Phenomenon: Medical school curricula challenge even the most adept learner, potentially leading to feelings of burnout. When faced with uncertainties in a new curriculum, confidence in achieving academic goals may be threatened. We previously found associations between academic performance and pride, hope, anxiety, and shame in medical students. Are these emotions still associated in the context of an evolving curriculum? Approach: All 1st-and 2nd-year medical students were invited to participate in a survey study (n ¼ 264). Year 1 students were in the first semester of the new curriculum. The Hope, Pride, Shame, and Anxiety subscales of the Achievement Emotions Questionnaire and the Maslach Burnout Inventory (MBI) General Survey for Students were administered in fall 2017. Academic performance (semester overall percentage) was matched to participants completing all 4 questionnaires. Descriptive and inferential statistics were used to analyze the results. Findings: Response rates for those who completed every survey administered was 18.5%. Combined data from the classes revealed relationships between academic performance with MBI subscale-professional efficacy (r ¼ .577), hope (r ¼ .497), pride (r ¼ .411), anxiety (r ¼ À.307), and shame (r ¼ À.402). Upon analyzing data from each class, professional efficacy (M1: r ¼ .535; M2: r ¼ .674) and pride (M1: r ¼ .591; M2: r ¼ .450) were correlated to academic performance. In a stepwise regression model, professional efficacy was the only predictor of academic performance (B ¼ .560, t ¼ 3.82, R 2 ¼ .31). Insights: When faced with challenges from medical school, positive emotions strengthen self-efficacy, allowing students to identify strategies to accomplish academic goals. Although it is important to acknowledge the emotions that students experience, our finding that professional efficacy was the most significant predictor of academic performance suggests the need for strategies to enhance self-efficacy. Use of flipped classrooms or problem-based learning offers opportunities for cognitive appraisal to foster their self-efficacy.

Glioblastoma (GBM) is the most common adult glioma. Differentiating post-treatment effects such as pseudoprogression from true progression is paramount for treatment. Radiomics has been shown to predict overall survival and MGMT (methylguanine-DNA methyltransferase) promoter status in those with GBM. A potential application of radiomics is predicting pseudoprogression on pre-radiotherapy (RT) scans for patients with GBM. A retrospective review was performed with radiomic data analyzed using pre-RT MRI scans. Pseudoprogression was defined as post-treatment findings on imaging that resolved with steroids or spontaneously on subsequent imaging. Of the 72 patients identified for the study, 35 were able to be assessed for pseudoprogression, and 8 (22.9%) had pseudoprogression. A total of 841 radiomic features were examined along with clinical features. Receiver operating characteristic (ROC) analyses were performed to determine the AUC (area under ROC curve) of models of clinical features, radiomic features, and combining clinical and radiomic features. Two radiomic features were identified to be the optimal model combination. The ROC analysis found that the predictive ability of this combination was higher than using clinical features alone (mean AUC: 0.82 vs. 0.62). Additionally, combining the radiomic features with clinical factors did not improve predictive ability. Our results indicate that radiomics is potentially capable of predicting future development of pseudoprogression in patients with GBM using pre-RT MRIs.

IntroductionTo practice effective evidence-based teaching, the need for well-designed studies that describe outcomes related to educational interventions is critical. The quality of the literate in basic science disciplines is unknown. The study objective was to conduct a systematic review of the literature to assess study design in articles describing innovations in preclinical medical education.MethodThe authors searched PubMed for all articles published in English between 2000 and 2017 describing interventions in preclinical medical education related to anatomy, physiology, and biochemistry. Articles were scored using a modification of the Medical Education Research Study Quality Instrument.ResultsOf the 817 articles identified, 177 met final inclusion criteria (75 anatomy, 86 physiology, and 16 biochemistry). Laboratory, student-driven, and online activities were the most frequently reported. The average score for all papers was 15.7 (27 points possible). More than 80% reported experiences with one cohort of students and >97% involved only one institution. Only 25–49% of reports utilized a comparison (control) group. Proper statistical models for analysis of results were used in only 44–62% of papers.ConclusionManuscripts had a strong tendency toward single institutional studies that involved one cohort of students. The use of a control/comparison group when assessing effectiveness was seen in <50% and nearly all reported outcomes solely in the form of student satisfaction or factual recall/skill performance.

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progressed following initial treatment with SRS. The purpose of this project is to report the outcome of our repeat SRS series. Materials/Methods: A total of 6 patients were treated with repeat SRS at our institution between 1993 and 2019. We excluded patients with bilateral disease at presentation or neurofibromatosis. All patients were required to have undergone magnetic resonance (MR) planning for both SRS treatments. DVH analysis was performed on the tumor and critical structures. Toxicity was assessed per CTCAE grading. All SRS treatments were delivered with a Linac system using head frame immobilization with the dose prescribed to the 70% or 80% isodose covering the periphery of the visible tumor on MR scan. The prescribed dose was 12.5 Gy in all initial and repeat SRS treatments with the exception of one repeat treatment that was 10 Gy. The average GTV volume was larger during repeat treatment than initial treatment (3.8 cc vs 1.9 cc). In addition to being larger tumors, tumors during repeat treatment had higher average touching distance with the brainstem (15.0 mm vs 6.7 mm) and more brainstem compression (2.8 mm vs 0.3 mm). Results: Follow-up with MR scan following the second SRS treatment was a median 3.9 years (range, 0.9-8.7 years). A second SRS treatment resulted in a tumor control rate (lack of progression) of 83% (5/6). The one patient who progressed after repeat SRS subsequently underwent surgical resection and is alive. Actuarial rates at 10 years following repeat SRS were as follows: tumor control, 80%; absolute survival, 80%; and cause-specific survival, 100%. Of the patients with at least minimal hearing retention prior to initial SRS, none had ipsilateral hearing preservation after initial radiation treatment. Improvement in any pretreatment cranial nerve deficits was not seen. The only permanent grade 3 toxicity from repeat SRS was a single case of V2 deficit. No patient developed a stroke, malignant transformation, induced second tumor, or facial nerve deficit. Conclusion: Repeat single fraction SRS as delivered in our series is an excellent treatment option for vestibular schwannoma that has progressed following initial treatment with SRS.

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