The power of coaching: Developing leaders and beyond

In recent decades, the application of coaching for career development and supporting faculty in leadership roles has greatly expanded in higher education. Coaching can offer transformational and life-changing experiences, inspire critical reflection in early career decisions, and (re)ignite passion and commitment at all career stages. While coaching focuses on transforming individuals, it also has the potential to impact organizations and professional environments. The power of coaching deserves appropriate recognition within dental education and scholarship. In this article, the authors discuss the potential for career coaching as a tool for developing future leaders in dental education. After differentiating between coaching and mentoring, coaching for professional development is reviewed as an evidence-based approach that can enhance traditional leadership and professional development programs. Although this article was inspired by programming supporting the development of female leaders, coaching applies to all leaders and may be particularly helpful in supporting the development of diverse leaders including but not limited to individuals from different backgrounds, national origins, gender, racial, socioeconomic, and cultural distinctions. After a review of existing coaching initiatives in dental education, a variety of coaching strategies for faculty, staff, and trainees will be described that can be implemented by oral health educational institutions. Examples of coaching strategies range from developing internal coaching programs to contractual agreements with external coaching groups. Step-by-step guidelines are included.

Oral health educators' reflections on teaching 2022 and beyond

INTRODUCTION

The global pandemic prompted changes in health science education affecting both teaching and learning. This multi-institutional study assesses the near-term implications of these changes on faculty and faculty development. The project goals were to: (1) describe faculty experiences of teaching during the pandemic; (2) identify ways to sustain new pedagogical approaches, (3) describe the types of support faculty members need, and (4) offer recommendations to enhance oral health professions education.

METHODS

A mixed-method approach using exploratory sequential design was conducted in two phases collecting qualitative and quantitative data. Focus group participants included didactic, pre-clinical, and clinical faculty in dental school (DMD/DDS), dental hygiene and dental therapy programs, and also faculty members serving in administrative roles in these programs (N = 37). One hundred forty-four faculty participated in the multi-institutional follow-up survey.

RESULTS

Focus group and survey results led to 14 recommendations (nine structural and five individual) for oral health profession institutions and educators.

CONCLUSION

Oral health profession education faculty were dramatically impacted by the pandemic and new faculty development needs were identified. Traditional faculty development topics and practices may be no longer applicable in the post-COVID-19 environment. Additionally, the pandemic stimulated creative approaches for curriculum design, teaching, and assessment in oral health profession education. Strategies need to be implemented to sustain these innovations.

A phase II open-label trial of avelumab plus axitinib in previously treated non-small-cell lung cancer or treatment-naïve, cisplatin-ineligible urothelial cancer

BACKGROUND

We hypothesized that avelumab plus axitinib could improve clinical outcomes in patients with advanced non-small-cell lung cancer (NSCLC) or urothelial carcinoma (UC).

PATIENTS AND METHODS

We enrolled previously treated patients with advanced or metastatic NSCLC, or untreated, cisplatin-ineligible patients with advanced or metastatic UC. Patients received avelumab 800 mg every 2 weeks (Q2W) and axitinib 5 mg orally two times daily. The primary endpoint was objective response rate (ORR). Immunohistochemistry was used to assess programmed death-ligand 1 (PD-L1) expression (SP263 assay) and the presence of CD8+ T cells (clone C8/144B). Tumor mutational burden (TMB) was assessed by whole-exome sequencing.

RESULTS

A total of 61 patients were enrolled and treated (NSCLC, n = 41; UC, n = 20); 5 remained on treatment at data cut-off (26 February 2021). The confirmed ORR was 31.7% in the NSCLC cohort and 10.0% in the UC cohort (all partial responses). Antitumor activity was observed irrespective of PD-L1 expression. In exploratory subgroups, ORRs were higher in patients with higher (≥median) CD8+ T cells in the tumor. ORRs were higher in patients with lower TMB (<median) in the NSCLC cohort and higher TMB (≥median) in the UC cohort. Treatment-related adverse events (TRAEs) occurred in 93.4% of patients, including grade ≥3 TRAEs in 55.7%. Avelumab exposures with 800 mg Q2W dosing were similar to those observed with 10 mg/kg Q2W dosing.

CONCLUSIONS

In previously treated patients with advanced/metastatic NSCLC, ORR appeared to be superior to anti-PD-L1 or anti-programmed cell death protein 1 monotherapy, irrespective of PD-L1 status, whereas in untreated, cisplatin-ineligible patients with advanced/metastatic UC, ORR was lower than expected, potentially limited by small patient numbers.

TRIAL REGISTRATION

Clinicaltrial.gov NCT03472560; https://clinicaltrials.gov/ct2/show/NCT03472560.

How to Teach Medical Students About Pain and Dementia: E-Learning, Experiential Learning, or Both?

OBJECTIVE

Pain management in persons with mild to moderate dementia poses unique challenges because of altered pain modulation and the tendency of some individuals to perseverate. We aimed to test the impact of an e-learning module about pain in communicative people with dementia on third-year medical students who had or had not completed an experiential geriatrics course.

DESIGN

Analysis of pre- to postlearning changes and comparison of the same across the student group.

SETTING

University of Pittsburgh School of Medicine and Saint Louis University School of Medicine.

SUBJECTS

One hundred four University of Pittsburgh and 57 Saint Louis University medical students.

METHODS

University of Pittsburgh students were randomized to view either the pain and dementia module or a control module on pain during a five-day geriatrics course. Saint Louis University students were asked to complete either of the two modules without the context of a geriatrics course. A 10-item multiple choice knowledge test and three-item attitudes and confidence questionnaires were administered before viewing the module and up to seven days later.

RESULTS

Knowledge increase was significantly greater among students who viewed the dementia module while participating in the geriatrics course than among students who viewed the module without engaging in the course (P < 0.001). The modules did not improve attitudes in any group, while student confidence improved in all groups.

CONCLUSIONS

Medical students exposed to e-learning or experiential learning demonstrated improved confidence in evaluating and managing pain in patients with dementia. Those exposed to both educational methods also significantly improved their knowledge.

Managing Acute Pain and Opioid Risks Following Wisdom Teeth Extraction: An Illustrative Case

Introduction

The opioid epidemic has awakened educators to the insufficiency of training in the areas of pain management and substance use disorders within the curricula of health sciences schools. The University of Pittsburgh Center of Excellence in Pain Education created an online educational module focusing on factors contributing to the opioid epidemic and the role of robust interprofessional communication in avoiding common practitioner errors.

Methods

The 1-hour module created by an interprofessional team comprised a pretest, video presentation featuring case vignettes, posttest, and learner satisfaction survey. The content of the module focused on four core concepts: (1) managing acute perioperative pain, (2) maximizing opioid safety, and (3) identifying and (4) managing suspected opioid abuse and diversion.

Results

Data were obtained from 250 dental, pharmacy, and nursing students from the University of Pittsburgh who completed the module as part of their respective profession-specific curricula. Results collapsed across the three school-specific implementations indicated an average increase in knowledge test scores from pre- to posttest (Z = -8.82, p < .001). In addition, the learner satisfaction data revealed an overall positive response to the module, with students commenting that they enjoyed the module and felt it provided them with a valuable learning experience.

Discussion

Learner outcomes and feedback suggest that our interprofessional team was successful in creating an effective learning module applicable to several health care professions, namely, pharmacy, dentistry, and nursing. Future studies might address the application of the knowledge gained to actual patient care.

Learning and Teaching Together to Advance Evidence-Based Clinical Education: A Faculty Learning Community

Clinical teaching is a cornerstone of health sciences education; it is also the most challenging aspect. The University of Pittsburgh Schools of Dental Medicine, Nursing, and Pharmacy developed a new evidence-based interprofessional course framed as a faculty learning community (FLC) around the principles of learning in a clinical environment. The aim of this study was to assess the overall effectiveness of this two-semester FLC at four health professions schools in academic year 2014-15. The assessment included anonymous participant surveys in each session and an anonymous end-of-course survey. Thirty-five faculty members from dental, health and rehabilitation sciences, nursing, and pharmacy enrolled in the FLC, with six to 32 enrollees attending each session. All attendees at each session completed the session evaluation surveys, but the attendance rate at each session ranged from 17.1% to 91.4%. Sixteen participants (46%) completed the end-of-course survey. The results showed overall positive responses to the FLC and changes in the participants' self-reported knowledge. Session surveys showed that the participants found the FLC topics helpful and appreciated the opportunity to learn from each other and the interprofessional nature of the FLC. Responses to the end-of-course survey were in alignment with the individual session surveys and cited specific benefits as being the content, teaching materials, and structured discussions. In additional feedback, participants reported interest to continue as a cohort and to extend the peer-support system beyond the FLC. This outcomes assessment of the first round of the FLC confirmed that this cohort-based faculty development in an interprofessional setting was well received by its participants. Their feedback provided valuable insights for changes to future offerings.

Assessing the Professional Identity of Dental School Faculty: An Exploratory Study

Experts have argued that dental education needs to shift from a teacher-centered paradigm to a learner-centered paradigm. Assisting faculty members to self-identify as educators may be a key to reaching that goal. The aim of this exploratory study was to assess how dental faculty members described their professional identity (educator or clinician) and the effect of their self-defined identity on their motivation to pursue professional development as educators. A 14-question anonymous survey was distributed electronically to all 536 part-time and full-time dental faculty members at two U.S. dental schools; 114 responses were recorded for a 21.5% response rate. Just over half of the survey respondents (53.5%, n=61) self-identified as educators, and the other 46.5% (n=53) self-identified as clinicians. A lower percentage of the self-identified clinicians were full-time employees (37.3%, n=25) than the self-identified educators (60.7%, n=42); the difference was statistically significant (p=0.0143). Among respondents who self-identified as educators, 53.2% (n=25) had taken four or more courses on teaching vs. 24.2% (n=8) of those who self-identified as clinicians (p=0.0321). Also, 50% (n=30) of the self-identified educators prioritized future teaching courses as their continuing education plan vs. 20.8% (n=11) of the self-identified clinicians (p=0.0013), and 49.2% (n=30) of the self-identified educators had attended at least one ADEA Annual Session vs. 15.4% (n=8) of the self-identified clinicians (p=0.0011); both of those differences were statistically significant. This study found that only about half of the respondents from two dental schools self-identified as educators, but nearly all viewed learning about teaching concepts and techniques as very or somewhat important. Administrators can use these findings to promote their faculty training initiatives and find ways to encourage and support educator identification.

Abstract P5-11-09: Sustained efficacy of eflapegrastim in breast cancer patients in a phase 2, open-label, dose-ranging study

Background: Eflapegrastim is a distinct biologic that uses the innovative proprietary long-acting protein/peptide discovery technology (LAPSCOVERY™) and consists of a novel, modified recombinant human G-CSF conjugated to the Fc fragment of IgG4 via a polyethylene glycol linker. A Phase 2 study of 3 doses of eflapegrastim vs pegfilgrastim was conducted in breast cancer patients receiving docetaxel + cyclophosphamide (TC) chemotherapy.

Methods: This was an open-label, global, multicenter, dose-ranging study designed to compare the safety and efficacy of eflapegrastim relative to a fixed dose of pegfilgrastim as a concurrent active control. The study included 4 treatment arms: 3 dose levels of eflapegrastim (45 μg/kg, 135 μg/kg, and 270 μg/kg) vs pegfilgrastim (6 mg). The primary objective of the study was the Duration of Severe Neutropenia (DSN) during Cycle 1. The results for the primary objective, along with demographics and safety, were described in a previous presentation (SABCS 2015 P1-10-05). The secondary endpoints included DSN in Cycles 2-4, absolute neutrophil count (ANC) in Cycles 1-4, the overall incidences of febrile neutropenia (FN) and hospitalization rates.

Results: A total of 147 evaluable patients were enrolled. Patient and tumor characteristics were comparable across all 4 treatment arms. Median age was 59.0 years (range 32 to 77 years); most patients were &lt;65 years (68%), Female (98%), and White (95%). The DSN for the 135 µg/kg and 270 µg/kg was non-inferior to pegfilgrastim during all cycles and the DSN for patients treated with 45 µg/kg was non-inferior during Cycles 2 and 3 (Table 1). The ANC was dose proportional across all 4 cycles. The incidence of FN and hospitalization rates was low in all arms and there were no significant differences between the Eflapegrastim and Pegfilgrastim Arms (Table 2).

Table 1. Duration of Severe Neutropenia in Cycles 2 to 4 of TC Chemotherapy by Treatment ArmDSN (Days)Eflapegrastim 45 μg/kg (N=39)Eflapegrastim 135 μg/kg (N=36)Eflapegrastim 270 μg/kg (N=36)Pegfilgrastim 6 mg (N=36)Cycle 2Difference with pegfilgrastim0.380.04-0.05NANon-Inferiority p-value0.001&lt;0.001&lt;0.001NACycle 3Difference with pegfilgrastim0.310.020.01NANon-Inferiority p-value0.002&lt;0.001&lt;0.001NACycle 4Difference with pegfilgrastim0.940.07-0.02NANon-Inferiority p-value0.781&lt;0.001&lt;0.001NADSN = Duration of Severe Neutropenia; NA = Not Applicable

Table 2. Incidence of Febrile Neutropenia and Hospitalizations Eflapegrastim 45 μg/kg (N=39)Eflapegrastim 135 μg/kg (N=36)Eflapegrastim 270 μg/kg (N=36)Pegfilgrastim 6 mg (N=36)Febrile NeutropeniaIncidence (%)3 (7.7%)1 (2.8%)1 (2.8%)2 (5.6%)Difference with Pegfilgrastim2.1 %-2.8%-2.8%NAp-value1.0001.0001.000NAHospitalizationsIncidence (%)3 (7.7%)3 (8.3%)1 (2.8%)5 (13.9%)Difference with Pegfilgrastim-6.2%-5.6%-11.1%NAp-value0.4690.7100.199NA

Conclusions: In breast cancer patients treated with TC, the non-inferiority of DSN of 135 µg/kg and 270 µg/kg eflapegrastim, compared to pegfilgrastim in Cycle 1, was sustained through Cycles 2-4 and the ANC profiles were comparable in Cycles 1-4. In addition, the overall incidence of FN and hospitalizations was comparable between the eflapegrastim arms and the pegfilgrastim arm.

Citation Format: Vacirca JL, Agajanian R, Papai Z, Horvath Z, Makharadze R, Ibrahim EN, Choi MR, Song T, Tedesco KL, McGregor K, Schwartzberg LS. Sustained efficacy of eflapegrastim in breast cancer patients in a phase 2, open-label, dose-ranging study [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-11-09.

Abstract P5-11-07: Pharmacokinetics of eflapegrastim in a phase 2 open-label dose-ranging study in breast cancer patients receiving TC regimen

Background: Eflapegrastim (SPI-2012/HM10460A) is a novel, long acting recombinant human granulocyte colony-stimulating factor (rhG-CSF). Eflapegrastim consists of an rhG-CSF conjugated to the recombinant E coli derived Fc fragment of IgG4 via a polyethylene glycol linker. Eflapegrastim is in clinical development for the treatment of chemotherapy induced neutropenia in cancer patients.

Methods: Pharmacokinetics (PK) of eflapegrastim was investigated in an open label, dose-ranging Phase 2 study in breast cancer patients receiving docetaxel + cyclophosphamide (TC) chemotherapy. The study consisted of 4 arms. Patients in Arms 1 through 3 received subcutaneous doses of 45, 135, or 270 µg /kg of eflapegrastim and patients in Arm 4 received 6 mg pegfilgrastim (Neulasta®) on Day 2 of each 21-day chemotherapy cycle. Serum samples were collected from a subset of eflapegrastim patients at pre-specified time-points and analyzed for eflapegrastim by a validated enzyme-linked immunosorption assay (ELISA). Pharmacokinetic analyses were conducted on serum concentration-time profiles after dosing in Cycle 1. The serum concentrations for samples collected in Cycle 3 were compared with the corresponding concentrations in Cycle 1. Pharmacokinetic analyses were not conducted for pegfilgrastim patients.

Results: The PK profile of eflapegrastim was investigated in 11 patients, including 3 patients in the 45 µg/kg treatment arm, 4 patients in the 135 µg/kg treatment arm, and 4 patients in the 270 µg/kg treatment arm. Following single eflapegrastim doses of 45, 135, or 270 µg/kg, peak serum concentrations increased in a dose proportional manner. The summary of pharmacokinetics of eflapegrastim is presented in the Table below.

Pharmacokinetic Parameters of Eflapegrastim in Patients Following Single Subcutaneous Doses in Cycle 1ParameterEflapegrastim 45 μg/kg/Eflapegrastim 135μg/kgEflapegrastim 270 μg/kgCmax, ng/mLN = 3; Mean = 7.00; SD = 6.08N = 4; Mean = 247; SD = 276N =3; Mean = 299; SD = 329Tmax, haN =2; Mean = 58.7; SD = 46.9 - 70.5N = 4; Mean =9.00; SD = 8 - 48.1N = 3; Mean = 24.00; SD = 24 - 24.1AUC0-312, ng•hr/mLN = 0; Mean = NC; SD = NCN = 2; Mean = 16000; SD = 5850N = 3; Mean = 22900; SD = 25100t1/2, hbN = 0; Mean = NC; SD = NCN = 2; Mean = 81.0; SD = 88.4N = 1; Mean = 31.5; SD = NCAUC = area under the concentration-time curve; Cmax = maximum serum concentration; h = hour; NC = not calculated; SD = standard deviation; t1/2 = half-life; Tmax = time to maximum serum concentration; a) Expressed as median and range; b) Expressed as harmonic mean and pseudo SD

The maximum serum concentrations of eflapegrastim in Cycle 3 increased with the dose of eflapegrastim. The serum concentrations of eflapegrastim in Cycle 3 were generally lower than those in Cycle 1, but the profile was similar to Cycle 1.

Conclusions: The Cmax and AUC(0-312) of eflapegrastim increased in a dose proportional manner following subcutaneous administration. The half-life of eflapegrastim ranged from 31.5 to 81.0 hours, which is consistent with the half-life of other long-acting myeloid growth factors.

Citation Format: Vacirca JL, Papai Z, Horvath Z, Makharadze R, Reddy G, Song T, Koli P, Schwartzberg LS. Pharmacokinetics of eflapegrastim in a phase 2 open-label dose-ranging study in breast cancer patients receiving TC regimen [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-11-07.

Abstract P5-11-08: Immunogenicity of eflapegrastim in a phase 2 open-label dose-ranging study of eflapegrastim in breast cancer patients receiving TC regimen

Background: Eflapegrastim (SPI-2012/HM10460A) is a novel, long-acting recombinant human granulocyte colony-stimulating factor (rhG-CSF). Eflapegrastim consists of an rhG-CSF conjugated to a recombinant E. coli derived Fc fragment of IgG4 via a polyethylene glycol linker. Eflapegrastim is in clinical development for the treatment of chemotherapy induced neutropenia in cancer patients.

Methods: Immunogenicity of eflapegrastim was investigated in an open label, dose-ranging Phase 2 study in breast cancer patients receiving docetaxel + cyclophosphamide (TC) chemotherapy. The study consisted of 4 arms. Patients in Arms 1 through 3 received subcutaneous doses of 45, 135, or 270 µg/kg eflapegrastim and Arm 4 received 6 mg pegfilgrastim (Neulasta®) on Day 2 of each 21-day chemotherapy cycle. Blood samples for immunogenicity analysis were collected before the start of each chemotherapy cycle (Day 1) and at the End-of-Study Visit. Samples were tested in a screening assay for Anti-Drug Antibodies (ADA) to eflapegrastim by a validated enzyme linked immunosorption assay (ELISA). Positive samples from the screening assay were further tested in a confirmatory assay for antibodies binding to eflapegrastim or G-CSF. Samples found positive in the confirmatory assay were further tested in a validated cell based neutralizing antibody assay.

Results: Serum samples from 143 patients in the study were tested for ADA to eflapegrastim and G-CSF. Preexisting antibodies binding to eflapegrastim or G-CSF were detected in 9 out of 143 (6.3%) patients. One out of the 27 patients (3.7%) in the Pegfilgrastim Arm who was negative prior to dosing was positive for ADA in the G-CSF confirmatory assay. Two out of 100 patients (2.0%) treated with eflapegrastim, who were negative prior to dosing, demonstrated treatment-induced formation of ADA in the G-CSF confirmatory assay. However, the responses in these patients were transient (ie, not consistently positive at all the sampling times) and the assay response values were low and only slightly above the plate-specific cut points. None of the patients tested were positive for G-CSF neutralizing antibodies. A formal assessment of the impact of serum ADA on the PK of eflapegrastim was not performed since PK was examined in only a limited number of patients and all of those patients were negative for ADA both at study initiation and post-dose.

Conclusion: No neutralizing antibodies against eflapegrastim or G-CSF were detected in patients administered eflapegrastim in this study.

Citation Format: Vacirca JL, Papai Z, Agajanian R, Horvath Z, Makharadze R, Ibrahim E, Koli P, Reddy G, Tedesco KL, McGregor K, Schwartzberg LS. Immunogenicity of eflapegrastim in a phase 2 open-label dose-ranging study of eflapegrastim in breast cancer patients receiving TC regimen [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-11-08.

Training Future Dentists for an Academic Career: A Three-Tiered Model

The anticipated shortage of dental faculty presents a challenge for dental education as it will greatly impact the training of the next generation of practicing dentists. One way to alleviate shortages is to identify students who are interested in an academic career at the predoctoral level and provide them with training in teaching, research, and leadership. Based on available evidence, formal programs offer the best way to introduce students to academia as a viable career path. A well-designed program can also equip interested students with the necessary skills and basic knowledge to facilitate starting an academic career. The University of Pittsburgh School of Dental Medicine has developed a three-tiered model for providing its dental students with exposure to and training in academic dentistry. The three tiers reflect differing levels of commitment: 1) a two-year academic career track program, 2) academic career track elective courses, and 3) extracurricular activities. The aim of this study was to provide an initial assessment of the program's overall effectiveness. Data were collected using student and faculty surveys and student applications for the two-year academic career track program. The data gathered included characteristics of, and feedback from, students taking the elective courses, as well as student and faculty feedback about student teacher effectiveness. The study found overall positive responses to the three-tiered program from faculty, students, and student teachers at this initial stage. Whether these students ultimately become faculty members (the ultimate goal of the program) will be assessed in the future.