Shahi, Varun

This article explores the assessment of professionalism within a cohort of medical students during a sequential 13‐week medical school histology and anatomy course. Across seven data points, students were asked to identify a professionalism role model from amongst their peers and to score Likert‐structured rationales for their decision. Based on density scores, an initial social network analysis identified six peer‐nomination “stars.” However, analysis of these stars revealed considerable variability and random‐like “noise” in both the nomination and explanation data sets. Subsequent analyses of both data sets explored the possibility of underlying patterns in this noise using tests of reliability, principal components factor analysis, and fixed‐effects regression analysis. These explorations revealed the presence of two dimensions (professional vs. supportive) in how students sought to explain their nomination decisions. Although data variability remained quite high, significantly less variability was present in the professional than in the supportive dimension, suggesting that academic helpfulness rationales are both empirically distinct and more mutable than rationales grounded in professionalism‐related factors. In addition, data showed that the greater the stability in one's choice of a professionalism role model nomination over the T1–T7 data periods, the more stable one's reasons for that nomination—both for professionalism and supportive dimensions. Results indicate that while peer assessment of professionalism by first‐year medical students may not be very reliable, students can differentiate between more personal and professional factors, even at this early stage in their professional development. Formal instruction within the pre‐clinical curriculum should recognize and address this distinction. Anat Sci Educ. © 2018 American Association of Anatomists.

AbstractObjectivesCaregiving can negatively impact well‐being. Cancer caregivers face unique challenges given the intense nature of cancer and treatment, which increases their risk for burden, poor quality of life (QOL), and burnout. Studies to reduce caregiver burden demonstrate QOL improvement and distress reduction in the short term. However, few studies exist to address long‐term benefits. We assessed changes in various QOL domains after participation in a QOL intervention for caregivers of patients having newly diagnosed advanced cancer.MethodsOur institutional review board‐approved study randomized patient–caregiver dyads to either usual care or an in‐person group intervention composed of six 90‐min sessions of structured multidisciplinary QOL components delivered over 4 weeks, with 10 follow‐up phone calls within 20 weeks. Caregivers attended four of the six sessions attended by patients. Sessions included physical therapy, coping and communication strategies, mental health education, spirituality, and social needs. Caregiver QOL (Caregiver Quality of Life Index‐Cancer Scale [CQOLC] and Linear Analogue Self‐Assessment [LASA]) and mood (Profile of Mood States‐Brief [POMS‐B]) were measured at baseline and 4, 27, and 52 weeks. Wilcoxon tests and effect sizes were used to compare the caregiver groups.ResultsOf the 131 caregivers (65 intervention and 66 usual care), 116 completed the study. Caregivers post‐intervention (at 4 weeks) had improved scores on LASA Spiritual Well‐being; POMS‐B total score, Vigor/Activity, and Fatigue/Inertia; and CQOLC Adaptation. At long term (at 27 weeks), caregivers retained improvement in POMS‐B Fatigue/Inertia and gained improvements in CQOLC Disruptiveness and Financial Concerns.ConclusionsCaregivers who received the intervention had higher QOL ratings for specific QOL domains but not for overall QOL. Although a comprehensive intervention was helpful, more specific, targeted interventions tailored for individual needs are recommended. Copyright © 2015 John Wiley & Sons, Ltd.

AbstractBackgroundPyoderma gangrenosum (PG) can be associated with systemic diseases, including inflammatory bowel disease, inflammatory arthritis, and hematologic malignancy. Previous literature exploring the rare association between PG and solid organ malignancy is predominantly limited to single case reports.MethodsWe retrospectively reviewed the cases of five patients with PG and solid organ malignancies at our institution between 1996 and 2013.ResultsFor the five patients identified, PG and solid organ malignancy occurred within three months of each other. Mean age at onset of PG was 55.6 years, and four patients were women. Three patients had breast carcinoma (one was recurrent), and two had gastrointestinal carcinoma. PG occurred before (n = 2), after (n = 2), or synchronously with (n = 1) the malignancy. In one patient with a history of PG and quiescent inflammatory bowel disease, recurrent PG developed synchronously with a new diagnosis of metastatic rectosigmoid carcinoma. Three patients had partial or complete response of PG with treatment of PG alone.ConclusionsTo our knowledge, our study is the first to report that the onset of PG can herald a recurrence of a solid organ malignancy and that recurrent PG can be associated with solid organ malignancy. A possible association of solid organ malignancy and PG should be considered in patients with PG of unknown etiology or with a history of malignancy.