Utility of selection methods for specialist medical training: A BEME (best evidence medical education) systematic review: BEME guide no. 45

Background: Selection into specialty training is a high-stakes and resource-intensive process. While substantial literature exists on selection into medical schools, and there are individual studies in postgraduate settings, there seems to be paucity of evidence concerning selection systems and the utility of selection tools in postgraduate training environments.

Aim: To explore, analyze and synthesize the evidence related to selection into postgraduate medical specialty training.

Method: Core bibliographic databases including PubMed; Ovid Medline; Embase, CINAHL; ERIC and PsycINFO were searched, and a total of 2640 abstracts were retrieved. After removing duplicates and screening against the inclusion criteria, 202 full papers were coded, of which 116 were included.

Results: Gaps in underlying selection frameworks were illuminated. Frameworks defined by locally derived selection criteria, and heavily weighed on academic parameters seem to be giving way to the evidencing of competency-based selection approaches in some settings.

Regarding selection tools, we found favorable psychometric evidence for multiple mini-interviews, situational judgment tests and clinical problem-solving tests, although the bulk of evidence was mostly limited to the United Kingdom. The evidence around the robustness of curriculum vitae, letters of recommendation and personal statements was equivocal. The findings on the predictors of past performance were limited to academic criteria with paucity of long-term evaluations. The evidence around nonacademic criteria was inadequate to make an informed judgment.

Conclusions: While much has been gained in understanding the utility of individual selection methods, though the evidence around many of them is equivocal, the underlying theoretical and conceptual frameworks for designing holistic and equitable selection systems are yet to be developed.     

Characterization of Self-Growing Biomaterials Made of Fungal Mycelium and Various Lignocellulose-Containing Ingredients

In this study, novel blends of mycelium biocomposites (MB) were developed. Various combinations of birch sawdust and hemp shives with birch bark (BB) and wheat bran (WB) additives were inoculated with basidiomycete Trametes versicolor to produce self-growing biomaterials. MB were characterized according to mycelial biomass increment in final samples, changes in chemical composition, elemental (C, H, N) analyses, granulometry of substrates, water-related and mechanical properties, as well as mold resistance and biodegradability. The mycelial biomass in manufactured MB increased by ~100% and ~50% in hemp and sawdust substrates, respectively. The lignocellulose ingredients during fungal growth were degraded as follows: cellulose up to 7% and 28% in sawdust and hemp substrates, respectively, and lignin in the range of 13% in both substrates. A larger granulometric fraction in hemp MB ensured higher strength property but weakened water absorption (600–880%) performance. Perspective MB combinations regarding strength performance were hemp/BB and pure hemp MB (σ10 0.19–0.20 MPa; E 2.9 MPa), as well as sawdust/WB combination (σ10 0.23 MPa; E 2.9 MPa). WB positively affected fungal biomass yield, but elevated water absorption ability. WB improved compressive strength in the sawdust samples but decreased it in the hemp samples. BB supplement reduced water absorption by more than 100% and increased the density of sawdust and hemp samples. All MB samples were susceptible to mold contamination after full water immersion, with identified fungal genera Rhizopus, Trichoderma and Achremonium. The MB exhibited high biodegradability after 12 weeks’ exposure in compost, and are therefore competitive with non-biodegradable synthetic foam materials.     

C‐reactive protein levels and common polymorphisms of the interleukin‐1 gene cluster and interleukin‐6 gene in patients with coronary heart disease

C‐reactive protein (CRP) is an inflammatory marker associated with increased cardiovascular risk. Production of CRP is regulated by interleukin (IL)‐1β, IL‐1 receptor antagonist and IL‐6. In 160 patients with coronary heart disease (CHD) confirmed by angiography, we examined the relationship between CRP level and five polymorphisms in genes coding for these cytokines: IL‐1B(?511), IL‐1B(+3954), a variable number tandem repeat (VNTR) polymorphism in intron 2 of IL‐1RN [IL‐1RN(VNTR)], IL‐6(?174) and IL‐6(?572). CRP values were logarithmically normalized (log‐CRP) for statistical calculations. In univariate analysis, carrier status for the IL‐1B(+3954)T allele and IL‐1RN(VNTR) allele 2 [IL‐1RN(VNTR)*2] correlated with higher (P < 0.01) and lower (P < 0.05) log‐CRP values, respectively. Among the potential confounding factors analysed, smoking, body mass index, total cholesterol (P < 0.05 for all) and diabetes (P = 0.056) were positively correlated with CRP level. After adjustment for non‐genetic covariates, CRP levels remained significantly (P < 0.01) higher in carriers of IL‐1B(+3954)T than in non‐carriers: mean log‐CRP (with 95% confidence interval) was 0.443 (0.311–0.574) for CT or TT genotypes compared with 0.240 (0.107–0.373) for the CC genotype, which corresponded to back‐transformed CRP levels of 2.77 and 1.74 mg l^?1, respectively. Adjusted association was also significant for IL‐1RN(VNTR)*2 (P < 0.01), with lower CRP levels in the presence of allele 2: the mean log‐CRP value was 0.252 (0.115–0.388) for carriers and 0.421 (0.290–0.552) for non‐carriers (CRP 1.79 and 2.64 mg l^?1, respectively). When alleles of both polymorphisms were entered into the model simultaneously, the association remained significant for IL‐1B(+3954)T (P < 0.05), but not for IL‐1RN(VNTR)*2. We conclude that IL‐1B(+3954)T is associated with higher CRP levels in patients with CHD, and we found that this association was significant after adjustment for major risk factors. Our data also suggest a possible relationship of IL‐1RN(VNTR)*2 with lower CRP levels in the same patients.     

Becoming an expert: a review of adult learning theory and implications for vocational training in ophthalmology

One of the key responsibilities of professional bodies, such as the Royal Australian and New Zealand College of Ophthalmologists, is to determine, teach and assess the competencies required for trainees to reach an expert level. Vocational training programs (VTP) need to incorporate advances in educational research and reflect changes in generational thinking and learning styles to provide the most optimal learning environment to meet the desired educational outcomes. This paper seeks to introduce some of the important concepts of adult educational theory and to explain how they connect to four strategic areas in the development and implementation of the VTP: 1 What are the learning needs of trainees? 2 What educational methods best address these needs? 3 What assessment methods best test the acquisition of the desired learning outcomes? 4 What are the needs of supervisors and teachers?     

Postmarketing nutrivigilance safety profile: a line of dietary food supplements containing red yeast rice for dyslipidemia

IntroductionIn the absence of a European standardized postmarketing food supplement surveillance system (nutrivigilance), some member states and companies have developed their own approaches to monitoring potential adverse reactions to secure a high level of product safety. This paper describes the use of a nutrivigilance system in monitoring the incidence of spontaneously reported suspected adverse reactions associated with food supplements containing red yeast rice (RYR).Material and methodsWe report the data from a widely used product marketed under the trademark Armolipid/Armolipid Plus. Postmarketing information was collected in a voluntary nutrivigilance system established by the manufacturing company (Meda Pharma SpA, a Viatris Company, Monza, Italy). From 1^st October 2004 to 31^st December 2019, this system captured cases of suspected adverse reactions spontaneously reported by consumers, healthcare professionals, health authorities, regardless of causality.ResultsThe total number of case reports received mentioning the RYR food supplement product line was 542, in which 855 adverse events (AEs) were reported. The total reporting rate of AEs was estimated to be 0.037% of 2,287,449 exposed consumers. Of the 542 cases, 21 (0.0009% of exposed consumers) included suspected serious adverse events (SAEs). After careful investigation, 6 cases (0.0003% of consumers exposed) and 6 AEs were assessed by the manufacturer as serious and potentially related to exposure to the above-mentioned RYR-based nutraceutical.ConclusionsThis nutrivigilance-derived data analysis clearly demonstrates a low prevalence of suspected adverse events associated with the red yeast rice product line. Consumer safety of food supplements could be generally improved by raising awareness of the importance of following the indications and warnings detailed in a food supplement’s labeling.     

Interleukin-6 gene promoter -174G/C polymorphism and insulin resistance: a pilot study.

BACKGROUND: The aim of this pilot study was to evaluate the relationship between interleukin-6 promoter -174G/C (IL-6 -174G/C) polymorphism and insulin resistance (IR) in obese patients with coronary heart disease (CHD). METHODS: Twenty obese male patients with CHD were selected from a larger database of patients (n=606). IL-6 -174G/C genotype was previously analysed and only homozygotes with the CC genotype (n=10) or GG genotype (n=10) were selected. IR was measured using the homeostasis model assessment for IR (HOMA-IR) method. RESULTS: Differences in age, body mass index, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol (HDL-C), triglyceride (TG), hypertension, IL-6, C-reactive protein and HOMA-IR were not significant between the genotypes (p>0.05), but analysis of a homogeneity-of-slopes model showed that genotype had a significant influence on HOMA-IR (p=0.037), and the interaction between genotype and HDL-C had a pronounced tendency to affect HOMA-IR (p=0.058). Using multiple regression analysis, we found that HDL-C had a significant effect on HOMA-IR (p=0.023), and TG had a tendency to affect HOMA-IR (p=0.066) only in the CC genotype. CONCLUSIONS: Our data show that IL-6 -174G/C polymorphism may have a significant effect on IR. A comparison between the effects of various cardiovascular risk factors showed that HDL-C may have a significant effect on HOMA-IR in the CC genotype but not in the GG genotype. Further research is needed to test the preliminary results.     

C-reactive protein levels and common polymorphisms of the interleukin-1 gene cluster and interleukin-6 gene in patients with coronary heart disease.

C-reactive protein (CRP) is an inflammatory marker associated with increased cardiovascular risk. Production of CRP is regulated by interleukin (IL)-1beta, IL-1 receptor antagonist and IL-6. In 160 patients with coronary heart disease (CHD) confirmed by angiography, we examined the relationship between CRP level and five polymorphisms in genes coding for these cytokines: IL-1B(-511), IL-1B(+3954), a variable number tandem repeat (VNTR) polymorphism in intron 2 of IL-1RN [IL-1RN(VNTR)], IL-6(-174) and IL-6(-572). CRP values were logarithmically normalized (log-CRP) for statistical calculations. In univariate analysis, carrier status for the IL-1B(+3954)T allele and IL-1RN(VNTR) allele 2 [IL-1RN(VNTR)*2] correlated with higher (P < 0.01) and lower (P < 0.05) log-CRP values, respectively. Among the potential confounding factors analysed, smoking, body mass index, total cholesterol (P < 0.05 for all) and diabetes (P = 0.056) were positively correlated with CRP level. After adjustment for non-genetic covariates, CRP levels remained significantly (P < 0.01) higher in carriers of IL-1B(+3954)T than in non-carriers: mean log-CRP (with 95% confidence interval) was 0.443 (0.311-0.574) for CT or TT genotypes compared with 0.240 (0.107-0.373) for the CC genotype, which corresponded to back-transformed CRP levels of 2.77 and 1.74 mg l(-1), respectively. Adjusted association was also significant for IL-1RN(VNTR)*2 (P < 0.01), with lower CRP levels in the presence of allele 2: the mean log-CRP value was 0.252 (0.115-0.388) for carriers and 0.421 (0.290-0.552) for non-carriers (CRP 1.79 and 2.64 mg l(-1), respectively). When alleles of both polymorphisms were entered into the model simultaneously, the association remained significant for IL-1B(+3954)T (P < 0.05), but not for IL-1RN(VNTR)*2. We conclude that IL-1B(+3954)T is associated with higher CRP levels in patients with CHD, and we found that this association was significant after adjustment for major risk factors. Our data also suggest a possible relationship of IL-1RN(VNTR)*2 with lower CRP levels in the same patients.