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A Long-term Faculty Development Initiative Improves Specificity and Usefulness of Narrative Evaluations of Clerkship Students 长期教师发展倡议提高见习学生叙述性评价的特异性和有效性
Pub Date : 2022-09-01 DOI: 10.1212/ne9.0000000000200003
C. Mooney, S. Powell, Spencer Dahl, C. Eiduson, Benjamin Reinhardt, R. Stone
Narrative-based evaluations are increasingly used to discriminate between levels of trainee performance, yet barriers to high-quality narratives remain. Prior evidence shows mixed results regarding the effectiveness of faculty development efforts on improving narrative evaluation quality.We used a quasi-experimental study incorporating a historical control group to examine the effectiveness of a pragmatic, multipronged, 4-year faculty development initiative on narrative evaluation quality in a neurology clerkship. We evaluated narrative evaluation quality using the narrative evaluation quality instrument (NEQI) in random samples of narrative evaluations from a historical control and intervention group. We used multilevel modeling to compare NEQI scores (and subscale scores) across groups. Informed by the theory of deliberate practice, our faculty development initiative included (1) annual grand rounds sessions focused on developing high-quality narratives and reporting evaluation metrics, (2) restructuring the clerkship assessment form to simplify and prioritize narratives, (3) recruiting key faculty to rotate on the clerkship grading committee to gain experience with and practice developing quality narratives, and (4) instituting a narrative evaluation excellence award to faculty and residents.The faculty development initiative was associated with improvements in the quality of students' narrative evaluations. Specifically, the intervention group was a significant predictor of NEQI score, with means of 6.4 (95% CI 5.9–6.9) and 7.6 (95% CI 7.2–8.1) for the historical control and intervention groups, respectively. In addition, the intervention group was associated with significant improvement in the specificity and usefulness NEQI subscale scores, but not the performance domain subscale score.A long-term, multipronged faculty development initiative can facilitate improvements in narrative evaluation quality. We attribute these findings to 2 factors: (1) pragmatic, solution-oriented efforts that balance focused didactics with programmatic shifts that promote deliberate practice and skill improvement and (2) departmental resources that prioritize and convey a commitment to improving trainee assessment.
基于叙述的评估越来越多地用于区分受训者的表现水平,然而高质量叙述的障碍仍然存在。先前的证据表明,关于教师发展努力在提高叙事评估质量方面的有效性,结果好坏参半。我们采用了一项准实验研究,纳入了一个历史对照组,以检验一项实用的、多管齐下的、为期4年的教师发展计划对神经病学见习人员叙事评估质量的有效性。我们使用叙事评价质量工具(NEQI)对来自历史对照和干预组的叙事评价随机样本进行叙事评价质量评估。我们使用多层模型来比较各组NEQI分数(和子量表分数)。在刻意实践理论的指导下,我们的教师发展计划包括(1)年度大型会议,重点是发展高质量的叙述和报告评估指标;(2)重组见习评估表格,以简化和优先考虑叙述;(3)招募关键教师在见习评分委员会中轮换,以获得发展高质量叙述的经验和实践。(4)为教师和住院医师设立叙事评价优秀奖。教师发展倡议与学生叙事评价质量的提高有关。具体来说,干预组是NEQI评分的显著预测因子,历史对照组和干预组的平均值分别为6.4 (95% CI 5.9-6.9)和7.6 (95% CI 7.2-8.1)。此外,干预组在NEQI子量表的特异性和有用性得分上有显著改善,但在表现领域子量表得分上没有显著改善。一个长期的、多管齐下的教师发展计划可以促进叙事评估质量的提高。我们将这些发现归因于两个因素:(1)务实的、以解决方案为导向的努力,在重点教学与促进刻意练习和技能提高的计划性转变之间取得平衡;(2)部门资源优先考虑并传达了对改进学员评估的承诺。
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引用次数: 3
Education Research: Enhancing Medical Student Interest in Careers in the Clinical Neurosciences Through a Hands-on Procedure Workshop 教育研究:通过实践程序工作坊提高医学生对临床神经科学职业的兴趣
Pub Date : 2022-09-01 DOI: 10.1212/ne9.0000000000200010
Collin Sanderson, Khadijah Mazhar, Mark P. Goldberg, Shilpa Chitnis, Ryan Hays, Hina Dave
It is predicted that the current shortfall of neurologists will continue to grow beyond current training rates. It is well documented that medical students often possess stigmatizing beliefs toward neuroscience-based careers. Preclerkship medical education is where many medical students lay the foundation for specialty interests, and at some medical schools, it may be their only direct exposure to neurology. Providing preclerkship students with exp osure to the unique aspects of clinical neuroscience such as procedures is a possible avenue for increasing student interest.We sought to assess the influence of a procedure workshop on student specialty interest. We organized a hands-on procedure workshop for preclerkship medical students to learn examination skills and procedures used by adult/pediatric neurologists, neurosurgeons, and psychiatrists. Twelve different stations were run by faculty, trainees, and technicians. Attendance was optional, and students were free to move between stations according to their time and interests. Most stations involved some brief education and time for students to practice or take part in the procedure. Attendees completed an exit survey on their retrospective interest in the relevant specialties before attending the workshop, prospective interest after attending the workshop, and the helpfulness of each station in understanding the procedure. Statistical analyses were performed on the survey responses to determine change in specialty interest resulting from the workshop.A total of 111 students attended the workshop, and 104 (94%) filled out the postsurvey. Most were from the second-year medical student class. Approximately 41% of the second-year class attended. There was an increase in student interest (d= 0.6346) in the clinical neurosciences by the Fisher exact test (p< 0.0001). Thirty-three attendees (32%) reported an increased interest in the specialties. Of the students who reported having no prior interest in the clinical neuroscience specialties, 82% (18/22) had an increased interest as a result of the workshop.A hands-on procedure workshop improved medical student interest in the clinical neurosciences. Although its effect on future specialty choice is unclear, preclerkship experiences such as a procedure workshop may be a useful addition to medical school curricula to foster interest in neurology and the clinical neurosciences.
据预测,目前的神经科医生的短缺将继续增长超过目前的培训率。有充分的证据表明,医科学生经常对以神经科学为基础的职业抱有偏见。见习医学教育是许多医学生培养专业兴趣的基础,在一些医学院,这可能是他们唯一直接接触神经学的地方。为实习前的学生提供临床神经科学独特方面的经验,如程序,是提高学生兴趣的可能途径。我们试图评估程序工作坊对学生专业兴趣的影响。我们为实习医学生组织了一个实践程序研讨会,学习成人/儿童神经科医生、神经外科医生和精神科医生使用的检查技巧和程序。12个不同的站点由教师、实习生和技术人员管理。考勤是可选的,学生可以根据自己的时间和兴趣自由地在车站之间移动。大多数电台都有一些简短的教育和时间让学生练习或参与程序。与会者在参加研讨会前完成了一项关于他们对相关专业的回顾兴趣,参加研讨会后的预期兴趣以及每个工作站对理解程序的帮助的调查。对调查结果进行统计分析,以确定研讨会导致的专业兴趣的变化。共有111名学生参加了研讨会,其中104名(94%)填写了问卷。其中大多数是医学院二年级的学生。大约41%的二年级学生参加了。通过Fisher精确检验,学生对临床神经科学的兴趣有所增加(d= 0.6346) (p< 0.0001)。33名与会者(32%)表示对这些专业的兴趣有所增加。在报告之前对临床神经科学专业没有兴趣的学生中,82%(18/22)的学生由于研讨会而增加了兴趣。实践程序工作坊提高了医学生对临床神经科学的兴趣。虽然它对未来专业选择的影响尚不清楚,但诸如程序研讨会之类的实习经验可能是医学院课程的有益补充,可以培养对神经病学和临床神经科学的兴趣。
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引用次数: 3
Education Research: Bridging the Undergraduate Neurosciences With Clinical Neurology 教育研究:衔接本科神经科学与临床神经学
Pub Date : 2022-09-01 DOI: 10.1212/ne9.0000000000200005
M. Minen, Sangida Akter, Mariana Espinosa-Polanco, R. Ramos
There is a significant shortage of neurologists in the United States, and this shortage is projected to worsen considerably. With the growth of undergraduate neuroscience majors, there may be opportunities to engage and motivate undergraduate students interested in the neurosciences toward clinical neurology. We surveyed undergraduate neuroscience faculty to better understand their curricular goals, existing interaction with neurologists, and their desire for additional connections with clinical neurologists and clinical neurology researchers. We invited 523 undergraduate neuroscience faculty (members of Faculty for Undergraduate Neuroscience) to complete an online survey assessing their research areas, courses taught, existing professional networks, and interest in developing connections in clinical neurology/neurology research. We had 140 of the 523 neuroscience faculty (26.8%) complete the survey. Of the 140 respondents, most respondents (93.6%, 131/140) stated their courses included a discussion about neurologic conditions, yet only 4% (6/139) stated addressing the shortage of neurologists in the country. Few reported they were able to partake in professional development opportunities for shadowing neurologists, neurosurgeons, or similar specialists prior to teaching neuroscience courses (19%, 26/140). Understanding neuroscience faculty's perspectives on how to bridge undergraduate neuroscience programs and the field of neurology is critical. This way, we can identify potential gaps and make recommendations for how to improve the neurology pipeline.
美国的神经科医生严重短缺,而且这种短缺预计会严重恶化。随着神经科学本科专业的增长,可能有机会吸引和激励对神经科学感兴趣的本科生走向临床神经病学。我们调查了本科神经科学教师,以更好地了解他们的课程目标,与神经学家的现有互动,以及他们与临床神经学家和临床神经学研究人员的额外联系的愿望。我们邀请了523名神经科学本科教师(神经科学本科学院的成员)完成一项在线调查,评估他们的研究领域、教授的课程、现有的专业网络以及在临床神经病学/神经病学研究中发展联系的兴趣。我们让523名神经科学教师中的140名(26.8%)完成了调查。在140名受访者中,大多数受访者(93.6%,131/140)表示他们的课程包括关于神经系统疾病的讨论,但只有4%(6/139)表示解决了该国神经科医生的短缺问题。很少有人报告说,在教授神经科学课程之前,他们能够参加神经学家、神经外科医生或类似专家的专业发展机会(19%,26/140)。了解神经科学教师对如何将本科神经科学课程与神经学领域联系起来的观点至关重要。通过这种方式,我们可以确定潜在的差距,并就如何改善神经学管道提出建议。
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引用次数: 3
The First Issue 第一期
Pub Date : 2022-09-01 DOI: 10.1212/ne9.0000000000200009
R. Strowd
The fi rst issue of Neurology ® Education is here. The journal publishes original research articles, curriculum innovations, and evidence-based teaching in neurologic education across all stages of training. Since launching in April, the journal has received numerous important papers on educational scholarship in the clinical neurosciences. Articles are published online continuously allowing rapid dissemination for authors. To facilitate reading, articles are assembled periodically into issues and are arranged thematically to engage readers and organize content around common themes. In this issue, readers will fi nd articles arranged thematically in 3 areas: (1) novel approaches to teaching clinical neurology with a focus on curricular lessons learned from the coronavirus disease 2019 (COVID-19) pandemic, (2) narrative evaluations and how a faculty development program can improve narrative assessment of medical students, and (3) innovative curricula that enhance the pipeline of students pursuing careers in clinical neuroscience.
第一期神经学®教育在这里。该杂志在神经学教育的各个阶段发表原创研究文章、课程创新和循证教学。自4月份创刊以来,该杂志已经收到了许多关于临床神经科学教育奖学金的重要论文。文章连续在线发布,为作者提供快速传播。为了方便阅读,文章定期组合成问题,并按主题排列,以吸引读者,并围绕共同的主题组织内容。在这期杂志中,读者将发现三个主题领域的文章:(1)临床神经学教学的新方法,重点是从2019冠状病毒病(COVID-19)大流行中吸取的课程教训,(2)叙事评估以及教师发展计划如何改善医学生的叙事评估,以及(3)创新课程,加强学生在临床神经科学领域的职业发展。
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引用次数: 1
Curriculum Innovations: Creation of a Longitudinal, Neurology-Centered Pipeline Program to Motivate and Support Students From Racial/Ethnically Marginalized Groups 课程创新:创建一个纵向的,以神经病学为中心的管道项目,以激励和支持来自种族/民族边缘群体的学生
Pub Date : 2022-09-01 DOI: 10.1212/ne9.0000000000200007
Shane Fuentes, R. Salas, Olivia S. Brumfield, R. Stone
Premedical students who identify from historically marginalized racial and ethnic backgrounds are more likely to lose interest in medicine than their White counterparts. Loss of interest has been attributed to a lack of exposure to the field and little mentorship.The PreDoc Program was designed as a longitudinal experience to promote exposure to and interest in academic medicine, particularly through the lens of neurology for premedical students who identify from historically marginalized racial and ethnic backgrounds.The program included the following core components: (1) senior (faculty) mentor to facilitate direct contact with a physician, networking, and professional development coaching; (2) junior (medical student) mentor to provide near peer support and increased knowledge of the medical school application process; (3) large group meetings aimed at teaching professional development and working through clinical problem-based learning; (4) shadowing experiences aimed at increasing knowledge of patient care delivery and other academic roles; and (5) a clinically oriented project. After initial grant support to create the program, it has been maintained successfully with minimal funding through the Department of Neurology.The program recruited 29 student participants who completed at least 1 year of the program, 18 senior mentors, and 23 junior mentors over 4 academic years. The overall quality of the program was rated at 4.7 of 5 (median 5, range 2), with an upward trend seen over time. Over its first 2 years, the program facilitated the following estimated activities: 45 in-person senior mentor meetings, 27 in-person junior mentor meetings, 42 shadowing experiences, 60 large group meetings, and 360 email communications. Student-reported strengths included ease of shadowing, usefulness of problem-based learning cases, mentor relationships, and encouragement received. Areas for improvement included increasing the strength of junior mentor relationships and increased opportunities for socialization outside of the formal meetings.It is feasible to create a successful, longitudinal, clinically focused undergraduate pipeline program for students who identify with historically minoritized racial and ethnic backgrounds with minimal funding centered in a Department of Neurology to help promote diversity within the field.
那些历史上被边缘化的种族和民族背景的医学预科学生比白人学生更有可能对医学失去兴趣。失去兴趣的原因是缺乏对该领域的接触和很少的指导。pre - doc项目被设计为一种纵向体验,以促进对学术医学的接触和兴趣,特别是通过神经病学的视角,为那些历史上被边缘化的种族和民族背景的医学预科学生提供帮助。该计划包括以下核心组成部分:(1)高级(教师)导师,以促进与医生的直接联系,网络和专业发展指导;(2)大三(医学生)导师提供近同伴支持,增加对医学院申请流程的了解;(3)大型小组会议,旨在通过临床问题为基础的学习来教授专业发展和工作;(4)旨在增加患者护理服务知识和其他学术角色的实习经验;(5)临床导向项目。在最初的拨款支持下创建了这个项目,它通过神经病学部门成功地维持了最少的资金。该项目招募了29名完成至少1年课程的学生,18名高级导师和23名超过4学年的初级导师。该计划的整体质量被评为4.7分(中位数5分,范围2分),随着时间的推移呈上升趋势。在最初的两年里,该项目促进了以下活动:45次面对面的高级导师会议、27次面对面的初级导师会议、42次影子体验、60次大型小组会议和360次电子邮件交流。学生报告的优势包括容易跟随,基于问题的学习案例的有用性,导师关系,以及得到的鼓励。需要改进的领域包括加强初级导师之间的关系,增加正式会议之外的社交机会。以神经病学为中心,以最少的资金为中心,为具有历史上少数种族和民族背景的学生创建一个成功的,纵向的,以临床为重点的本科管道项目是可行的,以帮助促进该领域的多样性。
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引用次数: 3
Pictorial Review of Lesion Localization for Patients With Stroke, Upper Limb and Lower Limb Pathology 脑卒中患者病变定位、上肢和下肢病理的影像回顾
Pub Date : 2022-09-01 DOI: 10.1212/ne9.0000000000200012
S. Lyon
Localization is a foundational skill in clinical neuroscience and a vital aspect of teaching and learning for students and educators. Stroke syndromes, brachial plexus injury, and lumbosacral nerve pathology are among some of the most challenging clinical scenarios for learners to understand and master. The 3 images in this article are teaching tools for learners and teachers in clinical neuroscience. The “ Vascular Localization of Stroke ” image is a reference tool for learning cerebrovascular anatomy and the e ff ect of a cerebrovascular accident, according to the location of the lesion. The “ Upper Limb Pathology ” and “ Lower Limb Pathology ” images are handout tools for learning how lesions to peripheral nerves or spinal nerve roots present with sensory and/or motor de fi cits.
定位是临床神经科学的一项基本技能,也是学生和教育工作者教与学的重要方面。中风综合征、臂丛损伤和腰骶神经病理是学习者最难理解和掌握的临床情景。这篇文章中的3个图像是临床神经科学学习者和教师的教学工具。“中风血管定位”图像是学习脑血管解剖学和根据病变位置判断脑血管意外影响的参考工具。“上肢病理”和“下肢病理”图像是了解周围神经或脊神经根病变如何表现为感觉和/或运动缺陷的讲义工具。
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引用次数: 1
Curriculum Innovations: Virtual Didactics as a Tool for Harmonizing Education About Rare Topics in Neuroimmunology 课程创新:虚拟教学作为协调神经免疫学罕见主题教育的工具
Pub Date : 2022-09-01 DOI: 10.1212/ne9.0000000000200008
J. Peters, Jeffrey A. Cohen, J. Corboy, S. Hopkins, L. Hua, Mihir Kakara, Derek McFaul, A. Obeidat, V. Yadav, E. Longbrake
Neuroimmunology is a rapidly evolving subspecialty. At this time, fellowship training is not standardized. Discrepancies exist in fellowship programs across the United States, including in faculty expertise in rarer neuroimmunologic conditions. Many graduating fellows feel uncomfortable managing the full spectrum of diseases within neuroimmunology.To evaluate the feasibility and efficacy of a series of live, virtual, interinstitutional seminars educating neuroimmunology fellows on topics that may be infrequently encountered by trainees.A steering committee of 6 neuroimmunology and multiple sclerosis fellowship program directors selected 18 topics felt to be high yield but representing unique areas of expertise. A live, interactive seminar series was organized. Recognized experts on each topic led seminars using a teleconferencing platform over the 2020–2021 academic year. Recordings were subsequently made available for asynchronous learning. Trainees were surveyed before and after the seminar series and comfort levels with each topic were recorded.An average of 41 trainees participated in each live seminar and an additional average of 17 trainees viewed each seminar on demand. Trainee comfort levels with each topic increased after the seminar series was completed. An average of 72% of trainees self-identified as at least “comfortable” with each topic after the series compared with 26% beforehand (p< 0.0001).A year-long series of live, interactive, interinstitutional seminars focusing on unique topics within a single subspecialty represents an effective way to increase trainee comfort levels with such topics.
神经免疫学是一个快速发展的亚专科。此时,研究金培训不规范。美国各地的奖学金项目存在差异,包括在罕见的神经免疫疾病方面的教师专业知识。许多毕业生在处理神经免疫学领域的各种疾病时感到不自在。评估一系列现场、虚拟、机构间研讨会的可行性和有效性,这些研讨会对神经免疫学研究员进行培训,培训学员可能很少遇到的主题。由6名神经免疫学和多发性硬化症奖学金项目主任组成的指导委员会选择了18个高收益但代表独特专业领域的主题。组织了一个现场互动的系列研讨会。在2020-2021学年,每个主题的公认专家使用电话会议平台主持研讨会。录音随后提供给异步学习。在研讨会前后对学员进行了调查,并记录了对每个主题的适应程度。平均有41名受训者参加了每次现场讨论会,另外平均有17名受训者按需观看了每次讨论会。研习班结束后,学员对每个主题的适应程度都有所提高。平均72%的受训者在培训结束后对每个主题至少感到“舒服”,而在此之前,这一比例为26% (p< 0.0001)。为期一年的现场、互动、跨机构研讨会,专注于单个子专业内的独特主题,是提高学员对这些主题的适应程度的有效途径。
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引用次数: 2
Curriculum Innovations: How Real Is Real Enough? 课程创新:多真实才算真实?
Pub Date : 2022-09-01 DOI: 10.1212/ne9.0000000000200004
Catherine Albin, E. Petrusa, James A. Gordon, Deepa Malaiyandi, Sahar F. Zafar
Simulation training has been increasingly adopted in neurology as an engaging way to promote active learning in a safe environment while offering a reproducible platform for real-time feedback. However, despite the increase in simulation programs, there remains uncertainty about which type of high-fidelity platform would best promote trainee knowledge and confidence acquisition. The objective of this study is to investigate whether increases in resident knowledge and confidence differ when a simulation course for acute neurology emergencies uses a standardized patient vs a manikin-video format. We also investigated trainees' management deviations from the treatment guidelines.Over 5 sessions, 20 junior neurology residents participated in a simulation training course in which they managed 3 neurologic emergencies: right middle cerebral artery stroke, status epilepticus, and pontine hemorrhage causing coma. Residents in the standardized patient group interacted with a live actor for the cases in which the patient was conscious. Residents in the manikin-video group interacted with a manikin for all 3 cases. Before and after the course, residents completed a 40-question multiple-choice test and a survey about their self-perceived confidence in handling 15 neurologic emergencies. To create an element of internal validity, 9 items were represented in the course curriculum and 6 were not. During the simulation, a detailed behavior checklist was used to assess decision-making and guideline adherence. All residents answered items about the educational quality of the simulation sessions.Residents had significantly higher scores on the knowledge assessment after the training session (pre: 49% vs post: 72%,p< 0.001, effect size 91%). There was no statistically significant difference between the 2 groups—each increasing 23% (p= 0.977). Regardless of group assignment, the median self-reported confidence score improved by 1 point on a Likert scale across the topics taught in the course. The behavior checklist demonstrated significant variations in treatment practices and provided targeted areas for feedback and teaching.This pilot study suggests that trainees' knowledge and confidence in the management of neurologic emergencies increase after simulated encounters, regardless of whether a live actor or manikin simulation platforms is used. The use of a behavior checklist uncovered important variations in guideline adherence among novice physicians.
神经学越来越多地采用模拟训练作为在安全环境中促进主动学习的一种有吸引力的方式,同时为实时反馈提供了一个可复制的平台。然而,尽管模拟项目有所增加,但仍不确定哪种类型的高保真平台最能促进学员的知识和信心获取。本研究的目的是调查急性神经紧急情况模拟课程使用标准化患者与人体模型视频格式时,住院医师知识和信心的增加是否有所不同。我们还调查了学员对治疗指南的管理偏差。20名初级神经内科住院医师参加了5次模拟培训课程,在此课程中,他们处理了3种神经急症:右大脑中动脉中风、癫痫持续状态和脑桥出血引起的昏迷。标准化病人组的住院医生在病人有意识的情况下与真人演员互动。人体模型视频组的居民在这三种情况下都与人体模型进行了互动。在课程之前和之后,住院医生完成了一项40道选择题的测试和一项关于他们在处理15个神经紧急情况时的自我认知信心的调查。为了创造一个内部效度的元素,课程课程中有9个项目,6个没有。在模拟过程中,使用详细的行为检查表来评估决策和指南遵守情况。所有住院医师都回答了有关模拟课程教学质量的问题。住院医师在培训后的知识评估得分显著提高(培训前:49% vs培训后:72%,p< 0.001,效应量91%)。两组间差异无统计学意义,均增加23% (p= 0.977)。无论小组分配如何,自我报告的自信得分中位数在课程所教主题的李克特量表上提高了1分。行为检查表显示了治疗实践的显著差异,并提供了有针对性的反馈和教学领域。这项初步研究表明,无论是使用真人演员还是人体模拟平台,学员在模拟遭遇后,对神经系统紧急情况管理的知识和信心都有所增加。行为检查表的使用揭示了新手医生在指南依从性方面的重要变化。
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引用次数: 3
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Neurology: Education
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