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Modernising engineering education demands integrating diverse perspectives through multidisciplinary, collaborative approaches. In developing countries, collaboration with stakeholders presents a significant challenge. This study aimed to develop a novel collective approach to establish priorities for modernising engineering education. A workshop was conducted by the Modernisation of Undergraduate Education Program at the Pontifical Catholic University of Paraná in a Southern Brazilian metropolis, with 63 stakeholders from various sectors (education, experts, government, industry, and civil society organisations). The workshop consisted of three rounds discussions, including two rounds with stakeholders of the same sector and one round with stakeholders of different sectors mixed in discussion tables. Each table, comprising 3–7 participants, aimed to reach a consensus. Several topics were addressed in the discussions, including curricularization of extension, updating outdated curricular bases, and integrating soft skills and entrepreneurship into engineering programs. The resulting goals emphasised the integration of engineering education with society and industry. Participants agreed on short to medium-term deadlines for achieving these goals. This approach connected stakeholders, fostering an extensive collaborative, multisectoral network supporting engineering education modernisation. [ABSTRACT FROM AUTHOR]

Sweet syndrome, also called acute febrile neutrophilic dermatosis, is a rare disorder characterized by skin lesions accompanied by high fever and elevated inflammatory markers.

Abstract Understanding the connection between seismic activity and the earthquake nucleation process is a fundamental goal in earthquake seismology with important implications for earthquake early warning systems and forecasting. We use high-resolution acoustic emission (AE) waveform measurements from laboratory stick-slip experiments that span a spectrum of slow to fast slip rates to probe spatiotemporal properties of laboratory foreshocks and nucleation processes. We measure waveform similarity and pairwise differential travel-times (DTT) between AEs throughout the seismic cycle. AEs broadcasted prior to slow labquakes have small DTT and high waveform similarity relative to fast labquakes. We show that during slow stick-slip, the fault never fully locks, and waveform similarity and pairwise differential travel times do not evolve throughout the seismic cycle. In contrast, fast laboratory earthquakes are preceded by a rapid increase in waveform similarity late in the seismic cycle and a reduction in differential travel times, indicating that AEs begin to coalesce as the fault slip velocity increases leading up to failure. These observations point to key differences in the nucleation process of slow and fast labquakes and suggest that the spatiotemporal evolution of laboratory foreshocks is linked to fault slip velocity.

During the COVID-19 pandemic, vitamin D was used along with vitamin C and zinc as a preventive and curative therapy against SARS-CoV-2 infection. Vitamin D toxicity, even if it is rare, occurs when serum concentrations exceed 150 ng/mL and is usually manifested by hypercalcemia phenomena.

Abstract Simulation-based learning occurs in multiple contexts, and one teaching style cannot adequately cover the needs at each learning level. For example, reflective debriefing, often used following a complex simulation case, is not what is needed when learning new skills. When to use which facilitation style is a question that educators often overlook or struggle to determine. SimZones is a framework used to clarify the multiple contexts in simulation. This framework, combined with elements of Debriefing With Good Judgment, can help educators match the appropriate facilitation style with learner needs and learning context. We have distilled the core elements of the “with good judgment” approach to debriefing and applied them to the SimZones framework to guide educators with (1) what type of learning can be expected with each learning context, (2) what behaviors and activities can be expected of the learners in each learning context, (3) what instructional strategies are most effectively used at each stage, and (4) what are the implications for the teacher-learner relationship.

Introduction: Schnitzler syndrome (SchS), first described in 1972, is a rare autoinflammatory condition characterized by chronic urticaria and monoclonal gammopathy of IgM or, exceptionally, IgG profile. Additional features include recurrent fever, evidence of abnormal bone remodeling, a neutrophilic dermal infiltrate on skin biopsy, leukocytosis or elevated C-reactive protein, according to the Strasbourg criteria.

IntroductionResults from experimental research in instructional psychology imply that a deep menu structure of a e-learning website may provide useful segmentation. However, menu depth also increases the need for navigation and thus, might have impairing effects on learning. Furthermore, instructional support can be provided by including a checklist, to ensure that learners reflect on their study progress. The study aimed at investigating which menu structure is beneficial for e-learning websites and whether a checklist could compensate the negative effects of an unfavorable menu structure.MethodsTherefore, in an online experiment, we let 101 students learn facts about rocks from an e-learning website with either a deep or a flat menu structure. We further manipulated whether metacognitive support through a checklist was provided or not. Learning outcomes, cognitive load, metacognitive factors as well as learning time were measured.ResultsResults show no main effects of the menu depth or the presence of a checklist on retention and transfer performance. Learning achievements in percent for retention were 37.31 (deep menu/checklist), 31.10 (deep menu/no checklist), 36.07 (flat menu/checklist), 38.13 (flat menu, no checklist) and for transfer were 35.19 (deep menu/checklist), 34.40 (deep menu/no checklist), 37.78 (flat menu/checklist), 33.23 (flat menu, no checklist). Yet, there are hints that the deeper menu structure had a negative effect on learning processes: The deep menu structure led to an enhanced extraneous cognitive load (ECL) and reduced learning efficiency. However, providing a checklist had beneficial effects mainly when learning with a deep menu structure but not overall. Unexpectedly, the presence of the checklist did not influence metacognitive measures.DiscussionOur study suggests that possible costs of a deep menu structure should be considered when designing instructional checklists. However, the study also provides a way in which these costs can be compensated, which is by using a checklist. Implications for instructional research and e-learning are discussed.

IntroductionAre nurses who voice work-related concerns viewed as positive contributors to a team? We propose that the extent to which healthcare professionals consider voice by nurses as helpful for the team depends on how psychologically safe they feel. Specifically, we hypothesized that psychological safety moderates the relationship between voice of a lower ranking team member (i.e., a nurse) and perceived contribution by others, such that voice is more likely to be seen as valuable for team decision-making when psychological safety is high but not when it is low.MethodsWe tested our hypotheses with a randomized between-subjects experiment using a sample of emergency medicine nurses and physicians. Participants evaluated a nurse who either did or did not speak up with alternative suggestions during emergency patient treatment.ResultsResults confirmed our hypotheses: At higher levels of psychological safety the nurse’s voice was considered as more helpful than withholding of voice for team decision-making. This was not the case at lower levels of psychological safety. This effect was stable when including important control variables (i.e., hierarchical position, work experience, gender).DiscussionOur results shed light on how evaluations of voice are contingent on perceptions of a psychologically safe team context.

In four experiments, a change detection task using emotional (i.e., angry and happy) faces as stimuli was implemented to investigate the effects of evaluative congruency on working-memory performance and to replicate the angry-face benefit (i.e., better performance for angry compared to happy and neutral faces) found in former studies. Although results of the single experiments were heterogeneous, an overall analysis revealed better performance in trials with evaluatively congruent compared to evaluatively incongruent displays and an angry-face benefit. The congruency effect is in line with recent assumptions that evaluative-priming effects might arise from a mutual facilitation of simultaneously active evaluatively congruent concepts. Research on the angry-face benefit is enriched by the finding that the benefit was also found in control experiments using inverted faces. This result suggests that the effect is based on perceptual features of angry faces.

Abstract The COVID-19 pandemic and the subsequent pressures on healthcare staff and resources have exacerbated the need for clinical teams to reflect and learn from workplace experiences. Surges in critically ill patients, the impact of the disease on the workforce and long term adjustments in work and life have upturned our normality. Whilst this situation has generated a new ‘connectedness’ within healthcare workers, it also continues to test our resilience. An international multi-professional collaboration has guided the identification of ongoing difficulties to effective communication and debriefing, as well as emerging opportunities to promote a culture of dialogue. This article outlines pandemic related barriers and new possibilities categorising them according to task management, teamwork, situational awareness and decision making. It describes their direct and indirect impact on clinical debriefing and signposts towards solutions to overcome challenges and, building on new bridges, advance team conversations that allow us to learn, improve and support each other. This pandemic has brought clinical professionals together; nevertheless, it is essential to invest in further developing and supporting cohesive teams. Debriefing enables healthcare teams and educators to mitigate stress, build resilience and promote a culture of continuous learning and patient care improvement.

Abstract The frontal megathrust of the Nankai Trough subduction zone is recognized as a seismogenic fault based on a record of frictional heating, but the underlying micromechanical processes that act on the fault surface are poorly known. Here we present a layer of fault gouge ∼2 mm thick within a core drilled across the megathrust, in which smectite‐rich siltstone has been transformed into a preferentially oriented illite aggregate. The nearly complete breakdown of smectite is consistent with fast frictional heating on this fault; however, the microtextures of the gouge and its surroundings are asserted one produced experimentally by slow slip. We suggest that slow slip with small shear strain has overprinted the textures produced by the previous faster and larger slip. This interpretation based on microtectonic evidence suggests a slow slip around the frontal megathrust took place during slow down, afterslip, or interseismic as observed now going in subduction zone. We suggest that the illite‐dominated gouge is conditionally stable, likely to shift from rapid to slow slip at different times.

The article examines some aspects of the political legitimization of illegal actions in international relations through the Kremlin's official discourse aiming to justify aggression against Ukraine. To "normalize" its actions in the international arena, Russian authorities organize large-scale and well-coordinated information campaigns, which, combined with diplomatic and economic pressure and other non-military measures, threaten to destabilize the global security. Enjoying virtually total control over the media within Russia and a using a number of powerful international media tools, Russia's political elites are trying to create an alternative political discursive reality to convince different target audiences of the "rationality" of their actions and influence their behavior accordingly. These measures constitute an integral part of Moscow's official discoursewith main goal to restore Soviet era geopolitical power and achieve strategic balance in the civilizational confrontation with the West. The article provides a brief theoretical analysis of the concepts of "legitimacy" and "discourse" in the context of international relations and causalities between Russia’s attempts to legitimize aggression against Ukraine and the Kremlin's perceptions of identity, historical memory and foreign policy. Based on the analysis of the existing scientific literature in the field of legitimation of political actions in the international arena, following categorization of legitimation strategies used by the Russian Federation in official discourse to justify annexation of Crimea and armed aggression in Donbass is proposed: 1) legitimation through reference to customs, laws and traditions; 2) legitimation by appealing to altruism and a certain system of moral and humanitarian values; 3) legitimation through rationalization, theorizing; 4) legitimation through emotions and a hypothetical future. The use of Kremlin discursive practices and legitimation strategies is illustrated by analyzing the text and talk of Vladimir Putin and other leaders of Russian political elite.

Abstract Background Multiple guidelines recommend debriefing after clinical events in the emergency department (ED) to improve performance, but their implementation has been limited. We aimed to start a clinical debriefing program to identify opportunities to address teamwork and patient safety during the COVID-19 pandemic. Methods We reviewed existing literature on best-practice guidelines to answer key clinical debriefing program design questions. An end-of-shift huddle format for the debriefs allowed multiple cases of suspected or confirmed COVID-19 illness to be discussed in the same session, promoting situational awareness and team learning. A novel ED-based clinical debriefing tool was implemented and titled Debriefing In Situ COVID-19 to Encourage Reflection and Plus-Delta in Healthcare After Shifts End (DISCOVER-PHASE). A facilitator experienced in simulation debriefings would facilitate a short (10–25 min) discussion of the relevant cases by following a scripted series of stages for debriefing. Data on the number of debriefing opportunities, frequency of utilization of debriefing, debriefing location, and professional background of the facilitator were analyzed. Results During the study period, the ED treated 3386 suspected or confirmed COVID-19 cases, with 11 deaths and 77 ICU admissions. Of the 187 debriefing opportunities in the first 8-week period, 163 (87.2%) were performed. Of the 24 debriefings not performed, 21 (87.5%) of these were during the four first weeks (21/24; 87.5%). Clinical debriefings had a median duration of 10 min (IQR 7–13). They were mostly facilitated by a nurse (85.9%) and mainly performed remotely (89.8%). Conclusion Debriefing with DISCOVER-PHASE during the COVID-19 pandemic were performed often, were relatively brief, and were most often led remotely by a nurse facilitator. Future research should describe the clinical and organizational impact of this DISCOVER-PHASE.

Abstract Background The world is facing a massive burden from the coronavirus disease 2019 (COVID-19) pandemic. Governments took the extraordinary step of locking down their own countries to curb the spread of the coronavirus. After weeks of severe restrictions, countries have begun to relax their strict lockdown measures. However, reopening will not be back to normal. Simulation facilities (SF) are training spaces that enable health professionals and students to learn skills and procedures in a safe and protected environment. Today’s clinicians and students have an expectation that simulation laboratories are part of lifelong healthcare education. There is great uncertainty about how COVID-19 will impact future training in SF. In particular, the delivery of training activities will benefit of adequate safety measures implemented for all individuals involved. This paper discusses how to safely reopen SF in the post-lockdown phase. Main body The paper outlines 10 focus points and provides operational tips and recommendations consistent with current international guidelines to reopen SF safely in the post-lockdown phase. Considering a variety of national advices and regulations which describe initial measures for the reopening of workplaces as well as international public health recommendations, we provide points of reflection that can guide decision-makers and SF leaders on how to develop local approaches to specific challenges. The tips have been laid out taking also into account two main factors: (a) the SF audience, mainly consisting of undergraduate and postgraduate healthcare professionals, who might face exposure to COVID-19 infection, and (b) for many simulation-based activities, such as teamwork training, adequate physical distancing cannot be maintained. Conclusions The planning of future activities will have to be based not only on safety but also on flexibility principles. Sharing common methods consistent with national and international health guidelines, while taking into account the specific characteristics of the different contexts and centres, will ultimately foster dissemination of good practices. This article seeks to further the conversation. It is our hope that this manuscript will prompt research about the impact of such mitigation procedures and measures in different countries.

Satisfying the exponential data growth is one of the main challenges for the design of future wireless networks. Given the abundant spectrum availability at millimeter-wave bands, exploiting these frequencies is a natural choice. WiGig (also known as 60 GHz WiFi) allows multi-gigabit transmissions in short range wireless links. The maximum data transfer rates occur in line of sight (LOS) connections. Given the small operating wavelength, obstructing the LOS causes significant power losses, severely impacting the attainable throughput of each user. This article presents empirical results to parameterize typical small-scale fades caused by pedestrians when blocking the LOS, in areas where a WiGig access point serves indoor users. Our results show that fades can be as large as 21 dB, in average. Furthermore, burst of fades are common, lasting up to 5200 ms in 90% of the observed cases.

Abstract Slow slip events (SSEs) have been identified at subduction zones globally as an important link in the continuum between elastodynamic ruptures and stable creep. The northern Hikurangi margin is home to shallow SSEs which propagate to within 2 km of the seafloor and possibly to the trench, providing insights into the physical conditions conducive to SSE behavior. We report on a suite of friction experiments performed on protolith material entering the SSE source region at the Hikurangi margin, collected during the International Ocean Discovery Program Expedition 375. We performed velocity stepping and slide‐hold‐slide experiments over a range of fault slip rates, from plate rate (5 cm/yr or 1.6 × 10−9 m/s) to ∼1 mm/s (10−3 m/s) and quantified the frictional velocity dependence and healing rates for a range of lithologies atdifferent stresses. The frictional velocity dependence (a‐b) and critical slip distance DC increase with fault slip rate in our experiments. We observe atransition from velocity weakening to strengthening at slip rates of ∼0.3 µm/s. This velocity dependence of DC could be due to a combination of dilatant strengthening and a widening of the active shear zone at higher slip rates. We document low healing rates in the clay‐rich volcaniclastic conglomerates, which lie above the incoming plate basement at least locally, and relatively higher healing rates in the chalk lithology. Finally, our experimental constraints on healing rates in different input lithologies extrapolated to timescales of 1–10 years are consistent with the geodetically inferred low stress drops and healing rates characteristic of the Hikurangi SSEs.

Introduction As global travel becomes more prevalent, medical students may be asked to care for patients with unforeseen exposures. We developed a simulation where clerkship medical students interviewed and examined a patient with recent travel who presented with bloody diarrhea and abdominal pain and was diagnosed with amebic colitis. The students had the opportunity to develop a differential diagnosis and discuss the workup of the patient. Methods We divided students into two groups. Each group took a turn participating in the simulation while the other group observed. Students were expected to interview and examine the patient as well as treat any urgent findings and develop a differential diagnosis. After each simulation, we reconvened with both groups for a faculty-led debriefing session to discuss the learning objectives, including approaches to caring for a patient with diarrhea and the differential diagnosis and workup of bloody diarrhea. Results To date, five different groups of six to 12 students have completed this simulation. The module has been well received, and 100% of survey respondents have agreed that after completing the activity, they had a better understanding of how to approach a recent traveler with diarrhea and abdominal pain. Discussion While most medical students will not travel abroad for traditional global health experiences, many will encounter patients with recent travel or immigration and must therefore be prepared to treat diseases typically categorized as global health. We developed this simulation and successfully incorporated workup of a returning traveler into the medical school curriculum for clerkship students.

En este Dossier visual se presenta la serie Los Coros Menores y el artículo el Fuego y los Perros. El artículo lo puede encontrar en la galerada bajo el título 01 PDF y la serie fotográfica: Los Coros Menores, en la galerada 02 PDF. Numerosas veces me han preguntado cuál es la relación entre el paisaje y los bailarines en Los Coros Menores y siempre la respuesta más elemental resulta la de mayor precisión: ambos son hechos de un mismo mundo. Los personajes provienen de tres lugares: Alto Hospicio, en Chile, y El Alto y Oruro, en Bolivia. En el caso chileno, los retratados son danzantes de la fiesta de La Tirana, celebración relativa a la Virgen del Carmen. En la festividad boliviana, son bailarines del carnaval que, al igual que en el resto del mundo católico, se celebra en todo ese país a fines de febrero.

Abstract Transitioning medical students are anxious about their readiness-for-internship, as are their residency program directors and teaching hospital leadership responsible for care quality and patient safety. A readiness-for-internship assessment program could contribute to ensuring optimal quality and safety and be a key element in implementing competency-based, time-variable medical education. In this paper, we describe the development of the Night-onCall program (NOC), a 4-h readiness-for-internship multi-instructional method simulation event. NOC was designed and implemented over the course of 3 years to provide an authentic “night on call” experience for near graduating students and build measurements of students’ readiness for this transition framed by the Association of American Medical College’s Core Entrustable Professional Activities for Entering Residency. The NOC is a product of a program of research focused on questions related to enabling individualized pathways through medical training. The lessons learned and modifications made to create a feasible, acceptable, flexible, and educationally rich NOC are shared to inform the discussion about transition to residency curriculum and best practices regarding educational handoffs from undergraduate to graduate education.

Introduction: Breaking bad news (BBN) in the emergency department (ED) represents a challenging and stressful situation for physicians. Many medical students and residents feel stressed and uncomfortable with such situations because of insufficient training. Our randomized controlled study aimed to assess the efficacy of a four-hour BBN simulation-based training on perceived self-efficacy, the BBN process, and communication skills. Methods: Medical students and residents were randomized into a 160-hour ED clinical rotation without a formal BBN curriculum (control group [CG], n = 31) or a 156-hour ED clinical rotation and a four-hour BBN simulation-based training (training group [TG], n = 37). Both groups were assessed twice: once at the beginning of the rotation (pre-test) and again four weeks later. Assessments included a BBN evaluation via a simulation with two actors playing family members and the completion of a questionnaire on self-efficacy. Two blinded raters assessed the BBN process with the SPIKES (a delivery protocol for delivering bad news) competence form and communication skills with the modified BBN Assessment Schedule. Results: Group-by-time effects adjusted by study year revealed a significant improvement in TG as compared with CG on self-efficacy (P < 0.001), the BBN process (P < 0.001), and communication skills (P < 0.001). TG showed a significant gain regarding the BBN process (+33.3%, P < 0.001). After the training, students with limited clinical experience prior to the rotation showed BBN performance skills equal to that of students in the CG who had greater clinical experience. Conclusion: A short BBN simulation-based training can be added to standard clinical rotations. It has the potential to significantly improve self-efficacy, the BBN process, and communication skills.

A través de un estudio cuasietnográfico en una escuela primaria con altos índices de intimidación de los estudiantes hacia sus profesores, se busca analizar las concepciones de infancia implícitas en los discursos de la comunidad escolar y su sentido para la validación de prácticas e interacciones escolares violentas. Para ello, se realizaron observaciones persistentes, entrevistas individuales y grupales y análisis de documentos oficiales, los que fueron analizados bajo el análisis de contenido categorial temático. Los resultados muestran cómo la Escuela activa diversos mecanismos para validar la infancia como espacio de tránsito, y coloca como referente una forma de adultocentrismo que se expresa en prácticas de control y discriminación. Se discuten los sentidos construidos acerca de la niñez y sus implicancias para la construcción de subjetividades infantiles.

H. pylori may colonize columnar-lined esophagus, although an etiologic role in esophageal adenocarcinoma is unproven. H. pylori can adhere to intestinal metaplasia in the stomach. This study was designed to examine if H. pylori adheres to specialized intestinal metaplasia in columnar-lined esophagus. Esophageal biopsies from patients with columnar-lined esophagus were reviewed. Patients with only gastric metaplasia were excluded. Sections with specialized intestinal metaplasia in at least one third of at least one gland were recut, stained using the Giemsa stain, and reexamined by two independent pathologists using strict criteria for adherence by H. pylori. The 209 esophageal biopsies with adequate specialized intestinal metaplasia from 58 patients were examined: H. pylori was only seen on gastric metaplasia in three patients-and never on specialized intestinal metaplasia. Within the esophagus, H. pylori adheres only to gastric metaplasia, which is not considered premalignant for esophageal adenocarcinoma. [ABSTRACT FROM AUTHOR]

Scientific ocean drilling’s first in situ stress measurement was made at Site C0009A during Integrated Ocean Drilling Program (IODP) Expedition 319 as part of Nankai Trough Seismogenic Zone Experiment (NanTroSEIZE) Stage 2. The Modular Formation Dynamics Tester (MDT, Schlumberger)wireline logging tool was deployed in riser Hole C0009A to measure in situ formation pore pressure, formation permeability (often reported as mobility=permeability/viscosity), and the least principal stress (S3) at several isolated depths (Saffer et al., 2009; Expedition 319 Scientists, 2010). The importance of in situ stress measurements is not only for scientific interests in active tectonic drilling, but also for geomechanical and well bore stability analyses. Certain in situ tools were not previously available for scientific ocean drilling due to the borehole diameter and open hole limits of riserless drilling. The riser-capable drillship, D/V Chikyu,now in service for IODP expeditions, allows all of the techniques available to estimate the magnitudes and orientations of 3-D stresses to be used. These techniques include downhole density logging for vertical stress, breakout and caliper log analyses for maximum horizontal stress, core-based anelastic strain recovery (ASR, used in the NanTroSEIZE expeditions in 2007–2008), and leak-off test (Lin et al., 2008) and minifrac/hydraulic fracturing (NanTroSEIZE Expedition319 in 2009). In this report, the whole operational planning process related to in situ measurements is reviewed, and lessons learned from Expedition 319 are summarized for efficient planning and testing in the future.

The Nankai Trough Seismogenic Zone Experiment (NanTroSEIZE) is a major drilling project designed to investigate fault mechanics and the seismogenic behavior of subduction zone plate boundaries. Expedition 319 is the first riser drilling operation within scientific ocean drilling. Operations included riser drilling at Site C0009 in the forearc basin above the plate boundary fault, non-riser drilling at Site C0010 across the shallow part of the megasplay faultsystem—which may slip during plate boundary earthquakes—and initial drilling at Site C0011 (incoming oceanic plate) for Expedition 322. At Site C0009, new methods were tested, including analysis of drill mud cuttings and gas, and in situ measurements of stress, pore pressure, and permeability. These results, in conjunction with earlier drilling, will provide a) the history of forearc basin development (including links to growth of the megasplay fault system and modern prism), b) the first in situ hydrological measurements of the plate boundary hanging wall, and c) integration of in situ stress measurements (orientation and magnitude) across the forearc and with depth. A vertical seismic profile (VSP) experiment provides improved constraints on the deeper structure of the subduction zone. At Site C0010, logging-while-drilling measurements indicate significantchanges in fault zone and hanging wall properties over short (

Abstract Introduction This case-based simulation exercise focuses on the evaluation and management of a patient presenting to the emergency department with an upper gastrointestinal (GI) bleed, or more specifically, a variceal bleed. Methods Clinical-year medical students, participated in this high-fidelity simulation during a 3− to 4-day long interclerkship intensive. Students were divided into groups of eight to 10 students, with four to five actively participating in this case, while four to five observed. Those who were participants were expected to manage the care of the patient. Those who observed during the first case then actively participated in the second case. Debriefing materials and references are included. All students actively participated in debrief. Typically, two faculty teach the simulation case. One faculty is from emergency medicine or critical care and is familiar with mannequin controls, as well as acute management of patients. The other faculty is a gastroenterologist who can speak to specific areas of management and is the content expert for the learning objectives. Results After completing 3 months of clinical clerkships, 160 core clinical-year medical students, participated in this simulation. While this case has been used for the past 4 years, evaluation data was only collected for the most recent year. Student evaluations this year indicated that 79% of the objectives were met and 19% were partially met. Three percent stated objectives were not met. Student feedback has been positive, and their varying knowledge and skill level allow the students to teach each other. Discussion This case has been well received by both students and faculty facilitators as an effective way to test students' ability to manage a patient presenting to the emergency department with an upper gastrointestinal (GI) bleed.