The T.H. Chan School of Medicine at UMass Chan Medical School was founded in 1962 with the mission to advance the health and well-being of the people of the Commonwealth and beyond through pioneering education, research, and health care delivery. This collection showcases journal articles, posters, presentations and other publications authored by medical students at UMass Chan. See also the collections for specific programs listed on the T.H. Chan School of Medicine community page.


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Recently Published

  • Francis Fontan (1929-2018): Pioneer pediatric cardiac surgeon

    Huynh, Elisah; Chernick, Rebecca E.; Desai, Manisha S. (2022-09-07)
    Up until the mid-1900s, tricuspid atresia - a birth defect of the tricuspid valve, was once categorized as a "death sentence." The challenge of achieving positive health outcomes for affected patients was compounded by a hesitancy to operate on children. The main concern was safely administering anesthesia to young patients who were going through a strenuous operation that was often poorly tolerated. Despite these assumed limitations, Francis Fontan, a pediatric cardiothoracic surgeon at the Hospital of Tondu in Bordeaux, was able to redirect blood flow from the superior and inferior vena cava to the pulmonary arteries in 1971, which elucidated the process of advancing clinical practice in medicine. With the support of mentors and a firm belief in this new technique, Fontan pioneered his eponymous procedure and ultimately paved the way for modern cardiovascular surgical techniques that helped to prolong the life of those with single functioning ventricles. The aim of this study is to examine the genesis and the evolution of the Fontan procedure to elucidate the process of advancing clinical practice in medicine by utilizing personal interviews, Fontan's works, associated primary and secondary sources in the context of 20th century cardiothoracic surgery and innovations.
  • COVID-19: a gray swan's impact on the adoption of novel medical technologies

    Dunlap, Denise; Santos, Roberto S.; Lilly, Craig M.; Teebagy, Sean; Hafer, Nathaniel S.; Buchholz, Bryan O.; McManus, David D. (2022-07-08)
    The COVID-19 pandemic offers a unique context and opportunity to investigate changes in healthcare professional perceptions towards the adoption of novel medical technologies, such as point-of-care technologies (POCTs). POCTs are a nascent technology that has experienced rapid growth as a result of COVID-19 due to their ability to increase healthcare accessibility via near-patient delivery, including at-home. We surveyed healthcare professionals before and during COVID-19 to explore whether the pandemic altered their perceptions about the usefulness of POCTs. Our network analysis method provided a structure for understanding this changing phenomenon. We uncovered that POCTs are not only useful for diagnosing COVID-19, but healthcare professionals also perceive them as increasingly important for diagnosing other diseases, such as cardiovascular, endocrine, respiratory, and metabolic diseases. Healthcare professionals also viewed POCTs as facilitating the humanization of epidemiology by improving disease management/monitoring and strengthening the clinician-patient relationship. As the accuracy and integration of these technologies into mainstream healthcare delivery improves, hurdles to their adoption dissipate, thereby encouraging healthcare professionals to rely upon them more frequently to diagnose, manage, and monitor diseases. The technological advances made in POCTs during COVID-19, combined with shifting positive perceptions of their utility by healthcare professionals, may better prepare us for the next pandemic.
  • Henry Jacob Bigelow (1818-1890): A champion for anesthesia and catalyst for the advancement of surgery

    Makris, Elizabeth M.; Makhoul, Kevin G.; Lee, Terence B. Jr.; Desai, Manisha S. (2022-01-20)
    Prior to the advent of anesthesia, surgery was limited in scope due to the excruciating pain experienced by patients. This raised challenges for surgeons who were distressed by the inadvertent suffering caused by surgery. The first successful use of ether anesthesia by William Thomas Green Morton (1819–1868) in 1846 at Massachusetts General Hospital was a turning point for the profession. The innovation and proliferation of operations catalyzed by the introduction of anesthesia altered the landscape of surgical practice. Initially, the introduction of ether into the field was met with hesitation and resistance by several parties in the medical field. It took the efforts of prominent surgeons to ensure that ether achieved its full potential. The greatest supporter of ether during this epoch was the young surgeon Henry Jacob Bigelow (1818–1890), who spent 30 years of his career advocating for and experimenting with anesthesia. The efforts of Bigelow, a gifted surgeon renowned for his contributions to orthopedic surgery, were instrumental in the promotion of anesthesia and the advancement of the surgical profession. In this article, we discuss the life, career, and contributions of Bigelow, particularly in the context of the introduction of modern anesthesia.
  • Dataset from: COVID-19: A Gray Swan’s Impact on the Adoption of Novel Medical Technologies

    Dunlap, Denise; Santos, Roberto S.; Lilly, Craig M.; Teebagy, Sean; Hafer, Nathaniel S.; Buchholz, Bryan O.; McManus, David D. (eScholarship@UMassChan, 2021-12-20)
    This dataset is used to examine how the COVID-19 pandemic has shifted many providers and patient perspectives related to healthcare and offers an opportunity to investigate potential changes in provider perceptions towards the adoption of novel point-of-care technologies (POCTs).
  • Pediatric basal cell carcinoma burden and management preferences in Gorlin syndrome: A survey study

    Neale, Holly; Breneiser, Julie A.; Hawryluk, Elena B. (2021-12-01)
    Gorlin syndrome (GS) is a risk factor for early basal cell carcinomas (BCCs), although its prevalence of fewer than 1 in 30,000 individuals limits existing literature. There are sparse pediatric GS studies beyond case reports, creating a knowledge gap regarding childhood cutaneous findings and sequelae, including BCC age at onset, quantity, treatments, and impact. Herein, we describe a global survey to illustrate the clinical presentation, childhood perspectives, and BCC management trends for pediatric GS to improve the understanding and inform patient care.
  • Topical 5% 5-fluorouracil versus procedural modalities for squamous cell carcinoma in situ and superficial basal cell carcinoma: A retrospective cohort analysis

    Neale, Holly; Michelon, Melissa; Jacob, Susan; Pinkston, Mary; Ukaegbu, Rebecca; Zamor, Waldo; Morrison, Emily; Deng, April; Levin, Nikki A. (Mosby, 2021-08-31)
    The topical chemotherapeutic agent 5-fluorouracil (5-FU) is commonly used to treat squamous cell carcinoma in situ (SCCIS) and superficial basal cell carcinoma (sBCC). Additional investigation is needed to understand whether topical 5-FU, under real-world conditions, has comparable treatment success to procedures for epidermally-limited keratinocyte carcinomas. Approval was obtained from the University of Massachusetts Medical School institutional review board to perform a retrospective chart review.
  • 2020 Hindsight

    Wada-Gill, Bronwyn; Hansen, Megan (2021-01-21)
    Bronwyn Wada-Gill and Megan Hansen, University of Massachusetts Medical School (UMMS) students in the Class of 2022, solicited creative works to commemorate the year 2020 through looking back. The 2020 Hindsight website explores the words, music, and photography that came from the collective hearts of the UMMS community.
  • Using Multisensory Haptic Integration to Improve Monitoring in the Intensive Care Unit

    Burdick, Kendall J.; Bell, Abigail S.; McCoy, Mary C.; Samuels, Jonathan L.; Jolly, Alex S.; Patal, Seema S.; Balas, Julia B.; Patten, K. Jakob; Schlesginer, Joseph J. (2020-06-04)
    Introduction: Alarm fatigue and medical alarm mismanagement reduces the quality of patient care and creates stressful work environments for clinicians. Here, the feasibility of a novel “prealarm” system that utilizes multisensory integration of auditory and haptic stimuli is examined as a possible solution. Methods: Three vital signs (heart rate, blood pressure, and blood oxygenation) were represented by three musically distinct sounds that were combined into soundscapes and progressed through five pre-alarm zones (very low to very high). Three haptic conditions were tested with the auditory stimulus to determine the best combination of auditory and haptic stimulation. Qualitative data was collected through surveys and the NASA TLX index Results: Alterations in frequency and timbre were most effective at transmitting information regarding changing vital sign zones with comparatively higher accuracy and quicker reaction time (RT), p < .01. The addition of haptic stimuli to the auditory soundscape caused no significant decline in study participant accuracy or RT. However, two weeks after training, participants performed the tasks significantly faster ( p < .001) and felt the alarm monitoring task was significantly less cognitively demanding ( p < .01), compared to the unisensory condition. Participants also felt more confident in identifying changing vital signs with the addition of haptic stimuli. Discussion: The current study demonstrates that multisensory signals do not diminish the perception of transmitted information and suggest efficient training benefits over unimodal signals. Multisensory training may be beneficial over time compared to unisensory training due to a stronger consolidation effect. The potential integration of haptic input with existing auditory alarm systems and training is supported.
  • Sleeping Soundlessly in the Intensive Care Unit

    Burdick, Kendall J.; Callahan, Christine J. (2020-03-01)
    An estimated 70% of patients who have been in the Intensive Care Unit (ICU) experience some form of Post-Intensive Care Syndrome (PICS). As a stressful environment, the ICU can be traumatic for any patient; however, the disruption of sleep experienced by patients in ICU negatively impacts their mental status and recovery. One of the most significant contributors to sleep disruption is the constant blare of monitor alarms, many of which are false or redundant. Through multisensory approaches and procedural redesign, the hostile acoustic environment of the ICU that causes so many to suffer from PICS may be alleviated. In this paper, we present suggestions for improving the ICU acoustic environment to possibly reduce the incidence of post-ICU complications such as PICS.
  • SAVIOR ICU: sonification and vibrotactile interface for the operating room and intensive care unit

    Burdick, Kendall J.; Jorgensen, Seiver K.; Combs, Taylor N.; Holmberg, Megan O.; Kultgen, Samantha P.; Schlesinger, Joseph J. (2019-08-27)
    Alarm fatigue is an issue for healthcare providers in the intensive care unit, and may result from desensitization of overbearing and under-informing alarms. To directly increase the overall identification of medical alarms and potentially contribute to a downstream decrease in the prevalence of alarm fatigue, we propose advancing alarm sonification by combining auditory and tactile stimuli to create a multisensory alarm. Participants completed four trials-two multisensory (auditory and tactile) and two unisensory (auditory). Analysis compared the unisensory trials to the multisensory trials based on the percentage of correctly identified point of change, direction of change and identity of three physiological parameters (indicated by different instruments): heart rate (drums), blood pressure (piano), blood oxygenation (guitar). A repeated-measures of ANOVA yielded a significant improvement in performance for the multisensory group compared to the unisensory group (p < 0.05). Specifically, the multisensory group had better performance in correctly identifying parameter (p < 0.05) and point of change (p < 0.05) compared to the unisensory group. Participants demonstrated a higher accuracy of identification with the use of multisensory alarms. Therefore, multisensory alarms may relieve the auditory burden of the medical environment and increase the overall quality of care and patient safety.
  • This Is My Body

    Norman, Kathryn E. (American Medical Association, 2018-08-07)
    In this narrative medicine essay, a medical student is reminded of Communion service at her New England Protestant church when she sees the beauty of the human anatomy in a cadaver, a former teacher who offered her body as the ultimate teaching moment, in an echo of Jesus’ words at the Last Supper: “This is my body, broken for you. Do this in memory of me.”
  • Prehabilitation for Shoulder Dysfunction in Breast Cancer

    Reynolds, Sara-Grace; Baima, Jennifer; Waugh, Debra; Woo, Lauren; Sooy, John; Larkin, Anne C.; Ward, B. Marie; Edmiston, Kathryn (2015-10-01)
    Objective: To evaluate prehabilitation exercises to improve shoulder pain and abduction range of motion (ROM) after breast cancer surgery; to evaluate methods of exercise teaching; to assess postsurgical seroma formation. Design: Pilot study Setting: Academic medical center Participants: 60 breast cancer patients were randomly assigned to either personal exercise instruction, group 1, n=36, or video only instruction, group 2, n=24. Interventions: Shoulder exercises were assigned to both groups 1 month prior to surgery at an outpatient visit. Group 1 received personal instruction on exercises, plus written exercise instruction, and a link to access an online video. Group 2 received only written exercise instruction and a link to access the online video. Main Outcome Measures: Exercise compliance, pain (via visual analog scale), shoulder abduction ROM (via goniometer), and presence or absence of seroma. Results or Clinical Course: 76% of study patients chose to exercise. There was no difference in exercise compliance between personal instruction versus video teaching. (75%, 24/32 in-person vs. 77%, 10/13 video only, OR=1.03). 66% of patients (20/30) lost greater than 10 degrees shoulder abduction ROM at 1 month post surgery. 29% of patients (9/31) had worse shoulder pain at one month post surgery than at baseline (24%, 6/25 exercisers, and 50%, 3/6 non-exercisers). 15% of patients (4/27) had worse shoulder pain at 3 months post surgery than at baseline (8%, 2/25 exercisers, and 100%, 2/2 non-exercisers). Prehabilitation exercise program inferred no additional risk of seroma formation (21%, 7/33 exercisers vs. 22%, 2/9 non-exercisers OR=.94). Conclusion: In-person teaching does not appear superior to video teaching for prehabilitation exercises in breast cancer. A high quality randomized controlled trial is necessary to assess efficacy of prehabilitation for improving post surgical outcomes. Prehabilitation exercises do not appear to increase risk of seroma formation in breast cancer surgery.
  • Is secondhand smoke exposure associated with increased exacerbation severity among children hospitalized for asthma?

    Andrews, Annie L.; Shirley, Nils; Ojukwu, Elizabeth; Robinson, Michelle; Torok, Michelle; Wilson, Karen M. (2015-05-01)
    OBJECTIVE: To determine the association between secondhand smoke (SHS) exposure and length of stay (LOS) and other exacerbation severity indicators in children hospitalized for asthma. METHODS: We conducted a retrospective chart review at 2 children's hospitals. Patients aged 2 to 18 hospitalized for asthma in 2012 were included. Outcome variables included LOS, PICU, magnesium, and intravenous (IV) steroids. Bivariate analysis determined differences between SHS-exposed and non-SHS-exposed groups. Geometric means were used for LOS to account for skewed distribution. Logistic and zero-truncated negative binomial regression models were used to determine the independent association between SHS exposure and hospitalization severity indicators. RESULTS: A total of 623 patients were included; 41% reported SHS exposure. Mean LOS was 47.5 hours. In the SHS-exposed group, LOS was 50.0 (95% confidence interval [CI] 46.7-54.0) and in the nonexposed group it was 45.8 (95% CI 43.4-48.4) (P = .02). In regression analysis, institution modified the effect of SHS exposure on LOS. At Children's Hospital Colorado, SHS exposure was associated with a 20% increase in LOS (incidence rate ratio 1.2, 95% CI 1.1-1.3). At the Medical University of South Carolina, there was no significant association. SHS-exposed patients were more likely to receive IV steroids (odds ratio 1.6, 95% CI 1.1-2.3). CONCLUSIONS: Among children hospitalized for asthma, we identified a significant association at 1 institution between SHS exposure and LOS and found that IV steroid use was significantly associated with LOS at both institutions. Eliminating SHS exposure among children with asthma is important.
  • Prehabilitation Before Lumpectomy Can Prevent Loss of Range of Motion

    Omer, Zehra B.; Baima, Jennifer (2015-03-01)
    Case Diagnosis: On intake exam, patient reported twenty year history of shoulder pain and history of bilateral subacromial bursitis . On the day of the exam, she rated her left shoulder pain (ipsilateral to breast cancer) at 2/10. Physical exam showed tenderness over left subacromial bursa, pain with resisted shoulder abduction and external rotation and ROM limited 120 degrees or less bilaterally. Case Description: Here, we report the case of a 73 year old woman with a 20 year history of bilateral subacromial bursitis and left shoulder pain who began an independent daily shoulder exercise regimen as instructed by a physiatrist 2.5 weeks prior to left sided lumpectomy for breast cancer, and continued the exercises following the operation. One month post-surgery, physical exam revealed no loss in range of motion (ROM) in flexion and abduction of the left and right shoulders. Patient reported intermittent pain, manageable with NSAIDs, which started only after tamoxifen use. Discussion: Decline in physical functioning such as loss of ROM, decreased strength, and pain following surgery for breast cancer is a well-documented phenomenon associated with difficulties in performing activities of daily living (ADL). Studies have shown that rehabilitation interventions during treatment period following breast cancer surgery result in improvements in shoulder and arm function; however, no study to date investigated the effectiveness of interventions initiated before surgery (prehabilitation) for breast cancer. Conclusions: A daily exercise regimen prior to and following lumpectomy for breast cancer may prevent the development of shoulder dysfunction that is often reported in the cancer treatment period.
  • Early hospital readmission of nursing home residents and community-dwelling elderly adults discharged from the geriatrics service of an urban teaching hospital: patterns and risk factors

    Bogaisky, Michael; Dezieck, Laurel (2015-03-01)
    OBJECTIVES: To compare rates and risk factors for early hospital readmission for nursing home residents and community-dwelling older adults. DESIGN: Retrospective cohort study. SETTING: Geriatric inpatient service at a large urban hospital. PARTICIPANTS: Nursing home residents (n=625) and community-dwelling individuals (n=413) aged 65 and older admitted over a 1-year period. MEASUREMENTS: Thirty-day readmissions. RESULTS: There were 1,706 hospital admissions within the 1-year study period involving 1,038 individuals. The 30-day readmission rate was higher for subjects discharged to a nursing home than those discharged to the community (34.4% vs 22.6%, P < .001). Chronic kidney disease and pressure ulcers were associated with greater risk of readmission in both groups. Chronic obstructive pulmonary disease was a risk factor for readmission only in community-dwelling individuals. Congestive heart failure and dementia were associated with greater risk of readmission only in nursing home residents. Readmission rates varied between individual nursing homes by more than a factor of 2. Risk of readmission was 30% lower in nursing home residents cared for by hospitalist than nonhospitalist geriatricians. CONCLUSION: Higher rates of hospital readmission for individuals discharged to nursing homes than to the community and differing patterns of risk factors for readmission indicate the importance of customized interventions to reduce readmission rates for two distinct elderly populations.
  • PedsQL correlates to PODCI in pediatric orthopaedic outpatient clinic

    Mahan, Susan T.; Kalish, Leslie A.; Connell, Patricia L.; Harris, Marie; Abdul-Rahim, Zainab; Waters, Peter (2014-09-01)
    PURPOSE: Quality-of-life (QOL) measures can be a valuable tool to assess the general welfare across a spectrum of patients in a pediatric orthopaedic outpatient clinic and can be a simple way to assess patient-based outcomes particularly for quality initiatives. The Pediatric Outcomes Data Collection Instrument (PODCI) is validated for many orthopaedic conditions but typically takes around 20 minutes to complete (86 questions). The Pediatric Quality of Life Inventory (PedsQL) takes < 4 minutes to complete (23 questions) but has not been assessed in an orthopaedic setting. We initiated this study to find the best method for assessing QOL in our outpatient clinic. A short pediatric QOL measure that is correlated to an established orthopaedic-specific QOL measure is needed; therefore, we compared the PedsQL to the PODCI in the outpatient orthopaedic clinic. METHODS: This was a quality initiative project and as such did not require a priori IRB approval. Families of patients 2 to 18 years old who presented for follow-up after upper or lower extremity fractures or brachial plexus injuries in the orthopaedic clinic from October 2010 through August 2011 were asked to fill out both the PODCI and the PedsQL. Patients aged 5 years and older filled out a patient-report PedsQL; patients aged 11 years and older filled out the patient-report PODCI. Parents/guardians completed questionnaires for children of all ages. Most fracture patients (and/or their parent/guardian) repeated the questionnaires after 6 to 12 weeks. Data were then assessed for correlation between the PODCI and PedsQL. RESULTS: A total of 428 parent/guardian reports for 283 patients and 172 self-reports for 104 patients were included. The correlation between the PODCI Global score and the PedsQL Total score for the parent/guardian-reported questionnaires for all injuries was 0.77 (95% confidence interval, 0.72-0.82). When categorized within domains and injuries, parent/guardian-reported correlations ranged from 0.23 to 0.79. In patients aged 11 years and older, the correlation between the PODCI and PedsQL for the patient-reported questionnaire for all injuries was 0.85 (95% confidence interval, 0.80-0.89). When categorized within domains and injuries, patient-reported correlations ranged from 0.30 to 0.99. CONCLUSIONS: Utilizing the substantially shorter PedsQL in a high volume orthopaedic clinic as a substitute for the PODCI for quality improvement measures seems reasonable. Correlation between the PedsQL Global score and the PODCI Total score for orthopaedic patients is strong. Utilizing the patient-reported questionnaires when age appropriate is best. In this era of increased outcome reporting, PedsQL may be a valuable tool.
  • Curricular factors associated with medical students' practice of the skin cancer examination: an educational enhancement initiative by the integrated skin exam consortium

    Garg, Amit; Belazarian, Leah; Domingues, Erik (2014-08-01)
    IMPORTANCE: As medical school curricula become progressively integrated, a need exists to optimize education related to the skin cancer examination (SCE) for melanoma, a relevant competency gap that influences secondary prevention efforts. OBJECTIVES: To identify curricular factors associated with medical students' confidence, intent, and performance regarding the SCE. DESIGN, SETTING, AND PARTICIPANTS: Survey-based cross-sectional study from the Integrated Skin Exam Consortium at accredited US medical schools among a volunteer sample of second-year students representing 8 geographically varied public and private institutions. Students were administered a questionnaire to assess characteristics, curricular exposures, and educational and practical experiences related to skin cancer, as well as knowledge of melanoma risk and a detection method. MAIN OUTCOMES AND MEASURES: Primary outcomes were confidence in performing the SCE, intent to perform an integrated skin examination, and actual performance of the SCE. RESULTS: Physical diagnosis session and clinical encounter were most predictive of confidence in performance of the SCE (odds ratios [ORs], 15.35 and 11.48, respectively). Other curricular factors associated with confidence included instruction time of at least 60 minutes on skin cancer (OR, 6.35), lecture on the SCE (OR, 7.54), knowledge of melanoma risk (OR, 3.71), and at least 1 opportunity to observe the SCE (OR, 2.70). Physical diagnosis session and at least 4 opportunities to observe the SCE were most predictive of intent to perform an integrated skin examination (ORs, 4.84 and 4.72, respectively). Other curricular factors associated with intent included knowledge of melanoma risk (OR, 1.83), clinical encounter (OR, 2.39), and at least 1 opportunity to observe the SCE (OR, 1.95). Clinical encounter, physical diagnosis session, and at least 1 opportunity to observe the SCE were most predictive of performance of the SCE (ORs, 21.67, 15.48, and 9.92, respectively). Other curricular factors associated with performance included instruction time of at least 60 minutes on skin cancer (OR, 2.42) and lecture on the SCE (OR, 5.04). CONCLUSIONS AND RELEVANCE: To augment the practice of the SCE among medical students, course directors may design an integrated curriculum that includes at least 60 minutes of instruction related to melanoma and the SCE, a description of the integrated skin examination as part of the physical diagnosis course, and education on high-risk demographic groups and anatomic sites specific to men and women and on the ABCDEs of melanoma, and at least 1 opportunity to observe the SCE.
  • Herb use, vitamin use, and diet in low-income, postpartum women

    Gardiner, Paula; Jarrett, Kelli; Filippelli, Amanda; Pecci, Christine; Mauch, Maya Y.; Jack, Brian (2013-03-01)
    INTRODUCTION: Little is known about herb use among underserved postpartum women and their patterns of communication about herb use with prenatal providers. METHODS: We interviewed women from the postpartum unit at an urban hospital about herb use during pregnancy, socioeconomic factors, prenatal vitamin use, and diet. We asked women if they discussed use of herbs and vitamins with their prenatal care providers and asked about their satisfaction with these discussions. We reviewed inpatient chart medication lists for herb use. RESULTS: Of 160 women surveyed, 39% reported using herbs during pregnancy. Sixty-five percent of participants took a prenatal vitamin. Fifty-seven percent of herb users (n = 40) reported taking prenatal vitamins. Herb users were significantly more likely to report making any dietary change during their pregnancies than non-herb users (P = .03). Only 38% of herb users discussed it with their prenatal providers, and 82% were satisfied with the conversation. Of all 160 participants, 125 had prenatal vitamin use documented, and no women had herbal medicine use documented in the medical record during their birth hospitalization. DISCUSSION: We report a higher frequency of herb use during pregnancy than other studies. The fact that women of all backgrounds and economic statuses report using herbs during pregnancy makes it even more important for all women to be asked about their use of herbs.
  • Expectations of gender in medical education

    McMullen, Kevin; Janko, Matthew; Wittbold, Kelley (2012-12-01)
    This article is a discussion and comment on: Isaac C, Chertoff J, Lee B, Carne M. Do students’ and authors’ genders affect evaluations? A linguistic analysis of medical student performance evaluations. Acad Med. 2011;86(1):59-66.
  • UMMS Student Perspectives on Small Group Teaching

    Robillard, Diana; Spring, Laura (2010-05-21)
    Provides small group facilitators at the University of Massachusetts Medical School with clear, vibrant, concrete student perspectives on effective practices for conducting small groups, as developed in a student-run focus group. Includes an executive summary.

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