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Wei X, Xu T, Guo R, Tan Z, Xin W. Physiology education in China: the current situation and changes over the past 3 decades. BMC MEDICAL EDUCATION 2024; 24:408. [PMID: 38609894 PMCID: PMC11015638 DOI: 10.1186/s12909-024-05395-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 04/04/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVE As an experimental biological science, physiology has been taught as an integral component of medical curricula for a long time in China. The teaching effectiveness of physiology courses will directly affect students' learning of other medical disciplines. The purpose of this study is to investigate the current situation and changes in physiology teaching over 30 years in Chinese medical schools. METHODS National survey was conducted online on the platform SoJump via WeChat and the web. The head of the physiology department in medical school was asked to indicate the information of physiology education from three periods: 1991-2000, 2001-2010, and 2011-2020. The responses of 80 leaders of the Department of Physiology from mainland Chinese medical schools were included in the study for analysis. RESULTS The survey showed that the class hours, both of theory and practice, had been decreased. During the past 20 years, the total number of physiology teachers, the number of physiology teachers who had been educated in medical schools, and the number of technicians had been reduced, whereas teachers with doctor's degrees had been increased. In addition to traditional didactic teaching, new teaching approaches, including problem-based learning/case-based learning/team-based learning, integrated curriculum and formative evaluation systems, had been employed, mostly for more than 5 years, in some medical schools. CONCLUSION The present study has provided historical data regarding the current status of physiology education in China and that in the past thirty years by showing that physiology education in China has developed quickly,even it faces many challenges.
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Affiliation(s)
- Xuhong Wei
- Department of Physiology, Zhongshan School of Medicine, Science and Technology Building, Sun Yat-Sen University, East Wing, 74 Zhongshan Road 2, Guangzhou, 510080, Guangdong, People's Republic of China
| | - Ting Xu
- Department of Physiology, Zhongshan School of Medicine, Science and Technology Building, Sun Yat-Sen University, East Wing, 74 Zhongshan Road 2, Guangzhou, 510080, Guangdong, People's Republic of China
| | - Ruixian Guo
- Department of Physiology, Zhongshan School of Medicine, Science and Technology Building, Sun Yat-Sen University, East Wing, 74 Zhongshan Road 2, Guangzhou, 510080, Guangdong, People's Republic of China
| | - Zhi Tan
- Department of Physiology, Zhongshan School of Medicine, Science and Technology Building, Sun Yat-Sen University, East Wing, 74 Zhongshan Road 2, Guangzhou, 510080, Guangdong, People's Republic of China.
| | - Wenjun Xin
- Department of Physiology, Zhongshan School of Medicine, Science and Technology Building, Sun Yat-Sen University, East Wing, 74 Zhongshan Road 2, Guangzhou, 510080, Guangdong, People's Republic of China.
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Pan SQ, Chan LK, Yan Y, Yang X. Survey of Gross Anatomy Education in China: The Past and the Present. ANATOMICAL SCIENCES EDUCATION 2020; 13:390-400. [PMID: 32107879 DOI: 10.1002/ase.1952] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 02/21/2020] [Accepted: 02/22/2020] [Indexed: 05/24/2023]
Abstract
Medical education in mainland China has undergone massive expansion and reforms in the past decades. A nation-wide survey of the five-year clinical medicine programs aimed to examine the course hours, pedagogies, learning resources and teaching staff of anatomy both at present and over the past three decades (1990-1999, 2000-2009, and 2010-2018). The directors or senior teachers from 90 out of the 130 five-year clinical medicine programs were invited to fill out a factual questionnaire by email. Ultimately, sixty-five completed questionnaires were received from 65 different schools. It was found that the total number of gross anatomy course hours has decreased by 11% in the past 30 years and that systematic and regional anatomy have been increasingly taught separately among the surveyed medical schools. Problem-based learning has been adopted in thirty-five (54%) of the surveyed schools, and team-based learning is used in ten (15%) of the surveyed schools. The surveyed schools reported receiving more donated cadavers in recent years, with the average number increasing from 20.67 ± 20.29 in 2000-2009 to 36.10 ± 47.26 in 2010-2018. However, this has not resulted in a decrease in the number of students who needed to share one cadaver (11.85 ± 5.03 in 1990-1999 to 14.22 ± 5.0 in 2010-2018). A decreasing trend regarding the teacher-student ratio (1:25.5 in 2000-2009 to 1:33.2 in 2010-2018) was also reported. The survey demonstrated the historical changes in gross anatomy education in China over the past thirty years.
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MESH Headings
- Anatomy/education
- Anatomy/statistics & numerical data
- Anatomy/trends
- Cadaver
- China
- Curriculum/statistics & numerical data
- Curriculum/trends
- Dissection/statistics & numerical data
- Dissection/trends
- Education, Medical, Undergraduate/history
- Education, Medical, Undergraduate/statistics & numerical data
- Education, Medical, Undergraduate/trends
- Faculty/statistics & numerical data
- History, 20th Century
- History, 21st Century
- Humans
- Problem-Based Learning/statistics & numerical data
- Schools, Medical/history
- Schools, Medical/statistics & numerical data
- Schools, Medical/trends
- Students, Medical/statistics & numerical data
- Surveys and Questionnaires/statistics & numerical data
- Teaching/history
- Teaching/statistics & numerical data
- Teaching/trends
- Time Factors
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Affiliation(s)
- San-Qiang Pan
- Division of Anatomy, School of Medicine, Jinan University, Guangzhou, People's Republic of China
| | - Lap Ki Chan
- Department of Biomedical Sciences, Macau University of Science and Technology, Macao Special Administrative Region, People's Republic of China
| | - Yu Yan
- Division of Pathology and Pathophysiology, School of Medicine, Jinan University, Guangzhou, People's Republic of China
| | - Xuesong Yang
- Division of Histology and Embryology, School of Medicine, Jinan University, Guangzhou, People's Republic of China
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Himelfarb I, Shotts BL, Hyland JK, Gow AR. Variables associated with successful performance on the National Board of Chiropractic Examiners Part IV examination. THE JOURNAL OF CHIROPRACTIC EDUCATION 2020; 34:43-51. [PMID: 31322907 PMCID: PMC7074951 DOI: 10.7899/jce-18-28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The objectives of this study were to (1) identify factors predictive of performance on the National Board of Chiropractic Examiners Part IV exam and (2) investigate correlations between the scores obtained in the Part I, Part II, Physiotherapy, and Part III exams and the Part IV examination. METHODS A random sample of 1341 records was drawn from National Board of Chiropractic Examiners data to investigate the relationships between the scores obtained on the National Board of Chiropractic Examiners exams. A hierarchical multiple regression analysis related the performance on Part IV to examinee's gender, Part IV repeater status, and scores obtained on the Part I, Part II, Physiotherapy, and Part III exams. RESULTS The analyses revealed statistical relations among all National Board of Chiropractic Examiners exams. The correlations between Part IV and Part I ranged from r = .31 to r = .4; between Part IV and Part II from r = .34 to r = .45. The correlation between Part IV and Physiotherapy was r = .44; between Part IV and Part III was r = .46. The strongest predictors of the Part IV score were found to be examinees' scores in Diagnostic Imaging, β̂ = .19, p < .001; Chiropractic Practice, β̂ = .17, p < .001; Physiotherapy, β̂ = .15, p < .001; and the Part III exam β̂ = .19, p < .001. CONCLUSIONS Performance on the National Board of Chiropractic Examiners Part IV examination is related to the performance in all other National Board of Chiropractic Examiners exams.
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Thistlethwaite JE, Bartle E, Chong AAL, Dick ML, King D, Mahoney S, Papinczak T, Tucker G. A review of longitudinal community and hospital placements in medical education: BEME Guide No. 26. MEDICAL TEACHER 2013; 35:e1340-64. [PMID: 23848374 DOI: 10.3109/0142159x.2013.806981] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND Traditionally, clinical learning for medical students consists of short-term and opportunistic encounters with primarily acute-care patients, supervised by an array of clinician preceptors. In response to educational concerns, some medical schools have developed longitudinal placements rather than short-term rotations. Many of these longitudinal placements are also integrated across the core clinical disciplines, are commonly termed longitudinal integrated clerkships (LICs) and often situated in rural locations. This review aimed to explore, analyse and synthesise evidence relating to the effectiveness of longitudinal placements, for medical students in particular to determine which aspects are most critical to successful outcomes. METHOD Extensive search of the literature resulted in 1679 papers and abstracts being considered, with 53 papers ultimately being included for review. The review group coded these 53 papers according to standard BEME review guidelines. Specific information extracted included: data relating to effectiveness, the location of the study, number of students involved, format, length and description of placement, the learning outcomes, research design, the impact level for evaluation and the main evaluation methods and findings. We applied a realist approach to consider what works well for whom and under what circumstances. FINDINGS The early LICs were all community-based immersion programs, situated in general practice and predominantly in rural settings. More recent LIC innovations were situated in tertiary-level specialist ambulatory care in urban settings. Not all placements were integrated across medical disciplines but were longitudinal in relation to location, patient base and/or supervision. Twenty-four papers focussed on one of four programs from different viewpoints. Most evaluations were student opinion (survey, interview, focus group) and/or student assessment results. Placements varied from one half day per week for six months through to full time immersion for more than 12 months. The predominant mechanism relating to factors influencing effectiveness was continuity of one or more of: patient care, supervision and mentorship, peer group and location. The success of LICs and participation satisfaction depended on the preparation of both students and clinical supervisors, and the level of support each received from their academic institutions. CONCLUSION Longitudinal placements, including longitudinal integrated placements, are gaining in popularity as an alternative to traditional block rotations. Although relatively few established LICs currently exist, medical schools may look for ways to incorporate some of the principles of LICs more generally in their clinical education programmes. Further research is required to ascertain the optimum length of time for placements depending on the defined learning outcomes and timing within the programme, which students are most likely to benefit and the effects of context such as location and type of integration.
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Affiliation(s)
- J E Thistlethwaite
- Centre for Medical Education Research and Scholarship, University of Queensland, Queensland, Australia.
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Peccoralo LA, Callahan K, Stark R, DeCherrie LV. Primary Care Training and the Evolving Healthcare System. ACTA ACUST UNITED AC 2012; 79:451-63. [DOI: 10.1002/msj.21329] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Benbassat J, Baumal R. Expected benefits of streamlining undergraduate medical education by early commitment to specific medical specialties. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2012; 17:145-155. [PMID: 21698422 DOI: 10.1007/s10459-011-9311-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Accepted: 06/14/2011] [Indexed: 05/31/2023]
Abstract
Undergraduate medical education is too long; it does not meet the needs for physicians' workforce; and its content is inconsistent with the job characteristics of some of its graduates. In this paper we attempt to respond to these problems by streamlining medical education along the following three reforms. First, high school graduates would be eligible for undergraduate medical education programs of 4 years duration. Second, medical school applicants would be required to commit themselves to a medical specialty and choose one of four undergraduate paths: (1) "Interventions/consultations" path that would prepare its graduates for residencies in secondary and tertiary specialties, such as cardiology and surgery, (2) "continuous patient care" path for primary care specialties, such as family medicine and psychiatry, (3) "diagnostic laboratory medicine and biomedical research" path that would prepare for either laboratory-based careers, such as pathology, biochemistry and bacteriology, or research in e.g., immunology and molecular genetics, and (4) "epidemiology and public health" path that would include population-based research, preventive medicine and health care administration. Third, the content of each of these paths would focus on relevant learning outcomes, and medical school graduates would be eligible for residency training only in specialties included in their path. Hopefully, an early commitment to a medical specialty will reduce the duration of medical education, improve the regulation of physicians' workforce and adapt the curricular content to the future job requirements from medical school graduates.
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Affiliation(s)
- Jochanan Benbassat
- Myers-JDC-Brookdale Institute, Smokler Center for Health Policy Research, PO Box 3886, 91037, Jerusalem, Israel.
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Shaffer K, Ng JM, Hirsh DA. An integrated model for radiology education: development of a year-long curriculum in imaging with focus on ambulatory and multidisciplinary medicine. Acad Radiol 2009; 16:1292-301. [PMID: 19596595 DOI: 10.1016/j.acra.2009.06.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Revised: 05/11/2009] [Accepted: 06/01/2009] [Indexed: 11/26/2022]
Abstract
RATIONALE AND OBJECTIVE In 2004, Harvard Medical School initiated a pilot program, the Cambridge Integrated Clerkship, in which students study the core third-year medical disciplines in a longitudinal year long experience. In this paper, the authors describe the design of the radiology portion of this program and compare outcomes to those of students in a traditional curriculum. MATERIALS AND METHODS Students in the integrated curriculum were compared to students in traditional clerkships on the basis of Objective Structured Clinical Examination cases, final exams, fourth-year comprehensive exam scores, and choice of specialty. RESULTS Scores on Objective Structured Clinical Examination cases and imaging final exams were not statistically different between the two groups, but Integrated Clerkship students had statistically lower scores on final exams. Integrated Clerkship students scored higher on the fourth-year radiology comprehensive exam than traditional students, but differences were not statistically significant. Choice of radiology as a specialty was not statistically different between the two groups. CONCLUSIONS Teaching radiology in an integrated year long curriculum is feasible, with a minimal drop in exam scores but no changes in other evaluative measures and no decrease in the choice of radiology as a specialty. The program may give students a better appreciation of the role of radiology in an ambulatory setting and in relationship to other specialties.
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Wamsley MA, Dubowitz N, Kohli P, Cooke M, O'Brien BC. Continuity in a longitudinal out-patient attachment for Year 3 medical students. MEDICAL EDUCATION 2009; 43:895-906. [PMID: 19674297 DOI: 10.1111/j.1365-2923.2009.03424.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
CONTEXT Concerns about the quality of medical student learning experiences during traditional clerkships have prompted calls to restructure clinical education around continuity. Many US medical schools have added longitudinal out-patient attachments to enhance student continuity with patients and supervising doctors. However, continuity with patients can be difficult to achieve and little is known about the independent effect of continuity with a supervising doctor and setting. This study describes students' perceptions of the types of continuity experienced in longitudinal attachments and the learning associated with continuity. METHODS This is a qualitative study using a grounded theory approach. Interviews were conducted with 12 Year 3 medical students about their continuity experiences with patients, supervisors and settings during their attachment. The resulting data were subjected to thematic analysis. RESULTS Continuity with supervising doctors provided students with career mentorship and personal support. Student autonomy varied and was most dependent on the supervisor and setting. Students with patient continuity were more likely to report learning about chronic illness and communication skills. Students described the longitudinal attachment as helping them to develop their clinical skills and gain self-confidence within their role as future doctors, and as influencing their career choice. CONCLUSIONS There is much variation in student experiences of patient continuity during a longitudinal attachment. Continuity with patients, supervisors and settings affects student learning in different ways. Additional dimensions of the experience, such as the nature of the patient-doctor relationship, the pace of work and the patient population, impact learning outcomes and should be considered when continuity experiences are being designed.
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Affiliation(s)
- Maria A Wamsley
- Department of Medicine, University of California San Francisco, San Francisco, California 94143-0320, USA.
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Griffith CH, Wilson JF, Haist SA, Albritton TA, Bognar BA, Cohen SJ, Hoesley CJ, Fagan MJ, Ferenchick GS, Pryor OW, Friedman E, Harrell HE, Hemmer PA, Houghton BL, Kovach R, Lambert DR, Loftus TH, Painter TD, Udden MM, Watkins RS, Wong RY. Internal medicine clerkship characteristics associated with enhanced student examination performance. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2009; 84:895-901. [PMID: 19550183 DOI: 10.1097/acm.0b013e3181a82013] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE To determine which internal medicine (IM) clerkship characteristics are associated with better student examination performance. METHOD The authors collected data from 17 U.S. medical schools (1,817 students) regarding characteristics of their IM clerkships, including structural characteristics, pedagogical approaches, patient contact, and clinical teacher characteristics. Outcomes of interest were postclerkship National Board of Medical Examiners (NBME) subject examination score, United States Medical Licensing Examination (USMLE) 2 score, and change in score from USMLE 1 to 2. To examine how associations of various clerkship characteristics and examination performance may differ for students of different prior achievement, the authors categorized students into those who scored in the top (1/4) of the cohort on USMLE 1 and the bottom (1/4). The authors conducted analyses at both the school and the individual student levels. RESULTS In school-level analyses (using a reduced four-variable model), independent variables associated with higher NBME subject examination score were more small-group hours/week and use of community-based preceptors. Greater score increase from USMLE 1 to 2 was associated with students caring for more patients/day. Several variables were associated with enhanced student examination performance at the student level. The most consistent finding was that more patients cared for per day was associated with higher examination performance. More structured learning activities were associated with higher examination scores for students with lower baseline USMLE 1 achievement. CONCLUSION Certain clerkship characteristics are associated with better student examination performance, the most salient being caring for more patients per day.
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Grant A, Robling M. Introducing undergraduate medical teaching into general practice: an action research study. MEDICAL TEACHER 2006; 28:e192-7. [PMID: 17594545 DOI: 10.1080/01421590600825383] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Following the publication of Tomorrow's Doctors and as a result of increasing numbers of students recruited to medical school it is necessary to involve more general practitioners (family physicians) in undergraduate medical education. Students have responded positively regarding experiences in general practices with a broad spectrum of clinical conditions to be seen and greater involvement in clinical decision-making. This action research study followed a small group general practice in South Wales through the required preparation for undergraduate medical education and its first year of teaching. Preparatory work for the practice focused mainly on summarizing patient notes, setting up a practice library and arranging accommodation for the students. Members of the Primary Health Care Team (PHCT) found that having students in the practice gave them a sense of achievement and enhanced self-worth. Individuals within the practice felt more confident in their professional role and the team ethic within the practice was strengthened. Doctors' anxieties regarding the adequacy of their clinical skills proved unfounded. Patients were reported to feel more included in their care and to have enjoyed hearing their condition being discussed with the students. Students valued the one-to-one teaching, seeing common illnesses and a variety of consulting styles. It is hoped that this paper will be of value to those responsible for recruiting GP practices into undergraduate teaching. It demonstrates benefits for the primary health care team in terms of improved morale and sense of professional self-worth. Patients felt more involved in their care. Generalization from these findings is limited by only one practice having been involved. Undergraduate teaching offers advantages, particularly in terms of professional self-esteem and team morale.
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Affiliation(s)
- Andy Grant
- Department of General Paractice, Cardiff University, Lanedeyrn Health Centre, Maelfa, Llanedeyrn, Cardiff CF23 9PN, UK.
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Ogrinc G, Mutha S, Irby DM. Evidence for longitudinal ambulatory care rotations: a review of the literature. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2002; 77:688-693. [PMID: 12114141 DOI: 10.1097/00001888-200207000-00008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
PURPOSE Block ambulatory rotations and longitudinal ambulatory care experiences are now common in U.S. medical schools, but little is known about their efficacy. Through a structured review of the medical literature from 1966 through March 2000, the authors summarize the characteristics of, the evidence for, and the evaluation of longitudinal ambulatory care rotations. METHOD The authors searched Medline using the terms "outpatients," "continuity of patient care," "ambulatory care," "mentors," "preceptorship," "graduate medical education," "curriculum," and "clinical clerkship" cross-matched to "medical students" and "internship and residency" for literature published from 1966 through March 2000. They narrowed the list to only articles containing empirical outcome data focusing on medical students' experiences in longitudinal ambulatory care rotations. Each study was scored to assess its strengths and weaknesses. RESULTS Seven articles met the search criteria. The articles identified the benefits of longitudinal ambulatory care experiences, including developing effective patient interactions and understanding chronic diseases. There were little or no differences in the students' overall knowledge acquisition when those with longitudinal experiences were compared with those in block rotations. DISCUSSION Although longitudinal ambulatory care experiences are now common in medical schools, evidence supporting their widespread implementation is sparse. Few studies employ rigorous methods to evaluate educational outcomes. Research to identify benefits and costs, improve the quality and consistency of the students' experiences, and develop other innovative ways of teaching and learning ambulatory care is needed.
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Affiliation(s)
- Gregory Ogrinc
- Veterans Affairs National Health Quality Scholars Program, White River Junction Veterans Hospital and Dartmouth Medical School, White River Junction, Vermont 05009, USA.
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