Purpose Psychological safety (PS) is recognized as key in health professions education. However, most studies exploring PS in medical education have focused on mistreatment, thus focusing on what PS is not. The authors set out to explicitly explore learners’ concept of PS in the context of medical education to better understand and define PS and its educational consequences for medical students. Method This descriptive exploratory study was conducted in the context of a pilot peer-assisted learning (PAL) program. The program brought together residents and medical students for 16 semiformal learning sessions. Eight medical students from a PAL program were recruited for semistructured interviews to explore their experiences of PS. Transcripts were thematically analyzed using an inductive approach, and social ecological theory was integrated in the later stages of analysis. Results Students described PS as not feeling judged. Having supportive relationships with peers and mentors improved PS. Students’ sense of PS appeared to free them to focus on learning in the present moment without considering the consequences for their image in the eyes of others. Feeling safe also seemed to facilitate relationship building with the mentors. Conclusions A sense of PS appears to free learners from constantly being self-conscious about projecting an image of competence. This enables learners to be present in the moment and concentrate on engaging with the learning task at hand. The authors propose that the term “educational safety” be used to describe a relational construct that can capture the essence of what constitutes PS for learners.

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Recent studies and consensus statements have expressed the need to involve palliative care services in the care of children with progressive neuromuscular diseases (PMD), yet there have been no reviews of the utilization of palliative care services by children who died on a palliative care program. We conducted a retrospective chart review of all children who had a PMD who died on a single-center palliative care program. Twenty cases were identified. Services utilized by these patients included respite care, transition services, pain and symptom management, and end-of-life care. Prominent symptoms in the last 24 hours of life included respiratory distress, pain, nausea/vomiting, and anxiety; however, symptom management was very good. Utilization of services differed depending on the disease trajectory, with respite playing a critical role in the care of children with PMD. Good symptom management can be achieved.

Quantitative immunological comparisons of three avian proteins, transferrin, ovalbumin, and penalbumin, indicate that penguins are phylogenetically most closely related to loons, albatrosses, herons, and grebes. These data support the theory that the ancestors of penguins were flying oceanic birds and that flightlessness in penguins has evolved independently from flightlessness in ratites.

One experiment was conducted in which radioactively labeled purine bases (adenine, guanine, hypoxanthine and xanthine) were individually given intravenously to young adult rats and the recovery of radioactivity in urine and gut, gut content and liver was measured at the end of the next 24 hours. The total recovery of radioactivity from orally and intravenously administered adenine was measured in experiment 2. A third experiment measured the recoveries of radioactivity from oral and intravenous adenine in a wider variety of tissues and organs than in experiment 1. The chemical identities of the urinary end products of the metabolism or orally and intravenously administered adenine were compared in a fourth experiment. When purines were given intravenously, significantly more of the administered radioactivity was recovered in urine from rats given guanine, hypoxanthine or xanthine compared with those given adenine. The greater recoveries of radioactivity in urine were associated with smaller recoveries in tissues. A larger proportion of intravenously compared to orally administered radioactivity from adenine was incorporated into all body tissues, and this was most pronounced in glandular and lymphoid tissues. The primary urinary end product of both orally and intravenously administered adenine was allantoin. The absorption of individual purines from isolated rat gut sacs was evaluated in a fifth experiment. A significant proportion of unaltered adenine crossed the mucosal to serosal barrier of intestinal sacs whereas unaltered guanine, hypoxanthine or xanthine did not cross into the serosal fluid. These results show that the intestinal metabolism of dietary adenine is uniquely different from that of guanine, hypoxanthine or xanthine.