Letter from the Editor-in-Chief - Medical Science Educator - LIMSC ...

Patient Oriented Research: The Duke-NUS Medical Student Experience 141Deidre Anne De Silva, John Carson Allen, Gita Krishnaswamy, Silke Vogel& Sandy CookIncreasing First Year Student’s Attitude and Understanding towards BiomedicalResearchNelleke A. Gruis & Jessica M. LangenhoffDevelopment of the Research Competency in the Curriculum of a Mexican MedicalSchoolGregorio T. Obrador148154The Sugar Study: A Monograph for In-Class Research with Medical Students 159Wendy Hodsdon, Carolyn Nygaard & Heather ZwickeyPublic Health Research in a Study Abroad Medical Service 165Christina Dokter, Shane Sergent & Gary WillyerdMeeting ReportLeiden International Medical Student Conference 170Announcements 194Medical Science Educator © IAMSE 2013 Volume 23(1S)

MEDICAL SCIENCE EDUCATORThe Journal of the International Association of Medical Science EducatorsMed Sci Educ 2013; 23(1S): 79Letter from the Editor-in-ChiefPeter G.M. de JongLeiden University Medical Center, Leiden, The NetherlandsTeaching students the basic sciences of medicine is an important aspect in the training of future health scienceprofessionals. A solid scientific and evidenced based knowledge foundation is necessary to deliver capabledoctors who are able to combine compassion, understanding and communication skills with a readily accessibleknowledge base. Therefore, teaching students fundamental research competencies and training them in theprocess of scientific critical and analytical thinking, should be an important aspect of every medical curriculumas well. Schools need to offer students opportunities to practice the learned research skills by performing realresearch projects and to be challenged to scientifically explore medicine. This asks for dedicated trainingprograms.The way this scientific training is incorporated in the medical curriculum differs from country to country andeven from institution to institution. In this issue we present 14 examples of scientific training programs inmedical schools around the world. It provides us a nice overview of different situations and different approachesto address scientific training.The various student conferences in the world that deal with scientific output of students, demonstrate thatperforming scientific research is of great importance to students. One of the largest student conferences inEurope is the bi-annual LIMSC meeting. This Leiden International Medical Student Conference providestalented medical and biomedical students with the opportunity to present their research projects and outcomesto an international audience. For the third time, Medical Science Educator offers the students of theinternational LIMSC meeting a platform to publish their research abstract as an illustration of their excellentwork. This year the 40 best rated abstracts are published, giving you as our readers an insight in theextraordinary and extremely high quality research projects students are involved in.I hope that you will enjoy this special supplement of Medical Science Educator and that it might be of inspirationto you for your own teaching programs.Peter G.M. de Jong, PhDEditor-in-ChiefMedical Science Educator © IAMSE 2013 Volume 23(1S) 79

MEDICAL SCIENCE EDUCATORThe Journal of the International Association of Medical Science EducatorsMed Sci Educ 2013; 23(1S): 80-83KEYNOTEUsing the Master-Apprentice Relationship whenTeaching Medical Students Academic Skills: TheYoung Excellence ClassDavid van Bodegom 1,2 , Maurits Hafkamp 1,2 & Rudi G.J. Westendorp 1,21 Leyden Academy on Vitality and Aging, The Netherlands2 Leiden University Medical Center, Leiden, The NetherlandsAbstractMedical education has historically been characterized by a master-apprentice relationship. In current medicalcurricula, this didactic method is only found in the master phase when students enter the hospital forapprenticeships. We plea for a re-appreciation of this method in the bachelor-phase to ensure a proper academictraining of young medical students. We describe our experience with the Young Excellence Class (YEC) of theLeyden Academy on Vitality and Ageing, a two weekly discussion group in which medical students train theiracademic skills while discussing scientific articles under guidance of an experienced scientist. In our experiencethe results of this method are fourfold. First, the students acquire skills that cannot be learned from books orlectures alone: reading, listening, reasoning and arguing. Second, the matured students learn to guide youngerstudents in how to perform a research project and how to write a scientific report. Third, this method canconvince talented students to pursue an academic career, also in disciplines such as ageing that are at first sightless attractive for young medical students. Out of the 15 alumni of the YEC, 12 have continued in a PhD trajectoryout of which 9 in the field of ageing. Fourth, students can under guidance contribute to scientific output at thehighest level, as was shown by two students who published their research as first authors in a high impactjournal. Finally, we have shown that the didactic model can also be successfully employed at a differentuniversity. Given the successes and the ability to disseminate the method, we encourage others to also adopt themaster-apprentice approach in their scientific field and start their own Young Excellence Class.IntroductionMedical education has historically beencharacterized by a master-apprentice relationship inwhich an experienced physician teaches hisapprentices side-by-side. 1 In medieval times, thisform was common in many professions thatrequired years-long training to perfect certainskills. 2 In these professions, the master-apprenticerelationship was an appropriate didactic model andphysicians would not only transfer medicalknowledge and skills but also communication skills,ethics, logical reasoning and other essentialqualities of a good physician.After the biomedical revolution, medicine becamean academic discipline and students would not onlybe trained in clinical skills but also in academicCorresponding author: D. van Bodegom, Leyden Academy onVitality and Aging, Rijnsburgerweg 10, 2333 AA Leiden, TheNetherlands; Tel: +31 71 5240960; Fax: +31 71 5240969; email:bodegom@leydenacademy.nlskills. The didactic models evolved with it and mostmedical curricula of the world now have a bachelorphase that provides students with a basic academictraining mainly characterized by textbook learningand large scale lectures. 3 In the master phase oftheir studies, however, students undergo anapprenticeship in the hospital that still resemblesthe old master-apprentice relationship.In this article we plea for a re-appreciation of themaster-apprentice method in the bachelor phase ofmedical education, an essential period in thedevelopment of the medical student to become anacademic scholar also. The personal guidance of themaster-apprentice relationship, that is now absentfrom the medical curricula, can be a powerfuldidactic method to inspire students. In this articlewe describe our experience of the past eight yearswith a small group of students known as the YoungExcellence Class of the Leyden Academy on Vitality& Ageing, a knowledge centre in the field of vitalityMedical Science Educator © IAMSE 2013 Volume 23(1S) 80

and ageing connected to the Leiden University inthe NetherlandsThe MethodThe Young Excellence Class (YEC) is a discussiongroup for medical students that meets on a twoweeklybasis to discuss scientific papers on topicsrelated to aging and evolutionary medicine.Currently the YEC has 16 members ranging from2nd year medical students to those who are almostfinished after six years of medical education. Everyyear two or three members who complete theirmedical studies leave the group and make room fortwo or three new members, who are recruited froma group of twenty students that follow an electivecourse called The Ageing Process. This three-weekcourse deals with the fundamentals of ageing,evolution as a scientific basis for the life sciencesand involves the critical reading of papers andplenary discussions. Students learn to perform asmall research project in couples, give a scientificpresentation and write a small scientific report.Each year, students that excel in these activities andare enthusiastic, active participants in the smallscale discussions are invited to join the YEC.YEC meetings start with a simple meal, last threehours and end with a glass of wine. During ameeting of the YEC its sixteen members criticallyappraise a scientific paper that they have readbeforehand and engage in a discussion. Themeetings are presided over by one of us (RW, DvB).Members take turns in selecting a paper fordiscussion. The student that has selected the paperleads the discussion and guides the others throughthe manuscript during the meeting. Examples oftopics discussed in the YEC include; the heritabilityof behavior, epigenetics, ageing in different animalspecies, the effect of caloric restriction on ageing,using animal models to study ageing and theevolution of longevity.During the meeting, the selected paper is reviewedthoroughly and the ideas that are presented in it arediscussed. Systematically, the paper is scrutinizedon its hypothesis, assumptions, methodology andthe logic and interpretation of the results. Thechairman maintains order throughout and attemptsto guide the discussions and elicits a consensusfrom the group. The members of the group arestimulated to bring forward their views using validarguments and through discussion convince others.The chairman aids in this process by correcting falseargumentation, by questioning the viewpoints ofmembers and challenging members to defend theirviews.Next to the meetings, the members of the YEC alsoassist in education themselves. During the electivecourse ‘The ageing process’, from which the YECmembers have originally been selected in previousyears, the members act as tutors to the students thatfollow the elective course and assist them with theirsmall research project. This resembles the way olderapprentices would teach younger apprentices in theclassical master-apprentice relationships.OutcomesThe YEC, an example of the master apprenticemethod of education, has provided us four mainresults. First of all, members of the YEC acquireessential academic skills from the meetings thatcannot be learned from books or lectures alone.They learn how to critically read a scientific paper,how to present the line of reasoning and theconclusions of a paper to the group and how todefend their views using scientific arguments. Theyalso learn to critically review the methodology andthe underlying assumptions of scientific articles. Inshort, they acquire insight in the principles ofscientific research and learn the skills of presenting,discussing and argumentation.Second, the vertical structure of the YEC results in agroup of students from different years of medicine.Younger students learn from older students whohave been in the YEC for several years. Vice versa,the older students learn to guide younger studentsin the basics of science which is a very useful skillfor them. The vertical structure is even furtherelaborated when YEC members during the electivecourse the ageing process guide younger students inperforming their own small research project andwrite their report.Third, YEC members have been able to get a goodappreciation of what science is about and after theirfour year membership, they are also well preparedfor a scientific career. When they finish theirmedical education and leave the YEC, most of themcontinue in a PhD position. In eight years’ time, 15alumni have left the YEC out of which 12 continuedin a PhD trajectory. Moreover, 9 out of thesecontinued their PhD in the field of ageing, a fieldthat has difficulty in attracting talented students fortheir PhD positions. Many also continue theirscientific career after their PhD trajectory, either fulltime as assistant professor or part time, next to theirclinical specializations. PhD students also presenttheir papers at YEC meetings. Not only do thepapers from the PhD students improve from thediscussions of these meetings, the PhD students arealso role models for the YEC members. One of theMedical Science Educator © IAMSE 2013 Volume 23(1S) 81

alumni continued with a full time academic careerafter finishing his PhD and is now an assistantprofessor at the department of gerontology andgeriatrics. He now organizes elective courses andpresides over YEC meetings that he onceparticipated in as a student.Fourth, the YEC not only provides benefits forstudents, but having a YEC also improves thescientific output of a department. YEC membersoften have creative and valuable contributions whenpapers of PhD students of the department arediscussed. However, students can also contribute toscientific output at the highest level themselves.Two students, under the guidance of another YECalumnus, expanded their small research project intheir spare time during two years and their studywas published in the famous Christmas edition ofthe British Medical Journal, a high impact journal. 4As an experiment, the elective course ‘The ageingprocess’ was organized at a different university.Here too, several students were inspired during thecourse to continue with their research project intheir spare time after the course ended. Thisindicates that the format itself is a powerful didacticmethod, independent of the lecturer or theuniversity.DiscussionIt is known that the master-apprentice relationshipis a very powerful didactic method. So powerful ineffect, that it often frustrates those involved in thebachelor phase of the regular curriculum.Everything they teach the students is easilyforgotten or abandoned when students enter the‘hidden curriculum’ of the hospital wards wherethey are reshaped quickly in the master-apprenticerelationship. 5-7 We plea that those involved in thebachelor phase of the curriculum should adopt thesame didactic method to teach students theacademic skills of critical reading, listening,questioning and arguing.Given the ability to employ the method successfullyat a different university, we think we have identifieda didactic model that can be applied in anydiscipline, by any scientist. The method has greatpower to attract and inspire talented students notonly for the specific field but also for science ingeneral. Now that medicine has become anacademic discipline, we should use the masterapprentice method as its most powerful didacticmethod not only to teach students the essentials ofclinical medicine in the master phase but also tomake them into academic scholars in the bachelorphase. They should acquire basic academic skillsand the master-apprentice relationship in smallscale groups where scientific articles are scrutinizedand discussed under guidance of an experiencedscientist have been found to be a successful methodto do this. Students need these skills before they aresubjected to master apprentice relationships in themaster phase when the dogma of clinical practice istransposed upon them.We believe that the master apprentice methodmakes students not only better scientists, but canmake them better doctors too. In a medicalcommunity in which the practice of evidence basedmedicine is held in ever higher regard, YEC-alumniare well-equipped to lead teams of doctors inappraisals of scientific evidence and approachpatient-care with a broad minded perspective onwhat constitutes good health.As a final call, we would like to encourage others tostart a Young Excellence Class in their field. Itrequires dedicated scientists who are willing tospend two evenings a month with a small group ofstudents, but the benefits to the students, thedepartment, the field and clinical science as a wholemake it an outstanding experience. On top of that,there are worse ways to spend an evening than witha group of young and enthusiastic students who settheir first steps in the field of science.Key WordsMedical education, master-apprentice relationship,didactic models, bachelorphase, academicdevelopmentNotes on ContributorsDAVID VAN BODEGOM, MD PhD, is scientific staffat Leyden Academy on Vitality & Ageing andAssistant professor at Leiden University MedicalCenter, Leiden, the Netherlands.MAURITS HAFKAMP, BSc, is YEC-secretary atLeyden Academy on Vitality & Ageing and Medicalstudent at Leiden University Medical Center,Leiden, the Netherlands.RUDI G.J. WESTENDORP, MD PhD, is director ofLeyden Academy on Vitality & Ageing and Fullprofessor at Leiden University Medical Center,Leiden, the Netherlands.Medical Science Educator © IAMSE 2013 Volume 23(1S) 82

References1. Sinclair S. Making doctors. An institutionalapprenticeship. Oxford: Berg, 1997.2. O’Malley, C. D. (Ed.), The history of Medicaleducation. UCLA Forum Med. SCi. No. 12, Univ.of California Press, Los Angeles, 19703. Bloom, S. W. The medical school as a socialorganization: the sources of resistance tochange. Med Edu, 1989:23:228–241.doi: 10.1111/j.1365-2923.1989.tb01538.x4. Zwiers R, Zantvoord FW, Engelaer FM, vanBodegom D, van der Ouderaa FJ, WestendorpRG. Mortality in former Olympic athletes:retrospective cohort analysis. BMJ. 2012345:e7456. doi: 10.1136/bmj.e7456.5. Hafferty FW, Franks R. The hidden curriculum,ethics teaching, and the structure of medicaleducation. Acad Med 1994;69:861-71.6. Hafferty FW. Beyond curriculum reform:confronting medicine’s hidden curriculum.Acad Med 1998;73:403-7.7. Cribb A, Bignold S. Towards the reflexivemedical school: the hidden curriculum andmedical education research. Stud Higher Educ1999;24: 195-209.Medical Science Educator © IAMSE 2013 Volume 23(1S) 83

MEDICAL SCIENCE EDUCATORThe Journal of the International Association of Medical Science EducatorsMed Sci Educ 2013; 23(1S): 84-87SHORT COMMUNICATIONSIntegration of the Medical College of WisconsinPhysician Scientist Pathway and SummerResearch Programs to Increase Medical StudentResearch SkillsDavid C. Brousseau & David R. HarderMedical College of Wisconsin, Milwaukee, WI, USAAbstractThe Physician Scientist Pathway provides students with protected curriculum time for research. A structuredprogram during first year teaches introductory research skills and prepares the student for an intensive summerresearch experience. Dedicated time during second and third year focuses on the dissemination of results in oraland written form.BackgroundThere has been a decrease in the number ofphysicians pursuing research careers. 1,2 Programs toincrease research skill development have beendeveloped by the National Institutes of Health (e.g.career development awards) and others to combatthis decline and increase physician research.Training has also shifted to earlier periods, withresidencies and medical schools encouragingresearch. During residency, one of the obstacles tosuccessful research has been the fact that mostresidents arrive with no research experience. 3Medical schools have developed areas ofconcentration or “selected student components” tohelp start research careers in medical school withthe hope that those programs will translate toincreased numbers of physician scientists in thefuture. 4-6Here we describe the Medical College of Wisconsin’sapproach to improving student research skills andexperience by integrating an established summerresearch program with a newer Physician Scientistpathway.Corresponding author: David C. Brousseau MD, MS, Professorof Pediatrics, Director Medical School Physician ScientistPathway, Medical College of Wisconsin 999 N 92 nd St. CCC 550Milwaukee, WI 53226 Tel:+1 (414) 266-2625, Fax:+1 (414) 266-2635, email: dbrousse@mcw.eduMedical College of WisconsinThe Medical College of Wisconsin instituted amandatory Pathways program in 2009. All studentsare required to participate, but may choose fromone of five current options (Clinician Educator,Global Health, Quality Improvement and PatientSafety, Physician Scientist, and Urban andCommunity Health). By combining the PhysicianScientist pathway with an elective researchexperience during the summer after the first year ofmedical school, students are provided a longitudinalresearch experience beginning early in the first yearand continuing throughout medical school. Thisnovel integration builds on a well-establishedsummer research program, integrating requiredcurricular activities developed as part of a scholarlypathway program, now in its fourth year.Participation in both the Physician Scientistpathway and Medical Student Summer ResearchProgram (MSSRP) has increased since theintegration, enabling a more rigorous researchexperience.Scholarly PathwaysThe Scholarly Pathways program at the MedicalCollege of Wisconsin (MCW) enables students toindividualize an aspect of their curriculum, whileexploring a career path of interest. Scholarlypathway time for first, second and third yearmedical students is built into the curriculum, withone half-day per week allotted for pathwayMedical Science Educator © IAMSE 2013 Volume 23(1S) 84

activities. Participation is mandatory, but thestudent selects the pathway that best matcheshis/her career goals. Students who wish to pursueresearch training through the completion of amentored research project select the PhysicianScientist pathway and begin their developmenttowards a career as a clinician scientist in the firstyear of medical school.The structure of the Physician Scientist pathwaycombines monthly core sessions with weeklynoncore time for students to work on researchrelated activities. The monthly core sessions are acombination of large and small group activities.Large group activities are primarily focused onlearning core competencies. Core topics aredescribed in Table 1; topics in the first year focus onpreparation for summer research, while jointly heldsecond and third year sessions focus ondissemination of results from the summer project.As the third year is longer than the second year inlength, sessions specific to third years weredeveloped and include: how to discuss your researchduring the residency match process (session taughtby fourth year former Physician Scientist students)and preparing for research in residency (taught bysuccessful resident researchers).Each monthly core session has a small groupactivity which allows for peer mentoring as well asinteractions with faculty facilitators. Groups of eightto ten first year students meet with one or twofaculty facilitators and two third year PhysicianScientist students. These groups, which remainintact for the entire year, meet monthly. Thestudents practice the skills discussed in the largegroup session with more experienced studentscritiquing work and discussing strategies forpreparing for the summer. Second and third yearstudents have additional small groups with facultyfacilitators; their goal is the completion of datacollection/analysis and dissemination of results inmanuscript form, with the student as either primaryauthor or co-author. Small group activities duringthese two years are focused on studentpresentations and feedback concerning progress.First Year Second/Third Year Specific to Third Year 2Research Ethics(Including on-line certification)Abstract writing and review Research in residency sessions 3Developing a research questionPoster development and presentationEmphasizing scholarly work in theresidency match process 4Conducting a literature searchManuscript writingIntroduction to bibliographic softwareAuthorship criteria(Including discussion of authorshipwith preceptor)Evaluation of oral abstractpresentations 1Critical review of manuscriptsJournal review processScoring abstracts for nationalpresentationEvaluation of oral abstractpresentationsTable 1: Core session topics during three year Physician Scientist pathway1In an interactive audience response session2Additional sessions specific to third year of medical school are required due to additional months in the third year.3Led by residents conducting research.4Led by Fourth year medical students who were in the Physician Scientist pathwayMedical Science Educator © IAMSE 2013 Volume 23(1S) 85

In addition to the monthly core sessions, studentsare required to spend a minimum of six hours permonth working on their research projects. While sixhours per month is insufficient to complete aresearch project, it does allow for preparation beforea project, study training, meetings with mentors,and continuation of an established project. Sixhours per month is a minimum, with some studentsdocumenting hundreds of hours of work dedicatedto a research project during the school year.Obviously, program success depends on facultyeffort, as project mentors, small group facilitators,and large group presenters. Students select summerpreceptors from a frequently updated website,listing projects and faculty investigators whoindicate they prefer working with a studentintegrating the MSSRP and pathway noncore time.The list is updated by polling faculty with a trackrecord of successful mentorship and by emailingnewer faculty to encourage participation. Most ofthe faculty have extensive experience with theMSSRP and are learning to improve the experiencethrough integration with the Physician Scientistpathway. During the school year, studentsdocument their project related activities and hoursin the medical school learning system, withguidance from a Pathway coordinator, sharedbetween multiple pathways, who also serves as theprimary contact for pathway related questions. Atthe midpoint and conclusion of each year, thefaculty member approves the hours and activities ofthe student and assesses progress on projectcompletion. Faculty, most of whom also serve asresearch mentors, also serve as facilitators for thesmall groups, dedicating one hour per month tosmall group sessions plus facilitating pre-work forthe sessions. Faculty presenters for core sessions arenot required to be small group facilitators but someserve in that role as well. A few faculty serve asmentors, facilitators and large group presenters.The Physician Scientist pathway functions bestwhen integrated with the Medical Student SummerResearch Program (MSSRP). Students select apathway advisor who also functions as theirsummer research preceptor. Together they eitherdevelop a project or decide on one of the mentor’sprojects that will become the student’s project.Students use pathway noncore time completingbackground reading related to the summer project,spending time in the preceptor’s lab, learningtechniques and becoming familiar with researchstaff and procedures.Medical Student Summer ResearchProgram (MSSRP)The MSSRP is an elective, academic enrichmentprogram designed to expose medical students toresearch and careers in biomedical research. Theprogram provides rigorous, hands-on, fundamentalresearch experiences within the translationalresearch laboratories of funded MCW investigators.It facilitates opportunities to participate in newdiscoveries and learn how research findings aretranslated into the clinical arena.Students in the MSSRP complete an eight to 12week intensive research experience in the lab ofresearch faculty. Funding for students is based on acompetitive application process, with moneyavailable from NIH grants (e.g. National Heart,Lung and Blood Institute, National Institute onAging), Department funds, and from charitablegiving. Some students choose to participate withoutfunding.Students who participate in the MSSRP are requiredto prepare an abstract and present a posterdescribing their research findings. The postersession is attended by all students in the program,the majority of first year students looking forresearch preceptors and a large number of facultyinterested in research conducted by summerstudents. Critical review of the abstracts and postersis provided during small group sessions in thepathway early in the second year, as describedabove.Successful students are invited to participate inthird and fourth year research electives to extendtheir research. An Honors in Research program,requiring 16 weeks of research and a written thesis,provides further incentive for successful researchcompletion.Impact of the integration of the twoprogramsWe are tracking the impact of the program throughparticipation, evaluation, and productivity.Participation in both programs has increased sincethe integration has been implemented. Enrollmentin the Physician Scientist pathway increased fromapproximately 50 students/year to almost 90 for thecurrent year, with the number of students applyingfor the MSSRP increasing from approximately 75students to over 110 students from a class size ofapproximately 210. Greater than 90% of students inthe Physician Scientist pathway participate in theMSSRP. Physician Scientist Evaluations, completedMedical Science Educator © IAMSE 2013 Volume 23(1S) 86

at the end of every year and primarily Likert scalequestions, revealed that approximately 90% ofstudents believed the Physician Scientist pathwayenhanced their growth as physicians and allowedthem to demonstrate curiosity resulting in evidencebasedcritical thinking. As the integration of theprograms is still early, we do not have productivityinformation. However, we are tracking publications,national and regional presentations and the numberof students who pursue research electives todocument changes resulting from the novelintegration of the Physician Scientist pathway andthe long-standing Medical Student SummerResearch Program. While the program has beenhighly successful, there are aspects that can presentdifficulties. Both student and faculty expectationsoccasionally need to be managed, as students arevery busy academically during the school year andfaculty may not see the level of progress they want.Students may also decide that they no longer wish tocontinue working on the project at the conclusion ofthe MSSRP. In both instances, improvedcommunication between the student and facultypreceptor, sometimes with Pathway Director help,usually resolves the problem. Students are assistedin finding an alternate project should that benecessary.References1. Ley TJ, Rosenberg LE. The physician-scientistpipeline in 2005. Build it, and they will come.JAMA 2005; 294:1343-1351.2. Miller ED. Clinical Investigators—TheEndangered Species Revisited. JAMA. 2001;286(7): 845-846.3. Rothberg MB. Overcoming the Obstacles toResearch During Residency: What Does ItTake? JAMA. 2012; 308(21): 2191-2192.4. Green EP, Borkan AM, Pross SH, Adler SR,Nothnagle M, Parsonnet J, Gruppuso PA.Encouraging Scholarship: Medical SchoolPrograms to Promote Student Inquiry Beyondthe Traditional Medical Curriculum. AcademicMedicine. 2010; 85: 409-418.5. Webster SS, Shotliff KP, Burton L. “TheGraduate as Scientist and Scholar”: Building aCurriculum Suitable for All. Medical ScienceEducator. 2012; 22(3S): 185-189.6. Bahner I, Somboonwit C, Pross S, Collins RJ,Saporta S. Teaching Science through BiomedicalResearch in an Elective Curriculum. MedicalScience Educator. 2012; 22(3S): 143-146.In conclusion, combining the Physician Scientistpathway with the Medical Student SummerResearch Program allows students to develop thebasic research skills required to continue researchthroughout their careers. The continued success ofthis program will help train the next generation ofresearchers in an era when time for research skilldevelopment is becoming more difficult to protect.Key WordsResearch, medical studentNotes on ContributorsDAVID C. BROUSSEAU, MD, MS, is Professor inthe Department of Pediatrics, and Director –Physician Scientist pathway, Medical College ofWisconsin, Milwaukee, WI, USA.DAVID R HARDER, PhD, is Professor in theDepartment of Physiology, Associate Dean forResearch, and Director – Medical Student SummerResearch Program, Medical College of Wisconsin,Milwaukee, WI, USA.Medical Science Educator © IAMSE 2013 Volume 23(1S) 87

MEDICAL SCIENCE EDUCATORThe Journal of the International Association of Medical Science EducatorsMed Sci Educ 2013; 23(1S): 88-91SHORT COMMUNICATIONSImpact of a 5-Year Research-Oriented MedicalSchool Curriculum on Medical Student ResearchInterest, Scholarly Output, and CareerIntentionsClemencia Colmenares, S. Beth Bierer & Linda M. GrahamCleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH,USAAbstractThe impact of research experiences on medical student career intentions is unclear. Short-term outcomes fromthe Cleveland Clinic Lerner College of Medicine’s five-year research curriculum show that most medical studentscan generate scholarly work during medical school and sustain a high level of interest in research as a careeroption.IntroductionOne of the main goals driving the establishment ofthe Cleveland Clinic Lerner College of Medicine ofCase Western Reserve University (CCLCM) in 2002was to incorporate comprehensive research traininginto medical education in order to encouragemedical students to become physicianinvestigators. 1 The five-year CCLCM programintegrates research activities and learningexperiences that expose students equally to basic,laboratory-based and to clinical, human subjectsresearch. The first two summers form the core ofresearch education as each student participates inone basic and one clinical research experience.During these summers, students complete shorttermresearch projects that are accompanied bycoursework and journal clubs to provide exposure toand analysis of core concepts in each field. In Years1 and 2, weekly seminar series complement theresearch curriculum, and these continue on abiweekly basis during Year 3 and monthly duringYears 4 and 5. Subject to approval by the ResearchEducation Committee (REC), students choose aresearch mentor and topic area for their requiredCorresponding author: Clemencia Colmenares, PhD, AssociateDirector of Research Education, Lerner Research Institute NB21,Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA.Tel: +1-216-636-1257; Fax: +1-216-444-3279;Email: colmenc@ccf.orgthesis project that is started during year 3 or 4.Students are encouraged, but not required, tocomplete core clinical rotations prior to beginningtheir year-long thesis research. An overview of theprogram and details of the design andimplementation of the research curriculum havebeen described previously. 2Given the curriculum’s balanced approach toresearch, we examined the proportion of studentswho chose to perform basic/translational or clinicalresearch projects for their thesis work, anddetermined the extent to which these choicescorrelated with students’ scholarly output, careerintentions, and research interests.Participants included 112 of 120 CCLCM graduatesfrom four class cohorts (2009-2012) who consentedto release their program evaluation data forresearch purposes. Students completed an in-housegraduation questionnaire (GQ) designed byCurricular Affairs faculty to elicit student feedbackabout program outcomes and students’ careerinterests not collected elsewhere. Data on thesiscategory classification were derived from a formdeveloped by the REC and completed by thesischairs when assessing student performance duringthe formal thesis defense. Classification coding wasconfirmed by a member of the REC who read eachthesis abstract. Clinical research was defined aspatient-based or public health research, whileMedical Science Educator © IAMSE 2013 Volume 23(1S) 88

laboratory-based projects were deemed basic ortranslational depending on the REC member’sjudgment of the project’s direct relevance to humandisease. A classification of “other” was included forprojects focusing on bioinformatics, education, orbehavior research.We discovered that 38% of theses from CCLCMgraduates were in clinical research while 25% werein basic science, 33% in translational science, and4% classified as other (Table 1). This distributionshows that over 50% of CCLCM’s graduates chose tocomplete basic/translational thesis projects, whichis much higher proportionally than the 21-37% ofmedical students choosing laboratory-basedresearch projects reported by other medical schoolprograms requiring student research. 3,5We used self-reports from graduating students toidentify the scholarly products associatedspecifically with the research thesis project (Table1). The majority of students reported generatingsome type of scholarly product, with only 8% ofstudents reporting no publications, abstracts, orposters. Once again, we note that the percentage ofstudents with scholarly products is larger thanreported by other programs with researchrequirements. 3-5 Furthermore, we did not detect acorrelation between the category of research (e.g.basic, clinical) and the number of publications,abstracts, or posters (Table 1).Number of Students (%) listing at leastone scholarly product type or noneGraduates’ Self-reportsof Scholarly ProductsBasicScience(n = 28)TranslationalScience(n = 37)ClinicalScience(n = 43)Other(n = 4)AllTheses(n = 112)Publication where you are first author 16(57) 21(57) 25(58) 3(75) 65(58)Publication where you are co-author 10(36) 16(43) 19(44) 45(40)Abstract published in proceedings 18(64) 26(70) 23(53) 4(100) 41(63)Oral presentation at conference 14(50) 12(32) 21(49) 1(25) 71(43)Poster at conference 20(71) 30(81) 32(74) 3(75) 85(76)No scholarly work 3(11) 2(5) 4(9) 9(8)Table 1: CCLCM graduates’ self-reports of scholarly products by type of thesis topic. Note that percentages do not sum to 100% as mostgraduates self-reported multiple products.An important goal of our research-focused programis to foster students’ interest in research toencourage them to pursue careers as physicianinvestigators. As a short-term measure of thisoutcome, we used GQ data to examine relationshipsamong students’ career plans, research intentions,and category of their thesis research (Table 2 inAppendix). Of note, a majority of the students(80%) expressed moderate or high interest inpursuing clinical research, with a preference forhuman subject research over analysis of largedatabases. Interest in clinical research was highregardless of the category of thesis research. Bycontrast, only 14% of students who completedclinical research theses were moderately or veryinterested in pursuing basic science research. Thislow level of interest stood out in stark contrast withthe much larger proportion of students with basic ortranslational theses, who remained interested inperforming basic science research. Fewer than halfof CCLCM graduates wanted only limited futureinvolvement with research, while less than 15%planned to pursue careers in research oradministration that excluded patient care.Many medical schools in the United States andCanada have introduced required or optionalresearch activities in response to the widespreadconcern regarding the dearth of physicianinvestigators. However, few studies have linkedstudents’ research products to their careerintentions or research interests. 6 Although ouroutcomes are extremely short-term, preliminaryevidence suggests that our research curriculumMedical Science Educator © IAMSE 2013 Volume 23(1S) 89

encourages students to develop and maintaindiverse research interests as evidenced by thevariability in their research thesis categories.Additionally, most students generate, based on theirself-reports, more scholarly products after a fullyear of research than reported elsewhere. 4 Mostenticing is the fact that the majority of our students,at graduation, continue to express a high degree ofinterest in continuing to conduct research. This isperhaps not surprising considering the fact thatCCLCM is a highly selective medical school programthat requires its matriculants to have previousresearch experience and articulate an interest inresearch. However, it is encouraging to note thatCCLCM’s research curriculum is, at the very least,not suppressing students’ interest in biomedicalresearch careers.A major limitation of this study is the assumption –or more accurately the hope – that students’ currentcareer plans will have an impact on their actualcareer trajectories in the longer term. Longitudinalfollow-up is needed and in place to track graduates’future career development.Another limitation is the fact that studentproductivity is based on self-reports. More time isneeded to validate fully the scholarly work producedby students, with particular emphasis on peerreviewedpublications. Finally, it is clear thatstudents’ choice of thesis topic may be influenced byfactors other than their research interests, such asavailability of mentors, availability of funding, ordesire to improve their applications for competitiveclinical specialties.The CCLCM program is designed to accept studentswho are interested in research and to place them inan environment where research is consideredinvaluable. The curriculum is designed to foster andexpand research interest by exposing students to themany varieties of research that can impact onclinical care. The importance of research issystematically reinforced throughout the five yearsof the program. The result is that students retaintheir interest in research and plan to make it part oftheir professional practice.Notes on ContributorsS. BETH BIERER, PhD, is the Director ofEvaluation at the Cleveland Clinic Lerner College ofMedicine of Case Western Reserve University,Cleveland Clinic, Cleveland, OH, USA.CLEMENCIA COLMENARES, PhD, is AssociateDirector of Research Education at the ClevelandClinic Lerner College of Medicine of Case WesternReserve University, and Full Staff in the Dept. ofCancer Biology, Lerner Research Institute,Cleveland Clinic, Cleveland, OH, USA.LINDA GRAHAM, MD, is Assistant Dean forResearch Education at the Cleveland Clinic LernerCollege of Medicine of Case Western ReserveUniversity, and Professor of Surgery, Dept. ofVascular Surgery, Cleveland Clinic, Cleveland, OH,USA.References1. Fishleder AJ, Henson LC, Hull AL. ClevelandClinic Lerner College of Medicine: an innovativeapproach to medical education and the trainingof physician investigators. Acad Med2007;82(4):390-396.2. Ticknor TM, Bierer SB, Colmenares C, Hull AL.A comprehensive curriculum to preparephysician-investigators:Design,implementation and early outcomes. Med SciEduc. 2011;1S:21-28.3. Chongsiriwatana KM, Phelan ST, Skipper BJ,Rhyne RL, Rayburn WF. Required research bymedical students and their choice of a women’shealth care residency. Am. J. Obstet. Gynecol.2005; 192: 1478-80.4. Cohen BL, Friedman E, Zier K. Publications bystudents doing a year of full-time research:What are realistic expectations? Am J Med.2008;121:545-548.5. Dyrbye LN, Davidson LW, Cook DA.Publications and presentations resulting fromrequired research by students at Mayo MedicalSchool, 1976–2003. Acad Med. 2008;83:604-610.6. Bierer SB, Chen HC. How to measure success:The impact of scholarly concentrations onstudents—A literature review. Acad Med.2010;85:438–452.KeywordsResearch Interest, Scholarly Output, CareerIntentionsMedical Science Educator © IAMSE 2013 Volume 23(1S) 90

AppendixGraduates’ CareerIntentions by Thesis CategoryConducting…BasicScience(n = 28)% of Students Moderately or Very InterestedTranslational ClinicalScience Science Other(n = 37) (n = 43) (n = 4)AllTheses(n = 112) Research with human subjects (clinical trials, healthoutcome studies, etc.) 71 81 84 100 80 Research using large databases (Medicare databases, UScensus data, etc.) 36 51 70 75 55 Basic science research (animal studies, drug development,tissue sample research, etc.) 54 43 14 0 33Working… Full-time as a clinical science researcher AND as aphysician seeing patients 82 89 88 100 88 Full-time as a basic science researcher AND as a physicianseeing patients 64 54 19 0 41 Full-time with a focus on clinical care of patients andlimited involvement with research 32 38 47 50 40 Full-time in health care administration without a clinicalpractice (administrator, association or academic executive,business executive)7 5 21 50 13 As a research scientist in non-academic setting (industry,federal agency, state agency) 14 11 7 50 12 Full-time as a researcher BUT NOT as a physician seeingpatients 11 8 5 25 8Table 2: Relationship between career intentions of CCLCM graduates (n=112) and type of research thesis topic. Graduates used a 5-pointscale, ranging from 1 (Not at all interested) to 5 (Very interested) to rate their career intentions and research interests.Medical Science Educator © IAMSE 2013 Volume 23(1S) 91

MEDICAL SCIENCE EDUCATORThe Journal of the International Association of Medical Science EducatorsMed Sci Educ 2013; 23(1S): 92-98ORIGINAL RESEARCHCurricular Flexibility in the Pre-Clinical YearsPromotes Medical Student ScholarshipJustin G. Peacock, Lindsay L. Warner, Linda B. Drozdowicz,Brad A. Martin, Rahul Suresh, Bonnie J. Denzer, Ashley B. Wentworth,Jessica A. Adefusika, Maria J. Bachman & Joseph P. GrandeMayo Medical School, Mayo Clinic College of Medicine, Rochester, MN, USAAbstractMedical student research is recognized as a critical component of undergraduate medical education. Currentstudies focusing on curricular improvements to promote student research are limited by lack of objectiveoutcome data. At the Mayo Medical School, research has been an integral component of the curriculum since itsinception in 1972. In 2006, selectives (periods of time free from competing didactic or clinical responsibilities)were implemented, which permitted students flexibility in their pre-clinical years to pursue service projects,research endeavors, and career exploration. The purpose of this study was to quantify the effects of thiscurricular revision on research productivity by Mayo medical students. Publications by Mayo medical studentsgraduating in the 2004-2011 time period were queried in the PubMed database. The number, impact factor, andtime to publication for these publications was assembled and analyzed in a cohort of students that graduatedbefore and after selectives were implemented. We found that students who participated in selectives publishedmore papers, papers with a higher impact factor, and published papers earlier in their training than studentswho graduated prior to the implementation of selectives. We propose that selectives are an effective means toincrease research productivity in the Mayo medical school curriculum.IntroductionMedical student research is vital for helpingstudents integrate and apply classroom learning tothe basic sciences and clinical medicine. Medicalstudent research helps students develop hypothesisdriven,critical thinking that is required for formingdifferential diagnoses and making clinical decisionsas a physician. Research advisors provide studentswith valuable mentoring relationships duringcritical career decision time. Through research,students learn how to access and evaluate scientificand clinical information necessary for clinicaldecision-making. 1 Students also develop oral andwritten presentation skills, which are critical inmost fields of medicine. 1 Studies have shown thatmedical student research also influences specialtychoices, the decision to enter academic medicine,and future scholarly production. 1-3Corresponding author: Joseph P. Grande, Mayo Medical School,Mayo Clinic College of Medicine, 200 First St. SW Rochester, MN55905; Tel: +1(507) 284-2316; Fax: +1(507) 284-2634; email:grande@mayo.eduMedical schools across the world have seen thesebenefits for medical students and many havedeveloped research or scholarly work requirementsand other curricular programs to encouragestudents to get involved in research. 1,4-10 Some ofthese programs require students to complete ascholarly work during their medical schooleducation, some provide dedicated research timewithin the medical school curriculum, and some tryto incorporate research as a part of the didacticcurriculum. 1,4,5,7,9,11-15 In the 2012 Association ofAmerican Medical Colleges (AAMC) medical schoolgraduation questionnaire, students responded toquestions regarding required or voluntary researchexperiences during their medical education. 16 Thequestionnaire seemed to show a growing number ofmedical students participating in research duringmedical school in 2012, compared with 2008. Forexample, 36.4% of students in 2008 compared with42.4% of students in 2012 had participated in somesort of independent study for credit. Similarly, thepercentage of students conducting a researchproject with a faculty mentor grew from 60.0% inMedical Science Educator © IAMSE 2013 Volume 23(1S) 92

2008 to 68.1% in 2012. The number of studentsauthoring a publication during medical school grewfrom 35.3% in 2008 to 41.8% in 2012. Despiteincreasing introduction of research programs intomedical school curricula, little work has been doneto quantify the results of such programs ordetermine the effectiveness of these programs onproducing the intended aims. 1The Mayo Medical School has had a requiredresearch quarter during the third-year medicalcurriculum since the founding of the medical schoolin 1972. 17 In 2006, the medical school curriculumwas significantly altered to allow flexible selectivetime during the pre-clinical years for careerexploration, service learning, and/or researchexperiences. 18 These research programs led to33.3% of students in 2012 indicating that they hadparticipated in an independent study project forcredit, 97.2% of students indicating that they hadparticipated in a research project with a facultymember, and 84.4% of students indicating that theyhad authored a publication. 19 Despite thesestatistics, it was unclear what effect the flexibleselective experiences had on increasing andimproving scholarly production by Mayo medicalstudents. We hypothesize that the pre-clinicalselective time has increased the number of studentauthoredpublications, pushed the authorship ofpublications to earlier years in medical school, andpotentially improved the quality of research bymedical students. Using publication databasesearches, we wanted to quantify the number, year,and journal impact factor for medical studentpublications.Materials and MethodsMayo Medical School student research papers fromgraduating students during a 7-year period (2004 to2011) were included in this retrospective study. Theamount and quality of medical student research wascompared prior to and after the initiation ofselectives in 2006. The 2010 and 2011 graduatingclasses were the only classes from 2004-2011 thathad selectives in their curriculum. The paper byDyrbye et al., describes medical student researchprior to 2004 at the Mayo Medical School. 17 TheMayo Clinic Institutional Review Board (IRB)determined that the research did not need IRBreview in accordance with the Code of FederalRegulations, 45 CFR 46.evidence that the research was performed duringmedical school. Evidence included authors whocited Mayo Medical School, those who publishedduring their time in medical school, and those withthe B.S. or B.A. credentials, etc. Those authors whopublished after graduating medical school hadadditional medical school records showing theresearch was initiated during medical school.Publication titles, journal, publication date, andjournal impact factor were recorded. Journal impactfactor scores were found using the ISI Web ofKnowledge database.Statistical analyses were performed using JMPsoftware, version 9.0.1 (Cary, NC). The number ofpublications per student, journal impact factors forthe publications, and the year of medical school orpost-medical school were compared for the medicalstudents from each individual year from 2007 to2011 as well as the pre- (2004-2009) and postselective(2010-2011) time periods. For each ofthese comparisons, means were compared usingANOVA analysis with post-hoc Tukey-Kramer HSDanalyses at the α = 0.05 level. P-values less than0.05 were considered significant. Box plots withmedian and quartiles were created in the JMPsoftware and modified in Adobe Illustrator CS3.ResultsThe average number of publications per studentincreased following implementation of selectivetime.Selectives are a curricular change impacting the preclinicalyears, so we hypothesized that students maybe able to conduct more research projects at earliertime points in the medical education. Using the2004-2011 graduation lists and database searcheswe found the publications authored by graduatingstudents during medical school. We wanted to splitup the years of pre- and post-selective classes todetermine the impact of selectives on researchproduction. Students graduating in 2010 and 2011participated in two years of selectives. We groupedthe 2010 and 2011 years together as the postselectivetime period. The 2004-2009 years weregrouped together as the pre-selective years.An advanced PubMed search builder was used toinclude author (last name, first initial) and the word“Mayo” found in any other field. The papers foundwere then confirmed to be the student author’s withMedical Science Educator © IAMSE 2013 Volume 23(1S) 93

Figure 1: The average number of publications per student significantly increased after the implementation of selectives.(A) Box plot with 25% quartiles and median for the number of publications per four-year, traditional student during each graduating yearbetween 2004 and 2011. Additional degree candidates and students completing extra research years were excluded from this analysis. N =34, 30, 30, 32, 27, 31, 25, and 22 for each year from 2004 – 2011, respectively. One-factor ANOVA with repeated measures indicated asignificant difference in the average number of publications for students in several graduating class pairs [F Ratio = 3.1913, P = 0.0031].*P < 0.05, by post hoc Tukey-Kramer HSD. Significant pairings are designated by a bracket connecting the pairings with an * above thebracket. (B) Box plot similar to Figure 1A for the number of publications per four-year, traditional student during the pre- and postselectivetime periods. N = 184 and 47 for the pre- and post-selective time periods, respectively. One-factor ANOVA with repeatedmeasures indicated a significant difference in the average number of publications for students in the pre- and post-selective time periods [FRatio = 12.4700, P = 0.0005]. *P < 0.05, by post hoc Tukey-Kramer HSD.Figure 2: Students published research earlier in their medical education after the implementation of selectives. (A) Boxplot similar to Figure 1A for the time (in years) from matriculation to publication for each 4-year, traditional medical student publicationduring the graduating years from 2004-2011. N = 24, 30, 43, 41, 51, 58, 53, and 73 for each year from 2004 – 2011, respectively. OnefactorANOVA with repeated measures indicated a significant difference in the time to publication for student publications in severalgraduating class pairs [F Ratio = 3.0234, P = 0.0042]. *P < 0.05, by post hoc Tukey-Kramer HSD. (B) Box plot similar to Figure 1A for thetime (in years) from matriculation to publication for each 4-year, traditional medical student publication during the pre- and postselectivetime periods. N = 247 and 126 for the pre- and post-selective time periods, respectively. One-factor ANOVA with repeatedmeasures indicated a significant difference in the time to publication for student publications in the pre- and post-selective time periods [FRatio = 14.2609, P = 0.0002]. *P < 0.05, by post hoc Tukey-Kramer HSD.Medical Science Educator © IAMSE 2013 Volume 23(1S) 94

Students in the 2011 year, authored morepublications per student (3.3 ± 1.1 papers) than anyyear from 2004-2010 (Figure 1A). In particular,students in 2004 (0.7 ± 0.1 papers), 2005 (1.0 ± 0.2papers), and 2007 (1.3 ± 0.2 papers) authoredsignificantly fewer publications than students in2011 (Figure 1A). Students in the 2010 yearproduced more papers on average than previousyears at 2.1 ± 0.4 papers (Figure 1A). We nextwanted to compare the pre- and post-selective timeperiods within this group of four year medicalschool graduates. We found that the averagenumber of student publications per studentincreased by 108% from 1.3 ± 0.2 papers during thepre-selective time period to 2.7 ± 0.6 papers duringthe post-selective time period (Figure 1B).Students publish research earlier in medical schoolafter the introduction of selectives.Selectives not only give students time to conductresearch, but they provide early research exposureduring the pre-clinical years. We wanted to see ifthese early research exposures might lead studentsto author publications earlier in their medicaleducation. For each publication, we calculated thetime from matriculation to publication in years. Ifstudent publications were published aftergraduation we tallied these as year five, six, etc. Weagain looked at the subset of students completingtheir degree within the typical four years.Comparing the different graduation years, we foundthat students in 2004 (4.3 ± 0.3 years), 2005 (4.0 ±0.2 years), 2006 (3.9 ± 0.2 years), 2008 (3.9 ± 0.2years), and 2009 (3.7 ± 0.1 years) took significantlylonger to publish research compared with studentsin 2011 (3.3 ± 0.1 years) (Figure 2A). Students in2010 (3.5 ± 0.2 years) published researchsignificantly earlier than 2004 students, as well(Figure 2A). Comparing just 2004 students with2010 and 2011 students, we found decreases inpublication time of 19% and 23%, respectively.We again separated and compared the pre- andpost-selective time periods to assess the potentialimpact of selectives on time to publication (Figure2B). Students in the post-selective time period (3.4± 0.1 years) authored publications significantlyearlier than those students in the pre-selective timeperiod (3.9 ± 0.07 years) (Figure 2B). Thesedifferences represent a 13% decrease in time topublication after selectives were instituted.The quality of publications, as measured by journalimpact factors, improved with selectives.We wondered whether the additional time toestablish mentoring relationships, to conductresearch, and to review the background literaturemight produce higher quality research. Researchquality is difficult to measure or assess, but onemetric that is used is the impact factor for thepublication’s journal. 20 We recorded the journalimpact factors for the students’ publications andconducted similar analyses for the pre- and postselectivetime periods. The average impact factor forstudent publications significantly increased 59%from 3.205 ± 0.250 in the pre-selective time periodto 5.057 ± 0.645 in the post-selective time period(Figure 3A).Figure 3: The journal impact factor scores for medicalstudents significantly increased after theimplementation of selectives. (A) Box plot similar to Figure1A for the journal impact factor distribution for each 4-year,traditional medical student publication during the pre- andpost-selective time periods. N = 231 and 108 for the pre- andpost-selective time periods, respectively. One-factor ANOVAwith repeated measures indicated a significant difference in thejournal impact factors for student publications in the pre- andpost-selective time periods [F Ratio = 10.4730, P = 0.0013]. *P

with a higher impact factor, and published earlier intheir medical training than students prior to thischange.Current studies regarding student research arelimited by the lack of objective outcomes. 1,5,12 To ourknowledge, this is the first report documenting andquantifying the effect of a curricular revision onresearch productivity. 1 We believe that selectivesprovide medical students with an opportunity toengage with mentors early in their careers. Mayomedical students have employed this selective timeto engage with mentors, even those that did notchoose to do a formal research selective. Based onthese considerations, we propose thatimplementation of selectives has been effective inincreasing student research productivity.Medical student research has been shown toincrease critical thinking abilities, improve oral andwritten presentation skills, and enhance bothclassroom and clinical learning. 1 Research also hasbeen shown to influence choice of specialty and thedesire to pursue a career in academic medicine. 1,3Student research also increases students’ confidencein designing and conducting clinical research and inevaluating the clinical and scientific literature. 1,10Within the current study, we recognize severallimitations. All journal articles were searched forusing PubMed, rendering it likely that some paperspublished by Mayo medical students are notindexed in this database. Some of the journals werenot included in the Journal Citation Index, makingit impossible to obtain impact factors for allpublications. We also recognize that impact factorsare not the ultimate source of research quality. 20 Werecognize that the strong association reported herebetween selectives and research productivity doesnot prove causality. There certainly may beadditional factors that were not assessed in thisstudy that impacted medical student research, butwe note that student selection at the Mayo MedicalSchool has not changed during the study timeperiod, nor have the research requirements formatriculation.evaluation of the research. We would also like todetermine whether selectives will increase studentparticipation in research related to the science ofhealthcare delivery, quality, and systems-basedpractice, topics which have been accorded highpriority in medical education.ConclusionsFlexible time during the pre-clinical curriculum willpermit medical students to become engaged inresearch earlier in their medical education, whichwe have shown leads to more, higher qualitypublications during the medical school experience.Such research experiences will increase students’understanding of basic science and medicalconcepts, improve their oral and writtenpresentation skills, help them develop criticalthinking skills that will be important for clinicaldecision-making, help students more readily enteracademic medicine as a career, and help studentsestablish important mentoring relationships withestablished faculty. Our experience shows that welldirectedflexible time in the pre-clinical years willallow for these critical medical student researchexperiences.Key WordsPre-clinical; research; medical student; elective timeFurther studies are required to define the impact ofstudent research on specialty choice, on the decisionto pursue a career in academic medicine, and onfuture scholarship activity. Additional studies couldalso address the impact of selectives on otheraspects of medical education, including USMLEscores, clerkship grades, and clinical decisionmakingability. Other measures of research qualitycould also be addressed in the future, including thenumber of publication citations and expertMedical Science Educator © IAMSE 2013 Volume 23(1S) 96

Notes on ContributorsJUSTIN G. PEACOCK, PhD, is a third-year medicalstudent at Mayo Medical School, Mayo ClinicCollege of Medicine, Rochester, MN, USA.LINDSAY L. WARNER, BS, is a third-year medicalstudent at Mayo Medical School, Mayo ClinicCollege of Medicine, Rochester, MN, USA.LINDA B. DROZDOWICZ, BS, is a third-yearmedical student at Mayo Medical School, MayoClinic College of Medicine, Rochester, MN, USA.BRAD A. MARTIN, BA, is a third-year medicalstudent at Mayo Medical School, Mayo ClinicCollege of Medicine, Rochester, MN, USA.RAHUL SURESH, BA, is a third-year medicalstudent at Mayo Medical School, Mayo ClinicCollege of Medicine, Rochester, MN, USA.BONNIE J. DENZER, BA, is an educationadministration coordinator at Mayo Medical School,Mayo Clinic College of Medicine, Rochester, MN,USA.ASHLEY B. WENTWORTH, BA, is a third-yearmedical student at Mayo Medical School, MayoClinic College of Medicine, Rochester, MN, USA.JESSICA A. ADEFUSIKA, BS, is a third-yearmedical student at Mayo Medical School, MayoClinic College of Medicine, Rochester, MN, USA.MARIA J. BACHMAN, BS, is a third-year medicalstudent at Mayo Medical School, Mayo ClinicCollege of Medicine, Rochester, MN, USA.JOSEPH P. GRANDE, M.D., Ph.D, is an AssociateDean for Academic Affairs at Mayo Medical School,and Professor and Consultant in the Department ofLaboratory Medicine and Pathology, Mayo ClinicCollege of Medicine, Rochester, MN, USA.Author’s ContributionsJ.G.P. conducted student publication searches,analyzed the composite data, prepared the figuresand wrote the manuscript. L.L.W. conductedstudent publication searches, wrote a portion of themethods, and contributed to the discussion. B.J.D.compiled the graduation lists and additionaldegrees/research experiences for all the medicalschool years. L.B.D., B.A.M., R.S., A.B.W., J.A.A.,and M.J.B. conducted student publication searches.J.P.G. provided intellectual guidance and reviewedthe manuscript.References1. Bierer SB, Chen HC. How to measure success:the impact of scholarly concentrations onstudents--a literature review. Acad Med.[Review]. 2010 Mar;85(3):438-52.2. Reinders JJ, Kropmans TJ, Cohen-Schotanus J.Extracurricular research experience of medicalstudents and their scientific output aftergraduation. Med Educ. [Letter]. 2005Feb;39(2):237.3. Chongsiriwatana KM, Phelan ST, Skipper BJ,Rhyne RL, Rayburn WF. Required research bymedical students and their choice of a women'shealth care residency. Am J Obstet Gynecol.[Research Support, Non-U.S. Gov't]. 2005May;192(5):1478-80.4. Gotterer GS, O'Day D, Miller BM. The EmphasisProgram: a scholarly concentrations program atVanderbilt University School of Medicine. AcadMed. [Research Support, Non-U.S. Gov't]. 2010Nov;85(11):1717-24.5. Parsonnet J, Gruppuso PA, Kanter SL, BoningerM. Required vs. elective research and in-depthscholarship programs in the medical studentcurriculum. Acad Med. 2010 Mar;85(3):405-8.6. Sanford T, Chancer Z, Kiyosaki K. Medicalstudent research at the John A. Burns School ofMedicine (JABSOM): the Research InterestGroup. Hawaii Med J. 2010 Jul;69(7):172-3.7. Schor NF, Troen P, Kanter SL, Levine AS. TheScholarly Project Initiative: introducingscholarship in medicine through a longitudinal,mentored curricular program. Acad Med. 2005Sep;80(9):824-31.8. van Eyk HJ, Hooiveld MH, Van Leeuwen TN,Van der Wurff BL, De Craen AJ, Dekker FW.Scientific output of Dutch medical students.Med Teach. 2010;32(3):231-5.9. Zier K, Coplit LD. Introducing INSPIRE, ascholarly component in undergraduate medicaleducation. Mt Sinai J Med. 2009Aug;76(4):387-91.10. Zier K, Friedman E, Smith L. Supportiveprograms increase medical students' researchinterest and productivity. J Investig Med.[Research Support, Non-U.S. Gov't]. 2006May;54(4):201-7.11. Elwood JM, Pearson JC, Madeley RJ, Logan RF,Beaver MW, Gillies PA, et al. Research inepidemiology and community health in themedical curriculum: students' opinions of theNottingham experience. J EpidemiolCommunity Health. 1986 Sep;40(3):232-5.Medical Science Educator © IAMSE 2013 Volume 23(1S) 97

12. Green EP, Borkan JM, Pross SH, Adler SR,Nothnagle M, Parsonnet J, et al. Encouragingscholarship: medical school programs topromote student inquiry beyond the traditionalmedical curriculum. Acad Med. 2010Mar;85(3):409-18.13. Kramer K. Medical student involvement inresearch in the pre-clinical years. Hawaii Med J.2005 Jul;64(7):190-1.14. Boninger M, Troen P, Green E, Borkan J,Lance-Jones C, Humphrey A, et al.Implementation of a longitudinal mentoredscholarly project: an approach at two medicalschools. Acad Med. [Comparative StudyResearch Support, Non-U.S. Gov't]. 2010Mar;85(3):429-37.15. Ogunyemi D, Bazargan M, Norris K, Jones-Quaidoo S, Wolf K, Edelstein R, et al. Thedevelopment of a mandatory medical thesis inan urban medical school. Teach Learn Med.[Evaluation Studies]. 2005 Fall;17(4):363-9.16. Colleges AoAM. Medical School GraduationQuestionnaire: 2012 All Schools SummaryReport. 2012 July 2012.17. Dyrbye LN, Davidson LW, Cook DA.Publications and presentations resulting fromrequired research by students at Mayo MedicalSchool, 1976-2003. Acad Med. 2008Jun;83(6):604-10.18. Porter BL, Grande JP. Mayo Medical School.Acad Med. 2010 Sep;85(9 Suppl):S300-4.19. Colleges AoAM. Medical School GraduationQuestionnaire: 2012 Individual School ReportMayo Medical School. 2012 July 2012.20. Zwahlen M, Junker C, Egger M. The journalimpact factor in the evaluation of researchquality: villain, scapegoat or innocentbystander? Soz Praventivmed. 2004;49(1):19-22.Medical Science Educator © IAMSE 2013 Volume 23(1S) 98

MEDICAL SCIENCE EDUCATORThe Journal of the International Association of Medical Science EducatorsMed Sci Educ 2013; 23(1S): 99-107MONOGRAPHProviding Research Opportunities for MedicalStudents: Challenges and OpportunitiesEileen Duggan, Kieran Doran, Siún O’Flynn & Colm M.P. O’TuathaighUniversity College Cork, Cork, IrelandAbstractResearch electives are very popular components within the undergraduate medical degree program at UniversityCollege Cork, with all students required to complete an original translational or clinical research project in theirfinal year. Barriers to the provision of undergraduate research opportunities include costs of laboratory-basedand clinical projects, staffing resources, complex and lengthy research governance procedures, and increasingstudent numbers. In this article, we describe the undergraduate research program at our institution, and outlineseveral initiatives designed to counteract the impact of these challenges.IntroductionIn medical schools throughout Europe, fostering anunderstanding of scientific method and provision ofresearch opportunities are core elements ofundergraduate medical education. Medical schoolsin countries like Ireland, Germany, and the UK areincreasingly expecting undergraduates to completeresearch projects, usually as part of their studentselected components (SSC) programme. 1-4Completion of short research projects is also acommon feature in medical curricula in the USA. 5The World Federation of Medical Education(WFME) has highlighted the importance ofscientific method as among the basic standards formedical education; they propose awarding a qualitystandard to those curricula which encourage andprepare students to engage in medical research anddevelopment. 6 The UK General Medical Councilrecognizes that new medical graduates should beable to apply scientific method in their executionand appraisal of medical research, while the BritishMedical Association has outlined the importance ofresearch and training to the future development ofthe health service in the UK. 7,8Positive student outcomes attributable toparticipation in research at an undergraduate levelinclude improved performance across a number ofCorresponding author: Dr. Colm O’Tuathaigh, School ofMedicine, Brookfield Health Sciences Complex, UniversityCollege Cork, Cork, Ireland, Tel: +353 21490 5971; Fax: +35321490 1594; Email: c.otuathaigh@ucc.ieevidence-based medicine (EBM) - linkedassessments (e.g. formulating research questions,quantitative data analysis, critical appraisal ofscientific/medical literature). 9,10 Further outcomesinclude increased recruitment into academicmedicine, enhanced employability, and improvedpostgraduate research participation andproductivity. 11,12 There is also emergent evidence tolink increased undergraduate research exposurewith improved clinical decision-making and patientcare. 13 These tangible benefits are reflected instudent attitudes and perceptions, as surveys showthat students value opportunities for conductingresearch, seeing research experience as a means toestablish professional credibility, gain skills,improve their undergraduate curriculum vitae, andconfirm future career plans. 3,14 In any environmentwhere there is intense competition for postgraduatetraining posts (particularly in competitivespecialties such as surgery), undergraduate researchexperience, especially if evidenced through peerreviewedpublications, becomes an importantcommodity. 1,3,15 Several authors have howeverraised questions concerning the value ofundergraduate research activity. They propose thatmany basic science or clinically-based studentresearch projects are of little novelty or scientificimpact, can over-burden institutional governanceprocesses and, in the case of clinical research, mayplace human participants at greater risk due to theresearch inexperience of the studentinvestigator. 16,17 Our experiences over five years ofthe challenges and opportunities in our institutionMedical Science Educator © IAMSE 2013 Volume 23(1S) 99

in providing research opportunities for medicalstudents are likely to be representative of thoseencountered elsewhere, and of interest tocolleagues.Undergraduate Research Projects inMedicine – our Cork ExperienceThe research strategy of the College of Medicine andHealth (incorporating the Schools of Dentistry,Medicine, Nursing, Pharmacy, OccupationalTherapy, and Speech and Language Therapy) atUniversity College Cork has a basic science, clinical,and public health focus, which is supported by theuniversity’s network of hospitals and associatedresearch centers and institutes. The School ofMedicine at UCC has developed a substantialexpertise in professional learning and behavior inthe form of a research-active academic MedicalEducation Unit. University College Cork (UCC)offers three undergraduate programs in medicine: a5 year direct entry [DE] program for Irish and EUschool leavers (with a small number of placesavailable to mature students; ~ 120 students peryear intake); a 4 year graduate entry [GE] programfor graduates predominantly from Ireland andNorth America which commenced in 2008 andcurrently accepts ~ 80 students per year; a twinningprogram with the Allianz College of MedicalSciences in Malaysia (~ 60 students per year). Oneof the exit outcomes in our undergraduate medicalprogram is that students demonstrate evidence ofsuccessful application of scientific process andmethodology to the collection and analysis ofresearch data. To this end, students are required tocomplete a senior research project in the final years[years 4-5 for DE, years 3-4 for GE students], whichconstitutes 10% of their final year aggregate score[see figure 1 for project timelines]. There isflexibility in the type of research deemed acceptablewhich can range from a laboratory-based to aclinical or translation project, and all such projectsare assessed via completion of a minor dissertationof the research project, and oral presentation of theresearch findings to an open forum. We believe thatthe research project completed in the senior yearsfunctions as a capstone module, allowing studentsan opportunity to integrate EBM skills andknowledge gained in compulsory or elective coursesthroughout the curriculum. Additionally, studentsare allowed to complete research-based electivemodules during the preceding years as part of ourstudent selected components [SSC] program. Therole for SSCs within the core undergraduate medicalcurriculum has been reviewed elsewhere, but theirpurpose generally is to extend the depth of study,support EBM, enhance professionalism andpersonal skills and encourage effectivecommunication. 18,19 Our experience is that studentswho are very career aware and have made decisionsregarding their long-term career strategies are mostlikely to pursue a research-based SSC in the earlyyears of the course before the senior researchproject. 4The Senior Research Project ProcessAs indicated in Figure 1, students commence theirsenior project work in year 4 [DE] / year 3 [GE]. Allstudents are given seventeen months to completetheir short project dissertation, from initialapproach of supervisor to completed written report.All students are informed from the outset that theyare expected to initiate, plan and organize their ownresearch projects. They are required to initiatecontact with a research supervisor in their chosenarea of research. While some universities haveencouraged students to integrate with existingongoing projects in their departments of interest,we have encouraged students to approachsupervisors with specific research questions, ratherthan expect the supervisor to suggest researchtopics. 1,20,21 We suggest that the process ofacquainting themselves with their prospectivesupervisor’s current research interests is importantin their development as researchers, reinforcing theself-directed nature of seeking researchopportunities, and fostering an appreciation ofresearch collaboration. Students are also instructedthat if they become embedded with an existingresearch group, it is important that they play anindependent role in the project and contributeintellectually to the conception and design of thestudy. This is also emphasized in the assessmentprocess. With respect to research type, originalresearch and audit-style projects are acceptable,with completion of a systematic review accepted inexceptional circumstances (e.g. where the suggestedsupervisor has a particular expertise in thismethodology).The School of Medicine maintains an activeresearch website, which students are encouraged tovisit from first year onwards. Aiming to ensure thatstudents are aware of ongoing research programs atUCC, this website contains information aboutresearch-related events and opportunities, researchgovernance procedures, and undergraduate fundingopportunities. A number of events are organizedeach year to specifically showcase institutionalresearch to our undergraduate medical students. Allstaff and students receive a monthly newsletteradvertising both staff and student researchsuccesses. In their penultimate year, all studentscomplete a two-week preparatory lecture module.This is composed primarily of didactic lectures andMedical Science Educator © IAMSE 2013 Volume 23(1S) 100

practical skills workshops. As EBM is a central focusthroughout our medical curriculum, this essentiallyacts as a revision course, providing an opportunityfor students to revise and elaborate upon practicalEBM skills. As part of the module assessment, theyare also required to devise and present a projectproposal to school examiners, constituting a concisesummary of the research question, main hypothesis,and justification of the planned methodology.Typically, students require little guidance in theirchoice of research area, as their future careermotivates them in their selection of project area. 3,4All project proposals are subject to full ethicalreview. Further information regarding the researchgovernance process is detailed below.Figure 1: The senior undergraduate research project process at UCCUCC Senior Undergraduate Project inMedicine - Trends and Figures from 2008 -PresentStudents have undertaken a wide variety of seniorresearch projects related to medicine and health.Figures 2 & 3 provide a summary of percentage ofprojects (total n = 498) completed in various areasof medicine (and other clinical and biomedicalsciences) during the years 2008-2012 inclusive. Asindicated in Figure 3B, the majority of researchprojects were quantitatively based, and the crosssectionaldesign was the most frequently employedclinical study design [Figure 3C]. We have foundthat few students select the systematic review optiondue to a perception that other study types are morelikely to result in generation of publication-suitabledata. With respect to study design, there is anincreasing trend towards selection of laboratorybasedexperimental studies in the area of appliedbiomedical sciences (see figure 2).A preliminary comparison of research project marks[comprising aggregate of presentation anddissertation scores] indicated significant groupdifferences between DE and GE students in the year2011-2012 [t (150) = 2.55, p = 0.01], with studentswith a prior degree scoring higher than theirundergraduate-entry counterparts. This is notsurprising, as previous research from our School hasdemonstrated that GE students are more likely toavail of research opportunities during their medicaleducation. 3,4The Senior Undergraduate Research Project– Student PerspectivesAt the outset of the project planning process,student concerns typically focus on degree ofnovelty of their research projects, possibility ofdelayed progress due to research governanceprocedures, and some uncertainty regarding whatstudy criteria increase likelihood of publication inpeer-reviewed journals. In many cases, we find thatstudents feel that their research projects will notcontribute significantly to the body of scientificknowledge. Some of the barriers to effective studentparticipation in the project process include somequestioning of the relevance of the endeavor, assome students feel that it represents anacademically-centered activity which is distant fromthe main focus of their professional education.Medical Science Educator © IAMSE 2013 Volume 23(1S) 101

Figure 2: Number of projects completed, calculated as a percentage of total (n= 498), across the following departments/areas during2008-2012: medicine (including projects in cardiology, dermatology, endocrinology, gastroenterology, general medicine, geriatrics,haematology, immunology, infectious diseases, medical oncology, nephrology, neurology, neurophysiology, ophthalmology, palliativemedicine, radiology, respiratory medicine, and rheumatology), obstetrics and gynaecology (O & G), paediatrics, surgery, general practice(GP), psychiatry, epidemiology and public health, emergency medicine (Emerg Med), biosciences, pharmacy, medical education (MedicalEd).Although students generally find the researchprocess arduous, they enjoy the journey as well asthe opportunity to contribute to knowledge in theirresearch area. 2,9 Both research evidence andanecdotal observations from our institution wouldsupport this interpretation. 3 Table 1 outlines astudent research case study example, including ashort account of the research process from thestudent perspective.experimental subjects is also recognized asintegral. 23,24UCC Undergraduate Research in Medicine:Opportunities and ChallengesThe experience in our school has been that anumber of factors converge to present challengesand barriers to the provision of undergraduateresearch opportunities in medicine. Like manyschools elsewhere we have increased our studentintake across both DE and GE programs at UCC, weoperate in an environment where there are fewerundergraduate research funding schemes, staffteaching and administrative load has increased, andthere is an increasing trend towards introduction ofstricter research governance procedures. However,we have developed several initiatives designed tocounteract the impact of these challenges as follows:1. Streamlining the Internal Research GovernanceProcessIt is generally recognized that developing anunderstanding of research ethics and the workingsof ethical review bodies is an important aspect ofdeveloping skills in clinical reasoning and judgment,as well as the development of professional ethicalbehaviour. 22 Teaching students how to constructresearch protocols that ensure scientifically validfindings while safeguarding participants orFigure 3: Percentage of total number of senior undergraduateresearch projects completed during 2008-2012, summarisedaccording to study type (A), methodology (B), and study design(C).Medical Science Educator © IAMSE 2013 Volume 23(1S) 102

Figure 4: Summary of the dissemination status of student research projects published during the period September 2008 – November2012.The burden of research governance, includingapplication to ethical committee across universitiesand healthcare institutions, is increasing to thepoint that completion of the research project duringthe time allotted within the curriculum is becomingincreasingly difficult. 2,25 This also influencesmedical students’ perceptions of engagement inresearch, as they identify that securing ethicalapproval can prove a major obstacle. 24 However,governance remains crucial, as these observationsare taking place against a backdrop of ongoingconcerns about the potential conflict of interest (inaddition to potential for scientific misconduct)arising from allowing students to gain course creditsfor successful completion of clinical (or indeedpreclinical) research projects. 17 Five separateapproaches have been proposed towards ethicaloversight of student research: (a) a lenientapproach, in recognition of the prioritization withinstudent research projects of learning outcomes, asopposed to research outcomes; (b) a separate“specialized” governance process, due to the conflictof interest noted above; (c) application of strictergovernance processes to student projects due to theincreased risk status of human or non-humanparticipants; (d) excluding the possibility of studentresearch projects as a result of the myriad of ethicaland logistical challenges; (e) application of samescientific and ethical review process towardsstudents projects as those conducted by experienceresearchers. 17This latter approach has been adopted in ourSchool. We feel that student projects should besubject to the same institutional review processes,that they encourage students to apply a morerigorous and careful approach to study design, aswell as increasing the possibility of producingpublication-worthy research data. All studentresearch projects (including clinical audit andapplied biomedical research) are subject toinstitutional ethical review. We operate a noexceptionspolicy, both to ensure that studentsacquire familiarity with clinical and researchgovernance frameworks, and to reduce the potentialfor confusion on the part of supervisors in decidingwhich projects which may/not require ethicalapproval, as this has been an issue elsewhere. 26Students are required to submit a project proposalat an early state of the process (see figure 1), prior topreparation of the ethical application, which issubject to a rapid internal scientific review step byacademic staff within the School of Medicine.Where a study is deemed to contain significantmethodological flaws or may present potentialpractical obstacles, or where the student’s specificcontribution to the project is unclear, major orminor revision is advised. Congruent withprocedures employed by many medical schools, wehave adopted a governance approach which isproportionate to the risks that the majority of theseprojects generate. While it is important toemphasize that student projects are not subject tolower ethical standards, the process is tiered,reflecting degree of risk associated with theproposed project. In common with manyinstitutions, the majority of survey-based studies,audits, and chart reviews are subject to expeditedapproval. Those with greater risk liability aresubject to full ethical review. Where students areparticipating in projects which have already beenapproved by the ethical review body, a revision tothe existing approved protocol is submittedinvolving addition of student names to the project.In the past we have found that one of the primaryreasons for increased administrative burden on theclinical research ethics committee is the necessityfor resubmission of incomplete ethicsdocumentation, resulting in many applicationsMedical Science Educator © IAMSE 2013 Volume 23(1S) 103

eing evaluated on multiple occasions. 27 Reasonsfor return of applications to the applicant haveincluded absence of consent forms, insufficientstudy background, and absence of investigatorsignatures. For this reason, we have introduced aprocedure whereby students are required to submittheir ethics documentation to the School ofMedicine, whereupon applications are checked foraccuracy and completeness. All ethics applicationsare then sent directly to Clinical Research EthicsCommittee of the Cork teaching hospitals (CREC)for review.High-profile press revelations regarding violationsof patient confidentiality has led someundergraduate medical programs to modify theirresearch project module, allow students to generatea project protocol and complete a sham “researchgovernance process”, without collection of data. 2 Wecontend that this practice of a “dummy run” atresearch does not provide a full experience of theopportunities and pitfalls associated with research.We have sought to ensure that, while acknowledgingthe challenges of student research projects (i.e.deadlines, place in curriculum, administrativedelays), this does not involve compromising existingscientific and ethical standards and that a successfulundergraduate research program should seek abalance between both priorities.2. Space in the CurriculumIt has been noted in the literature that one of theobstacles many medical schools encounterregarding integration of research projects within theundergraduate program is finding space in thecurriculum. In order to reduce the potential waste ofopportunity arising for poor-quality studentresearch employing patients or non-clinical humanparticipants, we have sought to integrate thedevelopment of EBM and research skills from thebeginning of the degree program, recognizing thatinculcation of research knowledge and fostering ofspecific skills (e.g. data manipulation and analysis,conducting a literature review etc.) at an early stagewill raise the quality of the senior researchprojects. 28 Our students find that the prospect of ahigh stakes senior research project makes suchteaching more relevant to them and embeds theEBM curriculum in the course. 3Dr. Stephen Power graduated in medicine from UCC in 2011, having studied medicine via the GE route. Hecompleted his senior undergraduate project within the Department of Medicine under the supervision ofProfessor Mary Horgan, Consultant Physician in Infectious Diseases at University College Cork. The title of hisproject was “Challenges in chronic disease management of HIV infection: A study of predictors of medicationnon-compliance and assessment of long-term drug toxicities in a treated population”. He has since presentedthis work at both national and international conferences.“The final year project is often considered a rather unwelcome, time-consuming and arduous task especiallyin the face of the many other responsibilities which final year begets. However, despite these criticisms,ultimately, I found the experience to be a really rewarding one. Of all the elements of final year, it is the onlyaspect which is directed and dictated by the student. Like them or not, medicine, surgery, obstetrics andgynaecology and paediatrics are not optional components of the curriculum. In contrast, the Final YearProject allows you to personally decide on an area or topic that particularly interests you and to becomemore actively involved in this field.... Any final year project is constrained by specific limitations; namelythat only a certain amount of time can be devoted to the task and secondly, that it is generally a solo effortwithout the back-up of a more extensive team which the more seasoned researcher might have at theirdisposal. Therefore, designing a project that is feasible and achievable within the context of the fourth/finalyear schedule can be one of the most problematic steps of the entire process. Assessing all of the challenges inthe management of HIV was unrealistic, no matter how big your research group or budget. Therefore, myproject concentrated on two small areas of the puzzle.... Having concluded my final year project, I believethat while opinions amongst students regarding the endeavour will, no doubt, remain mixed, it certainlygives undergraduates a flavour for research and the associated opportunities and pitfalls. In addition, thechance to become actively involved in research in an area of your interest at an undergraduate level (albeit asmall involvement!) is an opportunity that will be valuable when competing for positions in the same field atpostgraduate level. Although the hours spent sifting through thick patients’ files or extracting data fromlarge databases is, admittedly, exasperating and laborious at times, the personal satisfaction of developingyour own, individual idea and creating a small piece of novel information makes the endeavourunquestionably worthwhile.”Table 1: Undergraduate research in medicine – a student’s perspectiveMedical Science Educator © IAMSE 2013 Volume 23(1S) 104

Competing clinical exposure requirements acrossthe senior cycle of the undergraduate medicalcurriculum mean that very little course time can bededicated to the project dissertation. Students arerequired to balance the time and effort betweentheir project and other assessments whichcontribute to their degree score. We have overcomethis challenge by adopting a longitudinal approach.The importance of the senior research project isemphasized from the outset, students are researchenabled as the course progresses and undergo a twoweek preparatory course described earlier. Finally,students are given an extended period of time [17months] to design and complete their researchstudy. The curriculum contact time (excludingmeetings with a supervisor) required to specificallysupport a senior research project is limited. Theextended project timeline relieves pressure onstudents to generate project results quickly, andincreases the attractiveness of project supervisionfrom the supervisor’s perspective.3. Issues related to CapacityAs student numbers increase, there is anaccompanying pressure to identify projects andsupervisors. One solution we have successfullyexplored is to widen the scope of potential projectareas by encouraging interdisciplinary researchopportunities, as well as supervision of students byacademic staff from other clinical sciences (e.g.pharmacy, nursing etc.). The GMC has emphasizedthe importance that medical schools provide formalcurricular interdisciplinary learning opportunitiesto today’s undergraduate medical students. 7 In abroader context, the benefits of interdisciplinarypractice across a variety of healthcare contexts arewell documented, with poor relations betweenphysicians and allied health professionalscontributing to reduced patient satisfaction andpoorer overall treatment outcomes. 29 In our school,as part of a multinational EU-funded project,BioApp [http://www.bioapp.eu], we haveestablished a biomedical design research modulewhich combines undergraduatemedical/engineering students at the seniorundergraduate level in interdisciplinary researchprojects, wherein they design novel biomedicaldevice and employ engineering expertise in theresolution of healthcare problems. Opportunities forsimilar novel collaborations will vary but areavailable in each institution and often help to fosterinnovative research themes.4. Focus on Research OutputsWe rely on original peer-reviewed publications andconference abstracts as evidence that students aresuccessfully disseminating research findings. Whilenot factored into course assessment, students areencouraged and incentivized to prepare their workfor peer-reviewed publication, to compete forresearch awards such as summer undergraduateresearch scholarships available from nationalscientific research funding bodies and selectedcharitable organizations, and to present results atnational/international research meetings. Facultywithin the medical education unit are required tofunction as a resource to support students in thisregard. Additionally, internal funding is provided,on a competitive basis, for students who wish topresent their research findings at national andinternational scientific meetings; these fundingawards are capped and generally do not fully coverall expenses associated with attending a conference.Priority is given to students who have been invitedto present their work orally, as well as to those whohave applied previously (successfully or otherwise)to external funding bodies for funds to support theirresearch activity. Figure 4 provides a summary ofthe dissemination status of student researchprojects published during the period September2008 – November 2012. Monitoring of outputs canbe challenging as many of these projects aresubsequently prepared for publication in themonths and years following graduation, especiallyas students begin to apply for postgraduate trainingpositions. Therefore, it is likely that outputs areunderestimated. It is important however todocument successes to ensure continued support forthe effort invested. Establishing a framework inwhich successful staff-student collaborations areregularly advertised, even in internal newsletters,further incentivizes others to disseminate their workin a peer-reviewed arena.5. Securing Buy-in from Research-active Cliniciansand Basic Science StaffThe onus is on medical schools to foster a ‘win-win’attitude to undergraduate research participation,where students benefit in a number of ways(complete course requirement, gain researchexperience and outputs, explore career areas), aswell as clinicians and academic faculty mentors(active research program, completion of serviceaudits, publications and other outputs). Addressingreluctance of some staff members to includestudents who are time-limited in terms of theircommitment to a project, and who may havespecific training needs, is a key challenge inensuring that the students are mentored by amotivated group of supervisors. 5 Some authors haveMedical Science Educator © IAMSE 2013 Volume 23(1S) 105

suggested that academic schools/departmentsshould provide staff training opportunities instudent supervision, as well as other means offaculty support. 3,30Particularly in the case of laboratory-based projects,research staff may be wary about allowing relativelyinexperienced students gain access to expensiveequipment, and may feel that this same lack ofexperience may result in less efficient use oflaboratory consumables.However, at a time where wider economic issueshave resulted in contraction of research fundingopportunities across the biomedical sciences,medical students can assist many research staff tocomplete studies or to generate pilot data in theabsence of alternative funding for research students.We have also found that, in cases where researchsupervisors have explicitly requested a student witha specific skill-set or range of techniques, theresultant “matchmaking” exercise has meant thatthe research supervisor values the time invested inthe project, while the student benefits from thesupervisor’s enthusiastic engagement in the project.This has proven particularly useful in the case of GEstudents, many of whom have already completedbiomedical research projects as part of their firstuniversity degree. Additionally, in recognition of theburden of completion of research governanceprocedures, we support students during their twoweekteaching block as they complete the necessarydocumentation, and provide follow-up supportwhere necessary. This support minimizes theadministrative burden, freeing up supervisors toassist the student with project design and logisticalarrangements, through to manuscript write-up,addressing reviewer concerns etc. In order toencourage clinicians who do not have a substantiveacademic appointment to undertake supervision ofstudent research, special consideration is given tosuch participation in the awarding of honorary titlesor any adjunct promotion pathways. Furthermoresuch staff-student collaborations are advertised as aroute to promote postgraduate student recruitment.ConclusionUndergraduate medical student research ispromoted by all accrediting bodies. Students arealso keen to avail of both laboratory-based andclinical research opportunities but are aware of thechallenges involved, as indeed are researchsupervisors.Our experience of enabling student research andrequiring research output as a learning outcome ofour course has required us to explore solutions tothe common institutional hurdles and identifysolutions to allow us to embed the activity in thecurriculum, support and encourage our students,streamline student research governance and securesupervisor engagement. We hope that ourexperiences may help and encourage others.Key WordsMedical students, research projects, researchgovernance, research outputsNotes on ContributorsEILEEN DUGGAN, PhD, is Lecturer in MedicalEducation at University College Cork, Ireland.KIERAN DORAN, PhD, is Senior Lecturer inHealthcare Ethics at University College Cork,Ireland.SIÚN O’FLYNN, MB B Med Sci (Hons) MRCPi,FRCPI, is Head of Medical Education at UniversityCollege Cork, Ireland.COLM M.P. O’TUATHAIGH, PhD, is Lecturer inMedical Education at University College Cork,Ireland.References1. Cursiefen C, Beer M, Altunbas A. Should allmedical-students do research during theirstudies?. Med Educ. 1995; 29: 254.2. Jones M, Singh S, Meakin R. Undergraduateresearch in primary care: is it sustainable? PrimHealth Care Res Dev. 2008; 9: 85-95.3. Burgoyne LN, O’Flynn S, Boylan GB.Undergraduate medical research: the studentperspective. Med Educ Online [Internet]. 2010Sep 10 [cited 2012 Dec 12]; 15.4. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2939395/Medical Science Educator © IAMSE 2013 Volume 23(1S) 106

5. O’Tuathaigh CMP, Duggan E, Khashan AS,Boylan GB, O’Flynn S. Selection of studentselected component [SSCs] modules across themedical undergraduate curriculum: relationshipwith motivational factors. Med Teach. 2012; 34:813-20.6. Rosenblatt RA, Desnick L, Corrigan C, KeerbsA. The evolution of a required research programfor medical students at the University ofWashington School of Medicine. Acad Med.2006; 81: 877-81.7. WFME Global Standards for QualityImprovement in Basic Medical Education[Internet]. 2011 Sep 13 [cited 2011 Dec 20].Availablefrom:http://www.wfme.org/standards/bme.8. General Medical Council. Tomorrows Doctors,outcomes and standards for undergraduatemedical education. London: General MedicalCouncil, 2009.9. British Medical Association. Academic medicinein the NHS: driving innovation and improvinghealthcare. London: British MedicalAssociation, 2008.10. Frishman WH. Student research projects andtheses: should they be a requirement formedical school graduation. Heart Dis. 2001; 3:140-4.11. Greenhalgh T, Wong G. Doing an intercalatedBSc can make you a better doctor. Med Educ.2003; 37: 760-1.12. Kemph JP, Sodeman W, Claybrook JR, Rand C.A follow-up of a program to foster medicalstudents’ interest in research and academiccareers. Acad Med. 1991; 66:122.13. Morrison J. Academic medicine andintercalated BScs. Med Educ. 2004; 38: 1128-9.14. Sastre EA, Denny JC, McCoy JA, McCoy AB,Spickard A. Teaching evidence-based medicine:Impact on students’ literature use and inpatientclinical documentation. Med Teach. 2011; 33:306-12.15. Heylings DJA, Tariq VN. Reflection andfeedback on learning: a strategy forundergraduate research project work. AssessEval High Educ. 2001; 26: 153-64.16. Nikkar-Esfahani A, Jamjoom AAB, FitzgeraldJEF. Extracurricular participation in researchand audit by medical students: opportunities,obstacles, motivation and outcomes. MedTeach. 2012; 34: e317-24.17. Bortolotti L, Heinrichs B. Delimiting theconcept of research: an ethical perspective.Theor Med and Bioeth. 2007; 28: 157-79.18. Edwards SJL. Student projects in medicine: alesson in science and ethics. Account Res. 2009;16: 285-306.19. Riley SC, Gibbs TJ, Ferrell WR, Nelson PR,Smith WC, Murphy MJ. Getting the most out ofstudent selected components: 12 tips forparticipating students. Med Teach. 2009; 31:895-902.20. Murdoch-Eaton D, Ellershaw J, Garden A,Newble D, Perry M, Robinson L, et al. Studentselectedcomponents in the undergraduatemedical curriculum: a multi-institutionalconsensus on purpose. Med Teach. 2004; 26:33-8.21. Greenhalgh T, Seyan K, Boynton P. "Not auniversity type": focus group study of socialclass, ethnic, and sex differences in schoolpupils' perceptions about medical school. BMJ.2004; 328: 1541.22. Greenhalgh T, Russell J. Promoting the skills ofknowledge translation in an online master ofscience course in primary health care. J ContinEduc Health Prof. 2006; 26: 100-8.23. Self DJ, Wolinsky FD, Baldwin DC Jr. The effectof teaching medical ethics on medical students’moral reasoning. Acad Med. 1989; 64: 755-9.24. Roberts LW, Green Hammond KA, Geppert CM,Warner TD. The positive role of professionalismand ethics training in medical education: acomparison of medical student and residentperspectives. Acad Psychiatry. 2004; 28: 170-82.25. Roberts LW, Warner TD, Hammond KA.Coexisting commitments to ethics and humanresearch: a preliminary study of theperspectives of 83 medical students. Am JBioeth. 2005; 5: W1-7.26. Oakeshott P, Yadava R. Research governance:major barrier to student research. Brit J GenPrac. 2006; 56: 139-40.27. Alcolado J, Bennett R. Research or audit?Ethical approval for medical student clinicalprojects. Med Educ. 2006; 40: 491.28. Bueno M, Brevidelli MM, Cocarelli T, SantosGM, Ferraz M, Mion Jr D. Reasons forresubmission of research projects to theresearch ethics committee of a universityhospital in Sao Paulo, Brazil. Clin. 2009; 64:831-6.29. Laidlaw A, Aiton J, Struthers J, Guild S.Developing research skills in medical students:AMEE Guide No. 69. Med Teach. 2012; 34: 754-71.30. Larson E. The impact of physician-nurseinteraction on patient care. Holist Nurs Pract.1999; 13: 38–46.Medical Science Educator © IAMSE 2013 Volume 23(1S) 107

MEDICAL SCIENCE EDUCATORThe Journal of the International Association of Medical Science EducatorsMed Sci Educ 2013; 23(1S): 108-118MONOGRAPHA Laboratory for Education in MolecularMedicine: a Dedicated Resource for MedicalStudent ResearchCurt M. Pfarr, Debra Bramblett, David Osborne, Amy Trott,Heather Balsiger, Martine Coue, Richard Brower & Tanis HoggPaul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USAAbstractThe Paul L. Foster School of Medicine in El Paso, Texas seated its inaugural class in 2009 and introduced ahighly-integrated pre-clinical curriculum that provides our students with a solid introduction to the scientificprinciples of medicine, medical skills, early clinical experiences, ethics and professionalism. To further enhancetheir undergraduate training, all students additionally complete a scholarly concentration requirement called theScholarly Activity and Research Program (SARP). Students can choose a wide variety of topics for this facultymentoredactivity; however, about two-thirds of the students choose projects relating to basic, clinical ortranslational research. To broaden the on-campus opportunities for students in these areas we have developed aresearch laboratory, called the Laboratory for Education in Molecular Medicine (LEMM), that is fully-dedicatedfor mentored SARP projects. This ‘community’ laboratory is housed in the Department of Medical Education andrepresents a unique model for the establishment and development of viable research projects. We discuss theevolution of the LEMM, its current organization and the challenges and opportunities in maintaining andgrowing this valuable resource.Introduction & BackgroundIn the more than three decades since concerns werefirst raised about the declining number ofphysician-scientists in the United States, there hasbeen an increasing awareness of the negativeimplications this shortage will have on researchdrivenadvancements in medicine. 1-3 Yet, the trendof decreasing numbers of MDs pursuing careers asphysician-scientists appears to have continued intothe 21st century. 4-5 To address this critical shortage,several national initiatives were established toincentivize recent medical school graduates topursue research careers, with early indicationssuggesting positive outcomes in the form ofrenewed growth in the physician-scientist careerpipeline. 6-8 Another welcome trend is the growingnumber of U.S. and international medical schoolsestablishing required and elective scholarlyCorresponding author: Tanis Hogg, PhD and Curt Pfarr, PhD,Department of Medical Education, Paul L. Foster School ofMedicine, 5001 El Paso Drive , El Paso, Texas 79905, USA. Tel:+1 915 215 4360; Fax: +1 915 783 1715;Email: curt.pfarr@ttuhsc.edu, tanis.hogg@ttuhsc.educoncentration (SC) programs as part of theirexisting medical curricula. 9-16 Beyond the desirableinfluence these SC programs have in cultivatingacademic career aspirations of medical students,there is a general belief that participation inresearch or scholarship during medical schooltraining will produce more competent physicians byfostering skills development within the realms ofcritical thinking, critical appraisal of medicalliterature, and lifelong learning. 17-19 At the newlyestablished Texas Tech University Health SciencesCenter Paul L. Foster School of Medicine (TTUHSC-PLFSOM) in El Paso, TX, a required SC curricularcomponent named the ‘Scholarly Activity andResearch Program’ (SARP) was developed andimplemented as part of the school’s innovativemedical curriculum. 10,20 In this article, we discussthe subsequent development and implementation ofa hybrid education/research environment – the‘Laboratory for Education in Molecular Medicine’(LEMM) – as a means to support SARP by enablingmedical students and medical education faculty toengage in collaborative basic and translationalresearch projects. We discuss the conceptual modelMedical Science Educator © IAMSE 2013 Volume 23(1S) 108

and physical design of the LEMM including itsevolution from a strict educational laboratory spaceto a flexible communal research and educationenvironment. We consider the limitations andchallenges of conducting independent ‘siloed’research projects in the LEMM, and discuss ourprogression towards a more conceptually appealingmodel of synergistic ‘team-based’ research themeswith complementary scholarly pathways.Figure 1: Schedule for completion of the Scholarly Activity and Research Program requirement at the Paul L. FosterSchool of Medicine. All students are required to submit a Project Plan towards the end of their first year. In addition, all students mustpresent their work as a poster presentation at a student research symposium held each fall. The students have the option of completingwork on their project during the summer between the first and second year (Track 1) or continuing work through the second and even thethird year (Tracks 2 and 3). If students are successful in publishing their results or presenting at national level meetings they can apply fora Distinction in Research and Scholarship award (DIRS) during the spring of their third or their fourth year.A Scholarship/Research Requirement atTTUHSC-PLFSOMThe hallmark of the innovative PLFSOM medicalcurriculum is the high level of integration andclinical contextualization that is designed into ourclinical presentation-based approach to surveyingthe basic medical sciences and clinical skillsunderlying the practice of medicine. During ourpreliminary curriculum-development phase, fourcourses were created as the core pre-clinicalcurriculum: (1) The Scientific Principles ofMedicine; (2) Medical Skills; (3) Society,Community and the Individual; and (4) Masters’Colloquium. Collectively, these courses weredesigned to address a broad majority of thePLFSOM Institutional Learning Objectives (ILOs).However, upon critical evaluation of the degree towhich each curricular component addressed theILOs, the PLFSOM Curriculum and EducationPolicy Committee (CEPC) expressed concern thatsome ILOs received comparatively limited attention,specifically, those related to (i) the application of thescientific method to problem solving, criticalthinking and literature appraisal, (ii) thecommunication of knowledge, (iii) the sophisticateduse of digital resources, and (iv) self-directedlifelong learning. To address these concerns, thefaculty conceptualized a required SC component,the Scholarly Activity and Research Program(SARP), which subsequently received approval bythe CEPC and was implemented as part of thefounding curriculum with our charter class in2009. 10The scope of research areas supported by SARP wasdesigned to be deliberately broad to enable thepursuit of a project that most closely matches astudent’s interests: (1) basic, clinical andtranslational research; (2) epidemiology,community-based, behavioral, public andenvironmental health, international-global health;and (3) medical humanities, biomedical ethics,health policy and medical education research.Figure 1 summarizes the structure of the ScholarlyActivity and Research Program that allows thestudents three different tracks to complete thiscurriculum requirement, with each track having abroader time envelope spread over the fourundergraduate medical school years. However,outside of the 10 week summer between the firstand second year, there is no dedicated time forresearch activities. Thus, completing and excellingat an individual research project requires a studentto be highly dedicated and organized and to be asMedical Science Educator © IAMSE 2013 Volume 23(1S) 109

efficient as possible. All students are stronglyencouraged to work with their mentors closely tooptimize their research efforts and to potentiallypublish their results in peer-reviewed journals andpresent posters or talks at national levelconferences. Achieving these ambitious outcomesenables the student to apply for a special Distinctionin Research and Scholarship (DIRS) award availableto them. This DIRS award consists of an annotationon the graduation diploma and, if application ismade in the spring of their third year, provides astrong commendation and description of thestudent’s research activities in their MedicalStudent Progress Evaluation component of theresidency application (Figure 1).Now in its fourth year of implementation, the SARPrequirement is highly regarded by our students asindicated by the Independent Student Analysiscomponent of the institutional LCME self-study. 21We have found that ~ 64% of our school’s medicalstudents elect to work on projects in the firstcategory (basic, clinical and translational research)with the remainder selecting projects distributed inthe other two categories (Table 1). Since most of ourstudents prefer the first research and scholarshipcategory and considering an anticipated class of 100students in 2013, the increasing demand for studentresearch experience in this area has createdpragmatic concerns related to faculty resources,mentorship, finances, research infrastructure, andculture – much as it has with SC programs at othermedical schools. 19Evolution of the Laboratory for Educationin Molecular Medicine (LEMM)By national standards the faculty body at thePLFSOM is relatively modest, with a current fulltimefaculty roster of 39 basic scientists and 207clinicians. 21 This lean faculty model posesconsiderable creative challenges in light of theincreasing demand for SARP projects in the basic,clinical and translational research domains.Although a number of students elect to performtheir SARP projects at other institutions, a growingnumber have been matching with PLFSOM facultymentors in our clinical departments and our fourtrans-disciplinary Centers of Excellence within theDepartment of Biomedical Sciences. Given that thebulk of the pre-clinical curriculum is delivered by adedicated group of basic scientist and clinicianmedical educators in the Department of MedicalEducation, the Medical Education faculty representsan important additional pool of available SARPmentors. However, until recently a chief barrier toleveraging the basic and translational researchexpertise of the Medical Education faculty has beenthe lack of dedicated research laboratory space andequipment (basic scientists in the Department ofMedical Education are under contract to dedicate~80% of their time and effort to curriculumdevelopment and delivery, and are not expected todevelop competitive NIH-funded basic-scienceresearch programs). To address these emergingissues, faculty in the Department of MedicalEducation who expressed a desire to serve as basicscience and translational research SARP mentorsestablished a focus group and held a series ofideation sessions, leading to a consensus proposal toconvert a dedicated BSL2-certified educationallaboratory space into a more flexible environment tobe used for core curriculum-based laboratoryexercises (e.g., TBL-based microbiology labsessions) as well as SARP-driven basic andtranslational research projects. Considering thelimited number of annual curricular laboratoryexercises scheduled in this space, the concept ofusing the facilities more efficiently and productivelyto support the school’s ILOs was universallyattractive to the faculty and administration. Justprior to seating our first class (July 2009) thePLFSOM administration instructed the focus groupto develop a facilities reinvestment funding proposalto finance the conversion of this dedicated BSL2teaching laboratory into a more flexible researchand education environment which could supportcore curriculum elements in addition to a widerange of SARP-based research projects. Theresulting proposal – to create a state-of-the-art‘Laboratory for Education in Molecular Medicine’(LEMM) – was awarded an initial investment of$1.2 million for renovations and instrumentation.LEMM: Layout and OrganizationTwo main goals in remodeling the available spacesand assembling the equipment and instrumentationto support this unique laboratory were to identifyand provide justification for: 1) items necessary forany expected PLFSOM student Scholarly Activityand Research Program activities that would beconducted in the LEMM; and 2) specific state-ofthe-artinstrumentation deemed essential for thewidest variety of standard cellular and molecularbiology methodologies and techniques. Anadditional important consideration was that thelaboratory be 100% radioactive-free; this simplifiesboth certification and safety training for the facultyand students and provides an overall more safe andfriendly environment for both curricular labs andresearch activities.Medical Science Educator © IAMSE 2013 Volume 23(1S) 110

Research Group Class 2013 Class 2014 Class 2015Basic Sciences, Translational Research, Clinical Research 59% 63% 70%Epidemiology, Community-based, Behavior, Public andEnvironmental Health, International-Global Health30% 26% 23%Medical Humanities, Biomedical Ethics, Health Policy, MedicalEducation Research11% 11% 7%Medical Student ClassStudents mentored by PLFSOM faculty2013 75%2014 59%2015 66%Table 1: Distribution of student project types for SARP requirement for the first three classes at the new Paul L. FosterSchool of Medicine. Students can choose to pursue their research / scholarly projects in a wide range of fields grouped broadly into thethree indicated categories. Basic science translational and clinical research (Group A) accounts for ~64% of all projects undertaken by thecombined 259 students in these classes. Of these 165 research projects, 62 were pursued with mentors and performance sites external to thePLFSOM.Figure 2: Laboratory for Education in Molecular Medicine: layout and design. The primary teaching laboratory space hasseating to accommodate 60 students for curricular labs in microbiology supporting the Scientific Principles of Medicine course. The labsspace is available to students anytime once safety training is completed. This same laboratory space is used in support of student researchprojects at all times when teaching laboratories are not being prepared or executed. A comprehensive set of molecular medicine/biologyequipment and instrumentation is located around the periphery of the main teaching area. In addition, two preparative rooms areimmediately adjacent to the main lab space providing chemical and bacterial prep areas, a dedicated mammalian cell culture area withflow cytometry and a microscopy suite along with the lab manager station.Medical Science Educator © IAMSE 2013 Volume 23(1S) 111

The layout and design of the Laboratory forEducation in Molecular Medicine is depicted inFigure 2. Three dedicated laboratory rooms with acombined footprint of 2700 square feet include alarge primary teaching lab space and two smallerlabs used for preparative activities in support ofboth curricular microbiology sessions and researchactivities (e.g., dishwashing, autoclaving, media andsolution preparation, bacterial culture, etc.). Thelarge primary teaching lab can seat up to 60students at custom-designed oval or semi-ovaltables that are configured for both AC power andethernet connectivity. Seating for such a large groupis only necessary for the microbiology wet-labs thatare delivered in support of the Scientific Principlesof Medicine course; however, these tables can beused as lab benches during the summer andintervals between teaching laboratories in supportof student research. Students are also welcome touse these lab benches at any time for self-study; e.g.,using available microscopes for microbiology,histology and pathology review.Table 2: Instrumentation ensemble installed in the PLFSOM Laboratory for Education in Molecular Medicine.Instruments support a robust standard set of molecular and cell biology methodologies and techniques. In particular, all classic radiationbaseddetection methods are replaced with corresponding photometric methods.Research equipment and instrumentation is locatedat the periphery of this main teaching lab, keepingthis primary space relatively open and uncluttered.Evenly distributed along two sides is a series of deepstainless sinks. Residing between the sinks includeelectrophoresis stations, a variety of centrifuges,shakers and incubators, sonicators and refrigeratedstorage (+4 o C, -20 o C, -80 o C, and liquid nitrogen)rounding out the equipment in the main teachingarea. Two wall-mounted large LCD flat-panelscreens are located on the front wall for projectionsfrom PCs or from video microscopes. A pair ofshared PC workstations is dedicated to molecularbiology and protein structure software. Each ofthese workstations can also project to the LCDpanels for wider viewing.In addition to the standard repertoire of equipmentto support basic molecular biology methods, a set ofmore specialized instrumentation is distributedthrough the three lab spaces to facilitate specializedexperimental techniques (summarized in Table 2).In particular, mammalian cell culture, stem cellbiology, quantitative PCR, flow cytometry, roboticliquid handling, chromatography, proteincrystallization, and automated imaging systems aresupported.Medical Science Educator © IAMSE 2013 Volume 23(1S) 112

Two full-time staff members are dedicated to theLEMM: a lab manager and a research technician.This staff ‘team’ is responsible for facilitating allcurriculum and research activities under facultysupervision. They also advise and implement safetypolicies and provide support to the faculty andstudents for SARP research activities. Importantly,this team manages the budget and lab ordering andprovides routine maintenance and upkeep ofinstrumentation and equipment.Student Research Project DevelopmentCurrently, there are a number of projects in theLEMM that have facilitated completion of SARPrequirements for eight students, with an additional12 students’ research on-going. These projects covera range of research areas including: detection ofHTLV serotypes in human transplant tissues; coloncancer cell growth analysis; crystallographicstructure determination of translation proteins;retina development; and muscle cell differentiation.These individual projects have developed primarilyat the level of a single mentor working with one orseveral students. Rather than facilitating a wideningarray of divergent research topics we are exploringways to augment the research environment in theLEMM to take advantage of the unique communalaspect of the lab. One strategy was to identify arelevant disease or clinical problem that providesmultiple research angles that are amenable to themolecular biology methods and techniques we haveconcentrated in the LEMM. The idea was toconsolidate a set of projects, and thereby coalesce agroup of faculty and students into more effectiveinteractions, and to provide useful overlap andpotential synergy between individual student SARPprojects. To this end, we identified DucheneMuscular Dystrophy as a suitable disease for such afocus.Developing cell and gene therapies forDuchenne Muscular DystrophyDuchenne Muscular Dystrophy (DMD) is a common(~1/3600 live births) life-threatening diseasecaused by X-linked mutations in the dystrophingene. Following the discovery of the gene in 1986,DMD has become, among all the musculardystrophies, the best understood at the molecularlevel, and is devastating in terms of disease progressand outcome. 22,23 Boys with DMD typically exhibitmotor dysfunction by 5 to 6 years of age, arewheelchair-bound in their mid-to-late teens, and diein their 20s due to organ failure (cardiovascular andrespiratory). Thus, the etiology of DMD is knownwith certainty and there is currently a large androbust research community exploring various basicbiology questions and therapeutic approaches tothis disease; therefore, we decided to develop aconsortium of research projects for our medicalstudents focusing on DMD (Figure 3). 24-28 Bydeveloping this focus, or center of gravity, for thestudent projects several important advantages areobtained. First, overlap between different projectsfacilitates cooperation between groups of studentsallowing more efficient use of their limited time andeffort committed to their research. Also, while thestudents are working on distinct individual projectsthey can share a common background literatureconcerning basic, translational and clinical researcharound DMD. This facilitates journal clubs andcommon lab meetings to bring together bothstudents and mentors sharing these interests.Finally, as projects progress synergy will naturallydevelop as students share ideas, reagents andresults.While there are currently no effective treatments forDMD, several cell and gene therapy strategies holdmuch promise and we have selected a subset ofthese for project development in the LEMM. 24-28These experimental approaches are tractable interms of both scope and resources available to ourstudents. Importantly, these projects involvemethodologies and techniques that will introducethe students to the most modern technology and upto-dateapproaches at developing effective therapiesfor DMD. Of course, the gene- and cell-basedexperimental strategies for DMD have many generalaspects that are relevant to research on a largenumber of both genetic and non-genetic diseases,including diabetes and cancer. Three ‘themes’ arebeing pursued for this LEMM project consortium(Figure 3).The first project theme is centered on basic musclecell biology. An in vitro model for skeletal musclecell differentiation is being refined in the LEMMbased on mouse myoblasts. These cells haveengineered inducible transcriptional cassettes stablytransfected through which several regulators ofdifferentiation can be controlled. 29 The secondtheme involves stem cell biology: inducedpluripotent stem cells (iPSCs) will be generatedfrom myoblastic cell lines through introduction of astandard cocktail of inducing genes. 28,30,31 Recentwork has demonstrated the feasibility of producingiPSCs from a patient’s own cells, thus providing animportant avenue for cell-based therapies targetinggenetic diseases, including muscular dystrophy. 32,33We hypothesize that by modulating differentiationthrough introduction of regulatable geneticelements, muscle cells will be rendered moresusceptible to induction of stem cell-like properties.This is an important consideration as any eventualMedical Science Educator © IAMSE 2013 Volume 23(1S) 113

effective therapy will regulate proliferation anddifferentiation of the muscle cells and precursors inthe living animal. 28,33 The in vitro characteristics ofthe various recombinant cell lines will becharacterized using RT-PCR arrays for muscledifferentiation, cell-cycle and stem cell markers.Further, the in vitro capacity to differentiate intocontractile myofibers will be determined usingstandard cell-based assays and live-cell microscopy.Our third experimental theme is on the structuralbiology of muscle cells. Projects related to thistheme include determination of the threedimensionalstructure of important muscleregulatory protein complexes containing myostatin,dystrophin and utrophin. Generation ofrecombinant proteins, purification andcrystallization will be accomplished in the LEMMfollowed by X-ray diffraction analyses performed incollaboration with the PLFSOM Department ofBiomedical Sciences X-ray Microanalysis corefacility. Developing a more complete understandingof the structure and function of dystrophin andutrophin, for example, will provide insight for thedesign of 'mini-genes' that can be ectopicallyexpressed and potentially rescue diseased musclecells. 25,34,35 Each of these experimental themescentered on DMD can easily generate multipleindividual SARP projects, each of which can developindependently to allow students a certain level ofautonomy and ‘ownership’ of their projects, whileproviding an opportunity for sharing a commonresearch endeavor with their fellow students andfaculty mentors. In addition, while studying themolecular details of this disease for their researchprojects, through participation in journal clubs anddiscussion groups students will be introduced toclinical, public health and epidemiological aspectsof muscular dystrophy in the local, national andglobal communities.Figure 3: Consortium of student research projects centered around Duchenne muscular dystrophy. This well-characterizedgenetic disorder was chosen to provide a number of experimental approaches generating themes for student research projects. Studentspursuing projects in each of these three theme areas will share a common set of background literature that will facilitate group discussionsin a journal club format, along with sharing ideas about projects and experiments.Prospects and ChallengesThe development of the SARP curriculumrequirement and the subsequent ‘spin-off’ of theLEMM resource has been an exciting and importantdevelopment for our new school. In particular, theSARP and LEMM have substantially contributed toour fulfillment of LCME accreditation standards,specifically ED-17A (that mandates that medicalschools introduce students to clinical andtranslational research), through the deliberateexpansion of student-centered opportunities toengage in translational biomedical science research.The projects pursued in the LEMM by our medicalstudents are designed to merge the worlds ofmolecular medicine, molecular biology andtranslational research. They offer our students aMedical Science Educator © IAMSE 2013 Volume 23(1S) 114

variety of important experiences that will provide asolid introduction to scientific methodology and thescientific way of knowing. By combining highqualitymentoring with the accessibility and supportof a fully equipped molecular biology laboratory,our students can participate in cutting-edgeresearch with the full expectation of publishingmeaningful results in good journals. However, theLEMM is a unique model for a functioning researchlaboratory in that it is a community, shared researchspace committed only to medical student research.As the PLFSOM class size grows to 100 students wecan expect approximately 60 students pursuingbasic, clinical or translational research projects,with the majority remaining on the PLFSOMcampus (Table 1). To date eight faculty mentorshave worked with SARP students in the LEMM;currently, we anticipate a ‘steady-state’ of five toseven faculty mentors from the Department ofMedical Education working with 12 to 18 studentspursuing their SARP projects with the LEMM as theperformance site. Thus, the LEMM can host asignificant fraction of our students. Importantly,developing medical student scholarship throughresearch will provide important achievements insupport of tenure and promotion for members ofthe Department of Medical Education. While facultytrained in the biomedical sciences have limited timeand effort allocated for research activities, they canderive enhanced recognition of this work throughthe transformation of student novices intopublished investigators.Reasonably accurate projections for LEMM use isnecessary to allow for planning in areas ofpersonnel, budgeting, and growing infrastructure.An important goal in managing this resource is toremain as flexible as possible, accommodating awide range of research projects and student / facultyinterests. While the discussed project themescentered on muscular dystrophy can provide auseful template for creating synergistic activities,every accommodation will be made for projectsoutside of this area. A diversity of projects will alsostrengthen the learning environment. While theinitial set-up and organization of the LEMM wasdesigned to provide support for a standardrepertoire of techniques and methodology in celland molecular biology, careful consideration will begiven for any additional equipment andinstrumentation so that maximum flexibility andutility is maintained.significant challenge. Limited financial supportexists for individual projects at the departmentallevel and intramural competitive funding is alsoavailable to faculty in the Department of MedicalEducation. While support for two full-time staffpositions is secure, we are still developing ideas forcomprehensive and ongoing maintenance andsupport of equipment and instrumentation.Collaborative arrangements with outsideinstitutions will be an additional viable route tosupport SARP projects both financially andintellectually. Ideally, PLFSOM SARP studentscould spend time in remote laboratoriesstrengthening any collaboration; reciprocally,external graduate or medical student researcherscould be hosted during summers at the PLFSOM.Such exchanges could bolster progress and alsoexpose students to the challenges of setting up andnurturing productive collaborations with ‘outside’groups. In particular, for the muscular dystrophyprojects, as we develop viable cell- and gene-basedtherapies collaboration with larger lab groups willbecome essential to begin animal model testing. Animportant challenge will be to grow each researchproject theme in a manner that will lead to thedevelopment of project ‘pipelines’ that will attract acontinuous flow of new students. Nothing willattract students more strongly to a mentor orproject than the track record of previous students:this would include success in publishing orpresenting their results at conferences, but alsopositive mentoring experiences, positive lab socialenvironment (e.g., students working in smallgroups), journal clubs, etc. As the LEMM wascreated in a ‘start-up’ academic and researchenvironment there existed a unique set ofopportunities for both innovation and flexibility inits design and set-up. The larger challenge now isestablishing dynamic and productive engagement ofstudents and mentors that will result in a trueresearch learning community. The hope is that suchan environment and the students’ SARP experienceswill add tremendously to their grasp andappreciation of the scientific underpinnings ofmodern medicine and prime them for pursuingresearch and scholarship later in their careers.As individual mentors will likely not be applying fornational level funding soon in support of theirresearch projects, financial support for the LEMMover the medium to long-term still poses aMedical Science Educator © IAMSE 2013 Volume 23(1S) 115

Key WordsMedical student research, scholarly concentration,biomedical researchNotes on ContributorsCURT PFARR, PhD, is Associate Professor andSARP co-Director in the Department of MedicalEducation, Paul L. Foster School of Medicine, TexasTech University Health Sciences Center, El Paso,TX, USA.DEBRA BRAMBLETT, PhD, is Assistant Professorin the Department of Medical Education, Paul L.Foster School of Medicine, Texas Tech UniversityHealth Sciences Center, El Paso, TX, USA.DAVID OSBORNE, PhD, is Professor in theDepartment of Medical Education, Paul L. FosterSchool of Medicine, Texas Tech University HealthSciences Center, El Paso, TX, USA.AMY TROTT, PhD, is Assistant Professor in theDepartment of Medical Education, Paul L. FosterSchool of Medicine, Texas Tech University HealthSciences Center, El Paso, TX, USA.HEATHER BALSIGER, MS, is Medical EducationLaboratory Manager in the Department of MedicalEducation, Paul L. Foster School of Medicine, TexasTech University Health Sciences Center, El Paso,TX, USA.MARTINE COUE, PhD, is Associate Professor andSARP co-director in the Department of MedicalEducation, Paul L. Foster School of Medicine, TexasTech University Health Sciences Center, El Paso,TX, USA.RICHARD BROWER, MD, is Associate Professorand Chair in the Department of Medical Education,Paul L. Foster School of Medicine, Texas TechUniversity Health Sciences Center, El Paso, TX,USA.TANIS HOGG, PhD, is Associate Professor andVice-Chair in the Department of Medical Education,Paul L. Foster School of Medicine, Texas TechUniversity Health Sciences Center, El Paso, TX,USA.References1. Wyngaarden JB. The clinical investigator as anendangered species. The New England journalof medicine. 1979 Dec 6;301(23):1254-9.PubMed PMID: 503128.2. Culliton BJ, D'Auria J. The physician-scientistreally is an endangered species. Journal ofinvestigative medicine : the official publicationof the American Federation for ClinicalResearch. 1998 Dec;46(9):417-9. PubMedPMID: 9861771.3. Rosenberg L. Physician-scientists--endangeredand essential. Science. 1999 Jan15;283(5400):331-2. PubMed PMID: 9925491.4. Zemlo TR, Garrison HH, Partridge NC, Ley TJ.The physician-scientist: career issues andchallenges at the year 2000. FASEB journal :official publication of the Federation ofAmerican Societies for Experimental Biology.2000 Feb;14(2):221-30. PubMed PMID:10657979.5. Goldman E, Marshall E. Research funding. NIHgrantees: where have all the young ones gone?Science. 2002 Oct 4;298(5591):40-1. PubMedPMID: 12364762.6. Ley TJ, Rosenberg LE. Removing careerobstacles for young physician-scientists -- loanrepaymentprograms. The New England journalof medicine. 2002 Jan 31;346(5):368-72.PubMed PMID: 11821517.7. Nathan DG. Careers in translational clinicalresearch-historical perspectives, futurechallenges. JAMA : the journal of the AmericanMedical Association. 2002 May8;287(18):2424-7. PubMed PMID: 11988063.8. Ley TJ, Rosenberg LE. The physician-scientistcareer pipeline in 2005: build it, and they willcome. JAMA : the journal of the AmericanMedical Association. 2005 Sep 21;294(11):1343-51. PubMed PMID: 16174692.9. Green EP, Borkan JM, Pross SH, Adler SR,Nothnagle M, Parsonnet J, et al. Encouragingscholarship: medical school programs topromote student inquiry beyond the traditionalmedical curriculum. Academic medicine :journal of the Association of American MedicalColleges. 2010 Mar;85(3):409-18. PubMedPMID: 20182113.10. Pfarr CM, Lacy NL, Coue M. A scholarly activityand research requirement at the Paul L. FosterSchool of Medicine. Medical Science Educator.2011;21(1S):91-7.Medical Science Educator © IAMSE 2013 Volume 23(1S) 116

11. Cook S, Grochowski CO, Atherton A, LaskowitzDT, Pervaiz S, Buckley E, et al. Developingphysician leaders for over 50 years: the Dukemedical student research experience in the USand Singapore. Medical Science Educator.2011;21(1S):53-8.12. ChichoskiKelly EM. Using research as a tool forreinforcing basic sciences in the clinical years:description of a fourth year teaching/researchrequirement at the University of VermontCollege of Medicine. Medical Science Educator.2011;21(1S):59-62.13. Aronson JF, Valbuena GA, Hellmich MR,Asimakis GK. Translational research track formedical students: developing interprofessionalcollaborative competencies for translationalresearch. Medical Science Educator.2011;21(1S):63-6.14. Hunt JE, Scicluna H, McNeil HP. Developmentand evaluation of a mandatory researchexperience in a medical education program: theindependent learning project at UNSW. MedicalScience Educator. 2011;21(1S):78-85.15. Mendonca VRR, Barral-Netto M. Stimulatingthe formation of the physician-scientist;scientific exposure during the medical course inBrazil. Medical Science Educator. 2011;21(1S):107-11.16. Bahner I, Somboonwit C, Pross S, Collins RJ,Saporta S. Teaching science through biomedicalresearch in an elective curriculum. MedicalScience Educator. 2012;22(3S):143-6.17. Straus SE, Straus C, Tzanetos K, InternationalCampaign to Revitalise Academic M. Careerchoice in academic medicine: systematic review.Journal of general internal medicine. 2006Dec;21(12):1222-9. PubMed PMID: 17105520.Pubmed Central PMCID: 1924755.18. Borges NJ, Navarro AM, Grover A, Hoban JD.How, when, and why do physicians choosecareers in academic medicine? A literaturereview. Academic medicine : journal of theAssociation of American Medical Colleges. 2010Apr;85(4):680-6. PubMed PMID: 20354389.19. Parsonnet J, Gruppuso PA, Kanter SL, BoningerM. Required vs. elective research and in-depthscholarship programs in the medical studentcurriculum. Academic medicine : journal of theAssociation of American Medical Colleges. 2010Mar;85(3):405-8. PubMed PMID: 20182112.20. Steele DJ, de la Rosa JM, Tobin BW. Texas TechUniversity Health Sciences Center Paul L.Foster School of Medicine. Academic medicine :journal of the Association of American MedicalColleges. 2010 Sep;85(9 Suppl):S555-7.PubMed PMID: 20736629.21. Faculty, PLFSOM LCME Institutional Self-Study 2012.22. Blake DJ, Weir A, Newey SE, Davies KE.Function and genetics of dystrophin anddystrophin-related proteins in muscle.Physiological reviews. 2002 Apr;82(2):291-329.PubMed PMID: 11917091.23. McNally EM, Pytel P. Muscle diseases: themuscular dystrophies. Annual review ofpathology. 2007;2:87-109. PubMed PMID:18039094.24. Meregalli M, Farini A, Belicchi M, Parolini D,Cassinelli L, Razini P, et al. Perspectives of stemcell therapy in Duchenne muscular dystrophy.The FEBS journal. 2012 Dec 3. PubMed PMID:23206279.25. Verhaart IE, Aartsma-Rus A. Gene therapy forDuchenne muscular dystrophy. Current opinionin neurology. 2012 Oct;25(5):588-96. PubMedPMID: 22892952.26. Partridge TA. Impending therapies forDuchenne muscular dystrophy. Current opinionin neurology. 2011 Oct;24(5):415-22. PubMedPMID: 21892079.27. Nowak KJ, Davies KE. Duchenne musculardystrophy and dystrophin: pathogenesis andopportunities for treatment. EMBO reports.2004 Sep;5(9):872-6. PubMed PMID:15470384. Pubmed Central PMCID: 1299132.28. Nishiyama T, Takeda S. [Induced pluripotentstem (iPS) cell-based cell therapy for musculardystrophy: current progress and futureprospects]. Brain and nerve = Shinkei kenkyuno shinpo. 2012 Jan;64(1):39-46. PubMedPMID: 22223500.29. Gossen M, Bonin AL, Freundlieb S, Bujard H.Inducible gene expression systems for highereukaryotic cells. Current opinion inbiotechnology. 1994 Oct;5(5):516-20. PubMedPMID: 7765466.30. Takahashi K, Yamanaka S. Induction ofpluripotent stem cells from mouse embryonicand adult fibroblast cultures by defined factors.Cell. 2006 Aug 25;126(4):663-76. PubMedPMID: 16904174.31. Park IH, Zhao R, West JA, Yabuuchi A, Huo H,Ince TA, et al. Reprogramming of humansomatic cells to pluripotency with definedfactors. Nature. 2008 Jan 10;451(7175):141-6.PubMed PMID: 18157115.32. Tedesco FS, Hoshiya H, D'Antona G, Gerli MF,Messina G, Antonini S, et al. Stem cell-mediatedtransfer of a human artificial chromosomeameliorates muscular dystrophy. Sciencetranslational medicine. 2011 Aug17;3(96):96ra78. PubMed PMID: 21849666.Medical Science Educator © IAMSE 2013 Volume 23(1S) 117

33. Darabi R, Baik J, Clee M, Kyba M, Tupler R,Perlingeiro RC. Engraftment of embryonic stemcell-derived myogenic progenitors in adominant model of muscular dystrophy.Experimental neurology. 2009 Nov;220(1):212-6. PubMed PMID: 19682990. Pubmed CentralPMCID: 2761496. Epub 2009/08/18. eng.34. Phelps SF, Hauser MA, Cole NM, Rafael JA,Hinkle RT, Faulkner JA, et al. Expression offull-length and truncated dystrophin mini-genesin transgenic mdx mice. Human moleculargenetics. 1995 Aug;4(8):1251-8. PubMed PMID:7581361.35. Wang B, Li J, Xiao X. Adeno-associated virusvector carrying human minidystrophin geneseffectively ameliorates muscular dystrophy inmdx mouse model. Proceedings of the NationalAcademy of Sciences of the United States ofAmerica. 2000 Dec 5;97(25):13714-9. PubMedPMID: 11095710. Pubmed Central PMCID:17641.Medical Science Educator © IAMSE 2013 Volume 23(1S) 118

MEDICAL SCIENCE EDUCATORThe Journal of the International Association of Medical Science EducatorsMed Sci Educ 2013; 23(1S): 119-121MONOGRAPHResearch as a Pedagogical Approach inUndergraduate Medical Education: An ExperienceKulsoom Ghias, Ruqaiyyah Siddiqui & Rashida AhmedAga Khan University, Karachi, PakistanAbstractThe importance of health research training in medical education has been well-documented in the literature andis fully recognized at Aga Khan University Medical College (AKUMC). The goals and attributes of undergraduatemedical education (UGME) at AKUMC emphasize the ability to become critical thinkers and conduct basicscience research. In the UGME curriculum, research is a longitudinal theme throughout the five year program.AKUMC is one of few medical schools to have a designated research-based community health sciences (CHS)course in Year 4. However, to instill this capacity and interest in undergraduate students and to further systemizeresearch training, a four week dedicated Introduction to Research module was recently introduced in Year 2. Theaim of this innovative module was to give students the intellectual tools to investigate new problems and evaluatedata critically, rather than solve the problem entirely. In keeping with the spiral nature of the curriculum, thismodule laid the foundation for research skills that are further expanded and utilized in a Year 4 CHS rotation.The Year 2 Research module is a curricular innovation that encourages analytical and creative thinking andpromotes a research culture among students. It is a valuable addition to the undergraduate medical curriculumand along with the Year 4 CHS rotation, it serves to enhance knowledge, skills and attitudes that are nownecessary for medical graduates.Why research in an undergraduatemedical curriculum?Research is imperative to improve health careglobally and providing adequate training to medicalstudents to equip them with the knowledge, skillsand attitude to conduct health sciences research istherefore necessary. 1-3 In addition to strengtheningthe research culture and productivity of aninstitution, training medical students to carry outresearch improves critical thinking skills andteamwork and is an early predictor of careerachievement in academic medicine. 4-9Research theme in undergraduatemedical curriculum at Aga KhanUniversityThe importance of research training has long beenrecognized at Aga Khan University Medical College(AKUMC). Established in 1983, AKUMC is the firstCorresponding author: Kulsoom Ghias, PhD, Department ofBiological and Biomedical Sciences, Aga Khan University,Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan; Tel:+9221 34864464; E-mail: kulsoom.ghias@aku.edumedical college in the private sector in Pakistan,and offers a five year undergraduate programme inmedicine. It attracts the best high school graduatesin Pakistan, with an admission ratio of 1:40 and~100 students admitted per class. The goals of theUndergraduate Medical Education (UGME)curriculum state that graduates will be able toconduct research and pursue careers in clinical,community and basic sciences. The attributes of thegraduates also require them to have the ability toconduct research in different domains. Thecurriculum is designed in a manner to achieve thesegoals. Since its inception, a mandatory communitybased research project was included in Year 5 as acomponent of Primary Health Care. In addition tothis systemic and mandatory uniform experience,many students engaged in ongoing researchprojects, both with institutional faculty membersand through placements with national andinternational research groups during non-curriculartime, including vacations and holiday periods.In 2002, with the review and introduction of aninnovative curriculum, the research component wasretained and strengthened with students required toMedical Science Educator © IAMSE 2013 Volume 23(1S) 119

work in a team with a faculty supervisor andexpected to produce the first draft of a publishablemanuscript during an eight week CommunityHealth Sciences rotation in Year 4. External reviewof the institution’s UGME curriculum in 2005highlighted the fact that it was one of the fewundergraduate medical curricula in the world thatincluded a course in research.In the initial years of study, however, studentparticipation in research remained largelyopportunistic, with almost half of the studentsunable to get involved in research, whether withinAKU, nationally or internationally. Although,required courses in basic epidemiology andbiostatistics in Years 1 and 2 served as buildingblocks for later research experiences, earlyinvolvement in research projects depended on theindividual commitment and resources of thestudent. This model saw moderate success with over100 publications in peer-reviewed journals bymedical student authors. To make this experiencesystemic rather than opportunistic, and in line withthe institutional mission to become a research-leduniversity, a four week research course termed“Introduction to Research Module” was designedand implemented in 2012 for Year 2 students.Introduction to Research ModuleThe aim of this innovative module was to givestudents the intellectual tools to investigate newproblems and evaluate data critically, rather thansolve the problem entirely. The module providedstudents with an opportunity to undertake aprogram of research in a related aspect of medicalscience. A total of 111 projects were designed byclinical, community health and basic sciencesfaculties of the medical college and presented tostudents. Out of these, 97 projects were thenallocated based on student preference, such thateach student was assigned to an individual project.The majority of students (85 out of 97) weresupervised by faculty members from the basicscience Department of Biological and BiomedicalSciences in projects encompassing HIV, cancer,superbugs, gastrointestinal infections, diabetes,nutrition, natural products in health and disease, toname a few. Clinical and public health projects werealso offered. Examples of these projects includestudies on the burden of care of psychiatric patients,gastric flora in patients with dyspepsia, andfrequency and influence of cigarette smoking oncommon dermatological disorders.research. They were taught manuscript writingskills, how to prepare a scientific poster, viva voceskills, precepts of intellectual property andknowledge transfer, ethical principles in research,plagiarism, career prospects in research, and wereintroduced to the concept of critical thinking.At the end of the module, students presented theirwork in the form of a scientific poster and sharedtheir findings with faculty members during a vivavoce examination. Students were also required tosubmit their research findings in the form of awritten manuscript, using the format of aprofessional journal article, in which emphasis wasawarded to the background and discussion sectionsrather than results. Several students chose tocontinue their research projects even after theconclusion of the module and four studentssubsequently authored published work in peerreviewedjournals. The module is a capacitybuildinginitiative and follows the same trajectory asthe first year of its implementation; it is envisagedthat it will lead to not only systematic training ofmedical students, but a marked increase in qualityand quantity of student-authored publications inpeer-reviewed journals. Additionally, an advantageof the module is the added opportunity for studentsto build a relationship with faculty members.Some limitations of the module were also identifiedfollowing feedback elicited from students andfaculty supervisors. These included limited time(four weeks) and funds available to complete theproject, a lack of standardized exposure to benchresearch laboratory techniques and in some cases(10%) inadequate mentoring by supervisors. All ofthese are now being addressed as the module designand implementation are being revised in responseto feedback prior to implementation in 2013.ConclusionThe Aga Khan University has highly experiencedfaculty, skilled laboratory staff, in combination withstate-of-the art facilities and access to outstandingstudents. The innovative Introduction to Researchmodule is an ideal strategy to build researchcapacity within the institution as well as realize thegoals of the undergraduate medical curriculum toprovide medical students with the opportunity tocarry out research within the fields of medical, basicand community health sciences.Along with carrying out their research project,students were trained on various aspects ofMedical Science Educator © IAMSE 2013 Volume 23(1S) 120

Key WordsResearch training, undergraduate medicalcurriculum.Notes on ContributorsKULSOOM GHIAS, PhD, is an Assistant Professorand Vice Chair, Undergraduate Medical Education,in the Department of Biological and BiomedicalSciences at Aga Khan University, Karachi, Pakistan.She is the Co-chair of the UndergraduateCurriculum Committee in the medical college.RUQAIYYAH SIDDIQUI, PhD, is an AssistantProfessor in the Department of Biological andBiomedical Sciences, Aga Khan University, Karachi,Pakistan. She is the Chair of the Introduction toResearch module.RASHIDA AHMED, MBBS, MHPE, FCPS, is is aProfessor in the Department of Pathology andMicrobiology, Aga Khan University, Karachi,Pakistan. She is the Chair of the UndergraduateCurriculum Committee at the medical college.References1. Global Forum for Health Research. 10/90Report on health research 2003-2004. Geneva.2004 [Accessed 2013 January 14]. Availablefrom:http://www.globalforumhealth.org/mediapublications/10-90-Report-2003-2004.2. The PLoS Medicine Editors. Improving healthby investing in medical education. PLoS Med.2005;2:e424.3. Aslam F, Shakir M, Qayyum MA. Why medicalstudents are crucial to the future of research inSouth Asia. PLoS Med. 2005; 2:e322.4. Aslam F, Waheed A. An audit of the students'corner of Journal of the Pakistan MedicalAssociation. J Pak Med Assoc. 2005; 55:517-519.5. Frishman WH. Student research projects andtheses: should they be a requirement formedical school graduation? Heart Dis. 2001;3:140-144.6. Houlden RL, Raja JB, Collier CP, Clark AF,Waugh JM. Medical students' perceptions of anundergraduate research elective. Med Teach.2004; 26:659-661.7. Brancati FL, Mead LA, Levine DM, Martin D,Margolis S, Klag MJ. Early predictors of careerachievement in academic medicine. JAMA.1992; 267:1372-1376.8. Reinders JJ, Kropmans TJ, Cohen-Schotanus J.Extracurricular research experience of medicalstudents and their scientific output aftergraduation. Med Educ. 2005; 39:237.9. Segal S, Lloyd T, Houts PS, Stillman PL, JungasRL, Greer RB, 3rd. The association betweenstudents' research involvement in medicalschool and their postgraduate medical activities.Acad Med. 1990; 65:530-533.Medical Science Educator © IAMSE 2013 Volume 23(1S) 121

MEDICAL SCIENCE EDUCATORThe Journal of the International Association of Medical Science EducatorsMed Sci Educ 2013; 23(1S): 122-134MONOGRAPHResearch Immersion at the Virginia Tech CarilionSchool of Medicine – An Integrated CurriculumProducing Scientist Physicians for the Future ofHealthcareLeslie LaConte, Timothy A. Johnson, Richard C. Vari& Michael J. FriedlanderVirginia Tech Carilion School of Medicine, Roanoke, VA, USAAbstractThe Virginia Tech Carilion School of Medicine (VTCSOM) is a four-year allopathic medical school in Roanoke,Virginia, that matriculated its first class of 42 students in August, 2010. The creation of a new medical schoolthrough the partnership of an established public research intensive university, Virginia Tech, and an establishedprivate health system, Carilion Clinic provided a rare opportunity to craft a high-impact research curriculum,unique in both design and delivery. As part of the new curriculum, the faculty created a comprehensive four-year,longitudinal, research program that integrates the principles and practice of active participatory research intoboth basic and clinical science education and ultimately into the lifelong application of evidence-based medicineto patient care.Importance of the Science ofMedicineA recent report, Scientific Foundations for FuturePhysicians, from the Association of AmericanMedical Colleges (AAMC) and the Howard HughesMedical Institute (2009) emphasizes theimportance of the science of medicine for selectingand educating tomorrow’s doctors and forimproving healthcare delivery. 1 A key element of thescience of medicine is the discovery process itself,including scientific reasoning, understanding howdata are obtained and evaluated, assessing thevalidity of medical and scientific claims andpracticing evidence-based medicine. Putting what’sbest for the patient as the top priority often requiresweighing competing claims from the medicalliterature, from colleagues, from industry, as well asfrom the patients themselves and their families.Also included in the recommendations was the needfor increased awareness of such potential conflictswhen evaluating claims and making decisions basedon evidence.Corresponding author: Richard C. Vari, PhD, Virginia TechCarilion School of Medicine, 2 Riverside Circle, Suite 140,Roanoke, VA, 24016, USA. Tel : +1 540-526-2517,Fax : +1 540-581-0741, Email : rcvari@carilionclinic.orgMedical schools throughout the United States andCanada accredited by the Liaison Committee onMedical Education (LCME) use a wide variety ofstrategies to address these educational goals. Thesestrategies range from students performing scientificliterature reviews of clinical topics in clerkships torequiring additional years spent in medical schooleither completing an in-depth research project orobtaining an advanced degree (MS, MPH or PhD). 2-7Some programs have incorporated as much as a fullyear of research carved out of the four yeartraditional medical curriculum. 3 The developmentof MD/PhD programs to train physician scientistshas been a major step in our nation’s approach tobridge the science-medical practice gulf. 8 The goalsof these programs include producing tomorrow’sleaders in academic medicine. However, due to thecosts and time involved, the percentage ofphysicians graduating from such programs willnecessarily remain relatively small and it stillremains to be determined how many graduates willfollow truly dual career paths, with active clinicalpractices and research programs. 9-14 While suchphysician scientists have much to offer the nation’shealth care enterprise, the case can also be made fora larger cohort of practicing physicians who alsoMedical Science Educator © IAMSE 2013 Volume 23(1S) 122

ing strong scientific training credentials and adeep understanding and appreciation of howbiomedical and health research are carried out. 15The pace of discovery in molecular, genetic,computational, behavioral and health outcomesresearch is increasingly rapid, howeverimplementation of these advances can lag farbehind since practicing physicians often have littletime to stay current in quickly changing disciplineswhile in training. 16-19 Moreover, as with good clinicalpractice, utilization of the principles ofcontemporary biomedical and health scienceresearch benefits from not only studying but alsodoing.Thus, to meet these challenges to contribute to thedevelopment of scientifically-based medical practiceand to the incorporation of the discovery processinto all aspects of medicine, the faculty developed aprogram for students to learn these values andcompetencies through participating in originalmedical research under the mentorship ofaccomplished scientists and physicians. VTCSOMhas embarked on a program to train scientistphysicians (vs. physician scientists) as acomplementary component of the physicianworkforce. Graduates of this program will primarilybe committed to the practice of patient-centeredmedicine. However, they will be differentiated fromclassically trained practitioners by virtue of activeparticipation in research throughout all phases oftheir four-year undergraduate medical education.This level of research engagement will instill healthyskepticism and an insistence on a sound scientificbasis for all medical decision-making amonggraduates. These attributes, coupled with theconfidence to evaluate primary research data, willempower graduates to be uniquely qualifiedadvocates for their patients' best interests.VTCSOM Curriculum OverviewAt VTCSOM four educational value domains (basicscience, research, clinical science, andinterprofessionalism) run in parallel throughout thefour years of medical school and provide theeducational framework for a unique medical schoolexperience that equips students with the knowledge,skills, and attitudes to become scientist-physicianswho can improve the quality and safety ofhealthcare for patients, generate new medicalknowledge, and improve operational aspects ofhealthcare systems of the future.The patient-centered curriculum at VTCSOMutilizes a variety of sound educational strategies tomaximize self-directed student learning. Chiefamong the many strategies employed at VTCSOM isa problem-based learning (PBL)-hybrid educationalmodel in which small groups of medical studentsdevote nine hours each week to work on patientcenteredlearning cases designed to introduce themto fundamental basic science concepts in a clinicalcontext. This occurs during the first phase of thestudents’ education (Years 1 and 2), in blocks ofvarying duration (themes and subthemes for Year 1are presented in Figure 1, Appendix). These weeklycases provide a framework that allow for integrationacross all of the VTCSOM value domains, includingresearch, as described below. Another hallmark ofthe VTCSOM curriculum is the immersion ofstudents in a longitudinal research experiencebeginning in the first year. Research immersionacross both phases (Phase 1 = Years 1 and 2; Phase 2= Years 3 and 4) of medical education is designed tofully develop the skills of inquiry necessary in ascientist physician devoted to the practice ofevidence-based medicine. Prior to the selection of aresearch project, students are engaged in aclassroom-based curriculum designed to immersethem in the language, culture and practice ofscientific research.Research Value Domain CurriculumThe Research Value Domain is incorporatedthroughout all four years of the curriculum with thegoal of developing scientist physicians. Scientistphysicians are medical practitioners whose mainfocus is patient care but who bring the perspective,knowledge and analytical skills of a scientist to allaspects of the practice of allopathic medicine.During the Year 1 classroom sessions, originalmedical scientific literature is used to exposestudents to both seminal and contemporaryresearch related directly to the topics that areexplored in the Basic Science Domain, as well as tointroduce them to real-world challenges andlimitations of modern medicine that requireongoing inquiry. Fundamental research principles(the scientific method, the ethical and regulatoryissues associated with human and animal research,successful scientific collaboration, inferentialreasoning) and contemporary tools of medicalresearch (biostatistics, epidemiology, analyticalexposition of the logic of research studies) areintroduced in the context of real medical scientificliterature, allowing students to simultaneouslyexperience how these concepts are applied in actualresearch and to become adept at navigating medicalliterature to efficiently identify the information theyseek. The Research Value Domain corecompetencies and goals are presented in Table 1.Medical Science Educator © IAMSE 2013 Volume 23(1S) 123

CORE COMPETENCYThe Scientific MethodThinking Like a Scientist PhysicianBasic, Clinical, and Translational ResearchThe Protection of Human Subjects inResearchThe Use and Protection of Animals inResearchBiostatisticsEpidemiologyKeys to Successful CollaborationIntroduction to Medical LiteratureMedical Research and ScientificMisconductGOALGraduates will be able to identify, understand and apply thescientific method in both basic and clinical science settings.Graduates will be able to frame questions using the tools nadlanguage of the scientist physician.Graduates will be able to describe the research continuum thattranslates scientific discoveries into clinical applications.Graduates will be able to identify the ethical foundations ofhuman research and apply the associated regulatory principlesand procedures.Graduates will be able to identify the ethical foundations of animalresearch and apply the associated regulatory principles andprocedures.Graduates will be able to identify, define, and apply the basic toolsof biostatistical analysis.Graduates will be able to identify, define, and apply the basic toolsof epidemiologic design.Graduates will be able to understand and apply the components ofcollaborative research.Graduates will have advanced competencies in literature search,citation, report type, and sources.Graduates will be able to interpret and apply legal principles tomedical research in clinical and basic science domains.Table 1: Core competencies and goals for the Research Value Domain at VTCSOM.Because often the most cutting-edge research isdisseminated not through written but rather oralmeans, the Research Value Domain Year 1curriculum is designed to provide ampleopportunity for students to become skilledattendees and participants at oral scientificpresentations. Students have in-class presentationsfrom faculty members describing on-going researchopportunities (a weekly series referred to as“Research Live!”) as well as a formal seminar seriesentitled the “Timothy A. Johnson, PhD MedicalScholar Seminar” series that integrates the Researchand Basic Science Domains by bringing in highlyaccomplished scientist physicians who areconducting research on topics that the students arecurrently studying. For example, during Block I,students study a case of a young girl with cysticfibrosis, meeting three times during this week intheir PBL groups (n=7) with a faculty facilitator toprocess the case, uncover the diagnosis and todevelop and present basic and clinical sciencelearning issues to each other. The introduction tothis case as well as the case objectives are presentedin Figure 2 (Appendix). At the end of the week, thesmall groups are brought together with the patient,family, and a physician to discuss the humanisticpatient-centered aspects of the case. During the2012-2013 school year, a physician investigatornationally known for research in the development ofnew treatments of cystic fibrosis was invited as aMedical Scholar to coincide with the cystic fibrosiscase. Prior to the Medical Scholar’s visit, studentsstudied current research papers (titles presented inTable 2, Appendix) published by the visitingMedical Scholar in a program called Methods inLogic, where not only the research results but thelogical foundations of the scientific approach wereexplored. A subset of students worked with facultycontent experts to prepare a student-led discussionof these papers during a Research Domainclassroom session. The experience concluded with aresearch seminar given by the Medical Scholar onthe latest advances in understanding of thepathogenesis and treatment of cystic fibrosis. Thisprocess fully integrates basic science foundationalknowledge, clinical application and reasoning, andresearch to bring enhanced understanding of aparticular disease and to improve patient care. Thisis a unique combination that affords VTCSOMstudents the complete experience of modernmedicine and unveils the sometimes hiddenconnection between research discovery, evidencebasedpractice, and quality patient care. VTCSOMcurrently has eight of these Medical Scholarseminars to be delivered this academic year (Table2, Appendix).Medical Science Educator © IAMSE 2013 Volume 23(1S) 124

The Medical Scholars seminars are open to theentire VTCSOM community, offering students acontinued opportunity to hear talks on groundbreakingresearch throughout Years 2-4 and tointeract with physicians and researchers who sharesimilar interests. This constant exposure to thelanguage of research is in keeping with the VTCSOMgoal of fostering life-long learning in its graduates.Scientist physicians who are driven by inquiry,research, and discovery will, of necessity, referconstantly to newly published research and seek outpresentations by active medical researchers inwhatever setting they are practicing; the ResearchDomain curriculum aims to help instill these habitsin our students from the beginning.The fundamental principles and application ofresearch are taught in Phase 1 using a variety ofapproaches that includes lectures, problems, paneldiscussions, online training courses, experientiallearning activities, and research-related objectivesin the previously described Patient CenteredLearning cases. Because 4.5 hours per week aredevoted to the Research Value Domain in Year 1,this program provides an in-depth foundation ofresearch principles from an instructional andexperiential perspective to first-year medicalstudents regardless of their prior researchbackground prior to coming to VTCSOM.VTCSOM Student ResearchThe primary VTCSOM educational strategy forcreating scientist physicians is the immersion ofstudents in actual research. Each student is requiredto complete a scholarly project that is hypothesisdriven,provide a written document suitable forpublication, and present their work to colleagues inan appropriate venue such as a national meeting. Tohelp ensure that these requirements are achievable,students are exposed to faculty researchers fromvarious disciplines during the Year 1 “ResearchLive” series mentioned above. These briefpresentations introduce students to potentialresearch mentors. Available research areas span awide range of topics, including lab-based basicbiomedical research, computational modeling,translational research, clinical research, andcommunity and population-based research.Students select a mentor and a project by the end ofBlock III (March of Year 1). Block IV, although stillclassroom-based, begins to help transition thestudents into their chosen research group. Classactivities and assignments focus on the student’sindividual research project. A research prospectusdefining the student’s research question andoutlining the proposed approach is prepared incooperation with the research mentor and a smallcommittee of faculty advisors. This proposal ispresented orally by the students to their classmates,and feedback is solicited and responded to. Thisprocess prepares each student to begin his or herresearch immediately. At the conclusion of Year 1,students’ participation in the Research ValueDomain becomes predominantly self-directed,beginning with a three-week summer course at theend of Block IV (May-June).Students have 4.5 hours per week of dedicated timein Year 2 to continue their research in concert withthe rest of the on-going VTCSOM curriculum.Students are guided in their project by a researchmentor and two co-mentors (basic and/or clinicalscientists) who provide regular feedback to thestudent on their progress and to the Director ofResearch Education at the end of every block. Inorder to successfully pass the Research ValueDomain in Year 2, students must submit a mentorsignedresearch progress report for approval by theDirector of Research Education. Representativeselections from the list of current research projects(total =84) in which VTCSOM students are activelyengaged is presented in Table 3 (Appendix).Beginning in late February during Block IX,students have 14 weeks dedicated to their project(no course work during this period) and topreparation for the USMLE Step 1 Exam.Phase 2 (Years 3 and 4)Blocks of time are subsequently designated for thestudent to be fully engaged in their research projectin each year of the curriculum. In addition to thesescheduled research times, students are expected tomaintain an active research effort duringintervening periods. This approach will prepare thestudent for the practice of evidence-based medicinewhere they will be required to integrate patient carewith the discovery process on a daily basis.Interested students may also pursue a Masters,MPH or PhD after Year 2.Phase 2 begins in July of a typical Year 3 medicalschool schedule which includes: 6-week rotations ininternal medicine, surgery, family medicine,pediatrics, psychiatry, and OB/GYN, 2-weekrotations in radiology and neurology and a 4-weekresearch rotation. Students can choose to takeadditional elective research rotations during Years 3and 4. Goals and objectives for all four domains arewoven into each of the rotations. An example of howradiology has integrated research goals andobjectives into the clerkship objectives is presentedin Figure 3 (Appendix).Medical Science Educator © IAMSE 2013 Volume 23(1S) 125

During Year 3, students are brought together twoFriday afternoons per rotation to continue tointegrate the four educational value domains (BasicScience, Clinical Science, Research,Interprofessionalism). The goal of these sessions(“Domain Days”) is to provide reinforcement of thefour VTCSOM domains through in-depth evaluationof concepts, cases, and/or technologies that arise inthe student clerkship experiences. One purpose ofDomain Days is to emphasize that both current andfuture medical care will be dependent not only onclinical knowledge and skills but on the continuinginsights of research into basic principles, translatedinto a clinical context, and increasingly deliveredthrough integrated, team-based practices. Theplanning and implementation of the content ofthese “Domain Days” sessions is rotated among thevarious clinical rotation departments.During Year 4, students complete a series of 2-4-week required clinical experiences in emergencymedicine, one medical subspecialty (2 weeks), andone surgical subspecialty (two weeks). In addition, a2-week rotation in ICU/Critical Care and research isrequired. Students have one 4-week elective that issite-specific, and 16 weeks of additional electivetime.The culmination of the Research Value Domain is apublishable quality manuscript that may eitherstand alone or may be integrated into a larger bodyof ongoing work from the mentor’s researchprogram. During Year 4, students submit theirmanuscript for approval to their committee andmake a formal oral presentation on their work. Inaddition, the student’s work is submitted to anappropriate medical or scientific forum forpresentation. The Research Value Domain activitiesduring Year 4 thus provide students the opportunityto demonstrate their successful mastery of both thelanguage and practice of research as future scientistphysicians. A medical student research postersession will provide a venue for the VTCSOMcommunity to learn about the accomplishments oftheir colleagues.class) of practicing physicians who are activelyinvolved as principal and/or co-principalinvestigators in translational medical research; 3)producing a substantial cohort (40% of class) ofpracticing physicians who, while not necessarilyactively engaged in research or in the provision ofresearch data or samples themselves, activelyincorporate contemporary medical findings intotheir practice. This will inform their delivery ofevidence-based medicine and allow them to serve aseffective advocates for their patients. It is criticalthat the impact of this four-year research emphasison VTCSOM graduates be measured over the courseof the next several years.Understanding the importance of the science ofmedicine is a fundamental principle for deliveringquality healthcare to patients. The curriculum atVTCSOM with the four integrated value domains ofbasic science, clinical science, research, andinterprofessionalism links the science of medicine tothe practice of medicine from the very beginning ofmedical school. VTCSOM is providing an innovativein-depth immersion experience in research in fouryears of medical school that typically would requirean additional year, additional tuition, and additionalstudent debt. Medical students are given theopportunity to observe research applied to patientcases, and this experience crystallizes for them theconnection between what is known about a givendisease and more importantly what may be yet to bediscovered. Medical students are required toparticipate in the generation of new medicalknowledge with all of the challenges and rewardsthat only participation at every level of a project canproduce. The Research Value Domain equipsstudents with the knowledge, skills, and attitudes toask important questions, generate new medicalknowledge, and to find solutions to improve thequality of healthcare delivery in their practices andin healthcare systems in the future.Desired ImpactThe intensive research curriculum at VTCSOM wasdesigned with the expectation of achieving severaloutcomes: 1) producing a substantial cohort (50% ofclass) of practicing community physicians who arewilling and able to collaborate successfully withacademic medicine physicians on research projectsthat require access to patients, samples, andoutcome data from community populations; 2)producing a small but significant cohort (10% ofMedical Science Educator © IAMSE 2013 Volume 23(1S) 126

Key WordsScientist physician, medical student researchNotes on ContributorsLESLIE LACONTE, PhD, is Assistant Professor andDirector of Research Education at Virginia TechCarilion School of Medicine, Roanoke, VA, USA.TIMOTHY A. JOHNSON, PhD, is ProfessorEmeritus at Virginia Tech Carilion School ofMedicine, Roanoke, VA, USA.RICHARD C. VARI, PhD, is Professor and AssociateDean for Medical Education at Virginia TechCarilion School of Medicine, Roanoke, VA, USA.MICHAEL J. FRIEDLANDER, PhD, is Professorand Senior Dean for Research at Virginia TechCarilion School of Medicine, Roanoke, VA, USA.References1. Association of American Medical Colleges(AAMC) and the Howard Hughes MedicalInstitute (HHMI). Scientific Foundations forFuture Physicians, 20092. Follen M, K Peck, BT Crain. Conference Report.New Pathways to educate future translationalresearchers: Early education forundergraduates. Gynecologic Oncology107:S50-S55, 20073. O’Conner GC, EC Halperin, EG Buckley. Acurricular model for training of physicianscientists: the evolution of the Duke UniversitySchool of Medicine curriculum. Acad Med82:375-382, 20074. Boninger M, Troen P, Green E, Borkan J,Lance-Jones C, Humphrey A, Gruppuso P, KantP, McGee J, Willochell M, Schor N, Kanter SL,Levine AS. Implementation of a longitudinalmentored scholarly project: an approach at twomedical schools. Acad Med 85:429-37. 2010.5. Green EP, Borkan JM, Pross SH, Adler SR,Nothnagle M, Parsonnet J, Gruppuso PA.Encouraging scholarship: medical schoolprograms to promote student inquiry beyondthe traditional medical curriculum. Acad Med85:409-418. 2010.6. Laskowitz DT, Drucker RP, Parsonnet J, CrossPC, Gesundheit N. Engaging students indedicated research and scholarship duringmedical school: the long-term experiences atDuke and Stanford. Acad Med 85:419-428.2010.7. Zier K, Wyatt C, Muller D. An innovativeportfolio of research training programs formedical students. Immunol Res 54:286-91.2012.8. Association of American Medical Colleges(AAMC). Dual Degree Training.www.aamc.org/students/considering/research/mdphd, 20099. Wyngaarden, JB. The clinical investigator as anendangered species. N Engl J Med 301:1254-1259, 197910. Rosenberg, LE. Physician-scientists-Endangered and essential. Science 283:331-332,1999.11. Miller, ED. Clinical investigators, theendangered species. J Am Med Assoc 286:845-846, 2001.12. Jeffe DB, Andriole DA. A national cohort studyof MD-PhD graduates of medical schools withand without funding from the National Instituteof General Medical Sciences' Medical ScientistTraining Program. Acad Med. 86:953-961. 2011.13. Patel CB, Schauberger EM. Nguyen FT. Towarda better understanding of the retention ofphysician-scientists in the career pipeline. AcadMed 87:390-391. 2012.14. Turner JR. Continuing attrition of physicianscientists(CAPS): a preventable syndrome?Gastroenterology. 143-511-515. 201215. Collins JP, S Farish, JS McCalman, G J McColl.A mandatory intercalated degree programme:Revisiting and enhancing academic andevidence-based medicine. Medical Teacher 32:e541-e546, 2010.16. Eve R, Golton I, Hodgkin P, Munro J, MussonG. Beyond guidelines: promoting clinical changein the real world. J Manag Med. 10:16-25. 1996.17. Rubin GL, Frommer MS, Vincent NC, PhillipsPA, Leeder SR. Getting new evidence intomedicine. Med J Aust. 172:180-183. 2000.18. Dean-Baar S, Pakieser-Reed K. Closing the gapbetween research and clinical practice. TopStroke Rehabil. 11:60-68. 2004.19. 19. Col NF. Challenges in translating researchinto practice. J Womens Health 14:87-95.2005.Medical Science Educator © IAMSE 2013 Volume 23(1S) 127

APPENDIXFigure 1: Curriculum themes and subthemes for the blocks in years 1 and 2 at the Virginia Tech Carilion School of MedicineMedical Science Educator © IAMSE 2013 Volume 23(1S) 128

Figure 1 (Continued)Medical Science Educator © IAMSE 2013 Volume 23(1S) 129

Figure 2: Cystic Fibrosis Case Introduction and ObjectivesHelen “Lilly” Hull is on your schedule today as a hospital follow-up. She is a one month old who was born at 38 weeksgestation and had intestinal obstruction due to meconium ileus. She was treated with daily hypertonic enemas, whichresolved her obstruction, and was sent home breastfeeding and doing well. Her appointment today was set up to make sureshe continued to do well and to review some laboratory testing that was pending at the time of discharge.Case Objectives1. Review the normal anatomy of respiratory passageways, both conducting and respiratory, from the nose to terminalbronchioles.2. Review the formation and composition of mucus. Discuss the molecular structure of cilia, and their function in clearingmucus from the respiratory tract. In light of this information, explain why Lilly is susceptible to lung infections?3. Review the normal location and functioning of CFTR in the cellular membrane, correlating CFTR structure withfunction. Briefly discuss the family of “ABC transporters” of which CFTR is a member.4. Describe the post-translational events for CFTR, from the time it is made on the ribosome to when it is incorporated intothe membrane. There is evidence that the most common CF mutation, the delta 508 mutation, activates the endoplasmicreticulum associated degradation (ERAD) and unfolded protein response (UPR) pathways. What are these?5. Review and contrast the functions of CFTR in lung, pancreas, and digestive tract. Describe how mutations in the CFTRgene lead to problems with breathing, growth, digestion, and reproduction.6. Discuss which parts of the diet are most affected by CF and why? (fat, protein, carbohydrates, vitamins).7. Review several of the more common mutations in the CFTR gene including a description of how each mutation affectsthe ability of CFTR protein to function. (Note: The delta 508 mutation is a good place to start).Adapted with permission form the University of North Dakota School of Medicine & Health SciencesMedical Science Educator © IAMSE 2013 Volume 23(1S) 130

Figure 3: An example of how clerkships integrate research objectives into their goals and objectives at Virginia Tech Carilion School ofMedicine.Medical Science Educator © IAMSE 2013 Volume 23(1S) 131

Table 2: Medical Scholar Series Topics at the Virginia Tech Carilion School of Medicine (2012-13)BLOCKIRELATEDCASESCystic FibrosisMETHODS IN LOGICPAPERSRowe et al 2010, “DF508 CFTRprocessing correction andactivity in polarized airway andnon-airway cell monolayers.”Pulm Pharmacol Ther. 23:268-278.SEMINAR TITLEProgress in Cystic FibrosisTranslational ResearchRamsey et al 2012, “Futuredirections in early cystic fibrosislung disease research: an NHLBIworkshop report.” Am J RespirCrit Care Med. 185: 887-892.Down SyndromeAngelmanSyndromeHunter SyndromeHilaire et al 2011, "NT5Emutations and arterialcalcifications." New Eng J Med.364:432-42.Gahl et al 2012, "The NationalInstitutes of HealthUndiagnosed Diseases Program:insights into rare diseases." Genin Med. 14:51-59.Rare Disease Discovery in theNational Institutes of HealthUndiagnosed Diseases ProgramII Trisomy 18MyocardialInfarctionCardiogenic ShockMuscularDystrophyKang et al 2010, "Purkinje cellsfrom RyR2 mutant mice arehighly arrhythmogenic butresponsive to targeted therapy."Circ Res. 107:512-519.Rentschler et al 2001,"Visualization and functionalcharacterization of thedeveloping murine cardiacconduction system." Develop.128: 1785-1792.Kwon et al 2011, "Increasingexpression and decreasingdegradation of SMN amelioratethe spinal muscular atrophyphenotype in mice." Hum MolGen. 20:3667-3677.The Cardiac Conduction System:From Development to DiseaseDeveloping Treatment for HereditaryNeuromuscular DiseasesFernandez et al 2011, "Efficacyand safety of dutasteride inpatients with spinal and bulbarmuscular atrophy: a randomisedplacebo-controlled trial." LancetNeurol. 10:140-147.Medical Science Educator © IAMSE 2013 Volume 23(1S) 132

IIINephroticSyndromeDiabeticNephropathyZhang et al 2011,"Pharmacological inhibition ofmyostatin suppresses systemicinflammation and muscleatrophy in mice with chronickidney disease." FASEB.25:1653-1663.Muscle Protein Metabolism inChronic Kidney DiseaseMitch 1984, "The influence ofthe diet on the progression ofrenal insufficiency." Ann RevMed. 35:249-64.IVPolycystic OvarianSyndromeAlzheimer’sDiseaseTasali et al 2011, "Treatment ofobstructive sleep apneaimproves cardiometabolicfunction in young obese womenwith polycystic ovarysyndrome." J Clin EndocrinolMetab. 96:365-374.TBDPolycystic Ovarian SyndromeThe Changing Medical View ofMemory Disorders and Alzheimer'sDiseaseMedical Science Educator © IAMSE 2013 Volume 23(1S) 133

Table 3: Representative research projects (total n=84) being performed by VTCSOM medical students (2010-2013)Basic lab-based research1. Glutamate uncaging in temporally precise patterns for long term plasticity modulation.2. Prevalence of inter-genogroup gene reassortment among human rotaviruses3. Co-electrospun scaffold with gradients in fiber alignment and chemistry for the regeneration of ligament-bonetransitions.4. Molecular Mechanisms Behind Low Dose LPS Exposure5. The role of RahU protein in pathogenesis of Pseudomonas aeruginosa in murine lung infection modelComputational modeling6. Identification of the genetic basis of novel diseases using exome sequencing7. Novel MD simulations to demonstrate the movement of anesthetics across the blood-brain barrier8. Microsatellite variations unique to malignant melanomaTranslational research9. Investigation of airway location as a risk factor for endobronchial fire with the use of neodymium-doped yttriumaluminum garnet laser photoresection in a swine model10. Using Wireless Accelerometers to Quantify Infant General Movements11. The Use of Joint Independent-Component Analysis for Multimodal Imaging Analysis in Patients with Mild TBI12. Efficacy of perfusion in ex vivo preservation of cardiac tissueClinical research13. A Randomized Controlled Trial of a Wait-and-See Approach to Reduce Antibiotic use in Emergency DepartmentAbscess Treatment14. Total Knee Arthroplasty after Bariatric Surgery: A Case Series15. Introduction of the RAM cannula into the neonatal ICU: Effect on rate of chronic lung disease16. The effects of sedation on the sensitivity of transbronchial needle aspiration flexible bronchoscopy17. Clinical Outcomes in Elderly Patients Suffering from Acute Subdural Hematoma on Pre-Injury AntithromboticTherapyCommunity and population-based research18. The effect of obesity on ED physician CT scan utilization rates19. Schwartz Center Rounds: Creating a forum for resolving moral distress20. Compliance with Caesarean section indications and guidelines in a rural hospital in Ghana21. Neonatal abstinence syndrome incidence and treatment at Carilion Clinic Children's Hospital22. Cost-effectiveness analysis of testing for latent TB against traditional screening protocolsMedical Science Educator © IAMSE 2013 Volume 23(1S) 134

MEDICAL SCIENCE EDUCATORThe Journal of the International Association of Medical Science EducatorsMed Sci Educ 2013; 23(1S): 135-140MONOGRAPHBiomedical Research at Namibia’s First School ofMedicine and PharmacyChristian Jacobson 1,2 , Christian J. Hunter 1 & Quenton Wessels 11 University of Namibia, Windhoek, Namibia2 University of Waterloo, Waterloo, Ontario, CanadaAbstractResearch is an integral part of the curricula of both the pharmacy and medical degree programs at the Universityof Namibia (UNAM) School of Medicine (SOM). Early in their career students identify research projects andpursue them within the context of their degree program. At a fundamental level these projects expose students tothe scientific method and encourage the development of analytical and interpretative tools that will be importantin their professional lives. The inclusion of research as a subject significantly aligns the institutions’ researchagenda with the health needs of the country. Research at UNAM SOM, within both the medicine and pharmacistdegree programs, aims to nurture self-directed learning within an inter-professional milieu.IntroductionThe University of Namibia (UNAM) School ofMedicine (SOM) was established in Windhoek inJune 2009 using a classical curriculum that wasinfluenced by those presented at contributing sisterinstitutions in South Africa. Courses commenced onthe 8th of February 2010 with five lecturers and the59 students that had been admitted to the Bachelorof Medicine and Bachelor of Surgery program(M.B.Ch.B.). At that time the University of Namibia(UNAM) had allocated one classroom and practicalconsiderations had the students remaining in classwhile the medical faculty rotated in throughout theday. This system would remain in place, with spaceincreased to two classrooms, until a separatemedical campus was inaugurated in April of 2011. Inthe initial two years, advanced program planningand efficient deployment of pedagogicalinfrastructure not only permitted the school topresent its pre-clinical curriculum but also allowedfor the school of medicine to expand. The secondintake, in February of 2011, admitted 65 studentsinto medicine with 25 more admitted into the newfour year Bachelor of Pharmacy degree (B.Pharm.).The UNAM SOM is currently one of the youngest inAfrica and forms part of the Consortium of NewSouthern African Medical Schools (CONSAMS). 1Corresponding author: Quenton Wessels, Department ofAnatomy, School of Medicine, University of Namibia, Windhoek,Namibia; Tel: +264 61 206 5008; Fax: +264 61 206 5091; email:qwessels@unam.naSub-Saharan Africa (SSA) medical schools areincreasingly streamlining their medical educationtowards becoming more relevant, communityoriented and nationally focused. 2,3 Results from asurvey by Mullan et al. demonstrate these curriculartrends within SSA. 2 Their findings indicate thatthree predominant educational methods arefrequently implemented together, community-basededucation, problem-based learning (PBL) andmultidisciplinary team-based learning (TBL). Theauthors also emphasize the importance of researchas a focus within these medical schools. 2 The scopeof health research within SSA as extrapolated fromMEDLINE-indexed publications is limitedpredominately to HIV/AIDS, chronic and noncommunicablediseases and malaria research. 4,5Parasitic research due to the high incidence ofassociated diseases also ranked high in the topics ofstudy. 6 Changing social conditions and fast pacedurbanisation has begun to shift research in SouthAfrica to address the increased rates of cancer,cardiovascular disease and other noncommunicablediseases. 5,6Medical education at the UNAM SOM embraces acommunity-based education curriculum aimed atthe training of generalists. As part of this themedicine and pharmacy curricula incorporate aunique subject known as Independent ResearchStudies (IRS) and Research Methods and Project forMedical Science Educator © IAMSE 2013 Volume 23(1S) 135

the M.B.Ch.B and B.Pharm. degrees respectively.The research focus of this program is student andsociety centered and aims to foster the developmentof self-directed learning skills. Self-directed lifelonglearning has become a fundamental element ofmedical competence. 7,8The independent research develops from studentinteractions with the communities in which theyserve or within the faculty based on current researchefforts. Outreach of this nature significantly alignsthe intuition with the health needs of the country.Here the authors describe the structure of IRS andits value to attaining the national health needs.Furthermore, insights to the institution’s researchfocus are also provided.Figure 1: Independent Research is a critical component of both the M.B.Ch.B. (A) and B.Pharm. (B) curricula. Independent ResearchStudies (IRS) progresses over seven semesters from: introduction to knowledge management (IRS I), proposal writing (IRS II), datacollection and analysis (IRS III), and writing and presentation of thesis (IRS IV). The pharmacist degree program initially addresses basicresearch skills in a subject known as Research Methods (RM) (Figure 1B). Data collection, analysis and writing a scientific report followlater under the heading of Research Project which stretches over two semesters. (*Environmental & Occupational Health;** Pharmacognosy & Phytochemistry; *** Complementary and Alternative Medicine)Medical Science Educator © IAMSE 2013 Volume 23(1S) 136

Research and Independent ResearchStudiesThe CurriculaStudents admitted to the UNAM SOM and School ofPharmacy (SOP) typically have just matriculatedfrom secondary school with many coming frompreviously disadvantaged social groups andenvironments. As such, there is often the need toestablish a strong foundation in the scientificmethod. It is within this context that the school hasimplemented an IRS program in which a strongunderstanding of research methodology is asimportant as the research topic itself. Theunderlying skills critical to research, the ability toconduct a literature review, the critical appraisal ofresults, and an escalated cognizance of researchtechniques all improve student independence andcritical thinking. 9 Beyond this, students acquire anin-depth knowledge of a specific research topic andbecome skilled in presenting their findings.10Globally, research develops critical assessment andthinking, promotes information literacy, and directsstudents to possible postgraduate training. 11At the SOM the primary objective of IRS projects isto develop the students’ ability to evaluate scientificliterature and participate in self-directed study.Both require the student to critically reflect. Theresearch projects are also aimed, through their linksto the community, at having a high impact value onhealth resource utilization and management ofdiseases relevant to Namibia. An important goal isto introduce students to both the theory andpractice of research.IRS for the medicine degree program is requiredand starts in the second semester of the second year(IRS I) and progresses until the tenth and finalsemester as IRS II to IRS IV (Fig. 1A). IRS ispresented concurrently with subjects such aspathology, medical microbiology, internal medicineand pharmacology. Initial didactic lectures conveykey aspects relating to biomedical research. Overseven semesters students learn the fundamentalskills in research methodology, statistics, how tocritically review literature, identify a researchquestion, formulate hypotheses and, develop aproblem statement and justification of the study.From here they progress to formulate objectives,select study design and strategy, critically appraiseexperimental design, and apply principles ofmedical ethics. An important feature of the programis that each student is assigned a faculty mentorwho has research expertise in the studentsdeveloping area of interest. Throughout this periodof independent study the student has theopportunity to develop their research proposal,collect data, and communicate findings throughwritten reports and an oral presentation. The facultymentor provides continual feedback and tutoringthroughout this period paying particular attentionto the development of the student’s scientificwriting skills. The subject is concluded in their finalyear as IRS IV with the writing and presentation of athesis (Fig. 1A).The pharmacist degree program addresses many ofthe same basic principles, such as conducting aliterature search and research tool development thatis presented in Research Methods (RM) (Fig. 1B).Data collection, analysis and write-up follow later,covering two semesters under the heading ofResearch Project (RP) (Fig. 1B). Again, theseresearch concerned subjects are offered in parallelwith subjects such as medical chemistry,pharmaceutics, pharmaceutical technology andpharmacotherapeutics (Fig. 1B). The finalrequirement, however, is not a thesis but a formalwritten research report and oral presentation.Research ProjectsIdeally student work can receive recognitionthrough publication but the ultimate goal is toprovide them with the tools necessary to evaluateresearch and its potential merit as a component oftheir practice as a general practitioner orpharmacist. These skills are developed within aninter-professional educational (IPE) framework andinstill the principle of life-long learning. Eachselected project is supervised by a member of thefaculty and relates to existing research within eachdepartment. Students have the option to eitherliaise with a specific department, for instance theDepartment of Anatomy, and develop a researchproject within that context or develop a project denovo. The research supervisor thus serves as amentor that continuously provides feedback on theprogress. An excerpt of the current projectssupervised by the Departments of Anatomy andPhysiology is shown in Table 1. As an example onestudent is focusing on a project titled “Ananatomical study of the accessory internal thoracicartery”. This project aims to document the incidenceand anatomical origin of the accessory internalthoracic artery among the cadaver population of theinstitution through dissection. In addition thestudent will have to extrapolate the embryologicalorigin of this variation and assess the clinicalrelevance and possible application in cardiac bypasssurgery.Medical Science Educator © IAMSE 2013 Volume 23(1S) 137

Regardless of its origins, there is often considerableinteraction and consultation with faculty over thecourse of a project. The research supervisor thusserves as a mentor that continuously providesfeedback on the progress and also advises onpossible ethical considerations associated with theproject. Ethical clearance for each project isobtained through a review process by adepartmental review committee that reports to theethics committee of the SOM.positively reinforce the teaching and learningactivities associated with the project throughfeedback by the supervisor and panel of judges. Thisfeedback will update students on their progress orthe lack thereof, they will gain advice on availableresources and project routing, and be motivated toengage and progress further. 13,14Research TitleEtiology of burn wounds and the subsequent infectionthereof in Windhoek, NamibiaAn anatomical study of the accessory internal thoracicarteryUse of and attitudes regarding influenza vaccine amongWindhoek Central Hospital nursing staffThe posterior intercostal vein and its relation to theinternal vertebral venous plexus (IVVP): A HistologicalStudyStudent approaches towards studying anatomy andtheir perceived responsibilityEpidemiology of rheumatic heart disease in NamibianchildrenDevelopment of a quality control evaluation in thecardiac catheterization laboratory in Windhoek CentralHospitalPhonocardiographic evaluation of non valvular heartdisease in NamibiaImpact of obesity on the development of hypertensionin Namibian school childrenTable 1: Samples of undergraduate research projectsAssessmentStudent assessment is both formative andsummative. The formative aspect allows for studentfeedback through the research supervisor or mentorand serves to guide the development of the projectand the streamlining of methodologies. This is toensure constructive alignment between the learningoutcomes of the subjects (IRS, RM and RP), thelearning experience and the environment in whichresearch is conducted. 12 This follows after thestudents have consulted their faculty supervisor andgained experience on the sample size, researchjustification, data collection tools and methods, theconsideration of independent and dependentvariables, ethical considerations and the calculationof a budget. Assessment of these criteria issummative and is conducted towards the end ofeach semester based on a marking scheme asdepicted in Figure 2. A panel of judges from thefaculty assesses the project’s progress and gradesthe candidate. The assessment ultimately aims toFigure 2: The research projects are assessed based on theabove marking scheme.Discussion and Future DirectionsThe significance of research extends beyond thecreation of new knowledge and promotes the overallgrowth of the medical school, the recruitment andretention of staff, the strengthening ofinfrastructure, and the attraction of externalcollaborators. 2 The latter has the danger of veeringthe research interests towards that of thecollaborator and ethical collaboration is thereforeencouraged by various organizations. 15,16 Currentliterature refers to research initiatives in medicalcurricula either as an elective subject or as aMedical Science Educator © IAMSE 2013 Volume 23(1S) 138

postgraduate program. The work by Willis andDeardorff in 2011, for instance, describes theevolution of a series of meetings, lectures,workshops and symposia towards the establishmentof a Research Learning Community (RLC). 17 TheRLC continues to serve as a consolidating entity forstudent focused elective courses with a researchfocus. The University of Vermont College ofMedicine makes provision of a fourth year researchrequirement as part of their undergraduateprogram. Their initiative was aimed at promotingcommunication skills, analytical reasoning andrevisiting basic science knowledge. 18UNAM SOM’s approach is formal and incorporatesresearch as a subject and imparts an obligatoryresearch culture within the curricula. An obviousdisadvantage here is the lack in data on the outcomeand evaluation of our IRS initiative as our firststudents have only finished IRS2 (Figure 1A).Regardless, research is a keystone of medicalpedagogy within UNAM’s SOM which is aimed atself-directed lifelong learning in the same way asproblem-based learning activities employed byother medical schools. 19 Furthermore, it isimportant to note that this course is not intended toproduce fully mature independent physicianscientists.Rather, we feel it is essential that allmedical and pharmacy student training begrounded, at least in part, in research methodology.Through this we hope that students are encouragedto develop an appreciation for the application ofscientific method to clinical quandaries and perhapsa desire to apply these to the unique clinicalchallenges that they will meet in our country.Assessing the strengths and weakness of theprogram is difficult at this stage. The first group ofstudents has yet to progress into the later stages ofthe program and as such there is little quantifiableproduct. That said, the quality of research is, andwill continue to be dependent on faculty interestand participation. For instance, at this juncturethere are a limited number of faculties engaged inresearch. This places a substantial supervisory roleon individual faculty members and often finds themworking outside of their subject areas. Continuedrecruitment of physician-scientists and researchfaculty will ameliorate this problem in some partbut a long-term plan will be needed toaccommodate the numbers of students entering theprogram. Perhaps some supervision may come fromcommunity physicians. Already many of thestudents have community based research projects.There may be an opportunity to directly strengthenhealthcare outcomes simply by codifying thesestudent-supervisor relationships. Lastly, studentengagement in research has the potential tostimulate revision of basic scientific content but thisneeds further investigation.ConclusionThe descriptive report presented here providessome insight in to the inclusion of research as asubject within the medical and pharmacy curricula.The primary purpose of these projects is to exposestudents to the scientific method and encourage thedevelopment of analytical and interpretative toolsthat will be important in their professional lives.The research projects result from student relationswithin the communities they serve or the currentresearch efforts of faculty members. Through thiswe hope to nurture self-directed learning.Key WordsIndependent research, self-directed learning, interprofessional,NamibiaNotes on ContributorsCHRISTIAN JACOBSON, PhD, is associateprofessor in the Department of Biochemistry andPhysiological Chemistry, Faculty of Health Sciencesat the University of Namibia, Windhoek, Namibia,and adjunct associate professor of the Departmentof Biology, University of Waterloo, Waterloo,Ontario, Canada.CHRISTIAN J HUNTER, MD, PhD, is associateprofessor and head of the Department of InternalMedicine at the University of Namibia, Windhoek,Namibia.QUENTON WESSELS, PhD, is a senior lecturer inthe Department of Anatomy, Faculty of HealthSciences at the University of Namibia, Windhoek,Namibia.Medical Science Educator © IAMSE 2013 Volume 23(1S) 139

References1. Eichbaum Q, Nyarango P, Bowa K, Odonkor P,Ferrão J, Mashalla Y, Vainio O, Vermund SH."Global networks, alliances and consortia" inglobal health education-the case for south-tosouth partnerships. J Acquir Immune DeficSyndr. 2012; 61(3):263-264.2. Mullan F, Frehywot S, Omaswa F, Buch E, ChenC, Greysen SR, et al. Medical schools in sub-Saharan Africa. Lancet. 2011; 377(9771):1113-1121.3. Greysen SR, Dovlo D, Olapade-Olaopa EO,Jacobs M, Sewankambo N, Mullan F. Medicaleducation in sub-Saharan Africa: a literaturereview. Med Educ. 2011; 45(10):973-986.4. Beattie P, Renshaw M, Davies C. Strengtheninghealth research in the developing world:malaria research capacity in Africa [Internet]The Wellcome Trust; 1999 [cited 2 Feb 2006].http://www.wellcome.ac.uk/assets/wtd003224.pdf>.5. Hofman K, Ryce A, Prudhomme W, Kotzin S.Reporting of non-communicable diseaseresearch in low- and middle-income countries:a pilot bibliometric analysis. J Med Libr Assoc.2006; 94(4):415–420.6. Sodjinou R, Agueh V, Fayomi B, Delisle H.Obesity and cardio-metabolic risk factors inurban adults of Benin: relationship with socioeconomicstatus, urbanisation, and lifestylepatterns. BMC Public Health. 2008; 4:8:84.7. Medical professionalism in the new millennium:A physician charter. Ann of Intern Med. 2002;136:243–246.8. Blank L, Kimball H, McDonald W, Merino J.Medical professionalism in the new millennium:A physician charter 15 months later. Ann ofIntern Med. 2003; 138:839–841.9. Frishman, WH. Student research projects andtheses: should they be a requirement formedical school graduation? Heart Dis. 2001;3(3):140-144.10. Zier, K, Coplit LD. Introducing INSPIRE, ascholarly component in undergraduate medicaleducation. Mt Sinai J Med. 2009; 76(4):387-391.11. Houlden, RL, Raja, JB, Collier, CP, Clark, AF,Waugh, JM. Medical student’s perceptions of anundergraduate research elective. Med Teach.2004; 26(7):659-661.12. Biggs J. Enhancing teaching throughconstructive alignment. High Educ. 1996;32:347-364.13. Gipps C. Socio-Cultural Aspects of Assessment.Rev Educ Res. 1999; 24:355-392.14. Shepard LA: The role of assessment in alearning culture. Educ Res. 2000; 29(7):4–14.15. Glew RH. Promoting collaborations betweenbiomedical scholars in the US and sub-SaharanAfrica. Exp Biol Med. 2008; 233(3):277–285.16. Burdick WP, Morahan PS, Norcini JJ. Slowingthe brain drain: FAIMER educationprogrammemes. Med Teach. 2006; 28 (7):631–634.17. Willis M, Deardorff A. Developing a researchfocusedlearning community at one medicalschool. Med Sci Edu. 2011;21(1S):98-103.18. CichoskiKelly EM. Using Research as a tool forreinforcing basic sciences in the clinical years:Description of a fourth year teaching/researchrequirement at the University of VermontCollege of Medicine. Med Sci Edu2011;21(1S):59-62.19. Neville AJ. Problem-based learning and medicaleducation forty years on. A review of its effectson knowledge and clinical performance. MedPrinc Pract. 2009;18:1–9.Medical Science Educator © IAMSE 2013 Volume 23(1S) 140

MEDICAL SCIENCE EDUCATORThe Journal of the International Association of Medical Science EducatorsMed Sci Educ 2013; 23(1S): 141-147MONOGRAPHPatient Oriented Research: The Duke-NUSMedical Student ExperienceDeidre Anne De Silva 1,2 * , John Carson Allen 2 * , Gita Krishnaswamy 2 ,Silke Vogel 2 & Sandy Cook 21 National Neuroscience Institute, Singapore, Singapore2 Duke-NUS Graduate Medical School, Singapore, SingaporeIntroductionThe next generation of doctors will practicemedicine in an era of evidence-based medicine,attended by an exponential increase in basic,translational, clinical and health-service-relatedresearch. By the start of their residency, today’smedical school graduates must have the ability tounderstand and apply medical research literature topatient care. Knowledge of the advances in clinicalresearch designs, methods and analytic approacheswill empower them to critically evaluate researchpublications and set a good foundation forparticipation in research throughout their careers. 1Most medical students initially acquire informationdelivered by lectures and textbooks. However, todeliver state-of-the-art patient care, studentsentering their clinical years must be able to evaluatethe relevance, value and limitations of individualresearch studies. To do so, they must understandthe fundamentals of clinical research design, clinicalepidemiology, and biostatistics in patient-orientedresearch reports. In 2008, only 15 medicalprograms reported having a scholarly component:eight required and seven elective. 2 This hasdramatically increased over the past few years. Of140 US medical schools listed in the 2011 MedicalSchool Admission Requirements, 71% (100) offerthe scholarly component as an option but only 29%(40) make it a curriculum requirement. 3Medical students at the Duke-National University ofSingapore (Duke-NUS) Graduate Medical SchoolCorresponding author: Sandy Cook, PhD, Senior AssociateDean for Curriculum Development; Associate Professor MedicalEducation, Research and Evaluation Department; Office ofEducation Duke-NUS Graduate Medical School Singapore 8College Road, Singapore, Singapore 169857;Tel: (65) 6516-8722; Fax: (65) 6227-2698;Email: sandy.cook@duke-nus.edu.sgparticipate in a compulsory clinical, health serviceor translational science research component duringtheir third year. 4-8 The goal is to provide in-depthexposure to research via a mentored experience thatenables students to understand the researchprocess, including developing an idea into aproposal, executing the proposal, and analyzing andinterpreting the results to answer importantquestions. By direct participation, students learn thestrengths and limitations of research studies and thefactors that affect a study’s validity orgeneralizability. Thus they become well-informedusers of and potential contributors to the evolvingbody of knowledge.In this paper, we focus on the portion of theresearch program that supports approximately 50%of third-year students who choose to conductclinical or health service research at Duke-NUS.Students in the basic science labs or who gooverseas are not a part of this complete program.This unique program focuses on the basicknowledge of patient-oriented medical research andprovides an extended mentoring of the student’sresearch process.Program GoalsThe program goals are for the student to:• Develop an understanding and appreciationof basic clinical research principles,procedures, practices and methodologies,particularly as they apply to study designselection and the development of studyaims and hypotheses• Develop a conceptual foundation forunderstanding the quantitative aspects ofclinical research, including commonlyapplied statistical tests and analysisMedical Science Educator © IAMSE 2013 Volume 23(1S) 141

methods, sample size and power, use ofstatistical software and presentation ofresearch findings• Engage in a research project with mentoredguidance from clinical and quantitativeexpertsProgram Content and ElementsClinical MentorsStudents conduct their research under thesupervision of a clinical mentor, a physician facultymember who is a specialist in a particular area. Thestudent is responsible for setting up meetings withpotential mentors, discussing possible projects andmaking final mentor and project selections. Underthe guidance of their mentors, all students arerequired to submit a preliminary proposal sixmonths before the start of the academic year, and asecond more comprehensive proposal within twoweeks after starting their research year.Mentors must be approved by the third-yearResearch Curriculum Review Committee. Whenseeking approval, the prospective mentors mustprovide evidence of:• Active peer-reviewed grants to ensure thatthe mentor has experience in generating asuccessful and fundable hypothesis-drivenproject and the resources to support astudent’s project• First or last author publications in peerreviewedjournals to demonstrate the abilityto successfully complete and publishprojects• Prior mentoring experienceIndividuals who do not meet these criteria might berecommended for co-mentorship and after havingworked with a student reviewed to determinewhether they can provide the guidance needed tofulfill the research experience goals.One to two weeks before the school semester begins,clinical mentors attend a face-to-face orientationsession with faculty who run the weekly seminarsand are provided with a printed guide. They areadvised to meet with students on a regular basis,and are required to provide periodic reports to theuniversity. Mentors are required to submit Interimand Final Evaluation reports of the student online,which are incorporated as a Pass/Fail component ofthe student’s grade reflecting their researchexperience.Quantitative mentorsClinical research students are also assigned aquantitative mentor. These are faculty or staff with aDoctor of Philosophy (PhD) or Masters Degree inepidemiology, statistics, or public health whoprovide expertise in study design, measurement andanalysis in support of student projects. The aim is toassist while empowering the student with thequantitative knowledge and skills required forclinical research. This close mentoring givesstudents the opportunity for frequent and intensiveone-on-one consultation throughout their thirdyear. Quantitative mentors continually reviewprogress on the assigned projects and provide helpin overcoming obstacles—help that might otherwisebe unavailable.Orientation to Third-Year Clinical ResearchProgram orientation is conducted at the beginningof the academic year. Students are assigned towatch selected Duke-NUS faculty prepared VoiceAnnotated Presentations (VAPs) on researchprinciples from the Clinical Research PrinciplesVAP library. VAPs are small portable files whichprovide easy online streaming on devices such astablets, smartphones and laptops. Each VAP is aPowerPoint ® presentation with voice annotation ofeach slide. Each VAP contains an indexed playlistthat allows the listener to return to or skip to anyslide.Clinical and quantitative faculty conduct a series ofthree-hour sessions over four days to facilitatediscussions on research principles presented in theVAPs. During these sessions, students are given anoverview of how the program fits into the third-yearresearch experience and are advised onexpectations, common pitfalls and deliverables.There are also practice sessions for converting ideasinto specific primary and secondary study aims andformulating hypotheses.Deciphering the Medical Literature (DML)The DML course was instituted in the 2010-2011academic year with the short-term aim of providingessential quantitative competencies thatcomplement the student’s third-year research. Thisis achieved through a program that emphasizesunderstanding research study designs and analyticapproaches. The approach is based onunderstanding the principles of biostatistics andclinical epidemiology as opposed to formulas andmathematics, and provides a foundational review ofthe language and terminology. The long-term goal isfor students to develop a sufficient understanding ofstatistical concepts and methods to enable them toread, evaluate, and interpret statistical analyses inMedical Science Educator © IAMSE 2013 Volume 23(1S) 142

peer-reviewed journal articles, practice guidelinesand systematic literature reviews with a discerningeye, and apply the principles of evidence-basedmedicine in their careers as practicing physiciansand scientists.The ten-month DML course is divided into twoparts, a text-based expository self-learningcomponent followed by multiple interactive casestudyand problem-solving sessions that apply theprinciples and concepts studied. The expositorycomponent employs an online self-instruction andself-assessment format that is accessible to all thirdyearstudents, regardless of where in the world theyare doing their research. Three textbooks (IntuitiveBiostatistics, A Nonmathematical Guide toStatistical Thinking 2 nd Edition by Harvey Motulsky;Clinical Epidemiology, The Essentials 4 th Edition byRobert H. Fletcher and Suzanne W. Fletcher; andDesigning Clinical Research 4 th Edition by StephenB. Hulley, Steven R. Cummings, Warren S. Browner,Deborah Grady, Norman Hearst, Thomas B.Newman) explain and illustrate concepts andgeneral principles without unwarrantedmathematical details, and cover essential elementsof clinical research principles and designs,biostatistics and clinical epidemiology. Each week,specific chapter readings are assigned andcomplemented with online multiple-choicequestions for student self-assessment. VAPsdeveloped by faculty and clinicians are alsoavailable to elucidate the reading material in greaterdepth. Quantitative faculty and staff are available tostudents throughout the academic year on anindividual basis as students proceed through theDML program. A midterm in January and finalexam in May are taken online that cover theassigned readings. Toward the end of the academicyear, multiple interactive sessions are held,facilitated by clinician and quantitative faculty,focusing on case studies, problem-solving andapplications of the studied concepts and principles.Weekly sessions led by clinical andquantitative facultyThe program includes a series of weekly interactivesessions facilitated by faculty clinicians andbiostatisticians. Students are assigned to groups offive to eight which are led by two to three leadersincluding at least one clinician faculty member andone quantitative expert, thus ensuring both clinicaland quantitative guidance. The clinician facultyinvolved are from various medical disciplines withexperience in patient-oriented research. The goalsof these sessions are to 1) develop critical thinkingand systematic approaches to study planning andexecution; 2) anticipate, identify and tackleproblems in research study execution; and 3) assistwith the management of tasks, time and people,including mentors.These groups meet weekly for one to two hours,during which one to two projects are discussed. Theformat of the session consists of a studentpresentation followed by an interactive discussionamong students, their peers and faculty facilitators.Thus, each student has the opportunity toparticipate in a few rounds of discussion regardingthe project. The sessions encourage studentparticipation and peer critiquing, with the facultyguiding and facilitating the process. The frequencyof sessions and the small-group setting build a closerapport between students and faculty.In the early months of the research year, thediscussions focus on developing and refining projectaims, hypotheses, significance and study plans. Asthe research projects progress, students presentupdates and their progress is monitored. Duringthese meetings, commonly encountered problemscan be anticipated and pre-empted, and facultymembers can assist with analytical approaches andprovide feedback on the presentation of results.Further, the discussion of other students’ projectsexposes students to a broad perspective of researchtypes, study designs, common research problemsand pitfalls that they may personally encounter.ThesisEach student is required to submit a thesis at end ofthe academic year. The thesis is graded separatelyby two individuals—a quantitative person and aresearcher—on the elements of the write-up anddescription of process, but not on the significance ofthe outcomes. The thesis is graded as pass, fail orhonours.Program OutcomesNumber of studentsOver 3 academic years from 2009 to 2011 (Class of2011, 2012, 2013), 125 students enrolled as medicalstudents, of which 109 entered the third yearresearch (5 received a waiver as had alreadyattained a PhD, 11 entered into a PhD program).There were 79 students who did their research inSingapore and 30 performing research at overseasinstitutions. Of those 79 staying in Singapore, 61engaged in patient oriented research, andparticipated in the weekly seminars. The DMLcourse began in 2010 with 79 students (Class of2012 and 2013) completing the course thus far. Allstudents submitted a thesis and received at least apass grade.Medical Science Educator © IAMSE 2013 Volume 23(1S) 143

Evaluation Survey by StudentsAt the end of the third year, a program survey wasadministered to all the students to evaluate theoverall program and specific components.Additional questions were added after the firstacademic year. For the surveys administered overthree years the response rate was 94% (102/109),and for the additional survey questions includedover the latter two years the response rate was95% (59/62).Actual Execution/Management of a ClinicalResearch StudyWhen evaluating this aspect of the program, 14%selected that it was close to a transformingexperience akin to revealing the secrets of theuniverse, 81% that it was quite useful and theylearnt a lot, 3% that it was useful about half of thetime, 3% that it was occasionally of value but oftennot informative or useful, and none that it was auseless waste of time.Clinical MentorWhen asked about their clinical mentors, 37%responded that their mentor was perfect indirection and assistance, 49% that the mentor wasquite supportive and met their needs most of thetime, 8% that the mentor was fairly helpful but theycould use more support, 6% that the mentor washelpful during the few times they saw the mentor,and none that they never saw their mentor.Quantitative MentorWhen evaluating the value of the quantativementors, 30% selected that it was close to atransforming experience akin to revealing thesecrets of the universe, 65% that it was quite usefuland learnt a lot, 5% that it was useful about half ofthe time, none that it was occasionally of value butoften not informative or useful, and none that itwas a useless waste of time.Weekly Seminar SessionsIn evaluating the usefulness of the weekly seminarsessions, 7% selected that it was close to atransforming experience akin to revealing thesecrets of the universe, 52% that it was quite usefuland learnt a lot, 30% that it was useful about half ofthe time, 11% that it was occasionally of value butoften not informative or useful, and none that itwas a useless waste of time.Deciphering Medical Literature (DML)Students evaluated the DML program by selectingtheir level of agreement to statements about some ofits various aspects: online assessment, articlesessions, level of content and workload. As DMLwas instituted in the second year of the program, wehave data for the class of 2012 and 2013 only. Fromthe class of 2012, 40% disagreed or stronglydisagreed that the workload was reasonable and28% that the level of content was appropriate fortheir level (Figure 1a). Thus the content of theprogram was amended for the subsequent year, withchanges in the required reading and discussiontopics for the class of 2013. Following thisamendment, from the class of 2013, 20% disagreedor strongly disagreed that the workload wasreasonable and 17% that the level of content wasappropriate for their level (Figure 1b).Overall Rating of the Third Year ResearchExperienceAmong the 102 students in the three academic yearswho completed the evaluation, 49% rated theirexperience as excellent, 40% as good, 10% as fairand 1% as poor.Research OutputAs of the present, 31% (11/35) of the students in theclass of 2011 and 2012 involved in this programwere authors on peer-reviewed publications basedon their third-year research. This is similar to the25% (4/16) of class 2011 and 2012 students involvedin basic science research locally who were notinvolved in this program. However, we note that thepublication rate of students involved in our programis lower than the 55% (6/11) of class 2011 and 2012students who did their research year at DukeUniversity in the US. As publications often takemore than a year to get finalized and accepted, wefind that our students are continuing to publishtheir research performed in the third year followinggraduation and during residency.Medical Science Educator © IAMSE 2013 Volume 23(1S) 144

Figure 1a: Survey results for Deciphering Medical Literature (DML) component for Class of 2012Figure 1b: Survey results for Deciphering Medical Literature (DML) component for Class of 2013Medical Science Educator © IAMSE 2013 Volume 23(1S) 145

DiscussionThis program was created to provide support andstructure to the third-year students involved inpatient-orientated research at Duke-NUS, animportant and integral component of the medicalcurriculum which is relatively unique. With theinauguration of the Duke-NUS medical school inSingapore, we aimed to develop a supportiveenvironment conducive to clinical research bymedical students similar to that at Duke University.The program promotes learning of researchmethods while executing clinical research andinvolves various pedagogical methods includingpractice-based learning, peer-review, self-learning,guided mentorship and interactive session. Thisrigorous program is feasible, with over 100 studentsbeing involved in the program over the first threeyears of Duke-NUS. Elements of this program mayalso be useful for subsequent research learningexperiences such as residency programs, othermedical school curricula and for other healthcareprofessionals.The main strengths of the program identified in thesurvey were the quantitative and clinical mentorsupervision. Regarding the weekly seminars, that41% of students thought they were useful only halfthe time or occasionally suggests the need to betterengage more of the students throughout thesessions and to maintain a high level of relevance asa learning experience for presenters and nonpresentersalike. Current practice in the weeklyseminars incorporates PowerPoint ® presentationsby one to three students discussing specific aspectsof their project (such as the aims and hypothesis,methods, statistical plan) and provides opportunityfor updates on project status as well as anyproblems encountered. Faculty facilitators providecomments and insights with opportunity for studentattendees to participate as well. Perhaps sessionscould be made more stimulating and satisfying tonon-presenting students by giving them the initialopportunity for inquiry, problem identification,comment and offering of solutions. Comments byquantitative and clinical facilitators could bedeferred until after a preliminary discussion amongthe students. The milieu is conducive to the Socraticapproach, and active engagement of both presentingand non-presenting students guided by facultymentors could be readily stimulated.The DML program was revised, based on feedback,with content amendments and workload reduction,after which the students’ evaluation of the DMLprogram improved. We are exploring ways toenhance the publication rate extending fromparticipation in this program in an effort to emulatethat achieved by our Duke-NUS studentsperforming their third year research at DukeUniversity.ConclusionsWe have developed a program to support a patientoriented research experience for medical students atDuke-NUS. Based on student feedback, the programis particularly strong in clinical and quantitativementoring. We continue to revise the program toaddress areas of potential improvement such as theweekly seminars and DML program as well as striveto emulate successes at Duke University,particularly the impressive publication record.AcknowledgmentThis entire third year project could not have beenaccomplished without the extensive supportprovided by the mentors, the Medical Education,Research, and Evaluation Department, the Office ofClinical Sciences, and these specific individualsfrom Duke-NUS: A. John Rush, MD; Arul Ernest,PhD; Rebecca Dent, MD; Goh Sok Hong, MSc;Aberith Ho Cai Xuan, BBM; Scott Compton, PhD.Key WordsResearch, Medical student, EducationNotes on ContributorsDEIDRE ANNE DE SILVA, MRCP, is AssociateProfessor in the Office of Clinical Sciences at Duke-NUS Graduate Medical School, Singapore andConsultant Neurologist at the NationalNeuroscience Institute, Singapore.JOHN CARSON ALLEN, Jr, PhD, is AssistantProfessor in the Office of Clinical Sciences at Duke-NUS Graduate Medical School, Singapore.GITA KRISHNASWAMY, MS, is Associate in theOffice of Clinical Sciences at Duke-NUS MedicalSchool, Singapore.SILKE VOGEL, PhD, is Associate Professor in theOffice of Clinical Sciences at Duke-NUS GraduateMedical School, Singapore.SANDY COOK, PhD, is Senior Associate Dean andAssociate Professor in the Office of Clinical Sciencesat Duke-NUS Graduate Medical School, Singapore.* Drs De Silva and Allen are considered to be cofirstauthors as both have equally contributed to thismanuscript.Medical Science Educator © IAMSE 2013 Volume 23(1S) 146

References1. Report of the AAMC-HHMI committee.Scientific foundations for future physicians.Association of American Medical Colleges;2009.2. Green EP, Borkan JM, Pross SH, Adler SR,Nothnagle M, Parsonnet J, et al. Encouragingscholarship: Medical school programs topromote student inquiry beyond the traditionalmedical curriculum. Acad Med. 2010; 85(3):409-418.3. Colleges AoAM. Medical School AdmissionRequirements (MSAR) 2012-2013: The MostAuthoritative Guide to U.S. and CanadianMedical Schools: RuveneCo, Incorporated;2011.4. Cook S, Grochowski CO, Atherton A, LaskowitzDT, Pervaiz S, Buckley E, et al. Developingphysician leaders for over 50 years: The DukeMedical Student Research Experience in the USand Singapore. Med Sci Ed. 2011;21(1S): 53-58.5. Blazer D, Bradford W, and Reilly C. Duke's 3rdyear: A 35-year retrospective. Teach Learn Med.2001; 13(3): 192-198.6. Grochowski COC, Halperin EC, and Buckley EG.A curricular model for the training of physicianscientists: The evolution of the duke universityschool of medicine curriculum. Acad Med.2007; 8(4): 375-382.7. Laskowitz DT, Drucker RP, Parsonnet J, CrossPC, and Gesundheit N. Engaging students indedicated research and scholarship duringmedical school: The long-term experiences atduke and stanford Acad Med. 2010; 85(3): 419-428.8. Grochowski CO, Petrusa E, and Buckley E. TheDuke curriculum – foundation for excellence.In: Association of American Medical Colleges.Washington DC; 2005.Medical Science Educator © IAMSE 2013 Volume 23(1S) 147

MEDICAL SCIENCE EDUCATORThe Journal of the International Association of Medical Science EducatorsMed Sci Educ 2013; 23(1S): 148-153MONOGRAPHIncreasing First Year Student’s Attitude andUnderstanding towards Biomedical ResearchNelleke A. Gruis & Jessica M. LangenhoffLeiden University Medical Center, Leiden, The NetherlandsAbstractWhen you want to teach students academic and scientific skills, why not start in their first week at University? Ina 7 day course, students in biomedical sciences go through the full process of doing research. The theme of thecourse is skin cancer, and students work in pairs, starting from pre-formulated research questions. A systematicliterature search is the main source of information for the answers. Other educational activities range fromlectures, group discussions, e-learning module to visiting a foreign laboratory by virtual meeting. The courseends with an oral presentation of the results and the presentations are marked for scientific quality. Grading isbased on scientific quality of the presentation and the literature research. Following completion of this course,improvement of first year student’s attitude and understanding towards biomedical research is remarkable.IntroductionAt Leiden University Medical Center (LUMC), thescientific and academic training of students is amajor thread throughout the medical andbiomedical curriculum.Scientific training aims at students acquiring skillsand knowledge in order to conduct scientificresearch, namely designing and performingexperiments, analyzing the results and engaging in ascientific discourse. Discussing and gaining anappreciation of the process of conducting researchimproves students’ attitude towards research andmay foster life-long learning. Academic trainingfosters scholarly attitudes, aiming at criticalreflection of the context of biomedical research andits applications, beyond their own researchenvironment. 1-3In both the medical and biomedical curriculum atLUMC, scientific and academic training is organizedin longitudinal programs, woven into block-orientedcurricula. In the biomedical curriculum, thislongitudinal program is called Biomedical AcademicScientific Training (BAST). It focuses on topics likeliterature research, critical thinking and reflectionskills, ethics, humanities, society, and philosophy.The first encounter of our students with the BASTprogram is our 7 full-day long course at the verybeginning of the first year. In this course, studentsget acquainted with the field of biomedical researchand their curiosity in science is stimulated.Although these students have had no single lectureon biomedical content yet, they are immersed insolving a realistic scientific question on the topic ofskin cancer.The learning goals of our course are:1. acquisition of knowledge of and insight intobasic aspects of a biomedical theme (in thisspecific situation skin cancer)2. discussion of the obtained knowledge andinsight with fellow students3. acquisition of and reporting on relevantvalid information on a scientific researchquestion4. grading and documenting of informationwith respect to a research question andpresenting the outcome to fellow studentsCorresponding author: Nelleke A. Gruis, PhD, Department ofDermatology, Leiden University Medical Center T-2-34, S2-P,Einthovenweg 20, 2333 ZC, Leiden, The Netherlands; Tel: +31-71-5269366; Email: gruis@lumc.nlMedical Science Educator © IAMSE 2013 Volume 23(1S) 148

Figure 1: Outline of the courseTo achieve the learning goals, we use severaleducational activities including plenary lectures andsmall group learning. Interactive discussions areinduced by a patient presentation, by making use ofclickers during the lectures and by holding a plenarySkype session. Other activities used are conceptmapping, e-learning, and oral presentation.explained to the students. Students are asked toformulate research related questions that they canask in an online discussion with the researcher(Figure 2). This session is intended to makestudents realize that biomedical research is a teameffort performed by collaborating researchers on anational and international level.Detailed layout of the courseOur course consists of five elements as depicted inFigure 1. All activities in the course are concentratedaround a realistic research question that studentshave to work on and solve during the week.Orientation on biomedical themeThe first element in the course is orientation on thebiomedical topic of skin cancer. Issues related tobiomedical research in this field are introduced in aplenary discussion with audience participation bymeans of response clickers. Discussion issues coverthe entire field of conducting biomedical research,from legislation on obtaining patient material forbiomedical research, storage of the material inbiobanks, access to material and data, grantproposal writing, experimental set-up, publicationand dissemination of research results, translation ofresults into the clinic or developing new researchprograms. From the very first moment in theircurriculum, the discussion forces students tobroaden their minds on research goals and how toachieve them. The session draws the basis for morespecialized lectures on these topics later in thecourse. More specific background information onthe biomedical topic of skin cancer is provided by aseries of plenary lectures. This series is completedby lectures on the philosophy behind biobanks andmedical registries.Another activity to get students introduced into theworld of research is a Skype meeting with aresearcher from another research institute. Beforecontacting this researcher, his/her research field isFigure 2: Students and tutor taking part in a Skype meetingwith a scientist from another research institute.The relevance of the theme is further illustrated bypresenting a real patient from our clinic. Thispatient with metastasized melanoma skin cancerspeaks about his journey as a cancer patient and hisexperiences with the medical field. Students areencouraged to ask questions.Orientation on the research questionThe first year of biomedical science consists of 70students. These students will work in small groups,consisting of 14 students, who are supervised by atutor. Seven research questions have beenformulated, meaning that within each group a pairof students can work on each question. All researchquestions are introduced by means of a concept mapdiscussion. At a plenary meeting, students areMedical Science Educator © IAMSE 2013 Volume 23(1S) 149

andomly divided over small groups in which one ofthe seven research questions is introduced. Allaspects that come to mind by discussing adesignated topic of this specific research questionare written or drawn at a huge piece of paper. Aftercompleting the concept map, one or tworepresentatives of each concept map group presenttheir results to their fellow students (Figure 3). Afterseven presentations, all students have some generalunderstanding and impression of each of the sevenresearch questions. This group activity allows themto make an informed choice on which of thequestions they will work on for the remaining partof the course. After this selection process, pairs ofstudents are responsible for the research outcomeand dissemination of that outcome by presenting tofellow students. Knowing their research questionalso motivates students when they take part in thethird element of our course.Information LiteracyInformation Literacy is the third element in thecourse. We constructed a blended learning strategy,starting with a general lecture introducing thesystem of systematic information search (Figure 4).Following this orientation, an e-learning module isoffered to the students in the presence of a tutor toanswer possible questions. The theme of the e-learning is the role of exposure to ultraviolet rays inthe development of melanoma as it relates to thetopic of the whole course. During the e-learning, allthe steps of a systematic literature search arecompleted by the students. During the first step,students have to formulate a search strategy forPubMed based on their research question. A wellbuiltpatient question containing four parts: 1)Population, 2) Intervention, 3) Comparison, and 4)Outcome(s), or simply PICO, is used. 4 In theorientation phase, students get an overview of thesubject and the English scientific vocabulary that isused. Internet and books are used as informationsources. After the orientation phase, studentsperform a database search in PubMed. Theyexperience the difference between their normal'Google style' way of searching for information andthe systematic way of searching as used in scientificresearch. They combine MeSH (Medical SubjectHeadings) terms, which are systematic subjectheadings added by PubMed, and free text (wordsexpected to be used in titles and abstracts) for eachcomponent (Population, Intervention, and/orOutcome(s) of PICO). After combining these termsfor one component with the conjunction ’or’,students combine the separate components with theconjunction ‘and’. The snowball method is used toretrieve more relevant information by checkingreferences from websites, journal articles, and otherpertinent sources. In a guided tour, students learnhow to use the physical library and retrievehardcopy books they found in the online Catalogueduring the orientation phase of the e-learning.Figure 3: Presentation of a concept map by a student to herfellow studentsSolving the research questionThe most important element in the course isincreasing the students' research experience andskills by working on and subsequently finding asolution to the research question of their choice. Inthis part, students repeat the steps of systematicsearching for their own research question. Theydocument what they do by filling in a standardizedreporting form in Microsoft Word. PubMedsearches are saved in this document. In this way, thetutor can closely monitor (and finally judge) whatsteps are taken and if the literature search meetsour quality standards.The next day, students obtain feedback on theirsearches in small groups, resulting in a list ofPubMed articles relevant for their researchquestion. Subsequently, they are taught how to readand analyze a scientific article on increasingincidence rates of skin cancer. 5 Acquired skills andknowledge can be applied immediately by thestudents when reading the articles they have foundduring the search.During the rest of the week, students work in smallgroups. In every group, couples working on one ofthe 7 different research questions are present.Students summarize the results of articles obtainedby their literature search. Tutors working in thebiomedical field, help them to interpret the(bio)medical information and to reach a sufficientscientific level.Medical Science Educator © IAMSE 2013 Volume 23(1S) 150

Figure 4: Schedule of systematic searchingPresentationA lecture is given on how to make an efficientscientific PowerPoint presentation. The layout of thepresentation is similar to the layout of a scientificpaper including an introduction, aims, results,discussion, and conclusion. Approaching the end ofthe course, students start preparing theirpresentations simulating that they are presentingfor fellow researchers at a skin cancer conference.On the final day of the course, each pair of studentspresents the answers to their research questions byPowerPoint presentation while the other studentsare allowed to ask questions. Two tutors are presentfor grading: the group tutor and a colleague who isnot familiar with the students.GradingThe focus of the course is on the research processand its related necessary skills rather than on therequirement of specific detailed knowledge on skincancer. For that reason an integrated assessmenthas been developed. Presentations are assessedindependently by two tutors, one of them is thegroup tutor and the other is invited for judgment ofthe presentations only. A standardized form is usedand assessment focuses both at the scientific qualityof the content and working attitude during thecourse. Information literacy skills are assessed bymeans of grading the standardized reporting formthe students filled in during the literature research.The final mark is a weighted average of 30% for theliterature research and 70% for the presentation.Electronic evaluationAt LUMC, all courses are systematically evaluatedby the students by means of an electronic evaluationsystem. The evaluation consists of multiple choicequestions on several aspects of the course. In openquestions, students are welcomed to comment onthe course. Most questions are used for all courses,but a number of specific course-related questionscan be added by the course director.Reflection and DiscussionIt is very unique to submerge new first year studentsin research questions and having them working in aquite independent way at the very first week of thecurriculum. To start with research cases is oppositeto the theory of Healey, which states that learningstarts with step-wise acquirement of basicknowledge, then using it in exercises, applying it toproblems, and finally discussing it at the end of the4-year curriculum. 6 However, we believe that ourapproach induces far more motivation in studentsto study and to work on their assignments.Medical Science Educator © IAMSE 2013 Volume 23(1S) 151

In our course, the example of skin cancer is used tointroduce students to scientific research andacademic thinking as this disease impacts societyand connects well to student’s knowledge andinterests at this early stage. The use of problembasedlearning is supported by theory, although theeffects in practice were not yet significant. 2 Insteadof taking a patient’s illness as a starting point, weraised scientific and academic attitude by researchquestions related to skin cancer. By engagingstudents in a concept map discussion, they arebetter informed on the context of a researchquestion and what issues might be relevant foranswering it. 7 In this way, students can make aninformed choice for one of these research questions.Once committed to a particular topic, they want tosearch for the answer and are more motivated totake part in the Information Literacy element of thecourse. Placement of the information literacyelement is located between the orientation elementsand the Solving of the Research question for thispurpose (Figure 1).The Information Literacy competency goals in ourcurriculum are adapted from the Association ofCollege and Research Libraries (ACRL) guidelines. 8Information literacy skills are best retained whenthey are integrated into the curriculum. 9 In ourcourse, the central theme of skin cancer is used topractice systematic literature research. The newskills can be applied immediately to search forliterature for the research questions. To achieveoptimal integration, close cooperation betweenfaculty members and the librarian is essential.Formulating challenging research questions whichare scientifically sound and suitable for literatureresearch was a time consuming, but very rewardingexperience, for librarian and faculty. Thiscollaborative experience is often described in libraryresearch literature. 10-12 To date, motivating studentswas an underestimated element in buildingcurricula, but it might have a significant positiveeffect on the outcomes of learning. 1 In our case,stronger engagement of the students was notableand resulted in better applying of the systematicapproach of literature research by the students.A suitable way of grading students' achievements inthis course is grading both the presentations and thereporting form of the literature research. In thisway, we don't test their knowledge on encyclopedicfacts, but we can really judge their academic andscientific skills. Tennant et al. had their studentspresenting posters instead of PowerPointpresentations, which resulted in similar positiveexperiences. 13ConclusionOur experience with this problem-oriented,integrated course on scientific and academic skillsfor first year students is very positive. Students areactively engaged in every aspect of doing their ownresearch by answering pre-formulated, but realtimeresearch questions. It is a pleasure to see howmotivated the students are working during thecourse. The presentations reflect that most of themreally get a strong understanding of scientificresearch. Designing and presenting a similar course,requires close cooperation of all teachers and tutors.With their combined efforts, the different elementsof the course form one consistent whole,incorporating Information Literacy as a logical andindispensable element. This approach helps ourstudents get off to a strong start for the rest of theirstudies and raises motivation for the next courseswhich will supply them with further basicknowledge and skills.Key WordsAcademic training, scientific training, problembasededucation, information literacyNotes on ContributorsNELLEKE A. GRUIS, PhD, is Associate Professor inthe Department of Dermatology, Leiden UniversityMedical Center, Leiden, The NetherlandsJESSICA M. LANGENHOFF, MSc, is informationspecialist at Leiden University Medical Center,Leiden, The Netherlands.Students like working through research questionsbecause this exercise gives them a sense of what it islike to be a scientist. The resulting presentationswere of high quality, reflecting the enthusiasticinvolvement of the students, an experience sharedby Porter et al. 3 It will help the students to staymotivated in the next courses in which they have tomaster a large amount of fundamental knowledge.Medical Science Educator © IAMSE 2013 Volume 23(1S) 152

References1. Kusurkar RA, Croiset G, Mann KV, Custers E,Ten CO. Have motivation theories guided thedevelopment and reform of medical educationcurricula? A review of the literature. Acad Med2012;87(6):735-743.2. Onyon C. Problem-based learning: a review ofthe educational and psychological theory. ClinTeach 2012;9(1):22-26.3. Porter JA, Wolbach KC, Purzycki CB, BowmanLA, Agbada E, Mostrom AM. Integration ofinformation and scientific literacy: promotingliteracy in undergraduates. CBE Life Sci Educ2010;9(4):536-542.4. Richardson WS, Wilson MC, Nishikawa J,Hayward RS. The well-built clinical question: akey to evidence-based decisions. ACP J Club1995;123(3):A12-A13.5. Janssen Heijnen ML. [Trends in the incidenceand prevalence of cancer and in the survival ofpatients in southeastern Netherlands, 1970-1999]. Nederlands tijdschrift voor geneeskunde2003;147(23):1118-1126.6. Healey M. Linking research and teaching:exploring disciplinary spaces and the role ofinquiry-based learning. In: Barnett Red (ed.).Reshaping the university: New relationshipsbetween research, scholarship, and teaching.:London, UK. McGraw-Hill/Open UniversityPress; 2005. pp. 67-78.7. Daley BJ, Torre DM. Concept maps in medicaleducation: an analytical literature review. MedEduc 2010;44(5):440-448.8. Information Literacy Competency Standards forHigher Education. Association of College andResearch Libraries. Published January 18,2000.http://www.ala.org/acrl/standards/informationliteracycompetency Last assessed 02/24/2013.9. Leasure AR. Health information literacy:hardwiring behavior through multilevels ofinstruction and application. Dimens Crit CareNurs 2009;28(6):276-282.10. MacEachern M, Townsend W, Young K, RanaG. Librarian integration in a four-year medicalschool curriculum: a timeline. Med Ref Serv Q2012;31(1):105-114.11. Kroth PJ, Phillips HE, Eldredge JD. Leveragingchange to integrate library and informaticscompetencies into a new CTSC curriculum: aprogram evaluation. Med Ref Serv Q2009;28(3):221-234.12. Ware F. The development of a blended learningapproach to delivering information skillstraining to large health related studentaudiences with limited staff resource. HealthInfo Libr J 2011;28(3):230-236.13. Tennant MR, Edwards M, Miyamoto MM.Redesigning a library-based genetics classresearch project through instructional theoryand authentic experience. J Med Libr Assoc2012;100(2):90-97.Medical Science Educator © IAMSE 2013 Volume 23(1S) 153

MEDICAL SCIENCE EDUCATORThe Journal of the International Association of Medical Science EducatorsMed Sci Educ 2013; 23(1S): 154-158MONOGRAPHDevelopment of the Research Competency in theCurriculum of a Mexican Medical SchoolGregorio T. Obrador 1,21 Universidad Panamerica School of Medicine, Mexico City, Mexico2Tufts University School of Medicine, Boston, MA, USAIntroductionIn Mexico, students start medical school aftercompletion of senior high school and typically are18 years of age. At the Universidad PanamericanaSchool of Medicine, medical studies include threesemesters of basic sciences and five semesters ofclinical sciences, followed by a year of actinginternship, and a final year of social serviceassignment. Although most students do the latter inunderserved rural or urban clinics, up to 5% of thegraduating class can apply for a research position.The Secretariat of Health is responsible for selectingcandidates for the approximately 80 social serviceassignment research positions available nationwidebased on the students’ previous academic andresearch performance.Universidad Panamericana School of Medicine is aprivate, not-for-profit, medical school located inMexico City. Founded in 1996, it currently has atotal of 230 students, with an entering class size of58 highly selected students. The school’s mission isto educate physicians who distinguish themselvesnot only for their competencies directed to furtherspecialty training and research, but also for theirhumane attitude, strong ethics, and socialresponsibility. The Universidad PanamericanaSchool of Medicine’s curriculum was thoroughlyrevised in 2003. The reasons to include research inthe mission and the curriculum were to develop inthe students more critical thinking, to provide themwith essential tools to perform research, andformation of future researchers. 1-5 In this paper, wedescribe the challenges, possible solutions,operational aspects, and preliminary results of ourCorresponding author: Gregorio T. Obrador, MD, MPHUniversidad Panamericana School of Medicine, Donatello 59;Col. Insurgenetes Mixcoac, Mexico, DF 03920; Tel: 52+ (55)1251-6856; Fax: 52+ (55) 5482-1720; Email:gobrador@up.edu.mxexperience with the changes made to the medicalschool’s curriculum regarding research.Challenges to develop the researchcompetency in the medical schoolcurriculumDevelopment of research competency in the medicalschool curriculum faces multiple challenges. First,students are rather young (see above). Second, mosthigh school students have none or only minimalresearch experience and often lack interest in it.Third, there are significant time constraints due tothe short duration of medical school, the increasingbody of knowledge and skills that are to be acquired,the short summer vacation time (limited to onemonth, or less since the end of the fourth year), andthe competition for research time by “moreappealing clinical courses.” Fourth, a need for somebasic knowledge and skills before students arecapable of doing research. Lastly, a significantcommitment of human and financial resources toprovide a meaningful research experience to thestudents.Possible solutions to develop the researchcompetency in the medical schoolcurriculumGiven the multiple challenges involved withdevelopment of the research competency in themedical school’s curriculum, we sought andanalyzed possible solutions. Regarding the students’young age, we could require them to take a 1-2 yearpremedical course before entering medical school.However, this requirement could prevent manycandidates from applying to our medical school. Thelack of research experience and/or interest could bemitigated by a careful selection of entering students,which would be possible due to the large numberand the high quality of applications we receive eachyear. The admissions’ profile could be changed soMedical Science Educator © IAMSE 2013 Volume 23(1S) 154

that students with previous experience and/orinterest in research could be given additional points.Instructional modules on the basic researchconcepts and opportunities to join a research teamin action could be offered before high-schoolstudents enter medical school. 6 Research interestcould be built or enhanced by highlighting researchaspects on the topics presented in regular medicalschool courses by professors who, in addition tobeing teachers, are active researchers; moreover,teaching laboratories could be redesigned so thatstudents become familiar with most of the currentbasic research techniques.Regarding time constraints related to the shortduration of medical school and the increasing bodyof knowledge and skills to be acquired, lengtheningthe duration of medical studies would be an option;however, this solution would be unpopular amongstudents. Offering summer research programswould also be a possibility, but restricted to thosewho wished to take them on an elective basis.Competition for research time from “moreappealing clinical courses” could be reduced byconsidering the research experience as a subject,and by giving the same weight to the grade obtainedas that of any other subject. Additionally, studentscould work in teams, particularly for projects thatare more time consuming, and have one-to-onetutoring as well as a time line for successfulcompletion of their projects.With regard to the need for basic knowledge andskills before being capable of doing research, thecurriculum required revision regarding thesequence and content of subjects to see if theywould provide the necessary knowledge and basicresearch tools, before embarking in a project. Basedon the premise that, for learning how to do researchit is necessary to do research, development ofhands-on-experience by participating in a researchproject was an essential component for the researchcompetency to be acquired. Lastly, the projectrequired careful consideration and planning of thehuman and financial resources needed for theschool to provide a meaningful research experience.Operational aspectsStarting in 2003, changes in the medical school’scurriculum regarding the research competency wereoperationalized and implemented as follows:Admissions requiremento Besides brightness and motivation, amongother factors, admission evaluationincluded prior research experience and/ordemonstrated interest in researchSequence of subjects and teaching methodso Basic sciences were taught in the first threesemesters and clinical sciences in semestersfour to eighto Teaching labs provided students withhands-on-experience on the mostcommonly used basic science researchtechniqueso Professors were selected based on theirteaching and research ability, and wereasked to emphasize research aspects on thetopics covered in regular courseso The following courses were redesigned andsequenced to provide basic knowledge andskills for doing clinical and epidemiologicalresearch:• Medical informatics and literaturesearches (1st semester)• Public health (2nd semester)• Biostatistics (3rd semester)• Clinical epidemiology(5th semester)• Social and preventive medicine (7thsemester)Research project subjecto 5th semester:• Students are asked to attend a briefresearch conference series onresearch methodology, statisticalmethods, protocol components, andethics committees• Students are asked to choose theirresearch project from either a briefcatalogue prepared by the school’sresearch projects committee ortheir own interest. In the lattercase, projects should be approvedby the school’s research projectscommittee. Projects can be done atthe medical school or any of theaffiliated hospitals, particularly theNational Institutes of Health. Forsome projects, teams of two to fourstudents are acceptable. EachMedical Science Educator © IAMSE 2013 Volume 23(1S) 155

student/team is assigned a primarytutor at the research site and asecondary tutor at the medicalschool. Additionally, students canrequest assistance on researchmethods from professors of theDepartment of Epidemiology,Statistics, and Public Health. Atime-table is provided for thestudents, which typically includesthree meetings and several reportsduring the course of the semester.Students are expected to dedicate aminimum of four hours per week totheir research project.o 6th semester:• After their research projects areapproved by the school’s researchprojects committee, all students arerequired to take the ResearchProject I subject. The goal is towrite the full protocol of theresearch project they selected. Ifrequired, students are responsiblefor getting approval by theInstitutional Review Board (IRB).Grading of the subject is based onreview of the written and oralpresentation of their protocol,standardized evaluations by theirtwo mentors, review of the ongoingreports and participation inscheduled meetings.o 7th semester:• All students are required to take theResearch Project II subject. Thegoal is to conduct the researchproject. If students were able tocomplete their written protocolearlier, they can start conducting itin the previous semester. Gradingof the subject is based on thewritten and oral presentation oftheir preliminary results,standardized evaluations by theirtwo mentors, review of the ongoingreports and participation inscheduled meetings.o 8th semester:• All students are required to take theResearch Project III subject. Thegoal is to finish the project, analyzethe results, write the final reportand prepare a presentation forResearch Day (Figure 1), which isheld in late April each year.Depending on quality, projects areselected for oral or posterpresentation. Students are trainedon how to make slides or postersand rehearse before presenting inResearch Day. Grading of thesubject is based on the written andoral/poster presentation of theirfinal results, standardizedevaluations by their two mentors,review of the ongoing reports andparticipation in scheduledmeetings.• Research Day is attended by allmedical students and consists of aconference by an outstandingresearcher, either from Mexico orfrom abroad, followed by 4-5 oralpresentations, poster presentations,and oral presentations by the 2-3students who are doing their socialservice assignment year in research.It ends with an award ceremony ofthe best projects. Selection of thelatter is made by a committeeformed by intramural andextramural researchers.Research electiveso Students are allowed to take researchelectives since the first year of medicalschool. They must be approved by theschool’s research projects committee. Somestudents also do summer research electivesin Mexico or abroad.Research awardo During each year’s graduation ceremony, anaward is given to the student who had morehigh-quality research accomplishments ofhis entire class as evaluated by the school’sresearch projects committee.Medical Science Educator © IAMSE 2013 Volume 23(1S) 156

Figure 1: Medical students during Research DayResults of the changes in the medical schoolcurriculumChanges in the medical school curriculum went intoeffect in 2003; thus, six cohorts of students havegone through the revised research curriculumbetween 2007 and 2012. Although it is relativelyearly to judge, we have noticed a number of positivepreliminary results. First, 75% of medical studentsview the research component of the curriculum as acompetitive advantage for them. Second, 70-75% ofmedical students indicated that the subjectResearch Projects helped them to develop thefollowing skills: literature search, critical review ofthe literature, protocol design, quantitative analysis,critical thinking, team work, and scientific writing.Third, most students become truly interested inresearch as documented by the following: a) at leastone third have a good number of publications andpresentations at national and internationalscientific meetings; b) launching in 2012 of astudents’ research journal titled UPdate Journal ofMedicine; to date, 21 articles have been published, 7of which are original and 8 review articles; c)passing of research projects done by more advancedstudents to younger students; d) development of a“culture” of doing research among the students; e)60% of medical students indicated that they wereinterested in doing research in the future and anincreasing number of alumni are pursuingpostgraduate research training. Fourth, ResearchDay has become one of the most notable events ofthe school; invited speakers and external researchevaluators often indicate that the level of thepresentations is far superior to that expected from afourth-year medical student. Lastly, it is possible tounderscore the research competency in the medicalschool curriculum without risking students’academic performance and achievement of othercompetencies.Since there will be seven cohorts of students thathave gone through the revised research curriculumin 2013, we are in the planning stages of astandardized and more objective evaluation of theresults of the research competency among thestudents. We are also planning to compare ourresults with those published in the literature. 7-10ConclusionsThe research competency is a fundamental aspect ofthe medical school’s mission. Inclusion of thiscompetency in the medical school curriculum isfaced with a number of challenges. However, it ispossible to solve most of them. With a well thoughtand structured program, it is possible to develop theresearch competency in the medical schoolcurriculum, without risking students’ academicperformance and achievement of othercompetencies. Although the preliminary results arepositive and encouraging, a more objectiveevaluation will allow us to discover additional areasof improvement and opportunity.Medical Science Educator © IAMSE 2013 Volume 23(1S) 157

KeywordsResearch, Competencies, Curriculum, MedicalschoolNotes on ContributorGREGORIO T. OBRADOR, MD, MPH, is a Deanand Professor of Medicine in the Faculty of HealthSciences and School of Medicine at the UniversidadPanamericana in Mexico City, Mexico as well as anAdjunct Assistant Professor of Medicine at TuftsUniversity School of Medicine in Boston, MA, USA.References1. Cooke M. Science for physicians. Science2010;329:1573.2. Cooke M, Irby D, O’Brien B, eds. Educatingphysicians. A call for reform of medical schooland residency. Stanford, CA: The CarnegyFoundation for Advancement of Teaching;2010.3. Frenk J, Chen L, Bhutta ZA, et al. Healthprofessionals for a new century: transformingeducation to strengthen health systems in aninterdependent world. Lancet 2010;376:1923-58.4. Ladhani Z, Scherpbier AJJA, Stevens FCJ.Competencies for undergraduate communitybasededucation for the health professions – Asystematic review. Medical Teacher2012;34:733-43.5. Laidlaw A, Aiton J, Struthers J, Guild S.Developing research skills in medical students:AMEE Guide No. 69. Medical Teacher2012;34:754-71.6. Scientific foundations for future physicians.Report of the AAMC-HHMI Committee; 2009.7. Burgoyne LN, Flynn S, Boylan GB.Undergraduate medical research: the studentperspective; 2010.8. Salgueira A, Costa P, Goncalves M, MagalhaesE, Costa M. Individual characteristics andstudent's engagement in scientific research: across-sectional study. BMC Medical Education2012;12:95.9. Siddiqui ZS, Jonas-Dwyer DR. Twelve tips forsupervising research students. Medical Teacher2012;34:530-3.10. van Schravendijk C, März R, Garcia-Seoane J.Exploring the integration of the biomedicalresearch component in undergraduate medicaleducation. Medical Teacher 2013;0:e1-e9.Medical Science Educator © IAMSE 2013 Volume 23(1S) 158

MEDICAL SCIENCE EDUCATORThe Journal of the International Association of Medical Science EducatorsMed Sci Educ 2013; 23(1S): 159-164MONOGRAPHThe Sugar Study: A Monograph for In-ClassResearch with Medical StudentsWendy Hodsdon, Carolyn Nygaard & Heather ZwickeyHelfgott Research Institute at National College of Natural Medicine, Portland, OR, USAIntroductionEvidence based medicine (EBM) calls for physiciansto read and understand research, and EBM traininghas been integrated in medical education. 1,2 Aftermany years of EBM education in medical schools,studies are starting to demonstrate theineffectiveness of certain methods of EBMtraining. 3-5 Although lectures in EBM can addressresearch knowledge, they may not change clinicianskills and behavior. 6 If students do not understandthe research process, they many not fully grasp thequality of the research they are reading.Paradoxically, as interest in EBM has increased,there has been a decline in the number of physicianscientists.7,8 To bridge this gap, new trainingprograms are emerging to train translationalresearchers. 9 The National Institutes of Health hasalso recognized the need to train additionalphysician-scientists, and has developed careerdevelopment awards for clinician scientists as wellas loan repayment programs to encourage thiscareer path. 10,11Providing in-class research activities in medicalschool courses may enhance student EBM skills andfurther nurture their interest in clinical research. Aneffective way to learn research is to have personalexperience conducting it. 12-14 When planning clinicalresearch projects, students experience thechallenges and pitfalls of designing and carrying outa study. They can then apply this understandingwhen evaluating medical literature. Further,medical students who resonate with the clinicalresearch process may choose to conduct patientorientedresearch or serve on multi-discipline teamswith researchers in the future.Corresponding author: Wendy Hodsdon, ND, Helfgott ResearchInstitute, National College of Natural Medicine, 049 SW PorterStreet, Portland, OR 97201, USA. Fax: +1-503-227-3750,Email: whodsdon@ncnm.eduThe challenge to the medical educator is defining aresearch study that is simple enough to conduct in aclassroom with many students, relevant enough tocontribute to generalizable knowledge while keepingstudents engaged, and inexpensive enough to beaffordable in today’s economy. In addition,conducting medical research in a classroom settinghas unique ethical concerns. 15 In this monograph,we outline considerations for in-class research andprovide an example of a study that we have usedsuccessfully for three years to teach the researchprocess to medical students.Faculty at the National College of Natural Medicinehave designed a participation based research studyto measure the effects of three sweeteners on postprandialblood glucose levels and compare theeffects of these different sweeteners, specifically rawsugar, agave, and corn syrup. This research study isconducted with first year medical students duringfour different class periods during their first term.The design of this Institutional Review Board (IRB)approved study can be found in Figure 1. We willuse the ‘sugar study’ to illustrate how research canbe integrated into a classroom setting.Educational OutcomesAs with any educational project, the first step isdefining the educational outcomes. We havegenerated outcomes that are introductory in level,but can be tailored to higher levels, and are generalenough to be applied to many in-class researchstudies. The outcomes are: 1) Demonstrate studyplanning relating to defining a scientific question,study population, and study design; 2) Illustrateprinciples of data collection and analysis; and 3)Apply skills learned in study to reading medicalliterature for EBM, and stimulate interest inpatient-oriented research (Table 1, see Appendix).In addition to meeting these educational outcomes,there are specific logistics with respect toMedical Science Educator © IAMSE 2013 Volume 23(1S) 159

conducting in-class research required for the study(Table 2, see Appendix).We introduce the scientific question in class fordiscussion, and consider the sugar study’s relevanceto medicine and health (e.g. increase in metabolicsyndrome and obesity, sugar role in inflammationand immunity, organic versus conventional sugars,amount of processing of sugars, serving size, andprevalence of sweeteners in processed foods).Additionally, students propose different scientificquestions that are related to this study (e.g. whichsweeteners to use, dose/amounts of sweeteners touse, timing for measuring blood glucose, effects ofsweetness, effects of delivery method, andunderlying disease affecting baseline blood glucoselevels).Initially, we allowed students to choose their ownscientific questions in any topic area. We rapidlydiscovered that students at this level of training(first term of their first year) were unable to discernoutcomes quickly that are simple to collect andinexpensive to measure. This process also requiredstudents to spend a great deal of time outside ofclass preparing for the study. When the facultymember furnishes the scientific question, she/hecan ensure that background literature exists,students will see a result, and ethical considerationsare covered.Figure 1: The sugar study was designed to be performed infour time periods. Participants fast at least one hour and take abaseline blood glucose reading. For the control trial, they drinkunsweetened carbonated water, and take blood glucose after 30minutes. For the experimental trials, they drink carbonatedwater with an added sweetener, either raw sugar, agave syrup,or light corn syrup, and take blood glucose after 30 minutes.The amount of sugar is normalized to 16 grams ofcarbohydrates.Scientific QuestionThe described in-class research exercise is designedto be conducted with a pre-determined scientificquestion. The scientific question needs to be about asubject that is not of a sensitive nature. We havedesigned a study comparing blood glucose levelswith different sweeteners because it is a simple,impersonal physiological process that has medicalrelevance. Students are not embarrassed by bloodglucose levels, and the discussion can revolvearound sweeteners rather than health history. Thescientific question for the sugar study is: What is themagnitude of change in blood glucose levels at 30minutes for different types of sweeteners: rawsugar, agave, and corn syrup?PopulationStudents conduct this research on themselves in thisexercise, as we believe it is important for students toexperience being both a researcher and studyparticipant. The students are generally healthy,young, and at the National College of NaturalMedicine, often restrict sugar in their diet. Since thepopulation is restricted to students in class, wereview applicability of the study to the generalpopulation. We also weigh how recruitment affectsstudy outcomes and the importance ofinclusion/exclusion criteria. As students arescreened and recruited for the study, theycontemplate how choices about the studypopulation affect the outcome, and how recruitingamong themselves is different than recruiting fromother populations. They also note howinclusion/exclusion criteria are applied to a studypopulation.Using students for in-class patient-orientedresearch brings additional ethical considerations.Students are a protected population, and therefore,cannot be coerced into participating with rewards orpunishments. The students’ role as a participantmust be completely optional, while they continue toconsider their role as a researcher and student inthe class. Declining to enroll as a participant mustMedical Science Educator © IAMSE 2013 Volume 23(1S) 160

not have negative stigmas, which means theinclusion/exclusion criteria must contain nonthreateningreasons for people to declineparticipation. Students screen themselves duringclass using a handout so the student’s reason fordeclining is private. The specific reason for astudent declining to enroll is never disclosed to thefaculty member or the rest of the class.Although unique identifiers are used for the datacollection, the students and the instructor knowwho is participating in the study during the class. Toprotect the privacy of student’s participating in thestudy, a participant key linking participants to theirunique identifiers is never used. In class, we discusshow the unique identifier cannot be traced back to aparticipant, and therefore, we do not have evidenceof who participated after the course is complete.This necessary step also means that participantscannot retrieve their personal data.While this is a minimal risk study, the study andconsent form is IRB approved for a complete, realresearch experience. We cover the information thatis presented in the consent form, and what thestudent remembers from the form after they haveread it. This process provides a valuable learningexperience highlighting the differences betweenwhat a researcher and a participant take away fromthe consent process. In this case, the differences arenot only discussed, but experienced. Students areencouraged to individually reflect on theirperspective as a participant and as a researcher.Study DesignUnderstanding study design is essential to beingable to evaluate research studies. The focus of thecourse is not study design, yet students need to beintroduced to how specific study designs answerdifferent scientific questions. We must also take intoaccount students’ interest and the likelihood theywill agree to participate. The study must becompleted during class time, which limits the studydesign to an observational study or a simplecontrolled trial. Class size and course timing areadditional considerations. The sugar study is acontrolled trial that can easily be completed withfour glucometers per 16 participants. It takesroughly two hours to complete each trial of theintervention (one hour fasting, and one hour to takeblood glucose readings), and each of the readingsare taken at the same time of day on different dayswhen class meets. Instruction occurs between bloodglucose measurements.The discussion addresses different types of studydesigns that could be used to answer the sugar studyscientific question. Students must decide whetheran observational study can determine whetherdifferent sweeteners have an effect on post-prandialblood glucose levels or if this study requires acontrolled trial. They summarize the advantages ofhaving a randomized controlled trial versus an openlabel controlled trial. As the discourse continues, weaddress which specific questions this study willanswer. We want the students to understand that, asdesigned, the sugar study demonstrates a differencein blood glucose levels, but does not address thereason there is a difference (mechanism). They mustalso consider specific logistical decisions that havebeen made to accommodate the classroom settingthat affect the study design.The detailed intervention is examined by thestudents including: the types of sweeteners used,the glycemic index of the different sweeteners, theamount of each sweetener used (serving size,normalized to grams of carbohydrates or amountused in a glucose tolerance test), effect of sweetnessand taste on glucose levels, metabolism rate ofdifferent sweeteners, and organic versus nonorganicsweeteners. Appropriate controls areconsidered and reviewed in class including theadvantages and disadvantages of each. We questionwhether participants should be blinded to the typeof sweetener, whether taste should be disguised,how the sweeteners are administered (capsulesversus a drink), glucose measurement timing (mostpeople peak at 30 minutes after ingestion),consistency with time of day, and fasting longerbefore the intervention.Data CollectionThe practicalities of data collection are often notappreciated by a student until they experience itdirectly. Students see all the materials needed toperform the study. Because they are collecting datafor themselves, they participate in the entire processof data collection. The glucometers have somevariability in glucose readings. Students take threereadings so they can observe the reliability of acommonly used device. Since this device is widelyavailable for home use, it was approved for use in aclassroom situation. Participants do a finger stick todraw their own blood for the glucometer. Ademonstration before participants begin the studyassures that students can safely operate a lancet,and follow proper safety procedures while handlingblood products.Medical Science Educator © IAMSE 2013 Volume 23(1S) 161

Glucose measurements are taken in small groupswith participants and classmates helping each other.The medical data collected is limited to glucoselevels in generally healthy adults. Students are putin the role of a researcher as they collect data andcompare results, and through this process, they getto practice being respectful observers (researchers)as well as participants.Ethically, there could be HIPAA concerns as otherclass members will know who participates. Theprivacy of medical information is explained in detailduring the course. We elucidate how blinding canprotect the privacy of the participant, but may be alogistical challenge to the researcher. All the dataforms are given to the participants during the firsttrial with their unique identifier. In this way,students see that the data is not linked to theirname, and observe a method that can be used forblinding studies. We state clearly in the HIPAA formthat blood glucose readings are seen by other classmembers and students can choose not to participateif they do not want this information seen by theirclassmates.Students who decline participation can still take anactive role in the study because the class works insmall groups for data collection. They can act asresearch assistants, recording data and aiding inadministering materials to participants. By allowingother participation opportunities, students can stillcontribute to the research process.Data AnalysisThe data analysis portion of class is to introduce thestudents to statistics. Data is entered into aspreadsheet for analysis. Students witness thedifferences induced by the different sweeteners andcalculate standard deviation. The data analysis leadsto a conversation of what could be changed in thestudy to generate larger results (dose, timing, etc.)At the level of statistics, physicians and researchersneed a different set of skills. In fact, oftenresearchers within different disciplines often needspecific skill sets. Therefore, data management anddifferent databases are covered in other upper levelresearch courses. Additional courses emphasize howto read statistics in medical literature (required forall students) or calculate statistics for independentresearch (required for students who becomephysician researchers). Thus, we have only a cursoryexamination of statistics with this exercise.Application to Reading MedicalLiteratureThe in-class research project provides a jumping-offplace for understanding how research is conducted.Ultimately, students need to be able to apply theirexperience with the in-class research to otherresearch studies that they are reading in theliterature. In order to facilitate the connectionbetween their recent research experience andmedical literature, students evaluate whetherpublished studies address the scientific question,use the correct population and controls, and collectand analyze data appropriately. They also considerethical issues in other clinical studies and how thesecan affect outcomes.ConclusionConducting a research project with a medical schoolclass is a worthwhile educational activity. Personalexperience conducting research increases students’depth of knowledge and understanding of theresearch process. Ultimately, students whoparticipate in research become more confident intheir ability to evaluate research studies. Becausethey understand the limitations involved inresearch, they think critically about the studymethods as they are reading medical literature,rather than blindly accepting what they read.Prior to, or simultaneously to this course, studentstake a course in Evidence Informed Practice. Thiscourse introduces the principles of Evidence BasedMedicine, including: asking a clinical question,searching the medical literature, criticallyevaluating the literature, and applying the literatureto a patient case. The Evidence Informed Practicecourse also introduces students to some basicstatistics such as number needed to treat, relativerisk ratio, and absolute risk reduction. However, thestudents in the Evidence Informed Practice courseoften don’t have practical experience in research.As they become adept at evaluating medicalliterature, students need experience in the scientificprocess so they can frame their own scientificquestions and discuss them with colleagues.Practicing these skills refines their ability todetermine if a particular study design answers aspecific question. Furthermore, asking clinicalquestions is the critical first step in EBM, and theresearch experience can sharpen this skill whiledeveloping curiosity about what the research saysabout a particular problem.Medical Science Educator © IAMSE 2013 Volume 23(1S) 162

More than half of our medical students report thatthe in-class project is their first experience with aclinical trial involving study participants. They areintroduced to the complexity of patient-orientedresearch, including ethical and data collectionissues. Because they examine research frommultiple perspectives, that of participant,researcher, patient, and doctor, students gaingreater insight about the role of research in clinicaldecision-making. How research completed with astudy population applies to an individual patientbecomes more tangible. After completing the sugarstudy, all of the students, who completed theevaluation process, report that they are familiarwith asking a scientific question, defining apopulation, and collecting data, though their level ofconfidence with these activities differs. Importantly,100% of students who filled out the evaluationreport that they apply what they learned in thesugar study to reading the medical literature.Designed as previously described, in-class researchstudies set up an environment that mimics realworldmedical research. Students learn more abouta subject area, such as how different sugars affectblood glucose. Some of these students will choose topursue a career as a physician-researcher, whileothers will be more adept at applying EBM in theircareer as a physician. All of the students receive theopportunity to conduct themselves like physicianscientistsas they cultivate agile thinking andproblem-solving skills.Key WordsMedical education, evidence based medicine, EBM,in-class researchNotes on ContributorsWENDY HODSDON, ND, is Assistant Professor atHelfgott Research Institute, National College ofNatural Medicine, Portland, OR, USA.CAROLYN NYGAARD, ND, is Assistant Professor atHelfgott Research Institute, National College ofNatural Medicine, Portland, OR, USA.HEATHER ZWICKEY, PhD, is Professor and Deanof Research and Graduate Studies at HelfgottResearch Institute, National College of NaturalMedicine, Portland, OR, USA.References1. Sackett DL, Rosenberg WMC, Gray JAM,Haynes RB, Richardson WS. Evidence basedmedicine: What it is and what it isn't. BMJ1996;312:71-72.2. Straus SE, Glasizou P, Richardson WS, HaynesRB. Evidence-based medicine: How to practiceand teach it. 4th ed., Edinburgh: ChurchillLivingstone Elsevier, 2011.3. Buscaglia J, Nagula S, Yuan J, Bucobo JC,Kumar A, Forsmark CE, Draganov PV. Thepractice of evidence-based medicine (EBM) ingastroenterology: Discrepancies between EBMfamiliarity and EBM competency. Therap AdvGastroenterol 2011;4(5):283-294.4. Oude Rengerink K, Thangaratinam S, BarnfieldG, Suter K, Horvath AR, Walczak J, et al. Howcan we teach EBM in clinical practice? Ananalysis of barriers to implementation of onthe-jobEBM teaching and learning. Med Teach2011;33(3):e125-e130.5. Kitto SC, Peller JC, Villanueva EV, Gruen RL,Smith JA. Rural surgeons' attitudes towardsand usage of evidence-based medicine in ruralsurgical practice. J Eval Clin Pract2011;17(4):678-683.6. Coomarasamy A, Khan KS. What is the evidencethat postgraduate teaching in evidence basedmedicine changes anything? A systematicreview. BMJ 2004;329:1017.7. Goldstein JL, Brown MS. The clinicalinvestigator: Bewitched, bothered, andbewildered--but still beloved. J Clin Invest1997;99(12):2803-2812.8. Schafer AI (ed.). The Vanishing Physician-Scientist? Cornell University Press: Ithaca, NY,2009.9. Smith CL, Jarrett M, Bierer SB. Integratingclinical medicine into biomedical graduateeducation to promote translational research:Strategies from two new PhD programs. AcadMed 2013; 88(1):137-143.10. Zerhouni EA. Translational and clinical science--time for a new vision. N Engl J Med2005;353(15):1621-1623.11. Zerhouni EA. Translational research: Movingdiscovery to practice. Clin Pharm Ther2007;81(1):126-128.12. van Driel M. Growing research - involvingstudents in Cochrane reviews. Aust FamPhysician 2011;40(10):803.Medical Science Educator © IAMSE 2013 Volume 23(1S) 163

13. Basu Ray I, Henry TL, Davis W, Alam J,Amedee RG, Pinsky WW. Consolidatedacademic and research exposition: A pilot studyof an innovative education method to increaseresidents' research involvement. Ochsner J2012;12(4):367-372.14. Vale RD, DeRisi J, Phillips R, Mullins RD,Waterman C, Mitchison TJ. Graduateeducation. Interdisciplinary graduate training inteaching labs. Science 2012;338:1542-1543.15. Dalziel JR. Students as research subjects:Ethical and educational issues. Aust Psychol1996;31(2):119-123.AppendixDemonstrate study planning relating to: Define a scientific question and whether the study design answers the study question. Identify a study population and appropriate inclusion / exclusion criteria. Examine pros and cons of different types of study design.Illustrate principles of data collection and analysis: Recognize data that belongs on collection form. Understand use and implementation of unique identifiers and study keys.Apply skills learned in study to reading medical literature for EBM, and stimulate interest in patientorientedresearch.Table 1: Educational Outcomes for in-class research studies.1. Scientific question - relevant to medicine and health.2. Population - healthy student population with general enough inclusion criteria that most studentsare eligible to participate. Students can decide not to enroll in the study without obvious stigma,while continuing to participate in class.3. Study design - simple, safe design that can be completed during class.4. Data collection - complete in class without specialized equipment and with minimal cost. Datashould not be personally revealing because it will be collected during class time with assistancefrom classmates.5. Data analysis - simple enough to be discussed with basic statistics.Table 2: Logistical considerations for in-class research studies.Medical Science Educator © IAMSE 2013 Volume 23(1S) 164

MEDICAL SCIENCE EDUCATORThe Journal of the International Association of Medical Science EducatorsMed Sci Educ 2013; 23(1S): 165-169MONOGRAPHPublic Health Research in a Study AbroadMedical ServiceChristina Dokter, Shane Sergent & Gary WillyerdMichigan State University, East Lansing, MI, USAIntroductionHuamachuco, Peru is a small town in the NorthernAndes Mountains with a population ofapproximately 58,402 (2010 figure). 1 Local officialssay that approximately 60 percent of the localpopulation is displaced from routine healthcare andthat their average per capita income is $4.73/day or$141.90/month. The area is considered to be one ofthe 20 poorest areas within Peru. Public healthissues abound in terms of accessibility,environmental quality, and educational needsrelated to the general well-being of the inhabitants.Starting with a team of 12 students and four doctorsin 2008, our annual medical service team has grownto approximately 30 to 50 (expected in 2013)Michigan State University College of OsteopathicMedicine (MSUCOM) students, residents, andphysicians visiting Peru annually in August.Students and faculty visit rural areas of Peru toconduct research as well as provide clinical servicesto the underserved population. The process starts inJanuary as students enroll in an elective course,ranging from 1 to 24 credits, depending oninvolvement. Students who are accepted into thisprogram start with lots of training and engage infundraising activities leading up to the 10-dayservice trip in August. In this monograph, wedescribe the research aspect of the course and sharewith readers the processes and outcomes.BackgroundInitially, we began our medical service to Peruwithout the research component of the trip.Students raised money to buy medicines and othersupplies such as blankets, clothing, and shoes,donating more than $100,000 worth of suppliesCorresponding author: Christina Dokter, PhD, Department ofPharmacology and Toxicology, Michigan State University 1355Bogue Street, Room 305B, East Lansing, Michigan; Tel: +1-517-303-3646; Fax: +1-517-353-8915; Email: drdokter@msu.eduannually. The purpose of these trips is to servicethose individuals who have no access to care in therural areas of Peru; but the reward of providingpatient care to the indigenous people touched thehearts of the participants. Within the Peruvianculture, hospitality and gratitude is paramount.After our physicians were showered with praise,hugs, and kisses from grateful patients, our facultygained a new perspective of the needs of theapproximately 600 patients who entered our clinicdaily.Youth make up more than 60 percent of thepopulation of Huamachuco. According to theInstitute of Development Studies, chronicmalnutrition within Peru hovers at 31.3 percent(2010 figure) in rural areas for children under agefive. 2 Although this figure has been touted as animprovement from the past decade, in themountainous regions, such as the isolated areas ofHuamachuco, that rate is higher. Moreover, reportshave shown that most of the clean water is pollutedby the local mines. 3 During our visit in 2008, wehypothesized that local open pit mining practicesand the occupational status of the parents maymean that children carry higher than normal leadlevels in their blood.Much of the problems of the underserved can beresolved with education and cultural changetowards efficiency. We saw the need to study theenvironmental conditions of the natives, so that wecould first educate ourselves and then develop thelevel of care and concern that is needed to educatethe patients effectively. We wanted to study thepeople of Huamachuco and pioneer models of ruralliving that not only sustain but enrich the lives of itsnatives.Medical Science Educator © IAMSE 2013 Volume 23(1S) 165

Goals of the Research ProgramBy establishing a research component within thesemedical service trips, a mutually beneficial programwas created. While the natives needed clinical careand health education, the literature showed thatmedical students need to learn basic research skillsto foster life-long learning. Educationalphilosophers who studied undergraduate medicalstudents’ exposure and attitudes towardsconducting research state that students need moretraining and opportunities for research. 4-5 Lack ofexposure leave the students insecure and reluctantto pursue research, and thus ill-prepared for theresearch requirement facing them as residents.Michigan State University and University ofMichigan joining the teams.Research TopicsThe research topics are selected on perceived needfor public health, student interest, and from similartopics that are offshoots of the original. Forexample, after realizing the possibility of leadpoisoning from local mines, we collected andsampled blood as part of a research study to testlead levels in 2009. In addition, students beganconducting a body mass index study in 2009 using asample population of 300 children to monitor anddocument malnutrition in these patients.Therefore the faculty approached the researchcomponent with the following goals in mind: 1)Approach research as a means to providing betterhealthcare that is integrated and incremental. 2)Educate medical students about global health atboth MSUCOM and at Cesar Vallejo University tofoster compassion towards underserved populationsaround the world and at home. 3) Conductsustainable research that will impact the health ofwomen and children, but enable data collection overthe short duration of these 10-day medical servicetrips. Because we had these goals, our researchbegan focusing on clinically-based health outcomes.The Research Team StructureLiterature about teamwork shows that differingability levels in teams allow for maximized learningas students scaffold each other. 6 Most students aresecond year undergraduate medical students, but afew past attendees who are now third or fourth yearmedical students also attend. Each student appliesto the service trip by filling out a form describingtheir interest in participating. As students apply tothe study abroad course, their topic-interest area issorted through and leaders are selected. They arethen grouped according to interest and skills neededfor each research team. The new (or younger)members are assigned with older members, eitherbased on their research interest area, or by tasksthey will perform such as: project (background)development, data manager, data collector,processing and analysis, or project investigators (forInstitutional Review Board entry).Thus far, over 65 students have been involved inclinical research teams, although many lacked priorresearch experience. By working in teams, studentsshared their knowledge and skills, collaborating tomaximize their research skills. Led by students,more participants have joined the research teamseach year, with recent undergraduate students fromFigure 1: Children were measured for their height and weightto monitor and document malnutrition.This study was expanded each year to include otheraspects of children’s health, including a highaltitudeaerobic fitness study in children ages 9-16using the Progressive Aerobic CardiovascularEndurance Run (PACER) test. In recent years,studies have implemented osteopathic manipulationto relieve muscular and joint pain of farmers andminers within this community (See Table 1,Appendix).Medical Science Educator © IAMSE 2013 Volume 23(1S) 166

Outcomes of the research programThe establishment of a research component of themedical service trips opened the eyes of manystudents to the public health conditions of themedically indigent in Huamachuco. Theseexperiences also engendered further understandingsof systems-based practice as students researchedand obtained a community-based health assessmentas background for individual patient’s health.Students admit that a deeper understanding aboutthe environment and public health conditions of thepatients have led to better patient care as well asintellectual stimulation and emotional involvementwith patients."This experience has changed the way I seemedicine. Being an osteopathic physicianmeans more than treating symptoms; itmeans working to find the source ofsymptoms and disease, and workingtowards prevention. By taking the time toobserve trends and having the ingenuity tofind correlations, I am realizing new waysto treat communities,” said Shane Sergent,the Student Director of Research (and coauthor).Another learning outcome is research integrity. Allresearch has been IRB approved (Michigan StateUniversity IRB) either through faculty or studentapplication under the guidance of faculty. As thestudents learned more about the process, theytaught new participants and are serving as mentorsto underclassman. Today, with continued facultymentorship, these students are responsible for theiryearly IRB renewal and revisions. Additionally,students have learned about research integrity whileon the research field. For example, some data werelost in 2009, thereby teaching students theimportance of data security and management. Also,students were taught the importance of consistentaccuracy of measurements (with pediatricanthropometry and instrumental use), which wereemphasized through training.Our students report that they feel much moreconfident about research and look forward topursuing additional research opportunities in thefuture. The nature of the research elective is tointroduce second year medical students to clinicalresearch because they are often the only ones whoseschedule can accommodate the elective during theirrigorous medical training. It is unclear if otherstudents seek research options outside of thiselective once they conclude this course. There is,however, some evidence that most students do seekto continue their research. Two years ago, we beganincluding fourth year medical students in theelective, many of whom were previous participantsand had experience working within this researchelective. To date, 100% (n=11) of these fourth yearmedical students have participated in research,either working on ongoing projects or coming upwith original projects, which were mentored byMichigan State University faculty.The only possible downside to research whilestudying abroad is dividing ones attention betweentwo very crucial tasks. Study abroad is an enriching,eye-opening experience that is very valuable tomedical training. If a student is also concernedabout getting their research completed, they may betoo preoccupied to fully learn from the clinicalexperience.Although we are reporting anecdotal evidence, insummary, student participants in the researchprojects show many of the same traits that paststudies have shown: 1) a positive attitude towardsscience and research. 7 Each year, the number ofstudents participating in research has grown withseveral repeat participants. 2) Students developskills in critical literature review, datainterpretation, and an investigative approach tomedical problems. 8 Our students, for example, havealso presented posters and have written articles forpublication. Funding these research projects hasbeen obtained from various medical foundationssuch as the American Medical Association (AMA),American Osteopathic Association (AOA), MichiganOsteopathic Association (MOA), and StudentOsteopathic Medical Association (SOMA). 3)Students who engage in research are more likely tobe recruited into academic medicine and becomemore productive in research. 9 To date we havepublished 12 abstracts, been highlighted in variouspublications, and we are currently working on apublishable paper. The student leader has also givenlecture presentations and was a podium speaker atthe National American College of PhysiciansInternal Medicine conference. 4) Team-basedlearning has shown positive outcomes in research,and the growth of our research teams as well ascontinued application to the program by older, pastattendeesshow that students attitudes about teambasedresearch is a positive one. 10Medical Science Educator © IAMSE 2013 Volume 23(1S) 167

Community OutcomesEach year we share the research results with thecommunities in which we serve and offersuggestions in which prevention can be initiated.Each of the projects has manifested differentoutcomes in the community. Some recent examplesof changes which impact these communities are asfollows:The pediatric growth and development study hascaught the interest of a Peruvian medical school,and our researchers have been asked to collaboratewith them on a larger scale. Together, we hope toprovide better clinical outcomes in communities toreduce double burden and provide sustainablesolutions.One project which provided the most immediateimpact on the health of the community was a waterquality study. It found that numerous synthetic andtoxic chemicals existed in the rivers which thecommunity used for drinking water. It has beenspeculated that it is from run-off secondary tomineral mining in the Andes Mountains and may bethe cause of the high prevalence of kidneydysfunction we see in the clinic. This project is beingfurther investigated and includes many localorganizations and institutions who hope to remedythis problem.As a result of our presence in the community, wewere able to spread our knowledge of osteopathicmanual medicine (OMM) through a research study.This initiative fostered international interest andrecognition of osteopathic medicine in SouthAmerica. It was highlighted in numerous localpublications and even on the national Peruviannews.ConclusionAdding a research component to the medical serviceelective course taught students not only how toconduct research, but also helped them learn how towork in teams and to deliver patient care with amore systems-based understanding. Our outcomesin the community confirm what the literature saysabout research as a means to a community ofpractice in which learners create knowledge byinteracting with one another and the environment.Successful teamwork has led to students “feedingknowledge back to the community of researchpractice and supports the model of communities ofpractice as not just internal but histories ofarticulation with the rest of the world.” 6Key WordsStudent Research; Study Abroad; Medical StudentEducation; International Medicine.Notes on ContributorsCHRISTINA DOKTER, PhD, is Education ProgramCoordinator and Lecturer in the Department ofPharmacology and Toxicology at Michigan StateUniversity, East Lansing, MI, USA.SHANE SERGENT is the Student Director ofResearch at Michigan State University College ofOsteopathic Medicine, Walled Lake, MI, USA.GARY L. WILLYERD, DO, FACOEP-D, FAODME isan Associate Dean at Michigan State UniversityCollege of Osteopathic Medicine in Detroit, MI,USA.Figure 2: In recent years, studies have been implemented toexamine osteopathic manipulation and ability to relievemuscular and joint pain of farmers and miners.Medical Science Educator © IAMSE 2013 Volume 23(1S) 168

References1. Evolucion de la pobreza al. Instituto Nacionalde Esta distica e informatica. 2010; Vol. 2, p.7552. Andres Mejia Acosta (2011) Analysing Successin the Fight against Malnutrition in Peru.Institute of Development Studies. May, 2011.http://www.ids.ac.uk/files/dmfile/Wp367.pdfLast Viewed 03/08/133. Situation of Children in Peru: ExecutiveSummary. United Nations Children’s Fund(UNICEF). 2008;13-14. http://www.unicef.org/peru/spanish/Folleto_ing_correc_1.pdf LastViewed 02/20/20134. Murdoch-Eaton D, Drewrey S, Elton S,Emmerson C, Marshall M, Smith JA, Stark P,Whittle S. What do medical studentsunderstand by research and research skills?Identifying research opportunities withinundergraduate projects. Med Teach2010;32(3):e152-e160.5. Burgoyne LN, O’Flynn S, Boylan G.Undergraduate medical research: the studentperspective. Med Educ Online 2010;15:5212.http://med-edonline.net/index.php/meo/article/view/5212/pdf_15 Last Viewed 02/20/20136. MacDougall M, Riley SC. Initiatingundergraduate medical students intocommunities of research practise: What dosupervisors recommend? BMC Med Educ2010;10:83.7. Hren D, Lukic IK, Marusic A, Vodopivec I,Vajaklija A, Hrabak M, Marusic M.. Teachingresearch methodology in medical schools:students’ attitudes towards and knowledgeabout science. Med Educ 2004;38(1):81-86.8. Jacobs CD, Cross PC. The value of medicalstudent research: the experience at StanfordUniversity School of Medicine. Med Educ1995;29(5):342-346.9. Solomon SS, Tom SC, Pichert J, Wasserman D,Powers AC. Impact of medical student researchin the development of physician-scientists. JInvestig Med 2003;51(3):149-156.10. Parmelee DX, DeStephen D, Borges NJ. MedicalStudents’ Attitudes about Team-based Learningin a Pre-Clinical Curriculum. Med Educ Online2009; 14:1. http://www.mendeley.com/catalog/medical-students-attitudes-aboutteam-based-learning-pre-clinicalcurriculum/#page-1Last viewed March 1, 2013APPENDIXTable 1: Types of research conducted. The numbers (n) indicate the number of students involved in the research topic.Research in Peru by Michigan State University College of Osteopathic Medicine Students:1. Environmental Several studies on water, soil, & blood lead toxicity in Peruvian Children (9)2. Osteopathic Principles and Practices OMT: Reducing Pain and Changing International Patient Perceptionm (14) Transcending the International Osteopathic Identity: Cross-sectional Analysis of Osteopathic Principles andPractices in Peru (23)3. Public Health Assessment of Maternal and Reproductive Health in Women of Mala, Peru (5) Assessing Pediatric Health Care Needs in Huamachuco, La Libertad, Peru (22)4. Pediatric Growth and Development Assessment of Pediatric Anthropometry of Peru (26) Assessing the Risk of Pediatric Double Burden in International Models (10) Cardiovascular Assessment of Peruvian Children with PACER Fitness Test (8) Examining the prevalence of overweight and obese adolescents in contrasting elevations of rural Peru (18)Medical Science Educator © IAMSE 2013 Volume 23(1S) 169

MEDICAL SCIENCE EDUCATORThe Journal of the International Association of Medical Science EducatorsMed Sci Educ 2013; 23(1S): 170-193MEETING REPORTLeiden International Medical Student Conference8 th LIMSC 2013 Meeting, Leiden University Medical Center, Leiden,The Netherlands, March 13-17, 2013The eighth Leiden International Medical StudentConference (LIMSC) will be held from March 13th -17th in the Leiden University Medical Center.During LIMSC medical and biomedical studentsfrom all over the world have the opportunity topresent their own research. All (bio)medical topics,excluding dentistry and pharmacy, are represented.The presenting participants (actives) and visitingparticipants (passives) are offered and an extensiveprogram of interesting workshops, prominent guestspeakers, a special career and internship fair and anintensive social program.It has been a pleasure for me to guide the abstractprocedure, which is described in the followingparagraph, to a good end. The submitted abstractswere blindly evaluated in two rounds by ourScientific Committee consisting of qualified anddedicated researchers from the Leiden UniversityMedical Centre. Two hundred students were invitedto present their research; the best one hundred andtwenty of these two hundred were invited to give anoral presentation, the other eighty to give a posterpresentation.Furthermore we want to thank Peter de Jong(IAMSE Editor-in-Chief) and Julie Hewett (IAMSEAssociation Manager) who offered to give aworkshop at LIMSC, entitled 'Tips and tricks forsuccessfully publishing your research work in aninternational journal'. It is noteworthy that thisworkshop was fully booked very fast in comparisonto other interesting workshops, which clearly showsthe popularity of the subject among students.I hope you will enjoy reading the work of thestudents. Perhaps you will even have the possibilityto visit this edition of LIMSC, join our program andshare your knowledge, and might LIMSC be yourkey to the future.Justin JacobseSecretary Leiden International Medical StudentConference 2013We received 620 abstracts from 45 differentcountries. First of all Dionne Gootjes (President),Victoria Tedjawirja (Vice President) and I filteredthe abstracts to see if they met the criteria. 437abstracts were sent to the Scientific Committee, whoblindly evaluated the abstracts in two rounds onquality, relevance and clarity. I was delighted to seethe overall quality of the abstracts and the speed ofthe jury - the job was done within three weeks.We were invited to publish our best abstract inIAMSE. We were very pleased with an average scoreof 78 out of 100 for the best forty abstracts included.The abstract were divided into different poster andoral sessions based on their LUMC Research Profile.Medical Science Educator © IAMSE 2013 Volume 23(1S) 170

Impact of moderate alcohol consumption onperi-apneic blood pressure and heart ratecontrol in obstructive sleep apnea modelPresenter: Julia PiątekAuthors: Tomasz Wawrowski, Julia Piątek, JacekWolf, Wiesława Kucharska, Krzysztof NarkiewiczUniversity: Gdańsk, PolandIntroductionRepetitive apneic events in untreated obstructivesleep apnea (OSA) are associated with abrupt bloodpressure (BP) fluctuations and heart rate (HR)swings during sleep perchance triggering acutecardiovascular events.Patients often complain of poor sleep quality, thusfrequently drinking alcohol before bedtime. Up-todate,alcohol is a known risk factor exacerbatingapneic events, nevertheless, its impact onhemodynamic responses to apneas is unknown.Therefore, we investigated the influence ofmoderate alcohol consumption on peri-apneic BPand HR control.Methods10 healthy volunteers (3 females, age 23.9 ±1.1;mean±SD) underwent three studies: at baseline,with placebo (equivalent amount of non-alcoholicbeverage), following alcohol consumption (1g/kgbody weight dissolved in total vol.0,5L). Subjectswere randomly assigned to placebo or alcohol.Recordings consisted of beat-to-beat BP monitoring(Finometer), ECG, pulse oximetry and respiratorypatterns assessment while breathing through amouthpiece connected to an airflow valve inconjunction with a nose clip.Following 20min. of adaptation and sensorcalibration inspiratory resistance was down-titratedto -40cmH2O (Müller's maneuver). Each sessionregistered 15 pathological episodes lasting 1min.,separated by 20sec. of normal undisturbedbreathing. 10 final episodes were taken intoanalysis.Including minimal and maximal deflection for BPand HR, 3 values were averaged for each.Spearman's rank correlation coefficient andrepeated measures ANOVA were used; P

AlamarBlue assay. For downregulation of VEGFexpression in cells associated with endometriosisE.A.Hy926 cells were transfected with complexescontaining siRNA against VEGF.ResultsIt was shown that peptide carriers efficiently formedcomplexes with siRNA and protected siRNA fromenzymatic degradation. Modification with CXCR4ligand significantly increased transfection efficacy ofNA/peptide complexes on E.A.Hy926 cells and onprimary endometriotic cells. Moreover, transfectionefficacy of complexes containing CXCR4 ligand wassignificantly higher than of control complexescontaining PEI. We demonstrated thatsiRNA/peptide complexes are not toxic to secondarycell cultures. Delivery of siRNA/L1 and siRNA/L2complexes to Е.А.Hy926 cells resulted in 40-50%decrease of VEGF expression.DiscussionRecent study shows that utilization of peptidecarriers modified with CXCR4 ligand is a promisingapproach to development of targeted NA deliverysystem to human endothelial and endometrioticcells. Complexes containing these carriers andsiRNA significantly silence VEGF expression andthus can be used to develop treatment ofendometriosis.Promotion of HPV vaccination: potentialgaps between knowledge and practices ofPakistani female family practitionersPresenter: Ambreen PardhanAuthors: Maryam Sanaullah, Sanaullah Bashir,Junaid Ahmad Bhatti, Ambreen Pardhan, AmreekKatariaUniversity: Karachi, PakistanIntroductionLike most countries, cervical-cancer is one of theforemost cancer types in Pakistani-women. Aboutthree-quarters of invasive cervical cancer cases inPakistani-women has subtypes 16 and 18 of Humanpapillomavirus(HPV)-thechief etiological agent ofcervical cancer; associated with it. Thus awarenessabout the HPV vaccination that has recently beenmarketed is critical to the promotion of cancerprevention initiatives. As regards HPV vaccination,female family practitioners (FFPs) may have anedge over other health-care personnel for vaccinepromotion because of their proximity, bothphysically and culturally, with the at-riskpopulation. Hence the study aimed towardassessing the knowledge, attitudes and practices ofFFPs regarding cervical-cancer screening and HPVvaccination.MethodsHundred(100) FFPs were conveniently recruited indowntown Karachi, centre of the most populousmetropolitan of the country. Self- administered,structured-questionnaire was used to assess sociodemographicand clinical experience of FFPs andtheir knowledge, attitude and practices toward HPVvaccination.ResultsThe response-rate for the study was 99%. Only halfof FFPs(55.6%) had knowledge that cervical canceris one of the three leading cancers in women; whilemost(94.9%) reported the purpose of Pap test.90.9% identified HPV as a frequent etiological agentfor cervical cancer but only one in five knew aboutits prevalence(19.2%). Although 81.8% FFPs knewthat HPV vaccination can prevent cervical-cancer,only 23.2% had knowledge regarding the marketavailabilityof HPV vaccine and two in five FFPsreported that the ideal age for vaccination wasbetween 25 and 30 years. Most FFPs(84.8%) agreedthat HPV vaccine marketing is a good idea, howeveronly one-third(37.4%) were willing to prescribe it.Few(8.1%) reported the practice of everadministering HPV vaccine, while others reportedthat they would administer it if the governmentpromoted its use.DiscussionOverall, the findings did indicate some potentialgaps between knowledge and practices regardingHPV vaccination. While most FFPs seemed tosupport the HPV vaccination, the majority were notfully aware of practicalities such as target age andvaccine-availability. Other potential barriersobserved were the perceptions regarding the officialstandpoint on the HPV vaccination. Hence, for anyfuture cervical-cancer prevention initiative to besuccessful the above knowledge gaps should beresponded.Medical Science Educator © IAMSE 2013 Volume 23(1S) 172

Retrospective study on the Prevalence ofTuberculosis amongst the Indigenous Tribesliving at the Indo-Myanmar borderPresenter: Rhondemo A KikonAuthors: Rhondemo A KikonUniversity: Timisoara, RomaniaIntroductionTuberculosis remains a major health problem andranks as the second most dangerous infectiousdisease worldwide after HIV. WHO states that thereare almost 9 million new cases in 2011 and 1.4million TB deaths. Situation at the Indo-Myanmarborder remains critical. The number of suspectedcases from 2002-2011 (140-2682) has increased by20 times. A team from Medecins Sans Frontieres(MSF) was deployed on 16 April 2011 to increase theaccess and availability of diagnostics, treatmentsand care. This study was done in collaboration withMSF and National Tuberculosis Control Programduring my summer internship.MethodsA questionnaire following the WHO guidelines wasdistributed among the tribes. Personal investigationwas undertaken in visiting the epidemic regionsafter the census report from National Tuberculosiscontrol program. Results of the survey weretabulated and analyzed.ResultsIn the year 2002 the suspected cases examined was140 and 17 were treated out of which 15 were newsmear positive, 1 new smear negative, 1 new extrapulmonary,0 smear positive Re-Treatment.However in the year 2011 the suspected casesexamined was 2682 and 625 were treated out ofwhich 204 were new smear positive, 130 new smearnegative, 161 new extra pulmonary, 130 smearpositive Re-Treatment. An interesting increase in 20times the number of suspected patients and 37times the number of patients treated in 2011. Adecrease of 55.6 % of new smear positive, andincrease of 15 % of the new Smear negative, anincrease of 20 % of new extra pulmonary and anincrease of 20.8 % of smear positive re treatmentwere also seen.DiscussionIn spite an increase of TB suspects and patientstreated the number of new smear positive caseshave decreased (55.6%), however the new extrapulmonarycases have increased (20 %). This maybe explained by the high prevalence of HIV in theregion. Proper preventive measures should beimplemented as soon as possible since the locationof the Indo-Myanmar border is a strategic one,connecting India and other South-East Asiannations.Neurofibromatosis type 1: associationbetween genotype and cancer.Epidemiological study of 2337 families withNF1Presenter: Alexandra RedzkinaAuthors: Alexandra Redzkina, Henrik Hasle, JohnR. Oestergaard, Jeanette Falck WintherUniversity: Aarhus, DenmarkIntroductionNeurofibromatosis type 1 (NF1) is a quite commongenetic disorder of autosomal dominant pattern,affecting approximately 1:3500 individuals. It iscaused by a mutation in NF1-gene on the long armof chromosome 17. 50% of the mutations are meantto be inherited and the other 50% – de novomutations. Patients with NF1 have been proved tobe at greater risk of developing cancer than healthyindividuals. The purpose of this study is todetermine, whether the risk of cancer in an NF1-patient is higher, if this patient has a relative, whopresents with both NF1 and cancer.MethodsWe use an existing cohort of 2,424 NF1 patients,identified through the National Patient Register.Using Danish Civil Registration System, this cohortis divided into two groups: NF1-patients withoutrelatives, diagnosed with NF1, and the families withmultiple NF1 cases, so called NF1-families. All thecases of cancer in the above-mentioned groups aredetected through the Danish Cancer Registry, andcancer incidence is compared, by calculating SIRwith 95% CI for both groups.ResultsIndividuals with a relative diagnosed with both NF1and cancer (OR = 6, 95% CI: 4, 8.7) had more than a2-fold increase in the risk of cancer in general,compared to those without (OR = 2.8, 95% CI: 2.5,3.1). The biggest difference was seen for CNS andspinal cord tumours, tumours of respiratory system,mesothelium and connective tissue.DiscussionWe showed, that patients in the families withsupposedly inherited mutations of NF1 have greaterrisk of cancer. Our results are the first step inshowing that specific NF1-gene mutationspredispose to cancer. Based upon this study, itwould be relevant in the future to investigatepossible factors, which have influence onMedical Science Educator © IAMSE 2013 Volume 23(1S) 173

development of cancer in NF1-patients, to definespecific genotypes, which predispose to cancer andfinally improve treatment and counselling of thepatients and their families.A population-based study ofpharmacogenetics of statins in Azoresislands (Portugal): a step forward inpersonalized medicinePresenter: Letícia BalancoAuthors: Letícia Balanco, Mafalda Melo, Cláudia CBranco, Luisa Mota-VieiraUniversity: Ponta Delgada, PortugalIntroductionSimvastatin and pravastatin are the most prescribedstatins to lower cholesterol and reduce the risk ofatherosclerotic cardiovascular diseases. Severalstudies demonstrate that clinical efficacy andtoxicity (induced myopathy) of statins depend onseveral factors, which includes interindividualvariation of genes involved on drugpharmacokinetics or pharmacodynamics. Sincegenetic variations are different betweenpopulations, here we investigate alleles, genotypesand haplotypes of clinically relevant pharmacogenesunderlying simvastatin and pravastatin drugresponse in the Azores.MethodsDNA of 170 blood donors was examined for 11 SNPsin five candidate genes: three at HMGCR(rs3846662, rs17238540, rs17244841), one at CETP(rs708272), two at ApoE (rs7412, rs429358), threeat LDLR (rs688, rs1433099, rs2738466) and two atSLCO1B1 (rs2306283, rs4149056). All SNPs weregenotyped by TaqMan® Genotyping Assays.ResultsThe results demonstrate that allele frequencies forthe 11 SNPs in Azoreans were similar to thosereported for the HapMap CEU population and/orCaucasian. Here, we focus our analysis on statinsefficacy based on HMGCR and ApoE, as well asSLCO1B1 for induced myopathy. Regardingcholesterol metabolism, haplotype 7 of HMGCR wasidentified with low frequency (3.2%), allowing us toexpect a good drug response. The analysis of ApoErevealed the E2 (c.526T), E3 (wild type) and E4(c.388C) haplotypes with a frequency of 8.5%,82.4% and 9.1%, respectively. Knowing that thesehaplotypes have an increasing affinity for LDLreceptor, some studies suggest that E4 carriers willmore likely need to be on intensive therapy and useadditional LDL-C lowering methods (diet, exercise).In respect to toxicity, 50 (29.4%) individuals arecarriers of SLCO1B1 c.521C risk allele, being 3(6.1%) homozygotes and 47 (93.9%) heterozygotes;in the last group 6 (12.8%) are homozygous for thec.388A risk allele. Thus, physicians should be alertto statin myopathy episodes from genetic origin,and/or to redefine the dose in high risk patients.DiscussionThis research is a step forward in personalizedstatins therapy. Interpretation of the patient’sgenetic profile will allow clinicians to provide a safertherapy, improving statins efficiency and reducingmyopathy risk.Ghrelin: a New Potential Therapy forIschemic Heart DiseasePresenter: Dădârlat AlexandraAuthors: Dădârlat AlexandraUniversity: Cluj-Napoca, RomaniaIntroductionGhrelin, a newly discovered peptide hormonemainly secreted in the oxyntic mucosa of thestomach, was originally reported to induce growthhormone release. Recent studies have shownbeneficial effects of ghrelin in the cardiovascularsystem to support the widely distribution of itsreceptors in cardiovascular tissues. The purpose ofthis study was to investigate the relationshipbetween plasma ghrelin levels and ischemic heartdisease.MethodsThis analytical transversal study was performed on88 consecutive patients admitted in theRehabilitation Hospital Cluj-Napoca, between 1stNovember- 1st December 2011. The subjects wereaged between 38 and 89 with a mean of 61.7 ± 10.33years and 65 (73.86%) of them were women. Thepatients were divided in two groups: 37 (42.04%)patients were diagnosed with ischemic heart disease(group A) and 51 (57.95%) patients withoutcoronary heart disease (group B). Subjectsunderwent a comprehensive clinical evaluation,echocardiography and coronary angiography. Bothgroups were assessed for the presence ofcardiovascular risk factors (obesity, arterialhypertension, diabetes mellitus, metabolicsyndrome, plasma levels of LDL, cholesterol andtriglycerides and smoking). Plasma ghrelin levelswere determined with an ELISA kit. Statisticalanalysis was carried out by using the SPSS 16.0software for Windows, p value (Student test) andPearson correlation index.Medical Science Educator © IAMSE 2013 Volume 23(1S) 174

ResultsPlasma ghrelin levels were significantly lower ingroup A (38.65± 25.96 pg/ml) than in group B(40.45±13.21 pg/ml, p=0.04). In group A we founda negative correlation between ghrelin levels andage(r=-0.46, p=0.004). Circulating ghrelin wassignificantly lower in patients in which the diseasehad progressed to the chronic heart failure stage(31.44±13.02 pg/ml vs. 42.34±20.3; p=0.03),regardless of sex .We found no statisticallysignificant difference between ghrelin levels inpatients with cardiovascular risk factors and thosewithout cardiovascular risk factors. In group B,ghrelin was negatively correlated with waistcircumference (p=0.031, r= -0.303) and BMI(p=0.046, r=-0.281). Ghrelin levels were positivelycorrelated with fasting plasma glucose (r=0.29,p=0.03).DiscussionOur study showed that circulating ghrelin wasdecreased in patients with ischemic heart disease.These observations provide supporting evidence forthe potential therapeutic role of ghrelin incardiovascular medicine. More research is requiredto confirm our results.Skin Cancer Knowledge And Sun ProtectionBehaviors In Medical and Non-MedicalUniversity Students In Karachi, PakistanPresenter: Rafaqat RafaqatAuthors: rafaqat, komal motwani, saleem khawaja,ambreen pardhan, ghazanfar zaidiUniversity: Karachi, PakistanIntroductionSun exposure may lead to severe health problemslike skin cancers and diseases of eyes. Prolongedsun exposure during childhood increases thepossibility of skin cancer later in life. Therefore, it isimperative to evaluate the knowledge of sunexposure and sun protection practices amongadolescents such as university students. The studywas carried out to examine skin cancer knowledgeand sun protection behaviors in Medical and Non-Medical university students.MethodsWe surveyed 768 students (16-27 years) at two largepublic sector universities (401 Medical Students and367 Non-Medical Students) in Karachi, Pakistan.Survey data were collected regarding skin cancerknowledge and sun protection behaviors.Differences between the 2 groups were comparedwith chi-squared test.ResultsOf all the respondents, sun exposure as a risk factorfor skin cancer was identified by 77.7%, genetics by44%, ultraviolet radiation by 87.1%, multiple skinmoles by 19.1% and fair complexion by 27.7%.Knowledge of risk factors was greater among theMedical Students as compared to the Non-MedicalStudents. Of the total, 56% of the participants‘always’ wears sun-protective clothing, 41.4%‘always’ wears hat/dupatta, 13.2% ‘always’ seeksshade, 10.5% ‘always’ wears sun glasses, and 27.9%‘always or most of times’ apply sunscreen with sunprotection factor of ≥ 15. The most frequent methodof sun protection was found to be wearing sunprotectiveclothing, which was significantly morecommon among the Medical Students (64.1% vs.47.1, p

coated with micro-patterns of Collagen I(experimental condition), the third and the fourthwere treated with uncoated (negative control) andfully-coated of Collagen I (positive control) siliconedressing respectively. After sacrifice (day=6), tissueswere removed and analyzed forimmunohistochemistry (α-SMA: myofibroblastmarker) and standard histology (Hematoxylin &Eosin; Trichrome Masson). Myofibroblastsconcentration, Collagen deposition and Woundcontraction will be the main outcome.ResultsMicro-patterns of 4x2µm of Collagen I on siliconesurfaces showed a reduction (up to 2-fold) of bothmyofibroblasts concentration and collagendeposition in the wound (p

Mitochondrial DNA copy number in thebrain increases with development andageingPresenter: Gia Tuong TranAuthors: Tran, G.T, Tzoulis, C, Lilleng, P, Bindoff,L.A.University: Bergen, NorwayIntroductionMitochondria are the main producers of cellularenergy. Energy, in the form of ATP, is produced atthe mitochondrial respiratory chain which is partlyencoded by the mitochondria’s own genome,mitochondrial DNA (mtDNA). MtDNA is a multicopygenome found in up to thousands of copies percell and is inherited exclusively from the mother.MtDNA mutations including deletions and pointmutations have been shown to accumulate invarious tissues with advancing age and it is believedthat these may contribute to the process of ageing.The aims of this study was to investigate age-relatedmtDNA changes in the brain of mice and humans.MethodsFrontal cortex was collected from healthy mice of 15different age groups, spanning the complete lifecycle of the animals (0-2 years). Human frontalcortex was collected post mortem from 19 healthyindividuals, with no known neurological diseases, ofdifferent ages ranging from 8 days to 69 years. DNAwas extracted from cortical homogenate by standardmethods. MtDNA was quantified and assessed fordeletions by real-time PCR and long-range PCR.ResultsMtDNA gradually increased throughout life in bothmice and humans. In mice there was a biphasiccourse comprising a phase of rapid increase frombirth to two months of age, followed by asignificantly slower increase rate throughout life. Inhumans the increase appeared to be linear. Nodeletions were detected.DiscussionOur findings show that there is a gradual increase inmtDNA copy number in the brain throughout life inboth mice and humans. The biphasic increase inmice may reflect an initial rapid expansion inmtDNA copy number during neuronal growth anddifferentiation. We believe that the gradual mtDNAincrease observed in both mice and humans mayrepresent a compensatory mechanism for theaccumulation of age-related somatic mtDNAmutations.Salvage treatment of multiple myelomarelapsing after autologous peripheral bloodstem cell transplantation (APBSCT) byadditional courses of APBSCTPresenter: Szymon PiatekAuthors: Szymon Piatek, Dominika ZajacUniversity: Piaseczno, PolandIntroductionContemporary treatment of multiple myeloma(MM) in younger (below 70) patients is composed ofremission induction using combinations ofcorticosteroids, cytostatics, immunomodulators andproteasome inhibitors. This is followed by remissionconsolidation by either single or tandem peripheralblood stem cell transplantation (APBSCT) followinghigh dose melphalan (HDM). Such treatment is notcurative and sooner or later the myeloma relapses.It is than managed using combinations of the samedrugs that have been used in remission induction.However, some relapsing patients have surplusPBSC stored and these cells can be used to supportadditional rounds of HDM used as salvagetreatment in such patients. Aim of the study is toinvestigate whether salvage treatment of additionalcourses of APBSCT is tolerated by patients andeffective in prolonging overall survival (OS).Methods43 patients (19 women, 24 men, mean age: 59,475y) with MM were included to the study. They wereassessed using Durie-Salomon criteria and treatedwith various high-dose chemotherapy regimens(mostly vincistine, doxorubicin, dexamethasone)prior to auto-PBSCT. They were divided into 2groups.The study group contained 22 patients (6 women,16men, mean age: 61y) and received more than two(>2) series of auto-PBSCT.ResultsOverall survival in the study group vs. control groupafter 12, 24, 36, 48, 60, 72 months was: 0.8972 vs0.9474, 0.8972 vs 0.7565, 0.8374 vs 0.5296, 0.8374vs 0.4413, 0.8374 vs 0.3531, 0.7444 vs 0.3531 ,respectively (log rank test P=0.0406). Kaplan-Meieranalysis was used to asses survival and log rank testto compare survival between tested groups (SASSystem).DiscussionAdditional auto-PBSCT in patients with multiplemyeloma are not associated with worsen prognosison overall survival.Medical Science Educator © IAMSE 2013 Volume 23(1S) 177

Duke Treadmill Score for PredictingIschemic Prognosis in WomenPresenter: Dădârlat AlexandraAuthors: Dădârlat AlexandraUniversity: Cluj-Napoca, RomaniaIntroductionThe Duke treadmill score (DTS) is a compositeindex which is used in the evaluation ofsymptomatic patients to predict the presence ofcoronary artery disease and their prognosis. Thegoals of this study are to present the relationship ofwomen and DTS and the gender-related differences.MethodsWe carried on a transversal analytic study on 105patients aged 20 to 75 years submitted in theRehabilitation Hospital Cluj-Napoca, Romania,between 1st March-1st May 2012. 48(45.71%) ofthem were women. Patients underwent clinicalevaluation, exercise ECG and echocardiography.They were assesed for the presence ofcardiovascular risk factors. For statistical analysisANOVA test and Pearson correlation index wereused.ResultsFrom the exercise test, 20 and 28 females wereclassified as low and moderate risk, the mean ofDuke’s score was 2.54±5.36 and the mean STdeviation was 0.38 mm.The DTS was significantlylower in females with arterial hypertension(HTN)(2.03±4.89) than males with HTN(5.8±4.28;p

DiscussionIt would be expected that the VG does better inestimating RV pressure overload then the ECG BLscore because it considers both depolarization andrepolarization. Projection of the VG in a specificdirection is required to obtain specificity for theright ventricle. However, the direction of the X-axiscould be improved by assuming VGproj: use ofVGproj increased the correlation with the outcomevariable. A combination of this optimal VCG-VGprojwith the ECG-BL score could be used clinically tononinvasively monitor RV pressure overload in PH.Indicators of Endothelial Activity as aMethod to Detect Preclinical PortalHypertensionPresenter: Yevheniia ParastyvyukAuthors: Y. Parastyvyuk, O. Ivashchuk, N. SlyvkaUniversity: Chernivtsi, UkraineIntroductionPortal hypertension is one of the most dangerouscomplication of the alcoholic liver cirrhosis, andthere is no effective conservative methods to treat iton the final stage. Early detection of hemodynamicdisorders in cirrhotic patients provides more wideopportunities for medical therapy. That is why wedecided to research this problem.Methods121 patients with alcoholic liver cirrhosis wereexamined, amongst them – 35 patients without PH(control group), 32 patients with preclinical PH (1ststudy group), 43 – with Ist stage of PH (2nd studygroup), 11 – with IInd stage of PH (3d study group).We used liver biopsy and doppler ultrasoundexamination of the liver ("En Visor HD", Philips,USA). To identify the functional activity of theendothelium (FAE) we used Celermajer-Sorensentest (1992) and nitric oxide assay(NO) by Griessreaction.ResultsWe detected hemodynamic disorders by the type ofpreclinical (hyperkinetic) phase of PH (increasing ofthe congestive index (CI) more than 0,034,decreasing of maximal velocity (Vmax) in the portalvein less than 10% and increasing of the portal veinmore than 20-25%) (р

and smr genes were downloaded from internationalGenBank, NCBI; MEGA5 software was used forphylogenetic tree generation using UPGMAalgorithm and Maximum Composite Likelihoodmethod for evolutionary distances computation.ResultsIt was found that among the studied cultures ofMRSA smr gene was detected in 94% of strains,gene qac A/B - in 75% of strains. High frequency ofoccurrence of these genes in MRSA (in comparisonwith methicillin-sensible strains, smr gene of whichwas detected in 5,9 % of strains, gene qac A/B - in7,5% of strains) provides them with highadaptability to hospital environment with itsantimicrobial regimens. The bioanalysis of qacA/B,smr gene sequences confirms the existence ofdistinct genetic groups, indicating that theindependent acquisition of this gene in severalisolated strains-precursor.DiscussionIn this work some of the genetic mechanisms ofmicrobial resistance to biocides were studied, andinvestigated the frequency of occurrence of genesqacA/B and smr causing resistance to QAC instaphylococci.Slow walking decreases cardiovascular riskfactors more than high intense cyclingduring similar energy expenditurePresenter: Bernard DuvivierAuthors: Duvivier BMFM, Schaper NC, BremersMA, van Crombrugge G, Jeuken R, Antoniou A,Kars M, Savelberg HHCMUniversity: Maastricht, The NetherlandsIntroductionCurrent guidelines stress the importance of half anhour of exercise per day. Thirty minutes of exercisecan be combined with 23.5 hours of sedentarybehaviour. Increasing evidence suggests that timespent sedentary has an independent, adverseinfluence on health. We tested the hypothesis that adaily bout of physical exercise cannot compensatefor the negative effects of inactivity during the restof the day on cardiovascular risk factors.MethodsEighteen healthy subjects (age: 21 ± 1.9 years, BMI:22.6 ± 2.6 kg/m2) were included. Each participantfollowed three different physical activity regimes forfour days in a randomized cross-over design. During‘sitting regime’, participants sat 14 hr/day. In‘exercise regime’, participants cycled 1 hr/day andsat 13 hr/day. During ‘low intense physical activity(LIPA) regime’, participants walked 5 hr/day on alow intensity, stood 3 hr/day and sat 8 hr/day.Energy expenditure was similar during ‘LIPAregime’ as during ‘exercise regime’. Physical activitywas assessed by an activity monitor (ActivPAL3).After each regime insulin sensitivity was determined(oral glucose tolerance test) and blood samples weredrawn to assess blood lipids.ResultsMatsuda Insulin Sensitivity Index was 29%respectively 15% higher after LIPA regime comparedto sitting and exercise regime (p

MethodsPeripheral blood mononuclear cells (PBMCs) wereobtained from venous blood of 9 patients withleukemia (4 with de novo diagnosed chronicmyeloid leukemia, 2 in acute myeloidtransformation of chronic myeloid leukemia, and in3 with acute myeloid leukemia; mean age 41 ± 12).Control PBMCs were obtained from 11 healthyvolunteers (mean age 32 ± 6.7). PBMCs wereisolated from heparinized blood by density gradientcentrifugation using LymphoPrep (Axis Shield,Norway). Acid phosphatase assay was used for thecell viability examination, while flow cytometricanalysis of cells stained with appropriatefluorochromes was employed for the measurementof phosphatydil serine exposure (Annexin VFITC/PI), and DNA fragmentation (PI). Electronmicroscopy analysis was used to examinemorphological changes of the cells.ResultsThe acid phosphatase assay revealed thatCompound 3 was significantly more toxic to PBMCof leukemic patients compared to those of healthyindividuals (IC50 values 31.5 ± 8.3 μM and 54.7 ±23.6 μM, respectively). The proportion of cellsdisplaying phosphatydilserine exposure and DNAfragmentation increased in a dose-dependentmanner upon treatment with Compound 3. Electronmicroscopy analysisdemonstrated that patients’ PBMC after treatment(25 μM; 24 h) became smaller, more spherical, withintact cell membrane and fragmented nuclei incomparison with those of untreated cells,confirming the ability of Compound 3 to triggerapoptotic death of primary leukemic cells.DiscussionOur data indicate that observed proapoptotic actionof cyclohexyl-functionalized ethylendiaminedipropanoic acid ethyl-ester was fairly selectivetoward leukemic cells, in comparison with normalblood mononuclear cells. These data couldcontribute to further research of these types ofcompounds of esteric nature and their antitumoreffects alone or as a part of different organo-metalliccomplexes.Quantification of DNMT3A R882 codonmutations – a novel methodPresenter: Kathrin BislingAuthors: Kathrin Bisling, Gillian HorneUniversity: Brighton, United KingdomIntroductionRecent literature has highlighted the importance ofmutations in epigenetic modifiers as a commonfinding in haematopoietic malignancies. DNMT3A,a DNA methyltransferase, offers a good exampleand mutations affecting this gene have recentlybeen identified in approximately 20% of patientswith Acute Myeloid Leukaemia. It has been shownthat harbouring this mutation is associated with anoverall impaired survival outcome. Furthermore, ithas been suggested that these mutations are stablethroughout disease evolution, highlighting theirpotential as a prognostic biomarker for earlydetection of relapse. In view of its importance, weaimed to establish a novel method for quantificationof the mutation.MethodsBased on initial PCR and restriction enzymeexperiments (Brewin et al. 2012) we established arapid method to detect DNMT3A mutations atcodon R882 which contains 60% of all DNMT3Amutations. We now extend the method by using realtime PCR to quantify the mutational proportion in asample. Serial dilutions were made of the OCIAML3 cell line, which harbours a heterozygousDNMT3A R882C mutation, and KG1 cell line, ascontrol. We then screened 25 AML primarysamples.ResultsOur assay could reliably detect the relative amountsof the DNMT3A R882C mutation (a C-to-Ttransition causing cysteine substitution) in a serialdilution series of 100-0.78% of OCI AML3 in KG1.The relative restriction enzyme cutting efficiencywas between 100-95% ensuring complete digestionof the mutated strand in relation to a similarrestriction site outside codon R882.We further detected 2 R882H mutations (G-to-Atransition causing histidine substitution) out of 25AML samples and quantified their mutational loadas 100% compared to the positive control OCI. Noneof the remaining 23 samples showed low copynumbers of the DNMT3A mutation.DiscussionInterestingly, we detected either a 100% or 0%mutational load in our pool of 25 AML patientscontaining 14 pretreatment and 10 posttreatmentsamples. Both positive samples were obtained atMedical Science Educator © IAMSE 2013 Volume 23(1S) 181

initial diagnosis respectively the first course ofchemotherapy whereas none of the 10posttreatment samples showed any mutational load.This might suggest that DNMT3A rather belongs tothe group of initiating mutations in AML than to therelapse-specific group.Prognostic impact of BRAF mutation inpatients with papillary thyroid carcinoma,preliminary results from the firstmonocentric prospective studyPresenter: Simona CensiAuthors: Censi S, Mian C, Watutantrige-FernandoS, Barollo SUniversity: Verona, ItalyIntroductionPapillary thyroid carcinoma (PTC) is the mostfrequent malignancy of the thyroid.PTC is a well-differentiated carcinoma, derived fromfollicular thyroid cells. High cure rates are achievedafter initial treatment. However about 20-30% ofpatients will develop a local or distant recurrenceand 1% will die. Identifying these high-risk patientsat time of diagnosis through well-estabilishedprognostic factors can help to ascertain the mostappropriate treatment and follow-up for thesepatients.To date, no biological marker has yet been includedas a prognostic factor of PTC. BRAF is a serinethreoninekinase that mediates signal transductionthrough the MEK-ERK pathway. Severalretrospective studies have found BRAF mutation tobe associated with a worse outcome.The aim of the study was to assess the BRAFmutation prognostic impact in the first world-wideperspective study.MethodsThe study involved 186 consecutive patients(38(20%) males, 148(80%) females, mean age 49years, range 22-81 years, median age 48 years)diagnosed with PTC. We assessed the BRAFmutation status in fine-needle aspiration biopsyspecimens before the thyroidectomy and itsassociation with clinicopathologic characteristicsrevealed postoperatively and with outcome. Allpatients underwent total thyroidectomy, 131Iablationand thyrotropin (TSH) suppression andwere followed-up over a period of 36±8 months.ResultsBRAF positivity correlates with the histologicalvariant (p

DiscussionThe left DCBT is important in oromotor control.Preterms with microstructural damage in theLDCBT are more at risk of poor oromotor outcome.Whether the integrity of the DCBT is a goodpredictor of speech disorder in early childhoodremains to be investigated.DiscussionAccording to our findings, the D1 receptors found inthe VP play an important role in the negativereinforcement and spatial learning mechanisms,while D2 receptors do not contribute to thesefunctions. These results can contribute to betterunderstanding of diseases that involve thepathological function of the MLDR.The role of D1 and D2 dopamine receptors inlearning mechanisms of the ratPresenter: Adam SzaboAuthors: Adam SzaboUniversity: Gyúró, HungaryIntroductionThe ventral pallidum (VP) is located in the basalforebrain, and is extensively connected with themesolimbic dopaminergic system (MLDR). Itsfunction is important in learning and rewardprocesses. By microinjection of D1 receptor agonistSKF38393 or D2 agonist quinpirole, we investigatedthe role of D1 and D2 dopamine receptors of the VPin two paradigms.MethodsBilateral stainless steel cannulae were implantedinto the VP of male Wistar rats with by stereotaxicsurgical method. Drug effects were investigated inPassive Avoidance Learning (PAV) and MorrisWater Maze (MWM) tests. D1 or D2 agonists weremicroinjected in 0,1 g, 1 µg, and 5 µg doses. Thedrugs were dissolved in 0,4 µl saline and controlanimals received only the vehicle.On day 1 of the PAV, animals received an 0.5 mAelectric schock. Trials to measure the step-throughlatency into the dark compartment were conducted24 hours, 1 week, and 2 weeks after conditioning(Test1, Test2, Test3).On day 1 of the MWM test, the animals werehabituated. Trials on the 2nd and 3rd day wereconducted with the hidden platform presentfollowed by a trial without platform. During theswimming trials hidden platform finding latencyand the time spent in the target quadrant weremeasured.ResultsDuring the PAV test, D1 agonist SKF38393 in 1,0 µg, and 5,0 µg doses significantly increased the stepthroughlatency, while the D2 agonist quinpirolehad no effect.In the MWM test, the D1 agonist in 1,0 µg dosesignificantly reduced the target finding latency, theother doses had no effect. Administration of the D2agonist had no significant influence.Positive and negative effects of classicalmusic in the treatment of symptomaticepilepsyPresenter: Anastasiia VvedenskaAuthors: Vvedenska A.E., Grigorova I.A.,Resnitchenko E.K.University: Kharkiv, UkraineIntroductionScientists are studying efficiency of non-drugtreatments for epilepsy, including music therapy.Researchers believe that classical musicsynchronizes the rhythms of the brain. It issupposed that sound frequencies resonate withspecific areas of the brain, reducing its paroxysmalactivity. However, it was noted that music also maycause seizure activity.The aim of the study was to investigate theelectroencephalographic (EEG) parameters beforeand after listening to classical music for definition ofcharacter of its influence on the brain, and select themost effective melody for the treatment ofsymptomatic epilepsy.MethodsWe have examined 23 patients aged from 12 to 18years with a diagnosis: symptomatic epilepsy. Thefrequency of attacks varied from 1 per month to 8-7times a year. All the patients underwent EEG studybefore and after listening to Bach's Suite № 3,"Requiem" by Mozart (part "Lacrimosa") and afterrepeated playing of Bach.ResultsThe average amplitude of the alpha rhythm beforelistening to music was 110 mcV. The averageamplitude was 40 mcV in 19 patients out of 23 afterlistening to Bach. Amplitude of alpha rhythmincreased on the average to 180 mcV among allpatients after listening to Mozart. Also there wererecorded area of irritation, increasing of irritativechanges and disruption of the basic rhythm.Repeated playing Bach after Mozart showed that theamplitude was reduced to an average of 50 mcV in15 patients, to 100 mcV – in 8. Because there was asignificant reduction in the amplitude of alpha -Medical Science Educator © IAMSE 2013 Volume 23(1S) 183

hythm, we considered it appropriate to hold acourse of music therapy, which includes listening toBach suite for 10 minutes every day during 1 month.After the course, all patients marked reduction infrequency and duration of epileptic seizures.DiscussionBased on our study it was concluded that thetreatment and prevention of epilepsy on thebackground of drug therapy should be focused onstudying the efficiency of non-drug methods,including music therapy. However, it requirescareful selection of tunes and qualitative study ofclinical and anamnestic data and EEG parameters inorder to prevent the occurrence of side effects.Glutamatergic input to subthalamic nucleusand dopaminergic neurones of thesubstantia nigra in the ratPresenter: Maria AlgerAuthors: Miss Maria Alger, Prof. J. Paul BolamUniversity: Oxford, United KingdomIntroductionDopaminergic (DA) neurones in the midbrain havebeen implicated in many roles including reward,addiction, motivation and motor control. DAneurones of the substantia nigra (SN) are selectivelyvulnerable in Parkinson’s disease and their lossunderlies the motor symptoms of the disease. Theyreceive excitatory, glutamatergic input from severalcortical areas and subcortical structures includingthe subthalamic nucleus (STN) and these inputs arecritical in dopamine neuron firing and hencedopamine release. Similarly, neurones of the STNreceive excitatory input from both cortical andsubcortical structures that are critical for control ofSTN projections, such as those targeting DAneurones of the SN.MethodsThe aim of this study was to quantify glutamatergicinput to DA neurones of the SN and neurones of theSTN from cortical and subcortical regions in the rat.The cortical and subcortical glutamatergic inputswere identified by the presence of vesicularglutamate transporter type 1 (VGluT1) and VGluT2,respectively. This was achieved by immunolabellingfor tyrosine hydroxylase (one of the syntheticenzymes for dopamine) by the avidin-biotinperoxidasemethod together with immunogoldlabelling for VGluT1 or VGluT2 and analysis at theelectron microscopic level.ResultsTerminals from the cortex formed 19% ofasymmetric synapses in the SNc and subcorticalterminals formed 41%. In contrast, there was nodirect cortical input with SNr DA structures.Cortical input was seen onto unlabelled cells of SNr,but was rare. Subcortical glutamate terminalsformed 41% of asymmetrical synapses in the SNr.Symmetric input (putatively inhibitory) was foundto differ between the two compartments, with 47%of all synapses being symmetric in SNc and 76% inSNr. Asymmetrical synapses made up 53% of STNsynapses, with 49% of these formed by VGluT1(18%) or VGluT2 (31%) terminals. The remaining47% of synapses were symmetrical.DiscussionThese findings suggest that the major excitatoryinput to DA neurones is derived from subcorticalstructures; principally the thalamus andpedunculopontine tegmental nucleus. Similarly,although the common supposition is that theprincipal excitatory input to the STN neurones isfrom the cortex, the present findings show that thesubcortical input is more prominent.The Increase Of Intestine GlucoseAbsorption By The Administration Of 5%Glucose Solutions At Temperature Of 15 ˚ C,25 ˚ C And 40˚ C In Mice (Mus Musculus)Presenter: Kartika FauziaAuthors: Kartika A. Fauzia, Eka P.B. Mulia,Nareswari A. UlfahUniversity: Yogyakarta, IndonesiaIntroductionGlucose is combined into the rehydration solutionto overcome fatigue. Glucose entry should beabsorbed as effectively as possible because fatigueinhibits the activity of even detrimental for theathlete. Based on the theory that transporter proteinin the gastrointestinal tract is influence bytemperature, this research aims to prove thedifference in absorption of glucose in the smallintestine of mice after administration of 5% glucosesolution with a temperature of 15 ˚ C, 25 ˚ C and 40˚ C.MethodsThe design used in this experimental research wasSeparated Pre-Post Test. The study were conductedon 28 mice (Mus musculus) and were divided intofour groups; i.e. control group without glucoseadministration, the group treated with fluidadministration of glucose 5% at temperature ofMedical Science Educator © IAMSE 2013 Volume 23(1S) 184

15˚C, 25˚C and 40˚C per oral. Absorption of glucosewas determined by measuring blood glucose levelsin Portal Vein after 30 minutes using a glucosemeter.ResultsThe measurement results showed that the meanglucose level in the control group was 149.17 ± 17.62mg/dl, the group treatment at temperature of 15˚Cwas 207.67 ± 36.61 mg/dl, At temperature of 25˚Cwas 254.33 ±35.52 mg/dl and the temperature of40˚C was 256.5± 34.83 mg/dl. As indicated by thestatistical test, there were significant differencesbetween the control group and the group treatedwith 5% glucose administration at the temperatureof 15˚C; control group and 25˚C; and control groupand 40˚C. The treatment group at temperature 15˚Cto 25˚C shows significant differences, while at thetemperature of 25˚C to 40˚C the absorption ofglucose was increased although it was notstatistically significant.DiscussionIn the high glucose concentration, there is anincrease expression of GLUT-2, and the higher thetemperature, the higher the activity. Hightemperature also trigger the activation Heat ShockProtein which then increase the expression of(SGLT-1) Sodium Glucose Transporter-1.In conclusion the increase of temperature causetendency of increased glucose absorption, asindicated by elevated levels of glucose and thehighest glucose absorption of portal vein occurred attemperature of 40˚C of 5% glucose solution,compared to the groups at 15˚C and 25˚C.The effect of antiandrogenic and antioxidantcombined therapy on glucose metabolismand oxidative stress in PCOS rat modelPresenter: Cristina CucolaşAuthors: Cristina Cucolaş, Alexandra Dăneasă,Remus Moldovan, Pompei Bolfa, Nicoleta Decea,Sorin Dudea, Diana Olteanu, Adriana Mureşan,Adriana FilipUniversity: Cluj-Napoca, RomaniaIntroductionThe Polycystic Ovarian Syndrome (PCOS) is afrequent endocrine female disorder characterized byimpaired fasting glycemia (IFG), oxidative stressand hyperandrogenism. The exact causalrelationship between these pathological elementshas not been yet clarified.Our purpose is to investigate the impact on glucosemetabolism and oxidative stress of a combinedantiandrogenic and antioxidant treatment, i.e.Spironolactone (Sp) with dimethylsulfoxide(DMSO).MethodsPCOS was induced to 65 female Wistar rats, by asingle intramuscular injection of Estradiol Valerate(5mg) solved in sesame oil (0.4ml). A control group(n=7) received 0.4 ml sesame oil. After ultrasoundconfirmation of PCOS, an initial oral glucosetolerance test (OGTT) was performed, and theanimals were distributed accordingly to alteredglucose metabolism (AGM) group, or to normalglucose metabolism (NGM) group. The animalsfrom the NGM group were excluded from the study.The AGM group was subsequently divided in twosubgroups: one treated with Sp and DMSO (2 mg:0.2 ml) and one only with DMSO (0.2 ml). Beforeand 24 h after one month treatment, musclebiopsies were taken to evaluate the expression ofglucose transporter 4 (GLUT4) and glyceraldehyde3-phosphate dehydrogenase (GAPDH) throughwestern blot and immunohistochemistry, blood andmuscles were collected for oxidative stressparameters evaluation. After treatment, a finalOGTT was performed and ovaries were removed forhistopathological examination.ResultsCombined treatment decreased fasting glycemiafrom 124±11.83mg/dl to 106±9.9mg/dl (p

Respiration Changes on Fowler PositioningPresenter: Irham HanafiAuthors: Irham HanafiUniversity: Sleman, IndonesiaIntroductionFowler positioning by moving up the trunk 45degree from supine position while the legs stay,gives the lungs to have more parts in Zone 2 (V/Qmatch) than in supine position. This study is aimedto describe the improvement of respiration withFowler position.MethodsA randomized trial involved patients in ICU withnormal lungs and normal functions of kidneys andcardiovascular system or were had recovered fromany pathology. Blood samples were drawn fromradial artery twice for blood gas analysis, first inFowler position and second after 10 minutes insupine position. Blood pressures (systole, meanarterial pressure (MAP), diastole), hearth rate, andrespiratory rate were noted at a moment beforedrawing both blood sampling. Then the data wereexamined with paired t-test.ResultsTwenty patients (6 males,14 females) 14 – 65(mean: 36) years old were included in this study.The changes were as follow (data: mean±SD, Fowlerto supine): blood pressure (mmHg): systole:132.05±16.98 to 129.15±19.05 (p:0.234), MAP:94.75±13.03 to 92.12±14.43 (p:0.274), diastole:76.10±12.84 to 73.60±14.17 (p:0.370), hearth rate(x/minute): 93.65±17.02 to 94.20±17.15 (p:0.724),respiratory rate (x/minute): 20.10±4.42 to21.95±5.02 (p:008), blood gas analysis: pH:7.413±0.045 to 7.401±0.048 (p:0.067), PaCO2:34.50±5.25 to 35.98±5.73 (p:0.031), PaO2:121.02±42.25 to 110.54 ±22.60 (p:0.166), HCO3ion: 21.95±4.27 to 21.95±3.39 (p:0.991), BE: -2.03±3.40 to -2.28±3.50 (p:0.504).DiscussionThe physiologic condition that all of regulationsystems in the body work together to maintainhomeostasis of internal milieu, appears on our data.All parameters of our data were maintained inclinically normal ranges by the patient’s body.Despite of those normal ranges, the statisticallysignificant differences (increase of respiratory rateand PaCO2) indicated that the CO2 elimination inFowler position was more effective than in supineposition. If there is no difference of gas exchange,increase of respiratory rate should have lowerPaCO2 and vice versa.The effects of Kv1.3 and IKCa1 potassiumchannel inhibition on calcium influx ofhuman peripheral T lymphocytes inrheumatoid arthritisPresenter: Anna BajnokAuthors: Anna BajnokUniversity: Budapest, HungaryIntroductionThe transient increase of the cytoplasmic freecalcium level plays a key role in the process oflymphocyte activation. Kv1.3 and IKCa1 potassiumchannels are important regulators of themaintenance of calcium influx during lymphocyteactivation and present a possible target for selectiveimmunomodulation.The aim of this study was to evaluate the differencesin calcium influx kinetics and to characterize theeffects of potassium channel inhibition onperipheral blood T lymphocyte activation in patientsrecently diagnosed with rheumatoid arthritis (RA).MethodsWe took peripheral blood samples from 10 healthyindividuals and 9 recently diagnosed RA patients.We registered the calcium influx kinetics of CD4,Th1, Th2 and CD8 cells, applying a novel flowcytometry approach. We also assessed thesensitivity to specific inhibition of the Kv1.3 andIKCa1 potassium channels and measured theexpression of Kv1.3 channel in the above subsets.Recordings were evaluated with our specificsoftware (Facskin).ResultsThe peak of calcium influx in lymphocytes isolatedfrom RA patients is reached more rapidly. Inhealthy individuals, the inhibition of the IKCa1channel decreased calcium influx in Th2 and CD4cells to a lower extent than in Th1 and CD8 cells. Onthe contrary, the inhibition of Kv1.3 channelsresulted in a larger decrease of calcium entry in Th2and CD4 than in Th1 and CD8 cells. No differencewas detected between the lymphocyte subsets in thesensitivity to IKCa1 channel inhibition among RApatients. However, specific inhibition of the Kv1.3channel acts differentially in RA, CD8 cells areinhibited the most dominantly, although Th2 cellsare also affected. The changes to the sensitivity ofKv1.3 channel inhibition seem to be unrelated to itsaltered expression, hence functional alterationsmust also play a role.DiscussionLymphocytes isolated from RA patients respondmore quickly to stimulation than controls. Uponinhibition of Kv1.3 channel cytotoxic CD8 cells ofMedical Science Educator © IAMSE 2013 Volume 23(1S) 186

RA patients are inhibited mostly, however antiinflammatoryTh2 cells are also affected indicatingthat while specific inhibitors of Kv1.3 channels seemto be promising novel immunomodulators, so farour studies show that they are not specific enoughin peripheral RA lymphocytes.Motion correction using hierarchical localaffine registration improves image qualityand myocardial scar characterisation fromT1 maps acquired with MOLLIPresenter: Marcus RaultAuthors: Rault MEG, Karim R, Chen Z, Voigt T,Sohal M, Sammut E, Child N, Nagel E, Rinaldi CA,Razavi R, Shaeffter T, Puntmann VO, Rhode KUniversity: Barts, United KingdomIntroductionT1 mapping enables true quantitative assessment ofmyocardial tissue, separating scars and healthymyocardium. The modified Look-Locker inversionrecovery (MOLLI) sequence acquires eleven imagesover the duration of a minimum of fifteen heartbeats to obtain the final T1 map, which issusceptible to undesired respiratory motion due to arelatively long breath-hold. We aimed to implementa motion correction method using a hierarchicallocal affine registration of MOLLI images and testedif it improved image quality and thus producedmore accurate post contrast myocardial tissue T1estimation.MethodsMotion correction was implemented on T1 mappingimages acquired 20 minutes post gadoliniumcontrast injection in 15 patients with a previoushistory of chronic myocardial infarction. Threeexperiments were carried out to compare the preandpost-motion correction images. 1) Comparingvisual quality score assessment of the T1 maps bytwo experienced independent observers; 2)comparing histogram distributions of voxel T1values within the myocardium to allow tissuecharacterisation between the scarred region and thenon-infarct region; and 3) comparing the “error ofmismatch” measured by voxel misalignment in LVendocardial and epicardial borders. Wilcoxonsigned rank test was performed to test forsignificant differences between the median errors ofmismatch between the pre and post motioncorrection images.Results1) Visual qualitative assessment via twoindependent observers confirmed motion correctionproduced an improvement in image quality in 11 outof 15 patients. 2) The histograms assessing tissuecharacterisation showed an improvement in tissueT1 delineation after motion correction,demonstrated by more distinct signal intensitypeaks after motion correction. The estimated postcontrastmedian T1 values for non-infarct regionand scarred region were 375ms (IQR: 60ms) and240ms (IQR: 10ms); respectively. 3) There was asignificant difference in the median measure oferrors in epi- and endocardial borders after motioncorrection. Pre-motion correction: 2.2 voxel (IQR:1.3) epi; 2.2 voxel (IQR: 1.3) endo. Post-motioncorrection: 1.5 voxel (IQR: 0.8) epi; 1.7 voxel (IQR:1.0) endo; p

to the WHO protocol, the measure was taken at themid-point between the highest point of the iliaccrest and the last floating rib and 2) WC wasmeasured at the point of the minimal waist. Pearsoncorrelation was used for data analysisResultsMean fasting blood suger(FBS) and triglicerid(TG)levels were 101.67 mg/dL (range,77.00-159.00) and138.77 mg/dL (range,75.00-329.00) respectively.Mean weight, was 85.21 kg(range-62.40-85.21) andmean BMI was 32.83 kg/m2 (range,22.11-50.70).Ithas been shown in the study that there was acorrelation between TyG index and WC(measuredby WHO method (p

tubal disease (n=40), group 2 included women withcombined infertility (n=12), group 3 consisted ofinfertile clomiphene citrate-resistant (CCR) womenwith polycystic ovary syndrome (PCOS),n=19.Efficiency of surgical treatment was evaluatedaccording to level of positive pregnancy andpregnancy outcomes among women in each group.ResultsOf the 52 patients with tubal pathology, diagnosticlaparoscopy revealed unilateral tubal obstruction in20(38, 4 %); bilateral tubal obstruction in 12 (23,07%); hydrosalpinxs in 15 (28.8%); peritubaland/or perifimbrial adhesions were detected in 5(9,6%) of these patients. The following abnormalfindings were treated during endoscopic surgeryusing adhesiolysis, salpingostomy, falloposcopictuboplasty. Following endoscopic surgery 15(53.6%) pregnancies were achieved of the womenwith mild tubal disease; among the patients withsevere tubal disease the effectiveness was 16,7%. 8(15, 4%) patients were switched to assistedreproductive technology (ART) because of severetubal diseases. Of 19 patients with PCOS, 10(52, 6%)underwent ovarian wedge resection, 9(47, 3%)-laparoscopic ovarian drilling. The spontaneouspregnancy rates ranged from 4, 2% to 52, 6 % at 12months after. 23 (57, 5%) pregnancies wereachieved in group 1, including 6 ART-mediatedpregnancies; 8(66, 7%) pregnancies were achievedin group 2. The cumulative pregnancy rate after 8-10 months following laparoscopy was 23, 4%.DiscussionDepending on the degree of tubal dysfunction andovarian reserve of the patient, various approaches tothe treatment of infertility are available. Because ofthe potential diagnostic and therapeutic benefits,patients with infertility should undergo diagnosticlaparoscopy prior to ART.Developing Non-invasive Diagnostic Methodusing VI Capsular Polysaccharide IgMAntibody in Typhoid Fever Patients’ UrinePresenter: Wahyu TriadmajaniAuthors: Wahyu Triadmajani; Aditya IndraMahendra; Annisa Maulidia Mahdi; RizalRahmanda Akbar; Fredo Tamara; Sri WinarsihUniversity: Malang, IndonesiaIntroductionTyphoid fever is a life-threatening infectious diseasecaused by Salmonella enterica Typhii and Paratyphiiserotype. Approximately, 600.00 of 22 million casesof typhoid fever are death cases every year. Around70% from the death cases are the patients in Asia,mainly Indonesia. The recent diagnostic method,Widal test, hasn’t shown satisfying result because itcan be 30% negative in the typhoid fever patient.Therefore, developing a fast, accurate and noninvasivetyphoid diagnosis still becomes a challengefor researchers until the present time. This researchaim is to prove the examination effectivity of Vicapsular polysaccharides antigen and its antibody inurine.MethodsThis research was an experimental laboratoryresearch with posttest only controlled group design.IgM was produced by antigen vaccination in mice. 5groups of Balb/c mice are infected by E.coli,Shigella dysentriae, Salmonella Typhi, SalmonellaParatyphi, Salmonella Typhimurium. On the 7thday, the urine was taken to be checked using dotblotResultsThe research result showed there was a strongantigen-antibody reation between IgM polyclonalantibody and the urine sample from mice whichwere infected by Salmonella Typhi dan SalmonellaParatyphi. But, there was also a weak cross-reactionbetween IgM polyclonal antibody and urine samplefrom other infected mice (p=0,061). Theexamination of IgM antibody in urine using ViCapsular polysaccharides antigen showed theantigen-antibody reaction were strong and specificto mice that infected by Salmonella Typhi danSalmonella Paratyphi (p=0.015).DiscussionThe examination of vi capsular polysaccharidesantigen and its IgM antibody in urine sampleeffectively detected the infection of SalmonellaTyphi dan Salmonella Paratyphi. This result showedthis method is a new potential non-invasive andacurate diagnostic method of typhoid fever.Comparison of the peripheral nervestimulation and ultrasonography used inupper limb surgery: retrospective studyPresenter: Nadzieja BurayaAuthors: Nadzieja Buraya, Larisa Duniec, PiotrNowakowskiUniversity: Warsaw, PolandIntroductionNowadays different techniques of regionalanesthesia are widely used in upper extremitysurgery. Clinical studies confirm that regionalMedical Science Educator © IAMSE 2013 Volume 23(1S) 189

anesthesia techniques are safe and have a lowcomplication rate in comparison with generalanesthesia. In Poland, the use of ultrasound forregional anesthesia is relatively new, howeverinterest in this application is growing rapidly. Theaim of our study was to compare two modalities ofnerve location used in regional anesthesia:ultrasonography and peripheral nerve stimulationtechnique.MethodsAfter ethics committee approval retrospectivesurvey of all peripheral blocks performed within last5 years in Department of Orthopedic Surgery wascarried out. The study included 2834 patientsscheduled for upper limb surgery. All patients weredivided into 2 groups: in the first group (n=2437;86%) the conventional electrical nerve stimulationtechnique (NS) was used, in the second group(n=397; 14%) the ultrasonography (US) wasapplied. As an end point we evaluated theoccurrence of a sensory and motor block withoutneed of deeper sedation. In this case, we recognizedthe intervention as successful. If analgosedation orgeneral anesthesia was necessary to achieveanalgesia, we considered the manipulation as failed.In data analysis we also took into accountexperience of the doctor. Statistical analysis wasperformed at IT and Tele medicine Department ofWarsaw Medical University.ResultsIn the NS group: 1571 patients of 2437 (65%) hadtotal sensory and motor block without sedation andthe intervention was considered successful, 485patients (20%) required analgosedation and 381(15%) – general anesthesia. In the US group: 290patients (73%) had total block, 66 (17%) neededanalgosedation and 41 (10%) - general anesthesia.The analysis of the results shows that usingultrasonography results in higher success rate incomparison with peripheral nerve stimulation andthe difference is statistically significant. (OR=0.669,CI=0.53 to 0.85, p=0.002)DiscussionOur study shows that the new technique such asultrasonography is not only a new possibility foridentifying the nerves of the brachial plexus but alsoincreases the success rate of peripheral regionalanesthesia in patients undergoing the upper limbsurgery.Adverse cardiac or cerebrovascular eventsafter coronary artery bypass grafting aremore frequent in nitric oxide synthase-3Asp298 carriers but are prevented witheptifibatidePresenter: Sabina LicholaiAuthors: Sabina Licholai, Jadwiga Dworak, JakubKorbaś, Mirosław Wilczyński, Andrzej Bochenek,Marek SanakUniversity: Krakow, PolandIntroductionMultivessel coronary artery disease (CAD) is anextreme phenotype of the disease, often requiringcoronary artery bypass grafting (CABG). Thisprocedure is associated with a risk of adversethrombotic events. Several studies linked acutecoronary complications to the endothelialdysfunction, decreased nitric oxide (NO) productionand insufficient inhibition of platelet aggregation.Endothelial NO is constitutively produced by theNO synthase-3, encoded by NOS3 gene. A commonfunctional variant of the gene is Glu298 to Aspsubstitution (Glu298Asp, rs1799983).Aims:The aim of the study was to investigate a possibleassociation between Glu298Asp polymorphism ofNOS3 and major adverse cardiac andcerebrovascular events (MACCE) following CABG.This was assessed in subjects receiving anti-plateletacetylsalicylic acid or add-on eptifibatide(glycoprotein IIb/IIIa inhibitor, 51.4%) duringperioperational period.MethodsSubjects (n=140, age 64±9.4 year, 40 females) wereenrolled requiring emergency CABG surgery due toobjective heart ischemia symptoms in the course ofmultivessel CAD. Patients were followed-up for sixmonths after CABG. For population frequency ofNOS3 variants, 125 healthy volunteers were studied.NOS3 Glu298Asp polymorphism was ascertained byPCR-RLFP. Genotype frequencies were comparedbetween the groups with Fisher’s exact test.ResultsIn 16 patients (11,4%) no NOS3 genotype was notascertained due to genotyping failure. No differencein the frequency of variants of NOS-3 was notedbetween the study groups or the referencepopulation and the minor Asp298 variant frequencyin patients was 35%. Analysis of MACCE frequencywithin the first 7 days showed their higherfrequency in patients carrying NOS3 Asp298 variant(26.8%) vs. Glu268 homozygous (12.8%), thoughthis difference was not statistically significant(p=0.115). Interestingly, among 9 deaths, in 6Medical Science Educator © IAMSE 2013 Volume 23(1S) 190

patients who were genotyped, all deceased werecarrying NOS 3Asp298 variant (p=0.03). Thesestudy endpoints were not dependent onadministered anti-platelet therapy.DiscussionAsp298 variant of NOS3 was more frequent inpatients who had early MACCE after CABGprocedure. This variant of NOS3 was significantlymore frequent on CABG patients whose death wasobserved during the follow-up period. In a highcardiovascular risk population, additional burdenmay be due to endothelial dysfunction due to thefunctional NOS3 Glu298Asp mutation.The influence of obesity on centralhemodynamics and arterial stiffness inadolescent girlsPresenter: Anastasia LedyaevaAuthors: Anastasia LedyaevaUniversity: Volgograd, Russian FederationIntroductionThe aim: to analyze the influence of obesity oncentral hemodynamics and vascular stiffness inadolescent girls.MethodsThe study included 56 girls from 12 to 17 years oldwith normal blood pressure. They were 2 groups: 1-group with BMI≤85procentile (normal weight), 2-group with BMI≥85procentile (obesity). There were2 subgroups according to girls’ age: 1-subgroup14 years. The parameters ofcentral hemodynamics, pulse wave velocity PWVwere determined by applanation tonometry on theunit «SphygmoCor» («AtCor medical», Australia,Ver.9.0). Ambulatory blood pressure monitoringwith definition of vascular stiffness was performedby portable monitors «BPLab» («Petr Telegin»,Russia). The differences between groups and thedata of correlation analyze are shown with 5%significance level (p

Spearman correlation quotient (R) and p quotientwere calculated using Statistica. Statisticalsignificance was set at p < 0.05ResultsAverage patient’s age was 45 years (16- 91), SD14.21.We found statistically significant (p < 0.05)positive correlations between the severity ofcystoscopic findings and the severity of suprapubicpain (SPP) (R=0,15 ; p = 0,0017) and the severity ofurinary frequency (R = 0,16 ; p = 0,0008),respectively. The severity of stress urinaryincontinence (SUI) (R = -0,14 ; p = 0,0028) andurgency urinary incontinence (UUI) (R = -0,14 ; p =0,0027) were inversely correlated to the severity ofcystoscopic findings. We also observed positivecorrelations between urinary frequency (R = -0,12 ;p = 0,0123) and nocturia (R = -0,16 ; p = 0,0006)with MCC. However SUI (R = -0,01 ; p = 0,7688)and UUI (R = -0,1 ; p = 0,0285) were negativelycorrelated with MCC. Surprisingly, the patients’ agewas inversely correlated with severity of cystoscopicfindings (R = -0,12 ; p = 0,01).DiscussionOur study confirms our clinical impression thattheseverity of SPP and the severity of urinaryfrequency correlate to the severity of bladderinflammation. However, we could not confirm thesame correlation with nocturia. We also found thatyounger patients have more severe bladder changes.In conclusion, suprapubic pain and urinaryfrequency in younger patients correlate to severityof disease.Multimodal learning: a survey of twodifferent methods of teaching anatomy to365 medical students in University ofIndonesiaPresenter: Febrian SantausaAuthors: Febrian Mulya Santausa, Patricia LukasGoentoro, Damar Parasdyaningtyas Susilaradeya,Harris Soetanto, Ardi Findyartini, Isabella KurniaLiemUniversity: Kotabaru / Cikampek, Indonesiaachieve better understanding of anatomy comparedto the conventional method.MethodsAll first-year medical students in 2010/2011academic year (n=185) studying neuroanatomy onlyby cadaver prosections completed a practicalexamination using cadavers. The next year, anotherfirst-year medical students (n=180) studyingneuroanatomy by introduction lecture, cadaverprosections categorized based on subtopics ofneuroanatomy, labelled photos of anatomypreparations, and review session completed anonline practical examination using photos displayedon the computer. The test used in both groupsconsists of 20 questions containing the samecomponent of neuroanatomy knowledge. Data fromtwo groups was compared using Mann-Whitney testand presented in table displaying median score oftwo groups.ResultsIn both groups (16-21 years of age), there is noassociation between gender and practicalexamination score. The medical students whoexperienced new anatomy teaching method gotbetter score than the other group. The median offirst-year students’ practical examination score in2010/2011 academic year is 65, while the othergroup is 70. From the analysis, p value is 0.019which means the 5 points difference betweenpractical examination score of two groups isconsidered significant.DiscussionThe score difference is most likely caused bymultimodal learning involved in the second group.Photos can help them visualize parts of human bodywhich cannot be seen clearly in the cadaver. This isalso the reason why students prefer online practicalexamination using picture. Introduction lecture andreview session help them learning by listening to theteacher and repeating what they have been learningin the past few weeks. In conclusion, teachingmethods involving more human modality can helpstudents achieve better understanding of anatomy.IntroductionAnatomy is widely accepted as fundamental subjecttowards medical fields. There are lots of subjectivediscussions, but few data about anatomy teachingmethods applied to medical students. For the past17 years, cadaver prosections were used as the onlyteaching method for anatomy in our university. Ourstudy was aimed to assess if teaching methodinvolving more human modality can help studentsMedical Science Educator © IAMSE 2013 Volume 23(1S) 192

Functional condition of the heart in girlswith disorders of menstrual functionPresenter: Anastasiia VvedenskaAuthors: Vvedenska A.E.,Vvedenska T.S.,PolyakovA.V.University: Kharkiv, UkraineIntroductionDisorders of menstrual cycle (DMC) in girls at thestage of puberty are a marker of future healthproblems in women. Secondary amenorrhea (SA)and pubertal uterine bleeding (PUB) areaccompanied by deep changes of regulatorymechanisms of the neuroendocrine system and arethe actual problem of modern endocrine adolescentgynecology. Connective tissue dysplasia (CTD)- isone of the states, whose influence on thereproductive system is almost not studied.Hormonal disorders that arise in girls with DMC,particularly lowering of estrogen, contributesignificantly to the pathogenesis of diseases of thecardiovascular system. The combination of DMCand cardiac disorders causes a high risk forcomplications of the latter. The aim of our work wasevaluation of morphometric and hemodynamicindices of the heart, valve apparatus at rest and afterexercises in adolescent girls with DMC.MethodsWe examined 50 girls with SA (I group) and 25 -with PUB (II group). The age was 12-18 years. Weconducted Doppler echocardiography among allgirls (at rest and after radioelectrocardiography onthe background heart rate 170 beats / min.).ResultsIdiopathic prolapse of mitral valve was more oftenrecorded in I-st, than in the second group (54.6% ±4.1% ;12.0% ±6.6%; p

MEDICAL SCIENCE EDUCATORThe Journal of the International Association of Medical Science EducatorsAnnouncementsHarvard Medical School CME CoursePrinciples of Medical Education:Maximizing Your Teaching Skills.The meeting will take place April 4 - 6, 2013 , OmniParker House Hotel, Boston, MA, USA. New orexperienced teachers, from all specialties, willbenefit from this highly-regarded course that coversthe educational principles and skills needed to teachsuccessfully in a wide range of clinical settings.Participants will learn how to: assess a trainee andprovide effective feedback, present a lecture, lead acase-based discussion, teach at the bedside, balancethe needs of students and patients, use educationaltechnology, and challenge learners to move from"knowing" to "understanding." To view the coursedescription and to register online, visit:www.cme.hms.harvard.edu/courses/foundationsAACOM and AODME 2013 MeetingMake plans now to attend the Joint AACOM andAODME 2013 Annual Meeting, to be held April 24-27, at the Marriott Baltimore Waterfront Hotel inBaltimore, Maryland. The conference will focus on“Foundations for the Future”, with sessions thatexplore themes developed through the AACOM-AOA Blue Ribbon Commission for the Advancementof Osteopathic Medical Education and emerginginnovations throughout the continuum ofosteopathic medical education. Visit the site:http://www.aacom.org/events/annualmtg/Pages/default.aspx to learn more about the meeting.IAMSE 2013 meetingThe next annual meeting of the InternationalAssociation of Medical Science Educators (IAMSE)will take place in St Andrews, Scotland (UK). Themeeting theme is: “Science education for health careprofessionals across the continuum”. The meeting isdesigned for all those who teach and lead curriculain the sciences of medicine and health. Participantsinclude basic scientists and clinical faculty frommany health care disciplines. The IAMSE meetingoffers opportunities for faculty development andnetworking across the continuum of health careeducation. Conference dates are June 8-11, 2013.For more information: www.iamseconference.orgAssociation of Clinical AnatomistsThe 30th annual meeting of the AACA will be heldin Denver, Colorado at the Marriott City CenterHotel - July 9th - 13th, 2013. On July 9th, theScientific Program will start and run throughFriday, July 12th. The post-graduate course isscheduled for Saturday, July 13th. This year thecourse will be held out at the new University ofColoarado Medical Center site in Aurora. We will besectioning a structure during the meeting and thedataset will be ready for hands-on use by attendeeson Saturday. See: http://www.clinical-anatomy.org/AMEE ConferenceThe theme of AMEE 2013 is “Colouring outside thelines”. The conference will be held in Prague, CzechRepublic , from 24-28 August 2013. 2013 is anhistoric year in the life of AMEE, and representsforty years of AMEE conferences. Teaching,learning and assessment will of course form thebasis of the AMEE 2013 programme as it did at thefirst conference, but the range of additional topicsand sessions is truly amazing. The theme of thisyear’s Conference is Colouring Outside the Lines,where the organization challenges presenters to castaway preconceived ideas and think whether thereare new ways of working to produce futurehealthcare professionals to meet the needs of societyin these times of limited resources. www.amee.org.Webcast Audio Seminar 2013Fall seriesThe topic of the Fall WAS series will be: “Times areChanging: Evolution and Revolution in MedicalEducation 2013 Edition”. The series of 6 lectureswill start September 12, 2013. For more details anddates, see www.iamse.org.Individual Journal SubscriptionsAvailableMedical Science Educator is accessible for IAMSEmembers. If you are not a member, you can obtainan individual subscription. Visit this link to apply:www.medicalscienceeducator.org/subscription.htmlMedical Science Educator © IAMSE 2013 Volume 23(1S) 194

International Association ofMedical Science EducatorsWhat is IAMSE?IAMSE is our membership! And we are medical science educators for the healthcareprofessions. We include teachers and faculty development professionals at medical, osteopathic,chiropractic, veterinary, podiatric, nursing, and dental schools. We are an organization whereyou can share your passion for educating students and gain valuable perspective on the role thebasic sciences play in medical education. We currently represent over 40 countries and areexpanding. We are a nonprofit professional development society organized and directed byrepresentatives from our membership.Is Membership in IAMSE Right for You?Are you searching for a community of colleagues in the health professionswho share your passion for educating students?Do you seek a network of national and international friends to help youunderstand the changing role of science in health professions education?Do you want support and ideas for faculty development and careerpromotion within the academic world of medical education?Do you want an organization that is small enough to allow you to interactwith international leaders and students in a meaningful way?Can you benefit from a friendly annual meeting, designed around plenarysessions and small group interactive faculty development sessions?Then IAMSE is for You!Additional Membership BenefitsGain immediate access to faculty development Web Audio Seminars.Details: www.iamse.org/development/archive.htmMeet your colleagues through our electronic newsletter, IAMSEConnects. Details: www.iamse.org/archives.htmRead articles about current educational trends and experiments in ourpeer-reviewed journal, Medical Science Educator. Details:www.medicalscienceeducator.orgJoin our Annual meeting at a discout rate. Details:www.iamseconference.orgRead about our Medical Educator Fellowship. Details:www.iamse.org/fellowship.htmJoin IAMSE!Read more about our Member Benefits and very reasonable fees. Join as an individual memberor request that your dean supports you as part of a discounted institutional membership. Go towww.iamse.org/join.htm and join today!Website www.iamse.org E-mail support@iamse.org Follow us on

International Association ofMedical Science EducatorsMedical Science EducatorCall for PapersMedical Science Educator: The Journal of the InternationalAssociation of Medical Science Educators is now acceptingmanuscripts for issues to be published in 2012 & 2013.About the JournalMedical Science Educator is the successor of thejournal JIAMSE, a peer reviewed publication of theInternational Association of Medical ScienceEducators which has been published since 1997. Thepurpose of this online journal is to present scholarlyactivities, opinions, and resources in medical scienceeducation. Submissions that address a wide range oftopics are invited, including basic science education aswell as clinical teaching and the use of technology inthe classroom.Types of ManuscriptsAuthors are invited to submit manuscripts that take a variety of forms,including original research manuscripts, short communications, reviews,innovations, monographs, opinion papers, and announcements to thereadership.Instructions for AuthorsOn the website of the journal, full instructions for submission are available foryour reference. Manuscripts can be submitted via e-mail to journal@iamse.orgWe look forward to receiving your manuscripts!www.medicalscienceeducator.orgEditor-in-Chief: Peter G.M. de Jong, PhDWebsite www.iamse.org E-mail support@iamse.org Follow us on

International Association ofMedical Science EducatorsIAMSEWebcast Audio SeminarsJoin our unique Faculty Development program that IAMSE has been offeringfor over 11 years!Did you know? that we have over 250 internationalparticipants per session? that an institutional registration will allowyou to attend the sessions with a group ofpeople in a conference room? each 1-hour telephone conference call issupplemented by webcast PowerPoint slides?sessions are offered on Thursday, noon ET?that if the sessions are offered at aninconvenient time, you can always registerand use our archives for re-broadcast at yourconvenience?2013 WAS Program2013 Winter SeriesResearch Literacy: Strategies to Promote Competence in AssessingEvidence for Students in the Health ProfessionsThursdays, January 10, 17, 24, 31, February 7, 142013 Spring SeriesBest Practices for Technology Applications in Health ProfessionsEducationThursdays, February 28, March 7, 14, 21, 28 and April 142013 Fall SeriesTimes are Changing: Evolution and Revolution in Medical Education2013 EditionThursdays, September 12, 19, 26, October 3, 10, 17So now will you join us for our upcoming series? For additional informationand registration go to http://www.iamse.org/Website www.iamse.org E-mail support@iamse.org Follow us on

MEDICAL SCIENCE EDUCATORThe Journal of the International Association of Medical Science EducatorsInstructions for AuthorsMission of the JournalMedical Science Educator is the peer reviewedpublication of the International Association of MedicalScience Educators (IAMSE). The Journal offers all whoteach in healthcare the most current information tosucceed in their task by publishing scholarly activities,opinions, and resources in medical science education.Published articles focus on teaching the sciencesfundamental to modern medicine and health, and includebasic science education, clinical teaching, and the use ofmodern education technologies.Manuscript criteriaMedical Science Educator considers all manuscripts onthe strict condition that they are the property (copyright)of the submitting author(s), have been submitted only toMedical Science Educator, that they have not beenpublished already, nor are they under consideration forpublication, nor in press elsewhere. Medical ScienceEducator considers all manuscripts at the Editors'discretion; the Editors' decision is final.Medical Science Educator invites the following types ofsubmissions: Short Communication, Original Research,Innovation, Opinion, Commentary, Monograph, MedicalEducation Case Report, Letter to the Editor, Review andMeeting Report. All parts of the manuscript must beavailable in an electronic format; those recommended are:generic rich text format (RTF) or Microsoft Word for text,and JPEG for graphics. Papers not correctly formattedwill be returned to the authors for correction andresubmission. Manuscripts should be submitted throughthe website. The manuscript should be double-spacedwith a wide margin (at least 3 cm) on either side. All pagesshould be numbered. Do not use abbreviations. Allscientific units should be expressed in SI units. Beforesubmission please remove fields from automaticreferencing programs and switch off change tracking.Please supply a word count. 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Authors areresponsible for all statements made in their work.When authors report experiments that involve humansubjects, an indication of institutional Internal ReviewBoard (IRB) approval or exemption should be indicated,either in the text of the manuscript or directly to theEditor-in-Chief. When informed consent has beenobtained it should be included in the paper. If informedconsent has not been obtained then the anonymity of thesubject must be maintained.Editorial and peer review processAll submitted manuscripts are read initially by the Editorin-Chief.One or more Associate Editors may also beinvolved in early decision making. Papers withinsufficient priority for publication are rejected at thisstage – sometimes with advice about resubmission in adifferent category. Other manuscripts are sent to expertsin the field for peer review. The review process is usuallysingle-blinded so that reviewers’ identities are notdisclosed. We aim to give an initial decision within 10weeks.ProofsAll accepted manuscripts are edited according to theJournal’s style. Proofs for approval will be sent to thecorresponding author via e-mail as an Acrobat PDF file.Authors are required to provide corrections promptlywithin 4 days; if you are going to be out of email contactfor an extended period, please supply us with the contactdetails of someone who can attend to the proofs in yourabsence.Copyright RegulationsFor accepted papers copyright will be transferred to thejournal Medical Science Educator and IAMSE. Tomaintain and protect the Author's and Association'sownership and rights and to afford educators with theopportunity to publish in Medical Science Educator,IAMSE requires that the first author assigns a copyrightagreement to IAMSE on behalf of all the authors at thetime of submission of a manuscript. In this copyrighttransfer agreement, IAMSE grants to the author and allco-authors, the rights to republish any part of their articlein secondary publications (print, CD-ROM, and otherelectronic formats) for which they are authors, on thecondition that credit is noted for the original MedicalScience Educator publication. This copyright also extendsto cover all artwork, photographs, and any otherintellectual property published in the journal.Medical Science Educator © IAMSE 2013 Volume 23(1S)