process design. Multiple regression analyses were used to identify the factors affecting reflective thinking. Results: Significant factors were debriefing process design, learner communication skills, student-to-student interactions, and instructor-to-student interactions. Psychological safety did not affect the reflective thinking of nursing students. Conclusions: Nurse educators should design and implement strategies to maintain effective debriefing processes, improve communication skills, and facilitate student-to-student and instructor-to-student interactions to promote reflective thinking during simulation debriefing. [ABSTRACT FROM AUTHOR]

The article discusses highlights of the International Conference on the Future of Health Professions Education (HPE) 2022. Topics included impact of COVID-19 on HPE, global advances and challenges in HPE and development of the health workforce, role of university in transforming healthcare, holistic health systems approach, diversity, equity and patient-centric approaches, innovation in education and assessment, empowerment and collaboration in global health, health creation and primary care.