Medical students' higher performance on examination questions related to course content learned through TBL suggests that TBL enhances mastery of course content. Students in the lowest academic quartile may benefit more than highest-quartile students from the TBL strategy.

This study demonstrates that TBL and CBGD are equally effective active learning strategies when employed in a systems-based pre-clinical pathology curriculum, but students with lower academic performance may benefit more from TBL than CBGD.

A 46-year-old woman presented to two emergency departments within 12 hours because of acute abdominal pain. Physical exam demonstrated tenderness and epigastric guarding. An ultrasound was interpreted as negative; she was discharged home. Later that evening, she was found dead. Postmortem exam revealed acute hemorrhagic necrosis of a segment of jejunum secondary to volvulus. Clinical clues suggesting presentations of small bowel volvulus are usually nonspecific; the diagnosis is typically confirmed at surgery. Her unremitting abdominal pain, persistent vomiting, and absolute neutrophilia were consistent with an acute process. The etiology of this volvulus was caused by an elastic fibrous band at the root of the jejunal mesentery. While congenital fibrous bands are rare in adults, this interpretation is favored for two reasons. First, the band was located 20 cm superior to postsurgical adhesions in the lower abdomen and pelvis. Second, there was no history of trauma or previous surgery involving the site of volvulus.

Purpose:Previous studies on team-based learning (TBL) in medical education demonstrated improved learner engagement, learner satisfaction, and academic performance; however, a paucity of information exists on modifications of the incentive structure of “traditional” TBL practices. The current study investigates the impact of modification to conventional Group Application exercises by examining student preference and student perceptions of TBL outcomes when Group Application exercises are excluded from TBL grades.Methods:During the 2009–2010 and 2010–2011 academic years, 175 students (95.6% response rate) completed a 22-item multiple choice survey followed by 3 open response questions at the end of their second year of medical school. These students had participated in a TBL supplemented preclinical curriculum with graded Group Application exercises during year one and ungraded Group Application exercises during year two of medical school.Results:Chi-square analyses showed significant differences between grading categories for general assessment of TBL, participation and communication, intra-team discussion, inter-team discussion, student perceptions of their own effort and development of teamwork skills. Furthermore, 83.8% of students polled prefer ungraded Group Application exercises with only 7.2% preferring graded and 9.0% indicating no preference.Conclusion:The use of ungraded Group Application exercises appears to be a successful modification of TBL, making it more “student-friendly” while maintaining the goals of active learning and development of teamwork skills.

In the laboratory classes we teach, the time available for students to perform experiments is limited. Although students must repeat experiments until they obtain satisfactory results, we have had to minimise the time they spend doing so because of constrictions on the availability of instrumentation, and thus have had to provide more time for students to adjust their experimental conditions in order to achieve better results. This means they must have a detailed experiment design and must study the principles of each technique before they perform experiments. What was tried? In order to better prepare students to design and perform laboratory experiments, we used a virtual learning environment called '3DClass' to deliver homework about laboratory experiments. This must be completed before classes involving the design and performance of experiments. We developed a homework system that allows students to answer quizzes as many times as they wish. Students are scored according to the average among tries and can continue to answer quizzes until they achieve a score of 100%, and even continue to practise to improve their grades. 3DClass gives instructors access to a detailed report which not only provides the student's grades, but also indicates how he or she answers each quiz, including the choice made for each question and the time spent on each attempt. This enables us to detect the student's level of confidence in each question and to identify which details of each technique need to be better explained before students perform experiments. The data from the quizzes are saved in a confidential databank. In the subsequent class or laboratory experiment, the instructors are provided with a summary of the class answers, identifying the questions on which students had more difficulty and those on which they scored more highly. What was learned? Pre-laboratory graded homework has proved to be a useful tool for better preparing students for laboratory activities. Based on the 3DClass records, some student behaviours can be mapped. Students who take the quizzes seriously, those who guess, those who reattempt a quiz until they score 100%, those who continue to answer after scoring 100% in order to increase their grades, and those who never score 100% can be identified. However, the most relevant facility afforded by 3DClass is the ability to identify a student's confidence in his or her answers, which can be found by analysing that student's attempts on each question. If the student makes different choices, each try indicates a low level of confidence, whereas if the student always provides the same answer, this indicates a high level of confidence; it does not matter whether the student is selecting the right or the wrong answer. This has allowed instructors to identify students' difficulties and to map the classroom profile before performing experiments; it has also been particularly useful in enriching group discussions that take place in the process of planning experiments, thereby resulting in better experiment design...

Background Genetic and environmental factors contribute to the development of celiac disease (CD), but specific genetic predisposing factors remain poorly understood. One candidate is allele 2 of the hs1.2 enhancer within the immunoglobulin heavy chain region. In humans, there are four possible alleles and a previous study of an Italian cohort demonstrated a significantly increased frequency of allele 2 in patients with CD. Aims The purpose of the current study was to determine if a similar association between allele 2 and CD exists in an American population from Dayton, OH. Methods Subjects were screened for CD via esophagogastroduodenoscopy with duodenal biopsy. All biopsies were microscopically scored using a modified Marsh-Oberhuber classification. DNA was isolated from patients' buccal cells for hs1.2 genotype analysis using PCR. Results Unlike the Italian cohort, allele 2 frequency was not significantly different in patients with histopathologic evidence of CD compared to patients without such evidence. However, our patient population as a whole demonstrated a significantly increased allele 2 frequency when compared to that previously reported within diverse ethnic populations. Conclusions Since our comparative control patients do not necessarily reflect a healthy control population, an overall increase in allele 2 may reflect an association between allele 2 of the hs1.2 enhancer and a spectrum of gastrointestinal disorders.

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