Preparing faculty to teach in a problem-based learning curriculum: the Sherbrooke experience.

Over the last 6 years Sherbrooke Medical School has undertaken a major reform of its undergraduate curriculum. A new student-centred, community-oriented curriculum was implemented in September 1987. Problem-based learning (PBL) is now the main educational method. To adequately prepare teachers for the curriculum a series of faculty development programs in pedagogy were offered: first, a 2-day introductory workshop to initiate teachers into educational principles and their application in the new program; second, a 1-year basic training program in medical pedagogy; third, a 1-day workshop on PBL; and fourth, a comprehensive 3-day training program in PBL tutoring. Over 60% of all full-time teachers attended the introductory program and 80% the tutor training program. The 1-year basic training program was completed by 33% of the faculty members. The implementation of these programs, coupled with a high participation rate, resulted in a more student-centred educational philosophy and a greater interest in medical education. This had a significant impact when the new curriculum was instituted. Lessons learned from the experience are discussed.     

Labour is still painful after prepared childbirth training.

Labour pain was measured with the McGill Pain Questionnaire in 87 primiparas and 54 multiparas. The average intensity of labour pain ranked among the most intense pains recorded with the questionnaire. However, the pain scores had a wide range and were influenced by several medical and social variables. They were significantly higher for the primiparas than for the multiparas. Moreover, high pain levels were associated with a history of menstrual difficulties and lower socioeconomic status. The primiparas who had received prepared childbirth training had lower pain scores than those who had received no such training. Nevertheless, the effects of prepared childbirth training were relatively small, and most patients (81%) who received it requested epidural anesthesia. Because many women who received training suffered severe pain during labour, prepared childbirth training and epidural anesthesia should be regarded as compatible, complementary procedures.     

内镜大隐静脉获取术学习曲线研究

目的 研究初学者学习内镜大隐静脉获取术(EVH)的可行性及学习曲线.方法 选自2008年1月至2010年2月行择期冠状动脉旁路移植术的患者120例行内镜大隐静脉获取术,按手术时间分为6组,各20例患者.比较获取时间、静脉长度、手术结果等情况.结果 本研究长度-时间指数由G1组的0.41±0.08显著提高到G6组的0.85±0,03,这一变化也就代表了微创内镜大隐静脉获取术(EVH)的学习曲线.下肢伤口并发症的发生率及切口数随着手术例数的积累呈下降趋势,静脉修补个数无差异和组织学评估结果均证实所获取的静脉质量可靠.结论 EVH作为一种新兴技术有着广泛的应用前景,经80～100例的学习之后即可熟练掌握,满足临床实践的需要.     

Systemic calciphylaxis presenting as a painful, proximal myopathy.

A renal transplant patient who presented with a painful, proximal myopathy due to systemic calciphylaxis is described. The myopathy preceded the characteristic skin and soft tissue necrosis. Systemic calciphylaxis should be considered in a dialysis or a renal transplant patient presenting with a painful proximal myopathy even in the absence of necrotic skin lesions.