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Learners who struggle in medical education: Common presentations [Meeting Abstract]

Celdir, M G; Steeves-Fuentes, A; Schoenthaler, A; Yellin, P B; Lipkin, M
Needs and Objectives: It is common for students to struggle in the challenging academic and social environments of medical education. We posit that some who struggle are not simply the edge of a Gaussian distribution of success but present definable syndromes which are recognizable, testable, and remediable. In this first heuristic look at our hypothesis, we aimed to identify prominent learning profiles and early signs of struggle among medical students with poor academic performance and measurable factors that correlate with their struggles. Setting and Participants: Ninety medical students with academic struggles were referred to a learning assessment center between 2006 and 2018. Reports of the assessment process were constructed to provide remediation strategies for students and educators. Description: We evaluated reports of the comprehensive neurodevelopmental evaluations. Reports documented referral concerns, students' self-assessments of their competencies, academic history, neuropsycho-logical evaluations and interviews in the assessment process to establish learning profiles of strengths and challenges of each student and recommended remediation strategies. We applied grounded theory Methods to identify common patterns in students' comprehensive evaluations. Evaluation: Students who displayed signs of struggle earlier in medical school commonly presented after poor performance on standardized assessments (63%, 50/80). They had historically excelled in academic areas rewarding intuitive ways of learning and chosen academic degrees that played to their strengths. In medical school, rote memorization and passive study Methods such as transcribing lectures, without active information processing led to inefficient learning, requiring more time for their studies. They lacked strategies to plan their studies and exams, regulate their attention, filter and systematically store information of salient details. Students experienced high rates of anxiety and depression (41%, 37/90) and some received psycho/pharmacotherapy (27%, 24/90). Social isolation and feelings of inadequacy further exacerbated their struggles. Discussion/Reflection/Lessons Learned: Lack of learning and test-taking strategies appropriate for the unique and standardized medical school curriculum, combined with psychosocial stress in a competitive learning environment, expose challenges which may have been unnoticed by students in prior academic pursuits. Their patterns of presentation might alert instructors and students to seek evaluation and assistance early, receive guidance and remediation of specific learning challenges and avoid distressing, diminished academic performance
EMBASE:629003478
ISSN: 1525-1497
CID: 4052832

Learning differences and medical education

Chapter by: Yellin, Paul B
in: Remediation in medical education : a mid-course correction by Kalet, Adina; Chou, Calvin L [Eds]
New York : Springer, [2014]
pp. 157-171
ISBN: 1461490251
CID: 1019742

Linking mind, brain, and education to clinical practice: A proposal for transdisciplinary collaboration

Ronstadt, Katie; Yellin, Paul B
It has been suggested that the field of Mind, Brain, and Education (MBE) requires a stable infrastructure for translating research into practice. Hinton and Fischer (2008) point to the academic medical center as a model for similar translational work and suggest a similar approach for linking scientists to research schools. We propose expanding their model to include a formal role for clinicians. Including clinicians who work with children with learning problems brings an important perspective to the translational work. For example, the integration of the concept of 'differential diagnosis,' a core precept in clinical medicine, would bring needed diagnostic specificity to the field of MBE. We describe a virtual infrastructure for collaboration, or 'collaboratory,' consisting of research scientists, educators, and clinicians, linked to an academic institution. We anticipate that MBE graduates can play a critical role in the collaboratory model. With additional training, they can become 'neuroeducators' capable of moving comfortably among the disciplines, building linkages, fostering communication, and facilitating collaboration.
PSYCH:2010-16524-001
ISSN: 1751-2271
CID: 114372

Neonatologists' decisions about withholding and withdrawing treatments from critically ill newborns [Meeting Abstract]

Yellin, PB; Levin, BW; Krantz, DH; Shinn, M; Driscoll, JM; Fleischman, AR
ISI:000075810500198
ISSN: 0031-4005
CID: 53764

HIV in the NICU: Results of the 1996 survey of the Section on Perinatal Pediatrics, American Academy of Pediatrics [Meeting Abstract]

Levin, BW; Yellin, PB; Krantz, DH; Shinn, M; Driscoll, JM; Fleischman, AR
ISI:000075810500243
ISSN: 0031-4005
CID: 53765

Guidelines for the treatment of acidaemia with THAM [published erratum appears in Drugs 1998 Apr;55(4):517]

Nahas GG; Sutin KM; Fermon C; Streat S; Wiklund L; Wahlander S; Yellin P; Brasch H; Kanchuger M; Capan L; Manne J; Helwig H; Gaab M; Pfenninger E; Wetterberg T; Holmdahl M; Turndorf H
THAM (trometamol; tris-hydroxymethyl aminomethane) is a biologically inert amino alcohol of low toxicity, which buffers carbon dioxide and acids in vitro and in vivo. At 37 degrees C, the pK (the pH at which the weak conjugate acid or base in the solution is 50% ionised) of THAM is 7.8, making it a more effective buffer than bicarbonate in the physiological range of blood pH. THAM is a proton acceptor with a stoichiometric equivalence of titrating 1 proton per molecule. In vivo, THAM supplements the buffering capacity of the blood bicarbonate system, accepting a proton, generating bicarbonate and decreasing the partial pressure of carbon dioxide in arterial blood (paCO2). It rapidly distributes through the extracellular space and slowly penetrates the intracellular space, except for erythrocytes and hepatocytes, and it is excreted by the kidney in its protonated form at a rate that slightly exceeds creatinine clearance. Unlike bicarbonate, which requires an open system for carbon dioxide elimination in order to exert its buffering effect, THAM is effective in a closed or semiclosed system, and maintains its buffering power in the presence of hypothermia. THAM rapidly restores pH and acid-base regulation in acidaemia caused by carbon dioxide retention or metabolic acid accumulation, which have the potential to impair organ function. Tissue irritation and venous thrombosis at the site of administration occurs with THAM base (pH 10.4) administered through a peripheral or umbilical vein: THAM acetate 0.3 mol/L (pH 8.6) is well tolerated, does not cause tissue or venous irritation and is the only formulation available in the US. In large doses, THAM may induce respiratory depression and hypoglycaemia, which will require ventilatory assistance and glucose administration. The initial loading dose of THAM acetate 0.3 mol/L in the treatment of acidaemia may be estimated as follows: THAM (ml of 0.3 mol/L solution) = lean body-weight (kg) x base deficit (mmol/L). The maximum daily dose is 15 mmol/kg for an adult (3.5L of a 0.3 mol/L solution in a 70kg patient). When disturbances result in severe hypercapnic or metabolic acidaemia, which overwhelms the capacity of normal pH homeostatic mechanisms (pH < or = 7.20), the use of THAM within a 'therapeutic window' is an effective therapy. It may restore the pH of the internal milieu, thus permitting the homeostatic mechanisms of acid-base regulation to assume their normal function. In the treatment of respiratory failure, THAM has been used in conjunction with hypothermia and controlled hypercapnia. Other indications are diabetic or renal acidosis, salicylate or barbiturate intoxication, and increased intracranial pressure associated with cerebral trauma. THAM is also used in cardioplegic solutions, during liver transplantation and for chemolysis of renal calculi. THAM administration must follow established guidelines, along with concurrent monitoring of acid-base status (blood gas analysis), ventilation, and plasma electrolytes and glucose
PMID: 9506241
ISSN: 0012-6667
CID: 7701

Effect of magnesium sulfate on the development of cystic periventricular leukomalacia in preterm infants

FineSmith, R B; Roche, K; Yellin, P B; Walsh, K K; Shen, C; Zeglis, M; Kahn, A; Fish, I
To determine if magnesium sulfate has an effect on the development of cystic periventricular leukomalacia in preterm infants, this retrospective case control study was conducted. There were 23,382 infants born at three teaching hospitals in the metropolitan New York area from January 1992 to December 1994. Four hundred ninety-two infants met our entrance criteria. Criteria included a birth weight < 1750 g, survival to at least 7 days of life and at least one cranial ultrasound after 7 days of life. Infants exposed to magnesium sulfate in utero were less likely to develop periventricular leukomalacia. Two of 18 (11%) infants with periventricular leukomalacia were exposed to magnesium sulfate in-utero compared to 14 of 36 controls (39%) (p = 0.035) (OR = 0.196, 95% CI = 0.039-0.988). Pre-eclampsia as an independent factor was not associated with a reduced risk (p = 0.251) (OR = 0.294, 95% CI = 0.033-2.65). Preterm infants exposed to antenatal magnesium sulfate were found to have a reduced risk of developing cystic periventricular leukomalacia.
PMID: 9259949
ISSN: 0735-1631
CID: 690722

Analysis of variables associated with preterm birth and their predictive value in periventricular leukomalacia [Meeting Abstract]

FineSmith, R; Roche, K; Shah, N; Sirikonda, P; Walsh, K; Shen, C; Yellin, P; Fish, I
ISI:A1996VC68900170
ISSN: 0364-5134
CID: 1570372

THE EFFECT OF MAGNESIUM ON ISCHEMIC BRAIN-LESIONS IN THE PRETERM INFANT [Meeting Abstract]

FINESMITH, RB; YELLIN, P; AMBROSINO, M; KHAN, A
ISI:A1995RU33300044
ISSN: 0364-5134
CID: 1570362

DNR in the DR? [see comments] [Comment]

Yellin PB; Fleischman AR
PMID: 7666274
ISSN: 0743-8346
CID: 12779