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Roberts J, Zhong Q, Linger R. Integrating Foundational and Clinical Science Remotely by Combining Team-Based Learning and Simulation. MEDICAL SCIENCE EDUCATOR 2023; 33:925-934. [PMID: 37546193 PMCID: PMC10403461 DOI: 10.1007/s40670-023-01817-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 08/08/2023]
Abstract
Integrating foundational and clinical science in medical and other professional healthcare degree programs has been well established as a means to enhance learning. However, implementation remains challenging, and a significant gap exists in guidance for non-professional degree programs to effectively accomplish both types of integration. Additionally, many modalities described in the literature are resource-intensive, scale poorly to larger groups, and are widely inaccessible. We present an online modality combining team-based learning and a simulation-based learning experience that fosters vertical and horizontal integration of physiology, pharmacology, and clinical science. The tools utilized include a vital sign simulator, video conferencing software, and a document-sharing platform. The activity demonstrated improved knowledge comparing pre- and posttests and evidence that the activity helped students integrate physiology, pharmacology, and clinical medicine. The novel structure is effective and accessible, uses open-source software and standard equipment available to most undergraduate and graduate faculty, and is adaptable to in-person, hybrid-remote, and fully remote delivery. Supplementary Information The online version contains supplementary material available at 10.1007/s40670-023-01817-9.
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Affiliation(s)
- Joel Roberts
- Master of Science in Biomedical Sciences Program, Rocky Vista University, Englewood, CO 80112 USA
| | - Qing Zhong
- Department of Biomedical Sciences, Rocky Vista University, Ivins, UT 84738 USA
| | - Rachel Linger
- Department of Biomedical Sciences, Rocky Vista University, Englewood, CO 80112 USA
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Rider EA, Chou C, Abraham C, Weissmann P, Litzelman DK, Hatem D, Branch W. Longitudinal faculty development to improve interprofessional collaboration and practice: a multisite qualitative study at five US academic health centres. BMJ Open 2023; 13:e069466. [PMID: 37076167 PMCID: PMC10124268 DOI: 10.1136/bmjopen-2022-069466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
OBJECTIVES Interprofessional (IP) collaboration and effective teamwork remain variable in healthcare organisations. IP bias, assumptions and conflicts limit the capacity of healthcare teams to leverage the expertise of their members to meet growing complexities of patient needs and optimise healthcare outcomes. We aimed to understand how a longitudinal faculty development programme, designed to optimise IP learning, influenced its participants in their IP roles. DESIGN In this qualitative study, using a constructivist grounded theory approach, we analysed participants' anonymous narrative responses to open-ended questions about specific knowledge, insights and skills acquired during our IP longitudinal faculty development programme and applications of this learning to teaching and practice. SETTING Five university-based academic health centres across the USA. PARTICIPANTS IP faculty/clinician leaders from at least three different professions completed small group-based faculty development programmes over 9 months (18 sessions). Site leaders selected participants from applicants forecast as future leaders of IP collaboration and education. INTERVENTIONS Completion of a longitudinal IP faculty development programme designed to enhance leadership, teamwork, self-knowledge and communication. RESULTS A total of 26 programme participants provided 52 narratives for analysis. Relationships and relational learning were the overarching themes. From the underlying themes, we developed a summary of relational competencies identified at each of three learning levels: (1) Intrapersonal (within oneself): reflective capacity/self-awareness, becoming aware of biases, empathy for self and mindfulness. (2) Interpersonal (interacting with others): listening, understanding others' perspectives, appreciation and respect for colleagues and empathy for others. (3) Systems level (interacting within organisation): resilience, conflict engagement, team dynamics and utilisation of colleagues as resources. CONCLUSIONS Our faculty development programme for IP faculty leaders at five US academic health centres achieved relational learning with attitudinal changes that can enhance collaboration with others. We observed meaningful changes in participants with decreased biases, increased self-reflection, empathy and understanding of others' perspectives and enhanced IP teamwork.
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Affiliation(s)
- Elizabeth A Rider
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Calvin Chou
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Corrine Abraham
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Peter Weissmann
- Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Debra K Litzelman
- Department of Medicine, Regenstrief Institute, Indianapolis, Indiana, USA
- Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - David Hatem
- Department of Medicine, University of Massachusetts T H Chan School of Medicine, Worcester, Massachusetts, USA
| | - William Branch
- Medicine, Emory University, Atlanta, Georgia, USA
- Medicine, Emory Clinic, Atlanta, Georgia, USA
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Shimizu I, Kimura T, Duvivier R, van der Vleuten C. Modeling the effect of social interdependence in interprofessional collaborative learning. J Interprof Care 2022; 36:820-827. [DOI: 10.1080/13561820.2021.2014428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Ikuo Shimizu
- Center for Medical Education and Clinical Training, Shinshu University, Matsumoto, Japan
| | - Teiji Kimura
- Department of Fundamental Physical Therapy, Shinshu University, Matsumoto, Japan
| | - Robbert Duvivier
- Center for Educational Development and Research in Health Sciences (CEDAR), University Medical Center Groningen, Groningen, The Netherlands
| | - Cees van der Vleuten
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Bell SK, Langer T, Luff D, Rider EA, Brandano J, Meyer EC. Interprofessional Learning to Improve Communication in Challenging Healthcare Conversations: What Clinicians Learn From Each Other. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2019; 39:201-209. [PMID: 31306279 DOI: 10.1097/ceh.0000000000000259] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Although contemporary health care involves complex interactions among clinicians of varying professions, opportunities to learn together are relatively few. The authors assessed participants' views about the educational value of learning with colleagues of mixed health care professions in communication and relational skills training focused on challenging conversations. METHODS Between 2010 and 2013, 783 participants enrolled in 46 workshops hosted by the Institute for Professionalism and Ethical Practice at Boston Children's Hospital, Boston, USA. Participants received pre-, post-, and 3-month follow-up questionnaires with quantitative and qualitative questions about their experiences learning with clinicians of varying professions ("interprofessional learning"). Descriptive statistics and chi-square tests were used to compare participant groups. Responses to open-ended questions were coded according to standard principles of content analysis. RESULTS Seven hundred twenty-two (92%) participants completed surveys. Previous interprofessional learning was reported by 60% of respondents, but generally comprised <30% of their education. Clinicians with <3 years of work experience were least likely to have previous interprofessional learning. Nearly all (96%) participants reported interprofessional colleagues contributed valuably to their learning. Asked specifically what they learned, participants described five themes: Stronger Teamwork, Patient-Centered Focus, Specific Communication Skills, Content-Specific Knowledge, and Shared Global Values. After 3 months, 64% of respondents reported that workshop participation helped make their interactions with interprofessional colleagues more collaborative. DISCUSSION Communication skills training for challenging health care conversations is a valuable opportunity for interprofessional learning and generates sustained positive attitudes about collaboration. Clinicians learn from their colleagues a deeper understanding of each other's professional roles, challenges, and unique contributions; specific communication approaches; and a sense of belonging to a collaborative community reinforcing the patient at the center of care.
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Affiliation(s)
- Sigall K Bell
- Dr. Bell: Associate Professor, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, and Associate Professor, Institute for Professionalism and Ethical Practice, Boston Children's Hospital, Harvard Medical School, Boston, MA. Dr. Langer: Research Associate, Institute for Professionalism and Ethical Practice, Boston Children's Hospital, Harvard Medical School, Boston, MA, and Attending in Pediatric Neurology, Department of Neuropediatrics and Muscle Disorders, Center for Pediatrics, Faculty of Medicine, University of Freiburg, Freiburg, Germany. Dr. Luff: Associate Director, Institute for Professionalism and Ethical Practice, Boston Children's Hospital, Harvard Medical School, Boston, MA. Dr. Rider: Director of Academic Programs, Assistant Professor, Institute for Professionalism and Ethical Practice, Boston Children's Hospital, Harvard Medical School, Boston, MA, Director of Academic Programs, Assistant Professor, Department of Pediatrics, Harvard Medical School, Boston, MA, and Director of Academic Programs, Assistant Professor, Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, MA. Dr. Brandano: Senior Clinical Coordinator, Institute for Professionalism and Ethical Practice, Boston Children's Hospital, Harvard Medical School, Boston, MA, and Senior Clinical Coordinator, Department of Psychology, Simmons College, Boston, MA. Dr. Meyer: Senior Attending Psychologist, Associate Professor, Institute for Professionalism and Ethical Practice, Boston Children's Hospital, Harvard Medical School, Boston, MA, and Senior Attending Psychologist, Associate Professor, Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston MA
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Goolsarran N, Hamo CE, Lane S, Frawley S, Lu WH. Effectiveness of an interprofessional patient safety team-based learning simulation experience on healthcare professional trainees. BMC MEDICAL EDUCATION 2018; 18:192. [PMID: 30089502 PMCID: PMC6083611 DOI: 10.1186/s12909-018-1301-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 07/27/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Although the American Council of Graduate Medical Education (ACGME) mandates formal education in patient safety, there is a lack of standardized educational practice on how to conduct patient safety training. Traditionally, patient safety is taught utilizing instructional strategies that promote passive learning such as self-directed online learning modules or didactic lectures that result in suboptimal learning and satisfaction. METHODS During the summer of 2015, 76 trainees consisting of internal medicine interns and senior-level nursing students participated in an interactive patient safety workshop that used a flipped classroom approach integrating team based learning (TBL) and interprofessional simulated application exercises. RESULTS Workshop trainees demonstrated an increase in knowledge specifically related to patient safety core concepts on the Team Readiness Assurance Test (TRAT) compared to the Individual Readiness Assurance Test (IRAT) (p = 0.001). Completion rates on the simulation application exercises checklists were high except for a few critical action items such as hand-washing, identifying barriers to care, and making efforts to clarify code status with patient. The Readiness for Interprofessional Learning Scale (RIPLS) subscale scores for Teamwork and Collaboration and Professional Identity were higher on the post-workshop survey compared to the pre-workshop survey, however only the difference in the Positive Professional Identity subscale was statistically significant (p = 0.03). A majority (90%) of the trainees either agreed that the safety concepts they learned would likely improve the quality of care they provide to future patients. CONCLUSIONS This novel approach to safety training expanded teaching outside of the classroom and integrated simulation and engagement in error reduction strategies. Next steps include direct observation of trainees in the clinical setting for team-based competency when it comes to patient safety and recognition of system errors.
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Affiliation(s)
| | - Carine E. Hamo
- Department of Medicine, Stony Brook University Hospital,
| | - Susan Lane
- Department of Medicine, Stony Brook University Hospital,
| | - Stacey Frawley
- School of Nursing, Stony Brook University Hospital, 101 Nicolls Road, Stony Brook, 11794 NY USA
| | - Wei-Hsin Lu
- Department of Preventative Medicine, Stony Brook University Hospital, 101 Nicolls Road, Stony Brook, 11794 NY USA
- Stony Brook University School of Medicine, 101 Nicolls Road, HSC Level 4 Room 148, Stony Brook, NY 11794-8430 USA
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Harmon RB, DeGennaro G, Norling M, Kennedy C, Fontaine D. Implementing healthy work environment standards in an academic workplace: An update. J Prof Nurs 2017; 34:20-24. [PMID: 29406133 DOI: 10.1016/j.profnurs.2017.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 05/18/2017] [Accepted: 06/02/2017] [Indexed: 10/19/2022]
Abstract
In 2005 the American Association of Critical Care Nurses defined six Healthy Work Environment (HWE) standards for the clinical setting (AACN, 2005), which were reaffirmed and expanded in 2016 (AACN, 2016). These clinical standards were adapted for use in the academic setting by Fontaine, Koh, and Carroll in 2012. The intention of this article is threefold: to present a revised version of the academic workplace standards which are appropriate for all School of Nursing (SON) employees, staff as well as faculty; to proposes the addition of a seventh standard, self-care, which provides the foundation for all standards; and to describe the continuing implementation of these seven standards at the University of Virginia School of Nursing (UVA SON).
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Affiliation(s)
| | - Gina DeGennaro
- University of Virginia School of Nursing, United States.
| | - Meg Norling
- University of Virginia School of Nursing, United States.
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Currey J, Oldland E, Considine J, Glanville D, Story I. Evaluation of postgraduate critical care nursing students' attitudes to, and engagement with, Team-Based Learning: a descriptive study. Intensive Crit Care Nurs 2014; 31:19-28. [PMID: 25439141 DOI: 10.1016/j.iccn.2014.09.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Revised: 08/25/2014] [Accepted: 09/09/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate postgraduate critical care nursing students' attitudes to, and engagement with, Team-Based Learning (TBL). RESEARCH METHODOLOGY/DESIGN A descriptive pre and post interventional design was used. Study data were collected by surveys and observation. SETTING University postgraduate critical care nursing programme. MAIN OUTCOME MEASURES Students' attitudes to learning within teams (Team Experience Questionnaire) and student engagement (observed and self-reports). RESULTS Twenty-eight of 32 students agreed to participate (87% response rate). There were significant changes in students' attitudes to learning within teams including increases in overall satisfaction with team experience, team impact on quality of learning, team impact on clinical reasoning ability and professional development. There was no significant increase in satisfaction with peer evaluation. Observation and survey results showed higher student engagement in TBL classes compared with standard lecturing. CONCLUSION Postgraduate critical care nursing students responded positively to the introduction of TBL and showed increased engagement with learning. In turn, these factors enhanced nurses' professional skills in teamwork, communication, problem solving and higher order critical thinking. Developing professional skills and advancing knowledge should be core to all critical care nursing education programmes to improve the quality and safety of patient care.
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Affiliation(s)
- Judy Currey
- School of Nursing and Midwifery, Deakin University, 221 Burwood Hwy, Burwood, Victoria 3125, Australia.
| | - Elizabeth Oldland
- School of Nursing and Midwifery, Deakin University, 221 Burwood Hwy, Burwood, Victoria 3125, Australia.
| | - Julie Considine
- School of Nursing and Midwifery, Deakin University, 221 Burwood Hwy, Burwood, Victoria 3125, Australia; Eastern Health - Deakin University Nursing & Midwifery Research Centre, Australia.
| | - David Glanville
- Epworth Healthcare, Australia; Deakin University, 221 Burwood Hwy, Burwood, Victoria 3125, Australia.
| | - Ian Story
- Deakin University, 221 Burwood Hwy, Burwood, Victoria 3125, Australia.
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Varpio L, Bell R, Hollingworth G, Jalali A, Haidet P, Levine R, Regehr G. Is transferring an educational innovation actually a process of transformation? ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2012; 17:357-67. [PMID: 21725841 DOI: 10.1007/s10459-011-9313-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 06/22/2011] [Indexed: 05/12/2023]
Abstract
Recent debates question the extent to which adopting an educational innovation requires compromise between the innovation's original design and the adoption site's context. Through compromises, the innovation's fundamental principles may be transferred, transformed, or abandoned. This paper analyzes such compromises during the piloting of Team-Based Learning (TBL). We ask: When is the process of transferring an innovation actually a process of transformation? This study is an autoethnography of our research team's implementation process. Autoethnographies are personalized accounts where authors draw on their own experiences to extend understanding of a particular topic. To conduct this autoethnography, we used an in-depth, interactive interview with the piloting clinician educator. In the analysis of TBL's fundamental principles, some aspects of the principles transferred easily, while others were transformed. Analysis raised concerns that the transformations threatened the foundational principles of TBL. While an educational innovation's techniques may seem to be surface structures, they are realizations of deeper fundamental principles. The fundamental principles are themselves realizations of the innovation's foundational philosophy. When techniques and/or principles are modified to a context, it is important to analyze if the modifications continue to uphold the innovation's philosophy.
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Affiliation(s)
- Lara Varpio
- Academy for Innovation in Medical Education, Faculty of Medicine, University of Ottawa, ON, Canada.
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Kolluru S, Roesch DM, Akhtar de la Fuente A. A multi-instructor, team-based, active-learning exercise to integrate basic and clinical sciences content. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2012; 76:33. [PMID: 22438605 PMCID: PMC3305942 DOI: 10.5688/ajpe76233] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Accepted: 10/02/2011] [Indexed: 05/13/2023]
Abstract
OBJECTIVES To introduce a multiple-instructor, team-based, active-learning exercise to promote the integration of basic sciences (pathophysiology, pharmacology, and medicinal chemistry) and clinical sciences in a doctor of pharmacy curriculum. DESIGN A team-based learning activity that involved pre-class reading assignments, individual-and team-answered multiple-choice questions, and evaluation and discussion of a clinical case, was designed, implemented, and moderated by 3 faculty members from the pharmaceutical sciences and pharmacy practice departments. ASSESSMENT Student performance was assessed using a multiple-choice examination, an individual readiness assurance test (IRAT), a team readiness assurance test (TRAT), and a subjective, objective, assessment, and plan (SOAP) note. Student attitudes were assessed using a pre- and post-exercise survey instrument. Students' understanding of possible correct treatment strategies for depression improved. Students were appreciative of this true integration of basic sciences knowledge in a pharmacotherapy course and to have faculty members from both disciplines present to answer questions. Mean student score on the on depression module for the examination was 80.4%, indicating mastery of the content. CONCLUSIONS An exercise led by multiple instructors improved student perceptions of the importance of team-based teaching. Integrated teaching and learning may be achieved when instructors from multiple disciplines work together in the classroom using proven team-based, active-learning exercises.
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Affiliation(s)
- Srikanth Kolluru
- Rangel College of Pharmacy, Texas A & M Health Science Center, 1010 West Avenue B, Kingsville, TX 78363, USA.
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Okubo Y, Ishiguro N, Suganuma T, Nishikawa T, Takubo T, Kojimahara N, Yago R, Nunoda S, Sugihara S, Yoshioka T. Team-Based Learning, a Learning Strategy for Clinical Reasoning, in Students with Problem-Based Learning Tutorial Experiences. TOHOKU J EXP MED 2012; 227:23-9. [DOI: 10.1620/tjem.227.23] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Yumiko Okubo
- Department of Medical Education, Tokyo Women's Medical University
| | - Naoko Ishiguro
- Department of Dermatology, Tokyo Women's Medical University
| | - Taiyo Suganuma
- Department of Medical Education, Tokyo Women's Medical University
| | - Toshio Nishikawa
- Department of Surgical Pathology, Tokyo Women's Medical University
| | - Toshio Takubo
- Department of Respiratory Medicine, Tokyo Women's Medical University
| | | | - Rie Yago
- Department of Urology, Tokyo Women's Medical University
| | - Shinichi Nunoda
- Department of Medicine, Tokyo Women's Medical University Medical Center East
| | - Shigetaka Sugihara
- Department of Pediatrics, Tokyo Women's Medical University Medical Center East
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Pileggi R, O'Neill PN. Team-Based Learning Using an Audience Response System: An Innovative Method of Teaching Diagnosis to Undergraduate Dental Students. J Dent Educ 2008. [DOI: 10.1002/j.0022-0337.2008.72.10.tb04597.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Roberta Pileggi
- Department of Endodontics; College of Dentistry; University of Florida Health Science Center
- Department of Endodontics; University of Texas Health Science Center at Houston Dental Branch
| | - Paula N. O'Neill
- Department of Diagnostic Sciences; University of Texas Health Science Center at Houston Dental Branch
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