Effects of residency training in family medicine v. internship training on professional attitudes and practice patterns.

OBJECTIVES: To determine whether the professional attitudes and practice patterns of physicians with residency training in family medicine differ from those of generalists with internship training. DESIGN: Mail survey conducted in 1985-86. SETTING: Province of Quebec. PARTICIPANTS: A stratified random sample of French-speaking family and general practitioners who graduated after 1972 (325 physicians with residency training and 304 with internship training) (response rate 82%). MAIN RESULTS: Physicians with residency training were 3 years younger on average than those with internship training, were more likely to be female (38% v. 18%, p less than 0.001) and were more likely to work on a salaried basis in CLSCs (public community health centres) (36% v. 14%, p less than 0.001). Even after these confounding factors were controlled for, physicians with residency training seemed to be more sensitive to the psychosocial aspects of patient care and tended to attach more importance to informing patients about useful materials and resources concerning their health problems. They were not, however, more likely to value health counselling or integrate it in medical practice. CONCLUSION: Our findings provide some evidence that the new requirement that physicians complete a residency in family medicine to obtain medical licensure in general practice in Quebec may foster a more patient-centred approach to health care.     

Commensal bacteria make a difference

Nowhere is the relationship between microorganisms and eukaryotes as diverse, intimate and clinically relevant as in the gastrointestinal tract. An estimated 500-1000 mostly anaerobic species reside in the intestine, approaching enormous densities of 10(11)-10(12) organisms per gram colon content. The commensal interactions between intestinal microorganisms and animal hosts have been difficult to study in the past because of the diversity of microorganisms involved and because of the lack of culturability that accompanies many microbial consortia. However, recent work has provided new insights into these interactions.     

Epidermal patterning in Arabidopsis: models make a difference

The leaf and root epidermis in Arabidopsis provide ideal systems in which to explore the mechanisms that underlie the patterned assignment of cell fates during development. Extensive experimental studies have uncovered a complex interlocked feedback network that operates within the epidermis to coordinate the choice between hair and nonhair fates. A number of recent studies using mathematical models have begun to study this network, highlighting new mechanisms that have subsequently been confirmed in model-directed experiments. These studies illustrate the potential of integrated modeling and experimentation to shed new light on developmental processes. Moreover, these models enable systems-level comparative analyses that may help understand the origin and role of properties, such as robustness and redundancy in developmental systems and, concomitantly, the evolution of development itself.     

Combinatorial microRNAs: Working together to make a difference

MicroRNAs regulate gene networks and therefore are inherently complex. MicroRNAs themselves function in networks of other microRNAs, some of which are co-expressed from the same locus. To better understand the interplay among microRNAs that underlies their functions, we examined the potential of combinatorial effects of endogenously and exogenously co-expressed microRNAs. In this review, we first distill the similarities and differences between three microRNA families that function in cell division, miR-16, miR-34a and miR-106b, with emphasis on their exquisite phenotypic diversity. Given that the microRNAs affect cell cycle progression via distinct targets, we tested for phenotypic synergism among them. Furthermore, we investigate target regulation by individual and pooled microRNAs to gain insight into interactions among microRNAs co-expressed from the same chromosomal locus. The ability of microRNAs to modulate multiple genes within a molecular pathway engenders a novel way of thinking about targeting pathways: instead of a one-inhibitor-one-target model, multiple components in a pathway can be modulated by a microRNA resulting in a potent yet reversible inhibition of the pathway. To fully realize this potential, we need to understand how microRNAs function singly and in concert with each other.     

PQQ-dependent methanol dehydrogenases: rare-earth elements make a difference

Methanol dehydrogenase (MDH) catalyzes the first step in methanol use by methylotrophic bacteria and the second step in methane conversion by methanotrophs. Gram-negative bacteria possess an MDH with pyrroloquinoline quinone (PQQ) as its catalytic center. This MDH belongs to the broad class of eight-bladed β propeller quinoproteins, which comprise a range of other alcohol and aldehyde dehydrogenases. A well-investigated MDH is the heterotetrameric MxaFI-MDH, which is composed of two large catalytic subunits (MxaF) and two small subunits (MxaI). MxaFI-MDHs bind calcium as a cofactor that assists PQQ in catalysis. Genomic analyses indicated the existence of another MDH distantly related to the MxaFI-MDHs. Recently, several of these so-called XoxF-MDHs have been isolated. XoxF-MDHs described thus far are homodimeric proteins lacking the small subunit and possess a rare-earth element (REE) instead of calcium. The presence of such REE may confer XoxF-MDHs a superior catalytic efficiency. Moreover, XoxF-MDHs are able to oxidize methanol to formate, rather than to formaldehyde as MxaFI-MDHs do. While structures of MxaFI- and XoxF-MDH are conserved, also regarding the binding of PQQ, the accommodation of a REE requires the presence of a specific aspartate residue near the catalytic site. XoxF-MDHs containing such REE-binding motif are abundantly present in genomes of methylotrophic and methanotrophic microorganisms and also in organisms that hitherto are not known for such lifestyle. Moreover, sequence analyses suggest that XoxF-MDHs represent only a small part of putative REE-containing quinoproteins, together covering an unexploited potential of metabolic functions.     

The future of family practice training in California.

Although the number of physicians in California has doubled since 1963, the number of family and general practice physicians has declined. The ratio of office-based primary care physicians to population has also decreased. Graduate medical education is funded largely from patient care revenues, but the low rate of reimbursement for ambulatory care makes training in primary care specialties especially dependent on public support. Medicare, the Veterans Administration, and the University of California provide more than $325 million a year in support of graduate medical education in California. Federal and state grant programs provide $5 million a year for family physician training in the state, but appropriations to these programs have been reduced in real terms. California family practice residencies are disproportionately located at county hospitals, where funding shortfalls make them especially vulnerable to cuts in grant programs. Additional resources will be needed if more family physicians are to be trained.     

After the strike: using facilitation in a residency training program

Methods of alternative dispute resolution, including facilitation, can be used to identify and resolve areas of conflict. Facilitation was used by the University of Saskatchewan''s Department of Family Medicine (Saskatoon division) after the strike by residents in July and August 1995 so as to allow optimal use of the remaining educational time. Through facilitation, experiences of the strike and areas of potential conflict were explored. Participants had a broad range of responses to the strike. Specific coping strategies were developed to deal with identified concerns. Although outcomes were not measured formally, levels of trust improved and collegial relationships were restored. Because so many changes occur in health care and medical education, conflict inevitably arises. Facilitation offers one way of dealing with change constructively, thereby making possible the optimal use of educational time.     

Science communication: a career where PhDs can make a difference

Among careers for biologists with PhDs, science communication is one of the most diverse and rewarding pathways. Myriad options exist, from traditional journalism to new media, from writing for specialists to working in public outreach. Textbooks, mass-market books, and freelance writing that combines many of these pursuits are all viable choices. Communicating about science allows researchers to step away from the minutiae of a subdiscipline and to once again explore the breadth of science more fully through an ever-evolving array of stories. A doctoral degree can confer distinct advantages in the eyes of prospective editors and employers. Here I describe those advantages, possible career directions, and steps toward making such a transition.     

Small RFC subunits make a big difference

Comment on: Maradeo ME, et al. Cell Cycle 2010; 9:4370–8.