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Educational Challenge: Frequent transitions between core clinical rotations in medical school increase anxiety and cognitive load. Few formalized programs exist to ease these transitions. Our institutional needs-assessment found that approximately 85% of students believed that additional rotation-specific information prior to starting a new rotation would reduce anxiety and increase success., Proposed Solution and Implementation of Solution: We developed a novel web-based peer-to-peer handoff tool available to all clerkship students at a single, large academic institution. The tool contains the names and contact information of students who most recently completed rotations on each service for all clerkships. A handoff checklist was also created with suggested discussion points for handoffs. Students were encouraged to schedule a handoff 1-2 weeks before starting a new rotation., Lessons Learned: Overall, 83 students (66%) utilized the handoff tool, with use and efficacy decreasing with time during the clinical year. Of tool users, 65% expressed that having access to the tool prior to starting a new rotation helped to reduce anxiety, and 74% felt that the information gained helped to ease transitions. Our peer-to-peer handoff tool may help students feel more prepared to start a new rotation, decrease anxiety during clerkship year, and ease transitions., Next Steps: This low-resource intervention may be implemented at other institutions to provide students with equal opportunities to receive valuable information prior to starting new rotations, regardless of pre-existing peer connections. An automated update system, which we are implementing at our institution, could greatly decrease the time required to maintain a handoff tool and improve sustainability.

Context: A growth mindset and mastery approach have gained attention as useful learning orientations in medical education, however few studies of interventions to foster these orientations exist., Objectives: We sought to discover whether a communication skills session on delivering serious news could foster a communication growth mindset and/or a mastery approach in medical students., Methods: This was an interventional survey study of third-year medical students before and after a session on delivering serious news. Students were administered a communication mindset survey before and after the session; achievement goal and learning environment surveys were administered after the session. Chi-square tests were used to assess the difference in pre and post mindsets. Logistic regression was used to determine the odds of achieving a mastery approach with pre- and post-communication growth mindset as the independent variables., Results: Students' communication growth mindset increased from 79% (n = 186) before the intervention to 92% (n = 142) after the intervention. Achievement goal analysis demonstrated that 64% (n = 91) of students had a mastery approach, 14% (n = 20) had a performance approach and 22% (n = 32) had an avoidant approach. Ninety-nine percent (n = 151) felt the session provided a safe learning environment. The odds of having a mastery approach correlated with both pre and post-intervention growth mindset, with post-session growth mindset having the strongest correlation., Conclusions: A novel communication skills session on delivering serious news fostered a communication growth mindset in third year medical students. Most students exhibited a mastery approach to learning; this approach was more likely when they had a growth mindset., Competing Interests: Disclosures and Acknowledgments The CARE-7 curriculum is generously funded by Barbara M. Jordan, a Penn Medicine Board member and spouse of the late Henry A. Jordan, MD, a Penn alumnus (M’62 from the School of Medicine). The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (Copyright © 2024 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.)

Palliative care (PC) longitudinal curricula are increasingly being recognized as important in Undergraduate Medical Education (UME). They are however, not yet commonplace, and where they do exist may be implemented without a systematic, prospective approach to curriculum evaluation. This paper describes an implementation of a new longitudinal curriculum at the Perelman School of Medicine (PSOM) at the University of Pennsylvania. We used the Context Input Process Product (CIPP) model, a holistic evaluation model, to assess the local environment, design the curriculum, guide the improvement process, and evaluate outcomes. Comprehensive models such as CIPP provide a more robust approach to curriculum evaluation than outcomes-only models and may be of use to other programs who are implementing new curricula or improving upon existing programs., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

This study explored measures of subjective and objective sleep health and the association with fall occurrence and falls risk for older adults. A longitudinal observational study was conducted with participants in residential aged care (n = 36) and community dwelling (n = 35) settings. At baseline, objective sleep data involved wearing wrist worn accelerometers and measuring falls risk by walking using the Quantitative timed up and go (QTUG) of a simple, cognitive, and motor task. Subjective sleep data was collected by completing sleep diaries using the Karolinska Sleepiness Scale and sleep quality scale, respectively. Longitudinal falls data were collected at baseline, 3, 6, and 9 months. Falls risk was calculated via QTUG. Responses to a fall questionnaire were used to quantify fall occurrence. Independent samples t -test examined differences in objective and subjective sleep variables between settings. Logistic regression explored whether objective or subjective sleep variables could predict an overall fall occurrence. Linear regression determined if a particular sleep variable could predict an overall falls risk. Multiple regression determined if sleep variables could predict falls risk. No significant differences were found between residential and community-dwelling adults in subjective or objective sleep measures. Logistic regression showed no significant associations between most sleep variables and falls risk, except for average awakening length, where each additional minute was associated with a 1.8% increase in fall likelihood (OR = 1.02, 95% CI [1.00-1.03], P  = .037). Conversely, higher awakening frequency was associated with reduced falls risk in the simple timed up-and-go task ( R ² = .21, β = -.69, P  = .009, 95% CI [-1.20 to -0.18]). Findings suggest no significant differences in sleep health or falls risk between residential and community-dwelling older adults, though specific sleep disruptions showed minor associations with falls risk., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: Describe medical student perspectives on framework learning and develop a free, online, mobile-friendly framework website., Methods: Internal medicine clerkship students were surveyed at a single U.S. medical school regarding how they learn frameworks. We used Draw.io to create frameworks, which were edited by expert clinicians. Frameworks were hosted online through an academic server, and Google analytics was used to track website activity., Results: Most medical students report learning frameworks from attending clinicians. We developed 87 frameworks on the "Penn Frameworks'' website, which was visited by 9,539 unique users from 124 countries over three years., Conclusions: Most medical students perceive that they learn frameworks during clinical rotations from attending clinicians. We found that it is feasible to develop a low-cost, expert-curated, mobile-friendly resource to supplement in-person learning., (© 2023 Walter de Gruyter GmbH, Berlin/Boston.)

Objective: Contextually embedded and sanctioned gender minimization and sexual abuse toward female personnel within the military appears widespread. Left unabated, mental health complications of female personnel will challenge care responsibilities for military organizations., Method: Interview data from six ex-military women that sought positive and negative interpretations of gender minimization and sexual abuse while in the military was analyzed using interpretative phenomenological analysis., Results: Analysis revealed two superordinate themes: (a) Immature Culture, and (b) Ejection and Growth. These overarched four subordinate themes that explored fostered patriarchy and male privilege in the military. Participants expressed experiencing relentless belittling that eroded early adolescent goals of success and aborted their ability to thrive psychologically. By association, interpersonal violence compounded by organizational complicity triggered internalized shame and narcissistic defenses. Discharging from the military is remembered as a painful, isolated struggle for these participants as they sought to make sense of their fragmented identities as women. With time, all participants acknowledged pride in skills achieved during military life, and the strength to speak out against embedded organizational abuse. A persistent ruminative struggle to make sense of complex systemic biases against women that allowed organizational abuse to flourish facilitated posttraumatic growth., Conclusions: For these participants, personal experiences of gender minimization and sexual abuse in the military incubated a betrayal of hope and moral safety. As women, they felt violated at an organizational level seemingly orchestrated by male privilege and patriarchy. Clinical priorities include reparative validation and holistic trauma support underpinned by trauma and posttraumatic growth frameworks. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Introduction: Ubrogepant is an oral, small-molecule calcitonin gene-related peptide receptor antagonist approved for the acute treatment of migraine. The efficacy and safety of ubrogepant were demonstrated in two pivotal phase 3, single-attack, randomized, placebo-controlled trials (ACHIEVE I and ACHIEVE II)., Methods: We conducted a post hoc analysis of pooled data from the ACHIEVE trials to evaluate the efficacy, safety, and tolerability of ubrogepant 50 mg (the only dose evaluated in both trials) versus placebo across a large population of participants with migraine. The coprimary efficacy outcomes were pain freedom and absence of the most bothersome migraine-associated symptom (including photophobia, phonophobia, and nausea) at 2 h post dose. Secondary outcomes included pain relief at 2 h post dose, sustained pain relief and pain freedom from 2 to 24 h, and absence of specific migraine-associated symptoms at 2 h post dose., Results: A total of 2240 eligible participants were randomized to placebo (n = 1122) or ubrogepant 50 mg (n = 1118) in the ACHIEVE trials. Pain freedom at 2 h was reported in 13.0% of participants in the pooled placebo group and 20.5% in the pooled ubrogepant 50 mg group (odds ratio [OR] 1.72; 95% confidence interval [CI] 1.34, 2.22; P < 0.001). Absence of the most bothersome migraine-associated symptom at 2 h was reported by 27.6% in the pooled placebo group and by 38.7% in the pooled ubrogepant 50 mg group (OR 1.68; 95% CI 1.37, 2.05; P < 0.001). Adverse events (AEs) within 48 h after the initial or optional second dose were reported by 11.5 and 11.2% of participants in the pooled placebo and pooled ubrogepant 50 mg groups, respectively. The most common AE was nausea (1.8 and 1.9%, respectively). No serious AEs related to treatment or discontinuations due to AEs were reported., Conclusion: These results further support the efficacy, safety, and tolerability of ubrogepant for the acute treatment of migraine., Trial Registration: ClinicalTrials.gov Identifiers: ACHIEVE I: NCT02828020; ACHIEVE II: NCT02867709.

Objective: To describe headache characteristics, medication use, disability, and quality of life in a large patient cohort from the United States who have chronic migraine (CM) and medication overuse headache (MOH)., Methods: In all, 610 adult patients were enrolled into the Medication Overuse Treatment Strategy trial from 34 healthcare clinics, including headache specialty, general neurology, and primary care clinics. Descriptive statistics characterize baseline demographics, headache characteristics, medication use, disability (Headache Impact Test 6 [HIT-6] and Migraine Functional Impact Questionnaire [MFIQ]), pain interference (PROMIS Pain Interference), and quality of life (EQ-5D-5L). Relationships with headache frequency were assessed., Results: Mean age was 45 years (SD 13) and 531/608 (87.3%) were females. Mean headache days per 30 was 24.3 (SD 5.5), including 13.6 (SD 7.1) with moderate to severe headache. Daily headaches were reported by 36.1% (219/607) of patients. Acute headache medications were used on 21.5 (SD 7.5) per 30 days. The most commonly overused medications were simple analgesics (378/607, 62% of patients), combination analgesics (246/607, 41%), and triptans (128/607, 21%). HIT-6, MFIQ, PROMIS Pain Interference, and EQ-5D-5L scores demonstrated substantial negative impact from CM with MOH on patient functioning and quality of life. Higher headache frequency was associated with more moderate-severe headache days, more frequent acute headache medication use, greater headache-related disability, and lower quality of life. Only 272/606 (44.9%) were taking migraine preventive medication., Conclusions: CM with MOH is associated with a large burden on patients in the United States. Higher headache frequency is associated with greater impact on functioning, pain interference, and quality of life., (© 2021 American Headache Society.)

Introduction: Triptans, the most commonly prescribed acute treatments for migraine attacks are, per FDA labeling, contraindicated in cardiovascular (CV) disease patients and have warnings and precautions for those with CV risk factors., Methods: Headache specialists, cardiologists, and health economics and outcomes researchers convened to identify diagnostic codes for: (1) CV diseases contraindicating triptans based on FDA labeling; (2) conditions comprising "other significant underlying CV disease"; and (3) CV risk factors included as warnings and precautions for triptans. A retrospective, cross-sectional analysis of commercially insured adult US migraine patients in the 2017 Optum ® Clinformatics ® Data Mart (CDM) and the 2017 IBM ® Watson Health MarketScan ® Commercial Claims database was used to estimate the proportion of migraine patients with CV contraindications and warnings and precautions to triptans., Results: Of the 56,662 migraine patients analyzed from Optum CDM, 13.5% had ≥1 CV disease as specified in triptan labeling and an additional 8.5% had ≥1 "other CV disease" judged by the panel to constitute a "significant underlying CV disease" (total: 22.0% migraine patients). Of 176 724 migraine patients analyzed from MarketScan, 12.2% had ≥1 CV disease as specified in the labeling and an additional 8.0% had ≥1 "other significant underlying CV disease" (total: 20.2% of migraine patients). An additional 25.4% and 25.1% of migraine patients had ≥2 CV risk factors in Optum CDM and MarketScan. In total, 47.4% and 45.3% of migraine patients in both databases had a CV disease specified as a contraindication, an "other CV disease" endorsed as significant, or ≥2 CV risk factors identified as warnings and precautions to triptans., Conclusions: Analyses of more than 230,000 people with migraine showed that ≥20% of commercially insured US migraine patients have a CV condition that specifically contraindicates triptan treatment, and an additional 25% have ≥2 CV risk factors identified as warnings and precautions to triptans.

In the self-magnetic-pinch diode, the electron beam, produced through explosive field emission, focuses on the anode surface due to its own magnetic field. This process results in dense plasma formation on the anode surface, consisting primarily of hydrocarbons. Direct measurements of the beam's current profile are necessary in order to understand the pinch dynamics and to determine x-ray source sizes, which should be minimized in radiographic applications. In this paper, the analysis of the C IV doublet (580.1 and 581.2 nm) line shapes will be discussed. The technique yields estimates of the electron density and electron temperature profiles, and the method can be highly beneficial in providing the current density distribution in such diodes.

Purpose: The Chiefs' Service (CS), a structured approach to inpatient teaching rounds, focuses on resident education and patient-centered care without disrupting patient census sizes or admitting cycles. It has five key elements: morning huddles; bedside rounds; diagnostic "time-outs"; day-of-discharge rounds; and postdischarge follow-up rounds. The authors hypothesized the CS model would be well received by residents and considered more effective than more-traditional rounds., Method: The CS was implemented on Penn Presbyterian Medical Center's general medicine inpatient service using a quasi-experimental design. Its first year (January 2013-January 2014) was evaluated with a mixed-methods approach. Residents completed end-of-rotation evaluation questionnaires; 20 CS and 10 traditional service (TS) residents were interviewed. Measures of resident agreement on questionnaire items were compared across groups using independent sample t testing. A modified grounded theory approach was used to assess CS residents' perspectives on the CS elements and identify emergent themes., Results: The questionnaires were completed by 183/188 residents (response rate 97%). Compared with TS residents, CS residents reported significantly greater satisfaction in the domains of resident education and patient care, and they rated the overall value of the rotation significantly higher. The majority of CS residents found the CS elements to be effective. CS residents described the CS as focused on resident education, patient-centered care, and collaboration with an interdisciplinary team., Conclusions: The CS approach to inpatient rounding is seen by residents as valuable and is associated with positive outcomes in terms of residents' perceptions of learning, interdisciplinary communication, and patient care.

Background: Tribal sovereignty exempts tribal casinos from statewide smoking bans., Purpose: To conduct a tribally-led assessment to identify the characteristics of casino patrons at Lake of the Torches Resort Casino in Lac du Flambeau WI and their preferences for a smoke-free casino., Methods: A survey was administered from April to August 2011 to a stratified random sample of 957 members of the casino players club to assess their preferences for a smoke-free casino. These members were categorized into three groups: those who reported being likely to (1) visit more; (2) visit less; or (3) visit the same if the casino prohibited smoking. They were characterized by age, education, sex, race/ethnicity, annual income, players club level, and reasons for visiting the casino. Statistical analyses were conducted on weighted data in October to December 2011. Weighted logistic regression was calculated to control for potential confounding of patron characteristics., Results: Of the 957 surveyed patrons, 520 (54%) patrons were likely to visit more; 173 (18%) patrons to visit less; and 264 (28%) patrons were indifferent to the smoke-free status. Patrons more likely to prefer a smoke-free casino tended to be white, elderly, middle class and above, and visit the casino restaurants. Patrons within the lower tiers of the players club, almost half of the players club members, also showed a higher preference for a smoke-free casino., Conclusions: This tribal casino would likely realize increased patronage associated with smoke-free status while also contributing to improved health for casino workers and patrons., (Copyright © 2014 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

A trivalent inactivated influenza vaccine (Fluarix (™) , GlaxoSmithKline Biologicals) was licensed under US accelerated approval regulations. We performed a randomized, observer-blind, post-approval study to demonstrate its immunological non-inferiority versus an established US-licensed vaccine (primary endpoint). Adult (including elderly) subjects received a single injection of newly-licensed vaccine (n = 923) or established vaccine (n = 922). Serum hemagglutination-inhibition titers were determined pre-vaccination and 21-28 days after vaccination. Non-inferiority was assessed by post-vaccination geometric mean titer (GMT) ratio (upper 95% confidence interval [CI] ≤ 1.5) and difference in seroconversion rate (upper 95% CI ≤ 0.1) for all three vaccine strains. Safety was monitored for 6 months. The newly-licensed vaccine was non-inferior to the established vaccine in all subjects (≥ 18 years) and in elderly subjects (≥ 65 years). Adjusted GMT ratios (established/newly-licensed) against the H1N1, H3N2 and B strains were 0.65 (95% CI: 0.58, 0.73), 0.93 (0.83, 1.04) and 1.13 (1.03, 1.25) for all subjects and 0.75 (0.67, 0.85), 0.95 (0.82, 1.09) and 1.13 (1.00, 1.27) for elderly subjects. Corresponding values for the differences in seroconversion rate (established minus newly-licensed) were -0.12 (-0.16, -0.07), -0.02 (-0.06, 0.03) and 0.01 (-0.04, 0.06) for all subjects and -0.11 (-0.16, -0.05), -0.02 (-0.07, 0.04) and 0.02 (-0.04, 0.08) for elderly subjects. The most common adverse events with both vaccines were injection site pain, fatigue and headache, and no serious adverse events or deaths were considered related; there were no clinically relevant differences between the vaccines. In conclusion, the newly-licensed vaccine was well tolerated and immunologically non-inferior to the established vaccine for all three vaccine strains in the whole population and the elderly.

Purpose: This study was conducted to objectively evaluate the effect of feedback and instructional material on the acquisition of surgical psychomotor skills for a model system based on mandibular fracture repair., Materials and Methods: This study was a prospective cohort study comprised of students in the preclinical years of dental or medical education. The students were divided into 4 groups and exposed to different levels of feedback/written instructions (including none) in the testing environment. Each subject was given a pair of aluminum bars, representing a fractured human mandible, and a standardized set of tools, including a fixed length of stainless steel wire to fix the bars together. The strength of fixation was measured, using a calibrated testing apparatus, as the amount of load that the fixed sample could tolerate to the point of failure. All subjects completed 5 successive trials under the same conditions. Descriptive statistics were recorded to provide comparisons between groups. Bivariate statistics were computed to compare the different study groups; multiple-comparison testing was used to evaluate differences among the groups. A P value

Introduction: Rapidly expanding science and mandates for maintaining credentials place increasing demands on continuing medical education (CME) activities to provide information that is current and relevant to patient care. Quality may be seen as the perceived level of service measured against consumer expectations. Standard tools have not been developed to determine how well CME activities meet consumer expectations., Methods: A widely used approach for evaluating perceptions of service quality in other fields, SERVQUAL, was adapted for CME by eliciting perspectives from physician consumers of CME and CME providers through nominal group techniques. These perspectives were used to develop a CMEQUAL evaluation survey instrument. Feasibility testing was conducted. Data were analyzed and items were tested for internal consistency., Results: CME participants were individuals willing to complete items related to expectations before participation and perceptions after participation in a CME activity. Of the CME activity participants who provided CMEQUAL rating data for the study, 43% rated their overall perceptions of the CME activity below their overall expectations. CME activities most clearly met participant expectations in providing fair and balanced evidence-based content. Areas of lower priority for participants included opportunities for self-assessment, solving cases, and interactive learning. Two areas highly valued by participants but not adequately addressed by CME activities were (1) translating trial data to patient seen in practice and (2) addressing barriers to optimal patient management., Discussion: Developing standards for evaluating physician perceptions of the quality of CME activities may assist CME providers in improving the effectiveness of CME activities in meeting physician learning needs.

Introduction: As they care for patients, physicians raise questions, but they pursue only a portion of them. Without the best information and evidence, care and patient safety may be compromised. Understanding when and why problems prompt physicians to look for information and integrate results into their knowledge base is critical and shapes one part of reflection about care. This study explores the role of the Internet in gathering medical information as one step in that reflective practice, the barriers to its use, and changes in utilization over time., Methods: A questionnaire with 18 items adapted from previous studies was sent by facsimile to a randomly selected sample of U.S. physicians in all specialties and active in practice., Results: Specific patient problems and latest research in a specific topic most often prompt physicians to search on the Internet. Younger physicians and female physicians were most likely to seek information on a specific patient problem. Only 9% of all respondents (n = 2,500) searched for information during a patient encounter. When unsure about diagnostic and management issues for a complex case, 41.3% chose to consult with a colleague or read from a text (22.8%). Searching most often occurred at home after work (38.2%) or during breaks in the day (35.7%). Most (68.7%) found the information they were looking for more than 51% of the time. Searching was facilitated by knowing preferred sites and access in the clinical setting. The greatest barriers to answering clinical questions included a lack of specific information and too much information to scan., Discussion: Although physicians are increasingly successful and confident in their Internet searching to answer questions raised in patient care, few choose to seek medical information during a patient encounter. Internet information access may facilitate overall reflection on practice; physicians do not yet use this access in a just-in-time manner for immediately solving difficult patient problems but instead continue to rely on consultation with colleagues. Professional association Web sites and point-of-care databases are helpful. From physicians' use of the Internet, professionals in continuing medical education must learn which search engines and sites are trusted and preferred.

Background: Using technology to access clinical information has become a critical skill for family physicians. The aims of this study were to assess the way family physicians use the Internet to look for clinical information and how their patterns vary from those of specialists. Further, we sought a better understanding of how family physicians used just-in-time information in clinical practice., Methods: A fax survey was provided with 17 items. The survey instrument, adapted from two previous studies, was sent to community-based physicians. The questions measured frequency of use and importance of the Internet, palm computers, Internet CME, and email for information seeking and CME. Barriers to use were explored. Demographic data was gathered concerning gender, years since medical school graduation, practice location, practice type, and practice specialty., Results: Family physicians found the Internet to be useful and important as an information source. They were more likely to search for patient oriented material than were specialists who more often searched literature, journals and corresponded with colleagues. Hand held computers were used by almost half of family physicians., Conclusion: Family physicians consider the Internet important to the practice of medicine, and the majority use it regularly. Their searches differ from colleagues in other specialties with a focus on direct patient care questions. Almost half of family physicians use hand held computers, most often for drug reference.

Introduction: Our understanding about the role of the Internet as a resource for physicians has improved in the past several years with reports of patterns for use and measures of impact on medical practice. The purpose of this study was to begin to shape a theory base for more fully describing physicians' information-seeking behaviors as they apply to Internet use and applications for continuing education providers to more effectively support learning., Methods: A survey about Internet use and physician information seeking was administered by facsimile transmission to a random sample of 3,347 physicians., Results: Almost all physicians have access to the Internet, and most believe it is important for patient care. The most frequent use is in accessing the latest research on specific topics, new information in a disease area, and information related to a specific patient problem. Critical to seeking clinical information is the credibility of the source, followed by relevance, unlimited access, speed, and ease of use. Electronic media are viewed as increasingly important sources for clinical information, with decreased use of journals and local continuing medical education (CME). Barriers to finding needed information include too much information, lack of specific information, and navigation or searching difficulties., Discussion: The Internet has become an important force in how physicians deliver care. Understanding more about physician information-seeking needs, behaviors, and uses is critical to CME providers to support a self-directed curriculum for each physician. A shift to increased use of electronic CME options points to new demands for users and providers. Specific information about how physicians create a question and search for resources is an area that requires providers to develop new skills.

Purpose: Medical education reform has been the clarion call of U.S. medical educators and policymakers for two decades. To foster change and seed reform, Harvard Medical School created a professional development program for physicians and scientists actively engaged in educating future physicians that sought to transform both participants and their schools. This study focused on identifying the long-term effects of a professional development program on physician educators., Method: A follow-up survey of the 1995-97 cohorts of the Harvard Macy Program for Physician Educators was conducted by sending the 99 program participants a questionnaire two years after their participation. Main outcome measures studied were individual changes as reflected in participants' self-reported shifts in teaching behaviors, academic productivity, career advancement, and sense of commitment., Results: A total of 63 participants completed the questionnaire, for a response rate of 63.6%. Two years following participation in the program, a majority (88.8%) of respondents reported that participation had significantly affected their professional development, including long-term changes in teaching behaviors (77.8%), engagement in new educational activities from committee work (86%) to grant funding (52.4%), and renewed vitality/identification of themselves as educators., Conclusions: Long-term follow-up of participants enrolled in an intensive program for physician educators suggests that professional development programs that create an immersion experience designed in a high-challenge, high-support environment, emphasizing experiential and participatory activities can change behaviors in significant ways, and that these changes endure over time.

The authors describe their vision of what continuing medical education (CME) should become in the changing health care environment. They first discuss six types of literature (e.g., concerning learning and adult development principles, problem-based/practice-based learning, and other topics) that contribute to ways of thinking about and understanding CME. They then state their view that the Association of American Medical Colleges (AAMC) has made a commitment to helping CME be more effective in the professional development of physicians. In presenting their new vision of CME, the authors describe their interpretation of the nature and values of CME (e.g., optimal CME is highly self-directed; the selection and design of the most relevant CME is based on data from each physician's responsibilities and performance; etc.). They then present seven action steps, suggestions to begin them, and the institutions and organizations they believe should carry them out, and recommend that the AAMC play a major role in supporting activities to carry out these steps. (For example, one action step is the generation and application of new knowledge about how and why physicians learn, select best practices, and change their behaviors). Six core competencies for CME educators are defined. The authors conclude by stating that collaboration among the appropriate academic groups, professional associations, and health care institutions, with leadership from the AAMC, is essential to create the best learning systems for the professional development of physicians.

To characterize maternal thermal balance during pregnancy, the authors recorded the thermal response to moderate weight bearing exercise stress in four aerobically conditioned pregnant women. Studies were performed in a climate-controlled environment in each trimester of pregnancy and postpartum after modifying the exercise protocol for changes in maternal exercise condition. Core, vaginal, and mean skin temperatures were recorded at rest and during maximum exercise. Mean resting skin temperature increased during pregnancy; mean resting core and vaginal temperatures did not change. Core temperatures did not exceed 39C during exercise. Heat storage (heat content/kg) was not increased as a result of exercise with advancing pregnancy. According to these findings, thermal balance can be maintained with advancing gestation when exercise prescriptions are appropriately modified for conditioned women.

With the increase in continuing education programs being developed for more health professionals, more information for decision making is essential. A study was conducted to define costs of continuing education programming and to examine the productivity of the professional staff. Sixty-one programs were developed and offered in a semi-rural setting over a four-year period. Of the programs analyzed, 39.4% were interdisciplinary programs, 26.2% were allied health programs, 21.3% were nursing programs, and 13.1% were miscellaneous programs. During the four-year period, there were 4,528 participants. A total of 27,835 instructional units were generated. The direct program expenses totalled $47,411, with a cost per instructional unit of $1.70. To determine the total cost of programming, the supporting staff salaries were allocated to the programs and added to the direct program expenses. Staff salaries were allocated in three ways: by program, by participant, or by instructional unit. Based on the allocations, the average total cost per program was $3,488; the average total cost per participant was $47; and the average total cost per instructional unit was $7.65. Staff productivity figures were derived by comparing the numbers of programs offered to the full-time equivalency staff for a given period. Professional staff productivity was found to be equivalent to approximately seven programs per year with about 500 participants.

Preterm birth is the leading cause of perinatal mortality and morbidity despite the technological advances in neonatology and maternal-fetal medicine. Risk factors have been tabulated that can help identify the woman at risk for preterm birth. Past medical history, present pregnancy events, and demographic/environmental characteristics can help the practitioner select women who need special care to help prevent or reduce the effects of premature delivery. Recently, new concepts of risk have been identified through research, and emphasis needs to shift from intervention to prevention of the low birth weight infant. Past and present management of premature labor is discussed. New research protocols are presented. Strategies for nurses working in family planning or obstetrical areas are discussed, demonstrating areas for interventions from a prevention-oriented nursing base.