Introduction: We examined the interrelationships between context, mechanism, and outcome using a realist approach following the introduction of interprofessional education (IPE) to clinical practice for medical students in the community. Methods: Through participant observation and interviews, a working hypothesis was developed. To evaluate IPE in clinical practice, medical students' reports were thematically analyzed, and configuration on contexts, mechanisms, and outcomes were identified using a realist approach. Results: Influential contexts were medical students' experience of clinical practice and learning characteristics, the capacity of other professionals, interprofessional relationships, and characteristics of the community hospital. One key mechanism was observational learning. Others were self-regulated learning, legitimate peripheral participation, experiential learning, contact hypotheses, awareness of social structure, and cognitive empathy. As faculties supported these key mechanisms, medical students became aware of the legitimacy of community-oriented primary care, noting the roles of physicians who support patients' and/or their family's life in collaboration with other professionals, and reflecting the necessity of shifting from physician-centered perspectives. As a result, medical students deepened their empathic understanding for other professionals. Conclusion: Faculties should develop IPE programs in clinical practice based on the 'mechanism', 'context', 'outcome' pattern and 'context-mechanism-outcome' configuration in primary care settings.

Study DesignThe strength effects of a pedicle screw-rod system supplemented with a novel cross-link configuration were biomechanically evaluated in porcine spines.PurposeTo assess the biomechanical differences between a conventional cross-link pedicle screw-rod system versus a novel cross-link instrumentation, and to determine the effect of the cross-links.Overview of LiteratureTransverse cross-link systems affect torsional rigidity, but are thought to have little impact on the sagittal motion of spinal constructs. We tested the strength effects in pullout and flexion-compression tests of novel cross-link pedicle screw constructs using porcine thoracic and lumbar vertebrae.MethodsFive matched thoracic and lumbar vertebral segments from 15 porcine spines were instrumented with 5.0-mm pedicle screws, which were then connected with 6.0-mm rods after partial corpectomy in the middle vertebral body. The forces required for construct failure in pullout and flexion-compression tests were examined in a randomized manner for three different cross-link configurations: un-cross-link control, conventional cross-link, and cross-link passing through the base of the spinous process. Statistical comparisons of strength data were analyzed using Student's t-tests.ResultsThe spinous process group required a significantly greater pullout force for construct failure than the control group (p=0.036). No difference was found between the control and cross-link groups, or the cross-link and spinous process groups in pullout testing. In flexion-compression testing, the spinous processes group required significantly greater forces for construct failure than the control and cross-link groups (p<0.001 and p=0.003, respectively). However, there was no difference between the control and cross-link groups.ConclusionsA novel cross-link configuration that features cross-link devices passing through the base of the spinous processes increased the mechanical resistance in pullout and flexion-compression testing compared to un-cross-link constructs. This configuration provided more resistance to middle-column damage under flexion-compression testing than conventional cross-link configuration.

Background: Despite the increasing need for primary care physicians (PCPs) around the world, few physicians choose it as a career. PCPs who can find meaning and enjoyment in their work can be role models for medical students and professionals, which may encourage more physicians to specialize in primary care. We aimed to compare the kinds of work that Japanese PCPs who derive greater positive meaning from work engage in versus those who derive less positive meaning from work.Methods: This was a cross-sectional study that used self-administered questionnaires to ask Japanese PCPs about their basic characteristics and engagement in and enthusiasm for various types of work. The outcomes of the Japanese version of the work as meaning inventory (J-WAMI) were also assessed. Participants were divided into high-and low-scoring groups according to the median J-WAMI score, and logistic regression analysis was performed to identify factors related to the high J-WAMIscoring group.Results: A total of 268 out of 330 participants were included in the analysis. Males comprised 74.3%, and participants' average experience as a physician was 20.2 years.The median overall J-WAMI score was 38. Factors associated with the high J-WAMI scoring group were enthusiasm for outpatient care (OR: 1.04, 95%

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A 70-year-old man was referred to our clinic with a left inguinal mass. He had no complaints at the time of the examination except for the left inguinal mass. A physical examination revealed a soft, palpable mass in the left inguinal region without signs of inflammation. Abdominal computed tomography showed a cystic lesion that was not communicating with the abdominal cavity (Picture 1, 2, 3) and was compatible with iliopectineal bursa. Iliopectineal bursa is a rare cause of an inguinal mass. The differential diagnosis includes inguinal hernia, lymphoma, aneurysm of the femoral artery or vein, and iliopsoas abscess (1). It is commonly complicated with hip joint conditions, such as rheumatoid arthritis, osteoarthritis, and osteonecrosis (1). Patients diagnosed with iliopectineal bursitis are usually asked to rest and are prescribed analgesics. In cases with nerve or vessel compression, surgery is indicated (2). In the present case, we consulted with an orthopedic surgeon, who recommended observation on an outpatient basis. From this case, we learned that physicians should consider iliopectineal bursa as a possible cause of an inguinal mass.The authors state that they have no Conflict of Interest (COI).