Neurosurgical education in Ireland; a conference and medical student experiences

BackgroundAdult neurosurgery in Ireland is carried out in two specialist centres, attached to only two medical schools. This leaves four Irish medical schools with no formal clinical attachment in neurosurgery. We organised a student neurosurgical conference to increase exposure to neurosurgical topics and to evaluate student's experience of undergraduate neurosurgical education.MethodsThe conference was organised by students from two Irish Universities with assistance from the National Neurosurgical Centre. It was open to students from all medical students in Ireland. Attendees were invited to complete a questionnaire before and after the conference. Questions were either yes or no answer or responses on a Likert scale.Results95 students attended and all medical schools in Ireland were represented. 22% of attendees have received neurosurgical teaching during their medical education, while only 12% had a clinical rotation in neurosurgery. 40% of students are in a medical school attached to a hospital that performs neurosurgery. 54% of attendees disagreed or strongly disagreed that their medical education has comprehensively covered neurosurgical topics. 92% agreed or strongly agreed that they would like more teaching or clinical exposure in neurosurgery. 96% would attend future neurological study days.ConclusionsUndergraduate neurosurgical education in Ireland varies between Irish medical schools. Many students reported their medical education has not adequately covered neurosurgical topics and that they would like more exposure to neurosurgical teaching and clinical attachments. Nearly all students reported they would attend future neurosurgical student conferences and this may be one method of increasing exposure to neurosurgery as a medical student.     

The GP dilemma. Recommendations and synopsis of a student conference.

The proceedings of a conference organised by students are reported. The present standing of the general practitioner and his need in different societies are equated and the obvious deficiencies are considered. Such themes as maldistribution, service and education are discussed. Resolutions derived from the conference are reported in full.     

Editorial Commentary: A Commentary on a Meta-analysis of Short-Term Outcomes

Hip pain is prevalent and costly, and young patients with hip femoroacetabular impingement have similar levels of pain and quality of life to older patients with hip osteoarthritis. Hip arthroscopic surgery for femoroacetabular impingement is increasing in prevalence, and the benefits of operative treatment compared with nonoperative treatment require consideration. Hip arthroscopy should not be a first-line treatment but can be necessary in cases in which high-quality, exercise-based nonsurgical treatment options have been exhausted. Patients should be informed that surgery is not necessarily cost-effective and may have an increased risk of comorbidities such as chronic pain and insomnia. Patient-reported outcomes may improve by up to 20% with either surgery or physical therapy but are not likely to return to those seen in patients without hip pain. Although most patients return to sport after hip arthroscopy, the ability to participate at a preinjury level is seen in fewer than a quarter of patients. Return-to-sport rates with physiotherapist-led nonoperative treatment are not known.     

Competency-based student self-assessment on a surgery rotation

INTRODUCTION: Vascular endothelial growth factor (VEGF) is an angiogenic factor that increases vascular permeability. VEGF stimulates capillary formation and has mitogenic effects on vascular endothelial cells. The development of malignant ascites causes significant morbidity. We hypothesized that increased levels of VEGF play a role in the development of malignant ascites in patients with pancreatic cancer. METHODS: Athymic mice underwent orthotopic implantation of human pancreatic ductal adenocarcinoma tumors (250,000 cells) into the body of the pancreas. Tumors were allowed to grow for 12 weeks, at which time ascites develops in 50% of mice. Paracentesis was performed on mice with noticeable ascites. Saline lavage was performed in mice with equivalent pancreatic tumor masses without ascites and served as control. Both ascites and tumor masses were harvested for VEGF protein quantitation by ELISA. RESULTS: VEGF protein levels were elevated in malignant ascites by 15-fold compared to control mice with equivalent tumors (N = 6, P < 0.001, t test). VEGF levels were slightly higher in the primary tumor masses harvested from mice without ascites. Mice with ascites also had metastatic nodules throughout the abdominal cavity. CONCLUSIONS: We are reporting for the first time that VEGF levels are increased in the ascites of nude mice with orthotopically transplanted human pancreatic cancers. VEGF increases vascular permeability and allows for extrapancreatic seeding of tumors. Irrespective of primary tumor size, intraperitoneal VEGF levels are increased when ascites and extrapancreatic nodules are present, while a paradoxical decrease is observed in VEGF levels of primary tumors.     

Commentary on a framework for multicultural education

Today’s changing demographics require that multicultural factors be considered in the delivery of quality patient-centred health care in chiropractic. Yet minimal training in cultural competency in chiropractic education leaves graduates ill-equipped to treat a diverse population. This commentary examines cultural competency training in current literature, demonstrates frameworks for curriculum integration, and suggests how cultural competency might be included in a chiropractic college curriculum. A database search yielded little evidence that cultural competency is integrated into curricula of chiropractic schools. Some journal articles note that promoting multicultural education and cultural sensitivity is an important goal. However, they provide no mechanisms as to how this can be achieved within training programs. Thus, although an undeniable need exists for all healthcare practitioners to develop cultural competency in the face of an increasingly diverse population, cultural competency education has not kept pace. Chiropractic schools must review their curricula to develop the cultural competencies of their graduates and a basic framework is suggested.