Questioning Style and Pimping in Clinical Education: A Quantitative Score Derived from a Survey of Internal Medicine Teaching Faculty

Construct: Pimping is a controversial pedagogical technique in medicine, and there is a tension between pimping being considered as “value adding” in some circumstances versus always unacceptable. Consequently, faculty differ in their attitudes toward pimping, and such differences may be measurable and used to inform future research regarding the impact of pimping on learner outcomes. Background: Despite renewed attention in medical education on creating a supportive learning environment, there is a dearth of prior research on pimping. We sought to characterize faculty who are more aggressive in their questioning style (i.e., those with a “pimper” phenotype) from those who are less threatening. Approach: This study was conducted between December 2015 and September 2016 at Johns Hopkins University. We created a 13-item questionnaire assessing faculty perceptions on pimping as a pedagogical technique. We surveyed all medicine faculty (n?=?150) who had attended on inpatient teaching services at two university-affiliated hospitals over the prior 2?years. Then, using responses to the faculty survey, we developed a numeric “pimping score” designed to characterize faculty into “pimper” (those with scores in the upper quartile of the range) and “nonpimper” phenotypes. Results: The response rate was 84%. Although almost half of the faculty reported that being pimped helped them in their own learning (45%), fewer reported that pimping was effective in their own teaching practice (20%). The pimping score was normally distributed across a range of 13–42, with a mean of 24 and a 75th percentile cutoff of 28 or greater. Younger faculty, male participants, specialists, and those reporting lower quality of life had higher pimping score values, all p?<?.05. Faculty who openly endorsed favorable views about the educational value of pimping had sevenfold higher odds of being characterized as “pimpers” using our numeric pimping score (p?≤?.001). Conclusions: The establishment of a quantitative pimping score may have relevance for training programs concerned about the learning environment in clinical settings and may inform future research on the impact of pimping on learning outcomes.     

Diffusion-derived parameters in lesions,peri-lesion and normal-appearing white matter in multiple sclerosis using tensor,kurtosis and fixel-based analysis

Neuronal damage is the primary cause of long-term disability of multiple sclerosis (MS) patients. Assessment of axonal integrity from diffusion MRI parameters might enable better disease characterisation. 16 diffusion derived measurements from diffusion tensor imaging (DTI), diffusion kurtosis imaging (DKI), and fixel-based analysis (FBA) in lesions, peri-lesion and normal appearing white matter were investigated. Diffusion MRI scans of 11 MS patients were processed to generate DTI, DKI, and FBA images. Fractional anisotropy (FA) and fibre density (FD) were used to assess axonal integrity across brain regions. Subsequently, 359 lesions were identified, and lesion and peri-lesion segmentation was performed using structural T₁w, T₂w, T₂w-FLAIR, and T₁w post-contrast MRI. The segmentations were then used to extract 16 diffusion MRI parameters from lesion, peri-lesion, and contralateral normal appearing white matter (NAWM). The measurements for axonal integrity, DTI-FA, DKI-FA, FBA-FD, produced similar results. All diffusion MRI parameters were affected in lesions as compared to NAWM (p < 0.001), confirming loss of axonal integrity in lesions. In peri-lesions, most parameters, except FBA-FD, were also significantly different from NAWM, although the effect size was smaller than in lesions. The reduction in axonal integrity in peri-lesions, despite unaffected fibre density estimates, suggests an effect of Wallerian degeneration.     

国产司帕沙星颗粒剂的药效学试验

目的 :对国产司帕沙星颗粒剂的体内外抗菌作用进行试验考察。方法 :采用琼脂二倍稀释法测定司帕沙星颗粒对临床分离 2 90株革兰阳性、阴性细菌的体外抗菌活性及体内保护作用 ,并与司帕沙星原料及环丙沙星进行比较。结果 :司帕沙星颗粒剂体内外均具有其原料药相同的抗菌作用。对所试甲氧西林敏感金葡菌(MSSA)和甲氧西林耐药金葡菌 (MRSA)菌株及表皮葡萄球菌、嗜血流感杆菌均具有较强抗菌活力 ,MIC50 依次为 0 .1 2 5、0 .1 2 5、0 .0 6,0 .0 6mg·L 1;本品对革兰氏阴性杆菌的MIC50 <0 .5 (0 .0 3～ 0 .5 )mg·L 1。司帕沙星颗粒剂口服对金葡菌 981 92 ,铜绿假单胞菌 982 1 2感染小鼠的ED50 分别是 0 .3 0mg·kg和 7.1mg·kg 1与原料药的 0 .2 9mg·kg 1与 7.2mg·kg基本相同。 结论 :国产司帕沙星颗粒和司帕沙星原料有相同的体内外抗菌作用