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Saturated bicycles are becoming ever more important in the design and development of new pharmaceuticals. Here a new strategy for the synthesis of bicyclo[2.1.1]hexanes is described. These bicycles are significant because they have defined exit vectors, yet many substitution patterns are underexplored as building blocks. The process involves sensitization of a bicyclo[1.1.0]butane followed by cycloaddition with an alkene. The scope and mechanistic details of the method are discussed.

Inorganic chemistry 62(2), 769 - 781 (2023). doi:10.1021/acs.inorgchem.2c03278, Continued efforts are made on the development of earth-abundant metal catalysts for dehydrogenation/hydrolysis of amine boranes. In this study, complex [K-18-crown-6-ether][(NO)$_2$Fe(μ-$^{Me}$Pyr)(μ-CO)Fe(NO)$_2$] (3-K-crown, $^{Me}$Pyr = 3-methylpyrazolate) was explored as a pre-catalyst for the dehydrogenation of dimethylamine borane (DMAB). Upon evolution of H$_{2(g)}$ from DMAB triggered by 3-K-crown, parallel conversion of 3-K-crown into [(NO)$_2$Fe(N,N′-$^{Me}$PyrBH$_2$NMe$_2$)]− (5) and an iron-hydride intermediate [(NO)$_2$(CO)Fe(μ-H)Fe(CO)(NO)$_2$]$^−$ (A) was evidenced by X-ray diffraction/nuclear magnetic resonance/infrared/nuclear resonance vibrational spectroscopy experiments and supported by density functional theory calculations. Subsequent transformation of A into complex [(NO)$_2$Fe(μ-CO)$_2$Fe(NO)$_2$]$^−$ (6) is synchronized with the deactivated generation of H$_{2(g)}$. Through reaction of complex [Na-18-crown-6-ether][(NO)$_2$Fe(η$^2$-BH$_4$)] ($_4$-Na-crown) with CO(g) as an alternative synthetic route, isolated intermediate [Na-18-crown-6-ether][(NO)$_2$(CO)Fe(μ-H)Fe(CO)(NO)$_2$] (A-Na-crown) featuring catalytic reactivity toward dehydrogenation of DMAB supports a substrate-gated transformation of a pre-catalyst [(NO)$_2$Fe(μ-$^{Me}$Pyr)(μ-CO)Fe(NO)$_2$]$^−$ (3) into the iron-hydride species A as an intermediate during the generation of H$_{2(g)}$., Published by American Chemical Society, Washington, DC

Continued efforts are made on the development of earth-abundant metal catalysts for dehydrogenation/hydrolysis of amine boranes. In this study, complex [K-18-crown-6-ether][(NO)

Medical students have voluntarily initiated service-learning programmes with the aim of providing assistance to medically underserved communities, especially within remote indigenous villages. However, their values and goals have been challenged because rural health care demands have changed considerably since the introduction of integrated delivery system (IDS) programmes, that is, programmes that integrate local health care providers with outreach services provided by contracted hospitals. Our study aimed to explore how a health care service-learning group negotiates its position and how it responds to the tension of IDS implementation and changes in rural health care demand.Medical students who have been engaged in building or operating the health care service-learning group of one university in Taiwan were invited to participate in the study. We used cultural-historical activity theory (CHAT) to help us interpret the interactions between students, indigenous communities and the public health sectors and to understand the evolution of the service-learning relationship and its effectiveness.Eighteen participants were recruited for in-depth interviews. The implementation of IDS programmes brought change to the rural community and challenges to students' service learning. Utilising cultural-historical activity theory, we highlighted points of fragmentation within the system. This tension lead to medical students' personal conflict and also served as an impetus for change and learning. Flexible goal setting and coping ability were considered critical to the sustainability and maintenance of students' value systems.IDS implementation can upset the balance of rural health care supply and demand, resulting in accumulating tensions within and between activity systems. Those contradictions exposed medical students to an expansive learning cycle, resulting in transformational change and learning. Under the context of IDS programmes, health care service-learning can create a 'win-win' situation. Not merely medical students but also community residents gain benefits. This result may be extrapolated to health care service-learning programmes with similar context.

Saturated bicycles are becoming ever more important in the design and development of new pharmaceuticals. In this manuscript, a new strategy for the synthesis of [2.1.1]-bicyclohexanes is described. These bicycles are significant as they have defined exit vectors, yet many substitution patterns are underexplored as building blocks. The process involves sensitization of a [1.1.0]-bicyclobutane followed by cycloaddition with an alkene. The scope and mechanistic details of the methods are discussed.

BackgroundFeedback is an effective pedagogical tool in clinical teaching and learning, but the actual perception by learners of clinical feedback is often described as unsatisfactory. Unlike assessment feedback or teaching sessions, which often happen within protected time and space, clinical feedback is influenced by numerous clinical factors. Little is known about clinical teachers’ motivations to provide feedback in busy clinical settings. We aimed to investigate the motivations behind feedback being given in emergency departments (EDs).MethodsA qualitative analysis of semi-structured interview data was conducted between August 2015 and June 2016. Eighteen attending physicians were purposively sampled from three teaching hospital EDs in Taiwan. Data were thematically analysed, both inductively (from the data) and deductively (using self-determination theory (SDT)). Themes were mapped to the different motivation types identified by the SDT.Results and discussionDespite working in busy clinical settings, Taiwanese ED clinical teachers reported being motivated to provide feedback when they felt responsible for their learners, when they understood the importance of feedback (patient safety and partner building), or simply because they were committed to following a tradition of passing on their clinical knowledge to their juniors. Suggestions to facilitate the internalisation of external motivations are proposed.ConclusionsIn this qualitative study, motivations for clinical feedback were identified. Although the motivations are mostly extrinsic, the elicitation of internal motivation is possible once true satisfaction is fostered during the feedback-giving process. This understanding can be used to develop interventions to enable clinical feedback to be provided in a sustained manner.

Background: Evaluating the effectiveness of pediatric emergency medicine training is essential to ensure that emergency physicians and emergency medicine residents have sufficient knowledge, skill, and confidence in optimizing care for acute pediatric visits. Although the field of pediatric emergency medicine has experienced phenomenal growth in past decades, it still faces challenges in how to best implement the curriculums in emergency medicine residency training programs. Objectives: Exploring emergency physicians’ and emergency residents’ perspectives on pediatric emergency medicine training in emergency residency training programs in Taiwan through a nationwide survey. Methods: The survey was distributed to 1281 emergency physicians and emergency medicine residents in 43 teaching hospitals. The survey inquired about demographic data, hospital type, rank of proctored trainers and assessors, and the setting of pediatric emergency medicine training. Participants’ confidence in managing acute pediatric visits and their satisfaction and reflections of their pediatric emergency medicine training were explored. Results: In all, 258 responses were received from 117 residents and 141 emergency physicians. Seventy-seven percent reported working in medical centers. Clinical supervision was primarily performed by pediatric attending physicians and emergency physicians. Fifty-eight percent of participants felt satisfied with their pediatric emergency medicine training. However, only 52.3% felt confident managing acute pediatric visits, which was attributed to inadequate exposure to pediatric patients. Residents noted lack of confidence in managing newborns, infants, and clinical procedures. Therefore, simulation training and point-of-care ultrasound learning were considered advantageous. Conclusion: The pediatric emergency medicine training in emergency medicine residency programs is diverse in intensive care training, supervisors, and assessors. Surveys demonstrate that learning experience in pediatric wards and emergency department rotations is associated with overall satisfaction with pediatric emergency medicine training; inadequate exposure to pediatric patients contributed to learners having less confidence. Emergency medicine residency program reform might focus on adequate hands-on pediatric patient care.

Background: Medical schools prepare undergraduates for clinical practice. Clinical competencies build up gradually and continuously. Existing literature suggests that new graduates are often unprepared for independent practice. This study aims to validate a Chinese version of a Preparedness for Hospital Practice Questionnaire (PHPQ) in a Taiwanese undergraduate cohort. Methods: The original eight-domain English version PHPQ was translated into Chinese and back-translated for expert panel discussion. The eight domains encompass interpersonal skills, confidence, collaboration, management, science, prevention, holistic care, and self-directed learning. Reliability and validity were checked by Cronbach's alpha and by confirmatory factor analysis (CFA), respectively. Participants were divided into higher and lower preparedness groups according to PHPQ results, and compared by age, sex, professional identity, and perception of educational environment. Results: A total of 129 undergraduate medical students (55% males) participated in the study. The overall Cronbach's alpha was 0.94. Participants were found to be best prepared in the domain of disease prevention (M = 4.37, SD = 0.68) and least prepared in interpersonal skills (M = 2.68, SD = 0.77). A satisfactory goodness of fit data was yield from CFA with a CMIN/DF of 2.02. Higher levels of preparedness are associated with stronger professional identity (p

Improving the self-efficacy of intensive care unit nurses for delirium care could help them adapt to the changing situation of delirium patients. Validated measures of nurses' self-efficacy of delirium care are lacking OBJECTIVES: The objective of this study was to develop a Delirium Care Self-Efficacy Scale for assessing nurses' confidence about caring for patients in the intensive care unit and to examine the scale's psychometric properties.Draft scale items were generated from a review of relevant literature and face-to-face interviews with intensive care unit nurses; content validity was conducted with a panel of five experts in delirium. A group of nurses were recruited by convenience sampling from intensive care units (N = 299) for item analysis of the questionnaire, assessment of validity, and reliability of the scale. Nurse participants were recruited from nine adult critical care units affiliated with a hospital in Taiwan. Data were collected from August 2020 to July 2021.Content validity index was 0.98 for the initial 26 items, indicating good validity. The critical ratio for item discrimination was 14.47-19.29, and item-to-total correlations ranged from 0.67 to 0.81. Principal component analysis reduced items to 13 and extracted two factors, confidence in delirium assessment and confidence in delirium management, which explained 66.82% of the total variance. Cronbach's alpha for internal consistency was 0.94 with good test-retest reliability (r = 0.92). High scale scores among participants were significantly associated with age (≥40 years), work experience in an intensive care unit (≥10 years), delirium education, and willingness to use delirium assessment tools.The newly developed Delirium Care Self-Efficacy Scale demonstrated acceptable reliability and validity as a measure of confidence for intensive care nurses caring for and managing patients with delirium in the intensive care unit.

Before caring for patients, video instruction is commonly used for undergraduate medical students, and 360° virtual reality (VR) videos have gained increasing interest in clinical medical education. Therefore, the effect of immersive 360° VR video learning compared with two-dimensional (2D) VR video learning in clinical skills acquisition should be evaluated. This randomized, intervention-controlled clinical trial was aimed to assess whether immersive 360° VR video improves undergraduate medical students' learning effectiveness and reduces the cognitive load in history taking and physical examination (H&P) training. From May 1 2018 to October 30 2018, 64 senior undergraduate medical students in a tertiary academic hospital were randomized to receive a 10-min immersive 360° (360° VR video group; n = 32) or 2D VR instructional video (2D VR video group; n = 32), including essential knowledge and competency of H&P. The demographic characteristics of the two groups were comparable for age, sex, and cognitive style. The total procedure skill score, physical examination score, learner’s satisfaction score, and total cognitive load in the 360° VR video group were significantly higher than those in the 2D VR video group (effect sizes [95% confidence interval]: 0.72 [0.21–1.22], 0.63 [0.12–1.13], 0.56 [0.06–1.06], and 0.53 [0.03–1.03], respectively). This study suggested that a10-minute 360° VR video instruction helped undergraduate medical students perform fundamental H&P skills as effectively as 2D VR video. Furthermore, the 360° VR video might result in significantly better procedural metrics of physical examinations with higher learner satisfaction despite the higher cognitive load.

Intrahospital transport of critically ill patients for diagnostic or therapeutic procedures can be compromised by patient instability, equipment problems or inexperienced teamworking. This quasi-experimental study aimed to assess the effectiveness of an in-situ interprofessional simulation-based training (IIST) model for junior member transport teams. Newly registered postgraduate physicians, nurses and respiratory therapists underwent the IIST. The technical skills (TS) of each participant and non-technical skills (NTS) of each interprofessional team were assessed using well-validated checklists. Thirty-six participants enrolled and were randomly assigned to six experimental and six control teams. Most participants achieved a significantly higher level of both TS and NTS. Both the control and experimental teams overvalued their NTS in the pretest, while the posttest self-assessment scores among the experimental groups more closely matched the expert assessments. Despite challenges in scheduling and the setting, the IIST was successfully conducted in a crowded hospital, which enabled trainees to optimize their learning in a real-life environment. In conclusion, the IIST model can facilitate the development of both TS and NTS for transport team members. Transport teams made up of newly registered staff from different disciplines may lack insight into their NTS in critical patient transfer management, but simulation training may cause improvements.

We have developed an effective ortho C–H functionalization of arylpyridines and detachable N-pyrimidyl indoles by terminal and internal alkynes using a Re(I) catalyst providing an efficient access to various E-selective alkenylation products. The catalytic reaction is compatible with various aliphatic alkynes, aromatic terminal alkynes and internal alkynes, and structurally different nitrogen heterocycles. Deuterium-labeling experiments indicate that significant deuterium scrambling occurs with the directing groups and acetylenic sp C–H bonds before the migratory insertion.

Professional identities research in medical education has made significant contributions to the field. However, what comprises professional identities is rarely interrogated. This research tackles this relatively understudied component of professional identities research by understanding emergency medicine physicians’ perspectives on the important elements that comprise their professional identities. Q-methodology was used to identify different clusters of viewpoints on professional identities; by extension, the core components that comprise emergency medicine physicians’ professional identities are disclosed. Thirty-three emergency medicine physicians were recruited, through purposive sampling, from five hospitals across Taiwan. R software was used to analyse the Q-sorts, determine loadings on each viewpoint and formulate the viewpoint array. Analysis of interview data enhanced our understanding of these viewpoints. In total, twenty-five emergency medicine physicians loaded onto four distinct viewpoints, reflecting dominant perspectives of emergency medicine physicians’ understanding of their professional identities. These distinct viewpoints demonstrated what emergency medicine physicians deemed significant in how they understood themselves. The viewpoints comprised: skills acquisition, capabilities and practical wisdom; coping ability and resilience; professional recognition and self-esteem; and wellbeing and quality of life. All viewpoints stressed the importance of trust between colleagues. These findings demonstrate the multitude of ways in which seemingly unified professional identities diverge across groups of individuals. An enhanced understanding of speciality work culture is gained. By understanding facets of professional identities, the development of future educational interventions and departmental initiatives, which might support key components of professional identities, can be explored.

In-training examinations (ITEs), arranged during residency training, evaluate the residents’ performances periodically. There is limited literature focusing on the effectiveness of resident ITEs in the format of simulation-based examinations, as compared to traditional oral or written tests. Our primary objective is to investigate the effectiveness and discriminative ability of high-fidelity simulation compared with other measurement formats in emergency medicine (EM) residency training program. This is a retrospective cohort study. During the 5-year study period, 8 ITEs were administered to 68 EM residents, and 253 ITE measurements were collected. Different ITE scores were calculated and presented as mean and standard deviation. The ITEs were categorized into written, oral, or high-fidelity simulation test forms. Discrimination of ITE scores between different training years of residency was examined using a one-way analysis of variance test. The high-fidelity simulation scores correlated to the progression of EM training, and residents in their fourth training year (R4) had the highest scores consistently, followed by R3, R2, and then R1. The oral test scores had similar results but not as consistent as the high-fidelity simulation tests. The written test scores distribution failed to discriminate the residents’ seniority. The high-fidelity simulation test had the best discriminative ability and better correlation between different EM residency training years comparing to other forms. High-fidelity simulation tests had the good discriminative ability and were well correlated to the EM training year. We suggest high-fidelity simulation should be a part of ITE in training programs associated with critical or emergency patient cares.

Background Endotracheal intubation is crucial in emergency medical care and anaesthesia. Our study employed a high-fidelity simulator to explore differences in intubation success rate and other skills between junior and senior physicians. Methods We examined the performance of 50 subjects, including undergraduate students (UGY), postgraduate trainees (PGY), residents (R), and attending physicians (VS). Each participant performed 12 intubations (i.e. 3 devices x 4 scenarios) on a high-fidelity simulator. Main outcome measures included success rate, time for intubation, force applied on incisor and tongue, and Cormack Lehane grades. Results There was no primary effect of seniority on any outcome measure except success rate and Cormack Lehane grades. However, VS demonstrated shorter duration than medical students using Glidescope and direct laryngoscopy, whereas VS and R applied significantly more force on the incisor in the normal airway and rigid neck scenario respectively. Discussion Seniority does not always correlate with skill perfection in detailed processes. Our study suggests that the use of video laryngoscopy enhances the intubation success rate and speed, but the benefit only accrues to senior learners, whereby they applied more force on the incisor at a single peak under difficult scenarios. These findings are discussed in terms of psychological and cognitive perspectives. Conclusion Speed and safety are essential for high quality critical medical procedures. A tool should be designed and implemented to educate junior physicians with an emphasis on practice and efficiency, which should also contribute to updating senior physicians’ knowledge and competence by providing instant feedback on their performance. This type of fine-grained feedback could serve as a complement to traditional training and provide a sustainable learning model for medical education.

Background Graduating from medical school and beginning independent practice appears to be a major transition for medical students across the world. It is often reported that medical graduates are underprepared for independent practice. Most previous studies on undergraduates’ preparedness are cross-sectional. This study aimed to characterize the development and trend of medical students’ preparedness and its association with other objective and subjective indicators from the undergraduate to postgraduate periods. Methods This was a prospective cohort study. The participants were recruited and followed from two years before graduation to the postgraduate period. The preparedness for independent practice, professional identity, and teamwork experience were biannually measured using previously validated questionnaires. The participants’ basic demographic information, clinical learning marks from the last two years, and national board exam scores were also collected. Results A total of 85 participants completed 403 measurements in the 5 sequential surveys. The mean age at recruitment was 23.6, and 58 % of participants were male. The overall total preparedness score gradually increased from 157.3 (SD=21.2) at the first measurement to 175.5 (SD=25.6) at the fifth measurement. The serial individual preparedness scores revealed both temporal differences within the same learner and individual differences across learners. Despite the variations, a clear, steady increase in the overall average score was observed. Participants were least prepared in the domain of patient management at first, but the score increased in the subsequent measurements. The participants with better final preparedness had better professional identity (pp p Conclusions The preparedness for practice of medical students from the undergraduate to postgraduate periods is associated with their professional identity, teamwork experience, and objective clinical rotation endpoint. Although preparedness generally increases over time, educators must understand that there are temporal fluctuations and individual differences in learners’ preparedness.

BackgroundIn-training examinations (ITEs), arranged during residency training, evaluate the residents' performances periodically. The ITE usually consists of written and oral forms. There is limited literature focusing on the effectiveness of emergency medicine (EM) resident ITEs in the format of simulation-based examinations, as compared to traditional oral or written tests. Our primary objective is to compare high fidelity simulation with written and oral tests in the evaluation of the residents with different seniority in EM training programs. MethodsDuring the 5-year study period, 8 ITEs were administered to 68 EM residents, and 253 ITE scores were collected. Different ITE scores were calculated and presented as mean and standard deviation. Discrimination of ITE scores between different training years of residency was examined using one-way ANOVA test. ResultsThe high fidelity simulation scores correlated to the EM training year, and residents in their fourth training year (R4) had the highest scores consistently, followed by R3, R2, and then R1. The oral test scores had similar results but not as consistent as the high fidelity simulation tests. The written test scores distribution failed to discriminate the residents' seniority. The high fidelity simulation test had the best discriminative ability and better correlation between different EM residency training years comparing to oral or written forms.ConclusionsHigh fidelity simulation tests had a good discriminative ability and were well correlated to the EM training year. We suggest high-fidelity simulation should be a part of ITE of EM training programs and maybe adopted in EM board certification examination in the future.

Background During a novel virus pandemic, predicting emergency department (ED) volume is crucial for arranging the limited medical resources of hospitals for balancing the daily patient- and epidemic-related tasks in EDs. The goal of the current study was to detect specific patterns of change in ED volume and severity during a pandemic which would help to arrange medical staff and utilize facilities and resources in EDs in advance in the event of a future pandemic. Methods This was a retrospective study of the patients who visited our ED between November 1, 2019 and April 30, 2020. We evaluated the change in ED patient volume and complexity of patients in our medical record system. Patient volume and severity during various periods were identified and compared with data from the past 3 years and the period that SARS occurred. Results A reduction in ED volume was evident. The reduction began during the early epidemic period and increased rapidly during the peak period of the epidemic with the reduction continuing during the late epidemic period. No significant difference existed in the percentages of triage levels 1 and 2 between the periods. The admission rate, length of stay in the ED, and average number of patients with out-of-hospital cardiac arrest increased during the epidemic periods. Conclusion A significant reduction in ED volume during the COVID-19 pandemic was noted and a predictable pattern was found. This specific change in pattern in the ED volume may be useful for performing adjustments in EDs in the future during a novel virus pandemic. The severity of patients visiting the ED during epidemic periods was inconclusive.

BACKGROUND History taking and physical examination (H&P) is an important core competency of undergraduate medical education. Recent advances in virtual reality (VR) simulation, lowering the complexity of learning tasks and the cognitive load of the learners, make this novel technology well suited for the initial training of novices. Reduced heart rate variation (HRV) is associated with decreased cognitive efficiency. Whether a 360° VR video review can impact learning outcome, cognitive load, and HRV while learning H&P skills in undergraduate medical students is unknown. OBJECTIVE We explored the effectiveness of 360° VR versus 2-dimensional (2D) video review to learn H&P skills with regards to learning outcome, cognitive load, and HRV. METHODS In 2018, we randomly assigned (1:1) 64 undergraduate medical students to either a 360° VR or 2D video group (matched by age, sex, and cognitive style) with allocation concealment to learn H&P skills using VR headsets and controllers. Subsequently, the participants each performed a focused H&P with a real outpatient. Two raters used the Mini-Clinical Evaluation Exercise (Mini-CEX) and Direct Observation of Procedural Skills (DOPS) questionnaires to assess the participants’ performance blindly. The Cognitive Load Component questionnaire and a portable electrocardiogram monitor were used to measure cognitive load and HRV, respectively. RESULTS All participants completed the study (mean age=24.2 years, standard deviation=0.9 years; 44 [69%] males and 20 [31%] females). The physical examination and student’s satisfaction scores (Mini-CEX), total DOPS score, total and intrinsic cognitive load scores, and standard deviation of normal to normal R-R intervals in the 360° VR video group were significantly higher than those in the 2D video group (effect size=0.63, 0.56, 0.72, 0.53, 0.67, and 0.52, respectively). Differences in the other aspects of the Mini-CEX and cognitive loads of both groups were not statistically significant. CONCLUSIONS This study provides a high level of evidence to confirm that 360° VR video review can help undergraduate medical students to perform fundamental H&P skills as effectively as traditional 2D video review. Furthermore, a 360° VR video review could be used to more efficiently examine the body of a real patient with higher learner’s satisfaction. These findings may inspire the design of 360° VR video-based training protocols to enhance competencies other than history taking. CLINICALTRIAL Clinicaltrials.gov NCT03501641; https://clinicaltrials.gov/ct2/show/NCT03501641 (Archived by WebCite at http://www.webcitation.org/72f59ImWm)

Background Cutaneous lupus erythematosus (CLE) includes a broad range of dermatologic manifestations. Periorbital involvement, however, is a relatively rare clinical presentation of CLE. Objectives This clinical study aimed to investigate the characteristics of this unique presentation of CLE in tertiary medical centers. Methods We enrolled patients with periorbital erythema and swelling as the presenting sign of lupus erythematosus, from January 2003 to November 2017, using the data of 553 pathologically proven CLE cases from the registration database of the Chang Gung Memorial Hospitals in Taiwan. Results We enrolled a total of 25 patients. The mean age was 46.7 years and 68% of the patients were female. Most of the patients (84.0%) presented with unilateral involvement, with the left orbit involved in 15 patients (60%); the upper eyelid was the most frequently involved (72%). Mean duration between the onset of clinical manifestations and the diagnosis of CLE was approximately 59 weeks. Nineteen patients had been previously misdiagnosed. All patients had features compatible with CLE on histopathological examination. In contrast, laboratory analysis of the autoimmune profile often revealed negative results, including those for antinuclear antibodies (25%). Notably, anti-SSA/SSB (45.5%) showed the highest positive rate. During follow-up, six patients developed systemic lupus erythematosus (SLE) and two patients developed Sjögren syndrome. Conclusions The diagnosis of CLE presenting as periorbital erythema and swelling is often delayed because of clinical mimicry and the high proportion of negative results on autoantibody tests. Increased clinical suspicion and prompt histopathological examination are crucial for early diagnosis. Moreover, one-fourth of the patients ultimately developed SLE, which highlights the importance of clinical awareness.

Context The flipped classroom (FC), reversing lecture and homework elements of a course, is popular in medical education. The FC uses technology‐enhanced pre‐class learning to transmit knowledge, incorporating in‐class interaction to enhance higher cognitive learning. However, the FC model is expensive and research on its effectiveness remains inconclusive. The aim of this study was to compare the efficacy of the FC model over traditional lecture‐based (LB) learning by meta‐analysis. Methods We systematically searched MEDLINE, PubMed, ERIC, CINAHL, EMBASE, reference lists and Association for Medical Education in Europe (AMEE) conference books. Controlled trials comparing academic outcomes between the FC and LB approaches in higher education were considered eligible. The main findings were pooled using a random‐effects model when appropriate. Results Forty‐six studies (9026 participants) were included, comprising four randomised controlled trials (RCTs), 19 quasi‐experimental studies and 23 cohort studies. Study populations were health science (n = 32) and non health science (n = 14) students. The risk of bias was high (36/37 articles). Meta‐analyses revealed that the FC had significantly better outcomes than the LB method in examination scores (post‐intervention and pre–post change) and course grades, but not in objective structured clinical examination scores. Subgroup analyses showed the advantage of the FC was not observed in RCTs, non‐USA countries, nursing and other health science disciplines and earlier publication years (2013 and 2014). Cumulative analysis and meta‐regression suggested a tendency for progressively better outcomes by year. Outcome assessments rarely focused on behaviour change. Conclusions The FC method is associated with greater academic achievement than the LB approach for higher‐level learning outcomes, which has become more obvious in recent years. However, results should be interpreted with caution because of the high methodological diversity, statistical heterogeneity and risk of bias in the studies used. Future studies should have high methodological rigour, a standardised FC format and utilise assessment tools evaluating higher cognitive learning and behaviour change to further examine differences between FC and LB learning., The authors’ meta‐analysis (46 studies, >9000 participants, health and non‐health science education) found flipped classrooms generally have significantly better learning outcomes than lecture learning, with a tendency for better outcomes for more recent studies.

Hydroarylation of bicyclic alkenes has been developed using a low-valent ReI -catalyzed, directing group-assisted C-H bond activation strategy. The addition of sodium acetate significantly improves the reaction efficiency; moreover, bicyclic alkenes such as 7-oxa and aza benzonorbornadienes worked efficiently under this reaction condition. Preliminary mechanistic studies suggest that, after the alkene insertion, the rhenacycle preferentially undergoes protonolysis rather than reductive elimination.

Background Metaphorical expressions and conceptualisations are widely used in medical discourse to convey complex and abstract concepts. Our study uses a novel way to examine the spontaneous use of metaphors by emergency physicians as they articulate their experiences of practicing emergency care. These co-constructions shed light on the values and beliefs that shape their emergency care practice. Methods We invited 25 Taiwanese emergency physicians to participate in one-to-one semi-structured interviews. Results Drawing on social constructionism theory, systematic metaphor analysis method and Metaphor Identification Procedure (MIP) we identified metaphorical linguistic expressions in their talk, grouping them into five-overarching conceptual metaphors. We argue that these metaphors underpin emergency physicians’ experiences of practicing emergency medical care: Safety Net, Gateway, Market, War, and Sport. Discussion The Safety Net, Gateway, and Market conceptualisations highlight physician-patient relationships and the social mission, resource allocation, and consumerism aspects of emergency care practice. The Sport and War conceptualisations highlight the physician–physician relationship and the demanding, team-based nature of emergency care practice. Conclusion We propose that the choice of metaphorical conceptualisation deployed by emergency physicians has implications on their embodiment of professional identities. This discussion of using metaphors to study professional identities contributes to the literature concerned with finding creative and innovative ways to research identities. Future studies may utilize metaphors to gain a comprehensive understanding of physicians’ professional identities in other specialties.

Background Personality preference research on medical students and physicians demonstrates that personality preferences may affect one’s choice of specialty and transform over the course of one’s academic career as well as during one’s time spent in the clinical setting. The literature offers valuable methods for evaluating medical curricula, understanding medical specialties, and rethinking communication techniques between educators and learners. In line with this encompassing body of work, this study examines the personality preferences of junior doctors and attending physicians from various specialties to investigate how career stage and medical specialty are associated with personality preferences. Method The Myers–Briggs Type Indicator (MBTI) was applied to assess the personality preferences of junior doctors (postgraduates year 1–3) and attending physicians from six major medical specialties. Participants completed a self-administered 93-item questionnaire, while a certified MBTI practitioner explained the personality dichotomies as well as facilitated the self-evaluation process and the questionnaire’s interpretation. Contrasted dichotomous scores and radar plots were employed to illustrate the distinction between junior doctors and attending physicians’ personality preferences. All analyses were performed using the SAS statistical software, while a Wilcoxon rank-sum test was used to quantify the polarisation of personality preferences between junior doctors and attending physicians. Results In total, 98 participants were recruited, of whom 59 were attending physicians and 39 were junior doctors. The most common personality types among the junior doctors were ESTJ (15.4%), INTP (12.8%), and ESFJ (10.3%), while among the attending physicians, the most common types were ISTJ (23.7%) and ESTJ (18.6%). Both junior doctors and attending physicians expressed personality preferences for sensing, thinking, and judging. However, compared to the junior doctors, more polarised personality preferences were noted among the attending physicians for sensing (p = 0.038), thinking (p = 0.032), and judging (p = 0.024). Moreover, junior doctors exhibited less distinct personality preferences in this study. Conclusion Attending physicians and junior doctors exhibited greater personality inclinations for sensing, thinking, and judging, although the former expressed these personality preferences more strongly than the latter. These findings highlight that, amongst physicians, career stage is strongly associated with the expression of personality preferences.

In this study, we explored the considerations and the influencing factors for the technological integration of educational curricula based on the technological pedagogical content knowledge (TPCK) framework for health profession educators (HPEs). A mixed methodology was used that included semi-structured interviews with 15 HPEs and an online TPCK survey with a randomly selected sample of 319 HPEs from 217 Taiwanese universities. Five themes emerged, namely, supplementing traditional teaching methods, improving immediate educator&ndash, student interactions, tracking the learning process and improving the record-keeping, keeping up with technological trends, and advancing professional learning objectives for different student needs. The presence of pre-existing platforms and inspiration from colleagues and students were facilitators, whereas the risk of technological problems and the need to invest extra time into the preparation process were impediments to technology integration in the curriculum. Of the online respondents (n = 210), 64.2% have integrated at least one technological method into their curriculum. The logistic regression model revealed that gender, prior knowledge regarding how to incorporate technology with teaching, high mean TPCK scores, and relevant school policies were significant predictors of technology integration in the curriculum. Based on these results, recommendations for development in the health profession included efforts to equip HPEs with TPCK, in order to integrate technology into the curriculum effectively.

Background Feedback is an essential part of clinical teaching and learning, yet it is often perceived as unsatisfactory in busy clinical settings. Clinical teachers need to balance the competing demands of clinical duty and feedback provision. The influence of the clinical environment and the mutual relationship between feedback giving and seeking has been inadequately investigated. This study therefore aimed to quantify the adequacy, perceptions, and influential factors of feedback provision during resident training in emergency departments (EDs). Methods A multicenter online questionnaire study was undertaken. The respondents comprised ED residents and clinical teachers from four teaching hospitals in Taiwan. The questionnaire was developed via an expert panel, and a pilot study ensured validity. Ninety clinical teachers and 54 residents participated. Results The respondents reported that the majority of feedback, which usually lasted 1–5 min, was initiated by the clinical teachers. Feedback satisfaction was significantly lower for the clinical teachers than for the residents (clinical teachers M = 13.8, SD = 1.83; residents M = 15.3, SD = 2.14; p

English translation of Questionnaire. (DOCX 44 kb)