Contributing to the hidden curriculum: exploring the role of residents and newly graduated physicians.

The hidden curriculum has been investigated as a powerful force on medical student learning and ongoing physician professional development. Previous studies have largely focused on medical students' experiences as 'receivers' of the hidden curriculum. This study examined how residents and newly graduated physicians conceived of their roles as active participants in the hidden curriculum.

Patient-present teaching in the clinic: Effect on agency and professional behaviour.

Background/purpose: Although much has been written about the medical learning environment, the patient, who is the focus of care, is rarely the focus in this literature. The purpose of this study was to explore the role of the patient as an active participant with agency in the medical learning environment from the standpoint of the learner, the attending physician, and most importantly, the patient. We hoped to gain insights into the mechanisms that can reinforce professional values such as patient-centred and respectful behaviours in a patient-present learning environment.

Transforming Disruption Into Innovation: A Partnership Between the COVID-19 Medical Student Response Team and the University of British Columbia.

The COVID-19 pandemic caused substantial disruptions in medical education. The University of British Columbia (UBC) MD Undergraduate Program (MDUP) is the sixth-largest medical school in North America. MDUP students and faculty developed a joint response to these disruptions to address the curriculum and public health challenges that the pandemic posed.

Navigating Uncertainty in Respiratory Assessment: The Interaction of Culture and Technology During Phase I Postanesthetic Recovery.

Purpose: To explore postanesthesia care unit (PACU) nurses' interactions with technology during the critical Phase I recovery period.

Design: Interpretive description was used to understand nurses' experiences.

Methods: Nine PACU nurses were recruited from three mid-sized hospitals within the same health authority in a Western Canadian province.

Understanding Professional Identity Formation in Early Clerkship: A Novel Framework.

Purpose: Medical educators should foster students' professional attitudes because individuals are more likely to act in accordance with medicine's professional values if these values have been internalized. Still, there is much to be learned about how students examine and negotiate their emerging identities. This study examined third-year medical students' experiences of professional identity formation (PIF) during clinical clerkship.

Reflecting on what? The difficulty of noticing formative experiences in the moment.

Introduction: In the spirit of enacting an educational model of guided, collective reflection to support positive professional identity construction in healthcare learners, we implemented a reflection-based course for medical students transitioning to clerkship with three goals: to sensitize learners to the hidden curriculum; to provide a safe and confidential forum to discuss their experiences; and to co-construct strategies to deal with the pressures in the clinical environment METHODS: We used a design-based research protocol. Twelve students participated in ten sessions starting during their transition to clerkship. Faculty debriefed after each session, adjusting the format of the subsequent sessions.

(Almost) forgetting to care: an unanticipated source of empathy loss in clerkship.

Context: The erosion of empathy in medical students is well documented. Both the hidden curriculum associated with poor role modelling and a sense of burnout have been proposed as key factors, but the precise mechanisms by which this loss of empathy occurs have not been elaborated.

Objectives: In the context of a course designed to help students manage the hidden curriculum, we collected data that raised questions about current conceptualisations of the aspects of medical training that lead to loss of empathy.

Harnessing the hidden curriculum: a four-step approach to developing and reinforcing reflective competencies in medical clinical clerkship.

Changing the culture of medicine through the education of medical students has been proposed as a solution to the intractable problems of our profession. Yet few have explored the issues associated with making students partners in this change. There is a powerful hidden curriculum that perpetuates not only desired attitudes and behaviors but also those that are less than desirable.

Cardiac ischemia in patients with septic shock randomized to vasopressin or norepinephrine.

Introduction: Cardiac troponins are sensitive and specific biomarkers of myocardial necrosis. We evaluated troponin, CK, and ECG abnormalities in patients with septic shock and compared the effect of vasopressin (VP) versus norepinephrine (NE) on troponin, CK, and ECGs.

Methods: This was a prospective substudy of a randomized trial.

Agreement in electrocardiogram interpretation in patients with septic shock.

Objective: The reliability of electrocardiogram interpretation to diagnose myocardial ischemia in critically ill patients is unclear. In adults with septic shock, we assessed intra- and inter-rater agreement of electrocardiogram interpretation, and the effect of knowledge of troponin values on these interpretations.

Design: Prospective substudy of a randomized trial of vasopressin vs.

Developing a framework to support shared decision making for youth mental health medication treatment.

Medical shared decision making has demonstrated success in increasing collaboration between clients and practitioners for various health decisions. As the importance of a shared decision making approach becomes increasingly valued in the adult mental health arena, transfer of these ideals to youth and families of youth in the mental health system is a logical next step. A review of the literature and preliminary, formative feedback from families and staff at a Midwestern urban community mental health center guided the development of a framework for youth shared decision making.

The effects of vasopressin on acute kidney injury in septic shock.

Objective: To compare the effects of vasopressin versus norepinephrine infusion on the outcome of kidney injury in septic shock.

Design And Setting: Post-hoc analysis of the multi-center double-blind randomized controlled trial of vasopressin versus norepinephrine in adult patients who had septic shock (VASST).

Patients And Intervention: Seven hundred seventy-eight patients were randomized to receive a blinded infusion of either low-dose vasopressin (0.

Vasoactive drugs for vasodilatory shock in ICU.

Purpose Of Review: Vasoactive drugs are the mainstay of hemodynamic management of vasodilatory shock when fluids fail to restore adequate tissue perfusion. In this review, studies published during the past year that increase our understanding of the use of vasoactive drugs in the ICU are discussed.

Recent Findings: The Vasopressin and Septic Shock Trial did not find a difference between low-dose vasopressin and norepinephrine vs.

Interaction of vasopressin infusion, corticosteroid treatment, and mortality of septic shock.

Objective: Vasopressin and corticosteroids are often added to support cardiovascular dysfunction in patients who have septic shock that is nonresponsive to fluid resuscitation and norepinephrine infusion. However, it is unknown whether vasopressin treatment interacts with corticosteroid treatment.

Design: Post hoc substudy of a multicenter randomized blinded controlled trial of vasopressin vs.

Vasopressin decreases sepsis-induced pulmonary inflammation through the V2R.

Unlabelled: The early use of vasopressors in sepsis has been associated with a decrease in immune activation independent of hemodynamic effects, although the mechanism behind this remains unclear. We hypothesize that low dose vasopressin will reduce the pulmonary inflammation associated with sepsis. Our aims were to (1) determine whether vasopressin reduces lipopolysaccharide (LPS)-induced pulmonary inflammation and (2) determine which vasopressin receptor is responsible for pulmonary immune modulation.

Arginine vasopressin in the treatment of vasodilatory septic shock.

Vasodilatory septic shock is characterized by profound vasodilation of the peripheral circulation, relative refractoriness to catecholamines and a relative deficiency of the posterior pituitary hormone, vasopressin. Arginine vasopressin is effective in restoring vascular tone in vasodilatory septic shock and may be associated with decreased mortality in less severe septic shock as well as improved mortality and decreased renal failure in septic shock patients at risk for renal failure.

Vasopressin versus norepinephrine infusion in patients with septic shock.

Background: Vasopressin is commonly used as an adjunct to catecholamines to support blood pressure in refractory septic shock, but its effect on mortality is unknown. We hypothesized that low-dose vasopressin as compared with norepinephrine would decrease mortality among patients with septic shock who were being treated with conventional (catecholamine) vasopressors.

Methods: In this multicenter, randomized, double-blind trial, we assigned patients who had septic shock and were receiving a minimum of 5 microg of norepinephrine per minute to receive either low-dose vasopressin (0.

Vasoactive drugs in the intensive care unit.

Purpose Of The Review: Vasoactive drugs are the mainstay of hemodynamic management of vasodilatory shock when fluids fail to restore tissue perfusion. In this review, studies published during the past year that increase our understanding of the use of vasoactive drugs in the intensive care unit are discussed.

Recent Findings: In septic shock, there is no benefit in increasing mean arterial pressure from 65 to 85 mmHg.

Vasopressin.

Vasopressin is a hormone that is essential for both osmotic and cardiovascular homeostasis. A deficiency of vasopressin exists in some shock states and replacement of physiological levels of vasopressin can restore vascular tone. Vasopressin is therefore emerging as a rational therapy for vasodilatory shock.

Vasopressin in the ICU.

Purpose Of The Review: Vasopressin is one of the most important endogenously released stress hormones during shock. In this review, studies published in the past year that add to our understanding of the use of vasopressin in the ICU are discussed.

Recent Findings: Endogenous vasopressin levels are inappropriately low in adults with severe sepsis but not in children with meningococcal septic shock.

Science Review: Vasopressin and the cardiovascular system part 2 - clinical physiology.

Vasopressin is emerging as a rational therapy for vasodilatory shock states. In part 1 of the review we discussed the structure and function of the various vasopressin receptors. In part 2 we discuss vascular smooth muscle contraction pathways with an emphasis on the effects of vasopressin on ATP-sensitive K+ channels, nitric oxide pathways, and interaction with adrenergic agents.