Teaching medical students the important connection between communication and clinical reasoning

BACKGROUND: Medical students are rarely taught how to integrate communication and clinical reasoning. Not understanding the relation between these skills may lead students to undervalue the connection between psychosocial and biomedical aspects of patient care. OBJECTIVE: To improve medical students' communication and clinical reasoning and their appreciation of how these skills interrelate in medical practice. DESIGN: In 2003, we conducted a randomized trial of a curricular intervention at Johns Hopkins University School of Medicine. In a 6-week course, participants learned communication and clinical reasoning skills in an integrative fashion using small group exercises with role-play, reflection and feedback through a structured iterative reflective process. PARTICIPANTS: Second-year medical students. MEASUREMENTS: All students interviewed standardized patients who evaluated their communication skills in establishing rapport, data gathering and patient education/counseling on a 5-point scale (1=poor; 5=excellent). We assessed clinical reasoning through the number of correct problems listed and differential diagnoses generated and the Diagnostic Thinking Inventory. Students rated the importance of learning these skills in an integrated fashion. RESULTS: Standardized patients rated curricular students more favorably in establishing rapport (4.1 vs 3.9; P=.05). Curricular participants listed more psychosocial history items on their problem lists (65% of curricular students listing > or =1 item vs 44% of controls; P=.008). Groups did not differ significantly in other communication or clinical reasoning measures. Ninety-five percent of participants rated the integration of these skills as important. CONCLUSIONS: Intervention students performed better in certain communication and clinical reasoning skills. These students recognized the importance of biomedical and psychosocial issues in patient care. Educators may wish to teach the integration of these skills early in medical training.     

Teaching clinical skills in musculoskeletal medicine: the use of structured clinical instruction modules

OBJECTIVE: To assess student evaluation, satisfaction, and examination outcomes for a new method of teaching musculoskeletal (MSK) medicine clinical skills, structured clinical instruction modules (SCIM), and to compare with the outcomes of a traditional method of teaching clinical skills (small group bedside tutorials). METHODS: Year 2 students in a 4 year graduate medical school were taught using the method of bedside senior registrar teaching, supplemented by outpatient attendances in 1997 and by SCIM in 2000. All students in 1997 and 2000 were debriefed at the end of each unit of clinical skills teaching for student feedback on their teaching experience using a standardized questionnaire. At the end of the academic year, all students underwent an objective structured clinical examination (OSCE) in clinical skills that included rheumatology (hand examination) and orthopedic surgery (knee examination) stations. The effect of the method of teaching on the students' performance in the rheumatology (hand) and orthopedic surgery (knee) stations was analyzed. RESULTS: Sixty-seven students were taught clinical skills and completed the OSCE in 1997 and 78 students were taught clinical skills by SCIM and completed the OSCE in 2000. The teaching of orthopedics using traditional methods was poor, but there was no difference in satisfaction between traditional methods of teaching and SCIM for orthopedic surgery and rheumatology. There was no statistically significant difference in the performance of students in the hand OSCE stations in 2000 compared to the same station in 1997. There was a small but statistically significant difference in the performance of students in 1997 and 2000 in the knee station, the 1997 students performing better in this station. CONCLUSION: The SCIM is an effective method of teaching clinical skills in MSK medicine, comparable with patient partners and traditional registrar based bedside teaching methods, but it is less resource intensive.     

病案教学法在细菌学各论中的应用

本文探讨了病案教学法在细菌学各论中的教学效果。对医学本硕2009班、中医、中西医结合临床和厚博临床医学专业2010级共185名学生作为实验组,采用病案教学法,这些班级的210名学生作为对照组,采取传统讲授法为主,辅以多媒体教学,通过考试成绩分析、教学效果问卷调查,比较两个班的教学效果。实验组平均分为70分,最高分为100分,明显高于对照组（61分和94分）,问卷调查反映较好。病案教学在培养学生的科学素养和临床实践能力,全面提高学生的综合素质方面发挥了很大的作用,病案教学适合微生物学各论的学习。     

大数据平台结合翻转课堂教学法在急性心肌梗死教学中的应用探讨

目的 评价“大数据平台结合翻转课堂”教学法在急性心肌梗死教学中的应用效果。方法 随机选取空军军医大学2019级临床医学专业五年制本科生80人，随机分为两组：实验组（40人）和对照组（40人）。实验组进行“大数据平台结合翻转课堂”模式教学，对照组采用传统模式教学。在课程结束后，通过满意度问卷调查、学习投入时间及理论知识考核等方法对比评价“大数据平台结合翻转课堂”和传统教学法的教学效果。结果 实验组考核成绩为（88±4）分，对照组为（80±2）分，实验组理论知识考核成绩显著高于对照组（P<0.05）。实验组课前预习、课后复习与自主学习投入时间为（71±15）min、（74±17）min与（89±9）min，显著高于对照组（33±9）min、（62±18）min与（35±11）min（均P<0.05），实验组学习投入时间长于对照组，并且学习意愿更强。满意度问卷调查显示实验组在提升理论知识掌握、培养学习兴趣、提升自主学习能力、培养临床思维能力和对教学模式的认可5个方面优于对照组（均P<0.05）。结论 在教学中采用“大数据平台结合翻转课堂”教学模式可显著提升本科生对急性心肌梗...     

One-minute preceptor and SNAPPS for clinical reasoning: a systematic review and meta-analysis

Clinical reasoning teaching strategies could be important models to teach healthcare trainees. This study aims to assess the effectiveness of clinical reasoning teaching strategies (one-minute preceptor (OMP) and SNAPPS) for developing clinical reasoning skills, attitudes and satisfaction of medical/healthcare students and post-graduate trainees as compared to controls. A systematic review and meta-analysis of randomised controlled studies, with no restriction on language or publication date, were carried out by searching the PubMed, SCOPUS, ERIC, Web of Science, Embase and Cochrane Library databases. The risk of bias of the studies selected was determined using Cochrane's risk-of-bias tool (RoB 2) and the quality of evidence used the Grading of Recommendations Assessment, Development and Evaluation system. Of the 1066 articles retrieved, 12 were included in the systematic review and 10 in the meta-analysis. The results showed a growing body of literature on the use of strategies for teaching clinical reasoning that consisted predominantly of low-quality quasi-experimental studies. When only randomised controlled trials were included, analyses showed effectiveness among both healthcare students and post-graduate trainees for a series of outcomes, including total presentation length, duration of discussion, number of basic attributes, number of justified diagnoses in differential diagnoses and number of uncertainties expressed. Lastly, results for SNAPPS were better than for OMP relative to the control group. The strategies for teaching clinical reasoning improved the performance of healthcare students and professionals on this skill, promoting deeper discussion of clinical cases and a higher number of differential diagnoses. Further good-quality trials are needed to corroborate these findings. PROSPERO Registration: CRD42020175992.     

Using Theater to Teach Clinical Empathy: A Pilot Study

BACKGROUND: Clinical empathy, a critical skill for the doctor-patient relationship, is infrequently taught in graduate medical education. No study has tested if clinical empathy can be taught effectively. OBJECTIVE: To assess whether medicine residents can learn clinical empathy techniques from theater professors. DESIGN: A controlled trial of a clinical empathy curriculum taught and assessed by 4 theater professors. SETTING: Virginia Commonwealth University, Richmond, Virginia, a large urban university and health system. PARTICIPANTS: Twenty Internal Medicine residents: 14 in the intervention group, 6 in the control group. INTERVENTION: Six hours of classroom instruction and workshop time with professors of theater. MEASUREMENTS: Scores derived from an instrument with 6 subscores designed to measure empathy in real-time patient encounters. Baseline comparisons were made using two-sample T tests. A mixed-effects analysis of variance model was applied to test for significance between the control and intervention groups. RESULTS: The intervention group demonstrated significant improvement (p < or = .011) across all 6 subscores between pre-intervention and post-intervention observations. Compared to the control group, the intervention group had better posttest scores in 5 of 6 subscores (p < or = .01). LIMITATIONS: The study was neither randomized nor blinded. CONCLUSIONS: Collaborative efforts between the departments of theater and medicine are effective in teaching clinical empathy techniques.     

Reduced HbA1c levels in type 2 diabetes patients: An interaction between a pedagogical format for students and psycho-educational intervention for patients

In this prospective study we compared Hemoglobin A1c (HbA1c) levels in T2DM (Type 2 diabetes) patients who received psycho-educational intervention vs. usual care. Intervention was provided by pharmaceutics students, and accompanied by an academic course. We further examined the effect of the pedagogical format by which students were taught on HbA1c levels of the patients. The format of the academic course varied: the simultaneous format included theoretical, clinical, and practical themes taught within each lesson; whereas in the non-simultaneous format, theoretical themes were taught during the first several lessons, followed by practical skills taught in the following ones.T2DM patients (n = 171) were recruited through 10 primary care clinics. The inclusion criterion was patients with uncontrolled type 2 diabetes (HbA1c > 7%). Patients were randomly allocated to a training or control group. Pharmaceutics students (n = 85) in their fourth year participated in an academic course and were randomly allocated to a simultaneous vs. non-simultaneous pedagogical format. The interaction effect between intervention type and pedagogical format was significant. Only patients who participated in the training group consisting of students who participated in the simultaneous course format showed improvement on their HbA1c levels. Implications on patients' outcome and suggestions for future studies are discussed.     

Cluster randomized controlled trial of the impact of a computer-assisted learning package on the learning of musculoskeletal examination skills by undergraduate medical students

OBJECTIVE: To identify whether there was measurable impact of a specific computer-assisted learning (CAL) package, "Virtual Rheumatology," on the learning of musculoskeletal examination skills by medical students. METHODS: We conducted 2 parallel, cluster-randomized controlled trials using undergraduate curricula at 2 locations: Newcastle and London, UK. Medical students attending a musculoskeletal rotation were allocated to the intervention (Virtual Rheumatology CD) or the control arm of the study by placement group. A formative 14-item objective structured clinical examination (OSCE) assessment on the examination of shoulder and/or knee joints was the main outcome measure at Newcastle. At London, a 17-item knee station formed part of the summative OSCE. We also used a questionnaire including a 15-item confidence log (C-Log) for self assessment of musculoskeletal examination skills and knowledge. Analysis was by intention to teach. RESULTS: At Newcastle, there were 112 students in the CD allocated group and 129 in the non-CD group. The CD allocated group performed significantly better on the OSCE (P = 0.002) and C-Log (P = 0.005) than the non-CD group. At London, there were 48 students in the CD allocated group and 65 in the non-CD group. The CD allocated group performed better on the knee OSCE than the non-CD group (adjusted P = 0.040), but there was little difference in the change in C-Log scores from baseline to followup between the 2 groups (P = 0.582). CONCLUSION: The Virtual Rheumatology CD has a positive impact on the acquisition of musculoskeletal examination skills in medical students. Further study is needed to see if similar advantages could be gained in other clinical specialities and how CAL resources could be effectively integrated into the medical curriculum.     

翻转课堂结合TBL教学模式在生理学实验教学中的实践

目的 探讨翻转课堂教学方法结合以团队为基础的学习（TBL）在生理学实验教学中的效果。方法 研究对象选取72名临床医学本科学生。随机分为两组:实验组（36人）利用网络课程教学平台,在开课前以在线形式明确实验原理,整体技术路线并形成问题。对照组（36人）采用课题讲授和演示教学。通过成绩分析和问卷调查进行教学效果评价。学生对教学效果的评价以百分比表示,定量数据行t检验。结果 实验组综合测评平均成绩为（83.2±10.1）分;对照组综合测评平均成绩为（72.0±15.4）分,差异具有统计学意义（P<0.01）。调查显示,实验组85%以上学生认为,翻转课堂结合TBL教学模式有助于提升学习兴趣,有利于知识点的掌握及个人综合能力的提高。结论 翻转课堂与TBL教学相结合的新型教学模式可有效提高生理学实验教学效果,使学生的自主学习能力得以提高。     

Using a multimedia tool to improve cardiac auscultation knowledge and skills

OBJECTIVE: Today's medical school graduates have significant deficits in physical examination skills. Medical educators have been searching for methods to effectively teach and maintain these skills in students. The objective of this study was to determine if an auscultation curriculum centered on a portable multimedia CD-ROM was effective in producing and maintaining significant gains in cardiac auscultatory skills. DESIGN: Controlled cohort study. PARTICIPANTS: All 168 third-year medical students at 1 medical school in an academic medical center. INTERVENTIONS: Students were tested before and after exposure to 1 or more elements of the auscultation curriculum: teaching on ward/clinic rotations, CD-ROM comprehensive cases with follow-up seminars, and a CD-ROM 20-case miniseries. The primary outcome measures were student performance on a 10-item test of auscultation skill (listening and identifying heart sound characteristics) and a 30-item test of auscultation knowledge (factual questions about auscultation). A subset of students was tested for attenuation effects 9 or 12 months after the intervention. RESULTS: Compared with the control group (1 month clinical rotation alone), students who were also exposed to the CD-ROM 20-case miniseries had significant improvements in auscultation skills scores (P < .05), but not knowledge. Additional months of clerkship, comprehensive CD-ROM cases, and follow-up seminars increased auscultation knowledge beyond the miniseries alone (P < .05), but did not further improve auscultation skills. Students' auscultation knowledge diminished one year after the intervention, but auscultation skills did not. CONCLUSION: In addition to the standard curriculum of ward and conference teaching, portable multimedia tools may help improve quality of physical examination skills.     

Musculoskeletal examination teaching in rheumatoid arthritis education: trained patient educators compared to nonspecialist doctors

OBJECTIVE: To assess whether students taught by trained patients acquire the same levels of competence in musculoskeletal examination skills as students taught by nonspecialist doctors. METHODS: Year 1 Graduate Medical Program (GMP) students (N = 25) at Hospital A were randomized to 8 tutorial groups, each comprising 3-4 students. Groups were taught hand and wrist examination skills by patient educators trained by the Searle Patient Partners in Arthritis program (patient partners). Students at Hospitals B and C (N = 12) remained in their normal tutorial groups, each comprising 3-4 students. Groups at Hospitals B and C were taught hand and wrist examination skills by doctors who had no specialized training in musculoskeletal medicine or orthopedics, with an untrained patient present. RESULTS: Students' mean self-ratings of examination skills before and students' patient partners, and consultants' mean ratings of students' examination skills after the tutorial were summed. Before the tutorial there were no significant differences in level of skill between students at Hospitals A, B, and C as measured by students' self-ratings. After the tutorial all students showed clear gains in levels of skill. Students taught by patient partners had higher levels of skill than those taught by doctors for 3 (p<0.01) and 4 (p<0.05) out of 14 examination skills and all 4 communication skills (p<0.05), as measured by both patient partners' and consultants' ratings. Students taught by doctors showed higher levels of skill for 2 observation skills, but these differences were not significant. CONCLUSION: Patient partners are either equal or superior to doctors not specifically trained in musculoskeletal medicine or orthopedics, in the teaching of musculoskeletal examination techniques and basic communication skills.     

Using virtual patients to improve cardiac examination competency in medical students

BACKGROUND: Cardiac examination (CE) skills are in decline. Most prior studies employed audio recordings, evaluating only one aspect of CE (i.e., auscultation) that precluded correlation with visible observations. To address these deficiencies, we developed a curriculum using virtual patient examinations (VPEs); bedside recordings of patients with visible and audible cardiovascular findings presented as interactive multimedia. HYPOTHESIS: The purpose of this study was to evaluate whether VPEs improve CE skills, and whether any improvements are retained. We assessed CE competency overall and in 4 categories: inspection, auscultation, knowledge, and integration of audio and visual skills. METHODS: Students (n = 24) undergoing the 8-wk Internal Medicine (IM) clerkship rotation and receiving supervised instruction with VPEs (intervention group) were compared with students (n = 58) undergoing IM clerkship rotation without supplemental CE instruction (control group). The groups were tested at the beginning and the end of their rotations. RESULTS: The Intervention group improved significantly in overall mean scores: from 58.7 to 73.5 (p = 0.0001). The Control group did not improve: from 60.1 to 59.5 (p = 0.788). The Intervention group improved inspection, auscultation, and knowledge (all p 相似文献   

Undergraduate musculoskeletal examination teaching by trained patient educators--a comparison with doctor-led teaching

BACKGROUND: To compare the core hand and knee examination skills gained by undergraduates taught either by trained patient educators (PEs) or by doctors. METHODS: A total of 50 final year medical students were randomized to receive training from PEs or doctors. Group A were taught hand examination by a PE with rheumatoid arthritis, and knee examination by a PE with osteoarthritis. Group B was taught hand and knee examination by a consultant rheumatologist plus an untrained patient with appropriate signs. All students were taught an established core skills set in small group workshops. Students then undertook two validated objective structured clinical examination (OSCE) stations with two blinded assessors. Pre- and post-teaching questionnaires established the students' self-reported levels of skills (SRS) and a student evaluation of teaching (SET). The study was analysed as an equivalence trial. A mean difference in OSCE scores of 10% was assumed to be of educational significance. RESULTS: Although the SET scores of both groups were high, the doctor-led group received higher scores. Aside from this, the two student groups did not differ significantly. There were no significant differences in mean hand OSCE (mean difference = 0.88, P = 0.28, 95% CI = -0.73 to 2.49) or knee OSCE (mean difference = 0.28, P = 0.7, 95% CI = -1.19 to 1.75) scores. Both the upper and lower confidence intervals for each mean difference fell within the 10% range (-2.8 to 2.8 for the hand, and -2.5 to 2.5 for the knee) and equivalence was assumed. CONCLUSIONS: Adequately trained PEs can deliver clearly structured undergraduate skills, teaching with equivalent learning outcomes to those of rheumatology consultants. PEs are a valuable development to augment musculoskeletal education in the face of expanding student numbers.     

基于微课的新型翻转课堂教学模式在高原心脏病课程网络教学中的应用

目的 探究基于微课的新型翻转课堂教学模式在高原心脏病课程网络教学中的应用。 方法 选择40名临床医学专业学生为研究对象,随机分为试验组（20人）与对照组（20人）。试验组利用网络平台接受基于微课的新型翻转课堂教学,对照组接受在线开展的传统课堂教学,利用随堂测试+课后作业+期末终考的综合测评方式对学生学习效果进行评价,并通过网络问卷形式进行满意度调查。 结果 试验组学生在课后作业、期末终考以及综合考评整体表现方面显著优于对照组（P < 0.01）,同时试验组学生在学习兴趣提升、自学能力提升、实践能力提升、课堂知识的掌握等方面满意度高于对照组（P < 0.01）。 结论 基于微课的新型翻转课堂教学模式能够帮助学生更深刻地理解知识重点、难点,提高学生对医学学科的学习兴趣和学习能力,为我国未来医学发展奠定坚实基础。     

Acupuncture and moxibustion in the treatment of active Crohn's disease: a randomized controlled study

BACKGROUND: Acupuncture has traditionally been used in the treatment of inflammatory bowel disease in China and is increasingly being applied in Western countries. The purpose of this study was to investigate the efficacy of acupuncture in the treatment of active Crohn's disease (CD). METHODS: A prospective, randomized, controlled, single-blind clinical trial was carried out to analyze the change in the CD activity index (CDAI) after treatment as a main outcome measure, and the changes in quality of life and general well-being, serum markers of inflammation (alpha(1)-acid glycoprotein, C-reactive protein) as secondary outcome measures. 51 patients with mild to moderately active CD were treated in a single center for complementary medicine by three trained acupuncturists and randomly assigned to receive either traditional acupuncture (TCM group, n = 27) or control treatment at non-acupuncture points (control group, n = 24). Patients were treated in 10 sessions over a period of 4 weeks and followed up for 12 weeks. RESULTS: In the TCM group the CDAI decreased from 250 +/- 51 to 163 +/- 56 points as compared with a mean decrease from 220 +/- 42 to 181 +/- 46 points in the control group (TCM vs. control group: p = 0.003). In both groups these changes were associated with improvements in general well-being and quality of life. With regard to general well-being, traditional acupuncture was superior to control treatment (p = 0.045). alpha(1)-acid glycoprotein concentration fell significantly only in the TCM group (p = 0.046). CONCLUSIONS: Apart from a marked placebo effect, traditional acupuncture offers an additional therapeutic benefit in patients with mild to moderately active CD.     

Intravenous morphine reduces plasma endothelin 1 concentration through activation of neutral endopeptidase 24.11 in patients with myocardial infarction

STUDY OBJECTIVE: Morphine has multiple cardiovascular effects, but its action on hydrolysis of endothelin 1 (ET-1) has not been investigated. METHODS: We measured plasma levels of ET-1, C-terminal degradation products of ET-1, and neutral endopeptidase 24.11 (NEP) in 68 patients with acute Q-wave myocardial infarction and 29 control subjects. All the patients underwent blood sampling at initial presentation and 10 minutes later. Thirty-six of those with Q-wave myocardial infarction intravenously received 3 mg of morphine immediately after the first sampling (group 1), and the other 32 received the same after the second sampling (group 2). Twenty-four of the control subjects (group 3) were randomized to the protocol of group 1, and the remaining 5 subjects (group 4) were randomized to the protocol of group 2. RESULTS: The plasma ET-1 levels were significantly higher in groups 1 and 2 than in groups 3 and 4 (control groups). In group 1, the ET-1 level decreased significantly at second blood samplings (2.5+/-0.4 pmol/L versus 1.7+/-0.6 pmol/L, P <.001), whereas there were no definite changes of ET-1 levels in group 2 (2.5+/-0.5 pmol/L versus 2.6+/-0.6 pmol/L, P =not significant). However, the C-terminal degradation products increased significantly at second blood samplings in group 1 (0.8+/-0.2 pmol/L versus 1.3+/-0.4 pmol/L, P <.001), whereas there were no definite changes in group 2 (0.9+/-0.3 pmol/L versus 0.9+/-0.4 pmol/L, P =not significant). There was no significant difference in baseline NEP activities between groups 1 and 2 (5.02+/-1.30 nmol/mg protein versus 5.06+/-1.48 nmol/mg protein, P =not significant). However, the NEP activities at second blood samplings declined significantly in group 1 (9.76+/-1.76 nmol/mg protein, P <.001 versus baseline), whereas no definite changes were observed in group 2 (5.09+/-1.62 nmol/mg protein, P =not significant versus baseline). CONCLUSION: Intravenous morphine may increase NEP activities to accentuate hydrolysis of ET-1.     

Development of a standardized patient instructor to teach functional assessment and communication skills to medical students and house officers

Professional societies have called for increased geriatrics training for all medical students and physicians. A Geriatrics Standardized Patient Instructor (GSPI) was developed in which learners assess the functional status of a patient preparing for hospital discharge. Standardized patients (SPs) rate learners on functional assessment and communication skills, and provide feedback. Seventeen SPs were trained. Correlations of ratings by SPs with ratings by three geriatricians of videotaped encounters indicated good reliability (correlation coefficient = 0.69 and 0.70 for functional assessment and communication skills, respectively). Results from two learner groups illustrated the utility and feasibility of the GSPI. First, 138 house officers in nine specialties experienced the GSPI as a formative evaluation during implementation of new geriatrics curricula. Mean scores+/-standard deviation (on a 100-point scale) for functional assessment and communication skills were 78+/-16 and 86+/-11, respectively. House officers rated the overall experience positively (mean rating (1 = poor, 5 = excellent) 3.9+/-0.8). Second, 171 first-year medical students (M1 s) encountered the GSPI as part of an intense, multimodal educational intervention. Mean scores on functional assessment and communication skills were 93+/-10 and 93+/-7, respectively. Mean overall rating of the experience by M1 s was 4.1+/-0.8. After demonstrated success as a teaching tool in these two groups of learners, the GSPI has been successfully used with second- and third-year (M3) medical students and house officers from a total of 12 specialties and incorporated into multistation Objective Standardized Clinical Examination exercises for incoming house officers and M3 s. Unlike existing diagnosis-oriented SPs, the GSPI can be used to assess and teach geriatrics skills to physician learners across disciplines and levels of training.     

Cluster randomized controlled trial of the impact of a computer‐assisted learning package on the learning of musculoskeletal examination skills by undergraduate medical students

Objective

To identify whether there was measurable impact of a specific computer‐assisted learning (CAL) package, “Virtual Rheumatology,” on the learning of musculoskeletal examination skills by medical students.

Methods

We conducted 2 parallel, cluster‐randomized controlled trials using undergraduate curricula at 2 locations: Newcastle and London, UK. Medical students attending a musculoskeletal rotation were allocated to the intervention (Virtual Rheumatology CD) or the control arm of the study by placement group. A formative 14‐item objective structured clinical examination (OSCE) assessment on the examination of shoulder and/or knee joints was the main outcome measure at Newcastle. At London, a 17‐item knee station formed part of the summative OSCE. We also used a questionnaire including a 15‐item confidence log (C‐Log) for self assessment of musculoskeletal examination skills and knowledge. Analysis was by intention to teach.

Results

At Newcastle, there were 112 students in the CD allocated group and 129 in the non‐CD group. The CD allocated group performed significantly better on the OSCE (P = 0.002) and C‐Log (P = 0.005) than the non‐CD group. At London, there were 48 students in the CD allocated group and 65 in the non‐CD group. The CD allocated group performed better on the knee OSCE than the non‐CD group (adjusted P = 0.040), but there was little difference in the change in C‐Log scores from baseline to followup between the 2 groups (P = 0.582).

Conclusion

The Virtual Rheumatology CD has a positive impact on the acquisition of musculoskeletal examination skills in medical students. Further study is needed to see if similar advantages could be gained in other clinical specialities and how CAL resources could be effectively integrated into the medical curriculum.

     

Prostaglandin E1 attenuates postischemic contractile dysfunction after brief coronary occlusion and reperfusion

We have previously demonstrated that administration of the prostacyclin analogue iloprost improved postischemic functional recovery in reversibly injured ischemic-reperfused myocardium. The present study investigated the effects of administering an endogenous vasodilator prostanoid, prostaglandin E1 (PGE1), in the stunned myocardium (15 minutes of coronary artery occlusion and 3 hours of reperfusion) of anesthetized dogs. The percentage of regional myocardial segment shortening (%SS) after administration of PGE1 by two routes, intravenously (1 microgram/kg/min) or intraatrially (0.1 microgram/kg/min), to avoid pulmonary metabolism, 15 minutes before and throughout the period of occlusion, was compared to %SS in a control group treated with saline solution. Nearly equivalent reductions in mean arterial pressure during occlusion compared to pretreatment control (PTC) values were produced by intravenous (33%) or intraatrial (25%) PGE1. There was no difference in transmural myocardial blood flow (radioactive microsphere technique) in the ischemic region between the PGE1-treated and control groups at any time. Although there were no differences in %SS in the nonischemic region between groups throughout the experiment, postischemic recovery of segment function in the ischemic-reperfused area was significantly improved (p less than 0.05) at all times during reperfusion by intravenous PGE1 (%SS of PTC: 30 minutes = 65 +/- 8; 3 hours = 58 +/- 7) or intraatrial PGE1 (%SS of PTC: 30 minutes = 57 +/- 12; 3 hours = 50 +/- 4) compared to the control group (%SS of PTC: 30 minutes = 25 +/- 13; 3 hours = 10 +/- 13). Thus treatment with PGE1 attenuates postischemic contractile dysfunction in the stunned myocardium.2+ both.