How doctors learn: education and learning across the medical-school-to-practice trajectory.

People have needs they address daily over the course of their lives. They address these needs through identifying and resolving problems in ways that reflect their identities. This means that education, including medical education, is an identity development process because it provides people with more and better ways to satisfy their needs. Also, education does this by providing them with the knowledge and skills they use to occupy identifiable niches in society. These niches are describable in terms of what people do and the ways in which they relate to others. Medical education, in other words, allows medical students and residents to take on physicians' identities, and their identities go a long way toward defining when, where, and how they will address their psychosocial needs. Doctors begin developing the skills and knowledge they need in medical school and continue developing them through residency and into practice. However, there are important differences among medical students, residents, and practicing physicians, and these differences have an impact on how the individuals satisfy their psychosocial needs. These differences also bear on how well they will satisfy their needs later in their careers; i.e., the things physicians-in-training do to satisfy their psychosocial needs in the course of learning to become doctors are expected to prepare them to address their psychosocial needs later in life in their roles as both healers and professionals. It is against this background of describing how education helps physicians solve problems and so address their recurring psychosocial needs that the author presents 12 conclusions concerning physicians' learning.     

How to: implement procalcitonin testing in my practice

BackgroundAdding procalcitonin (PCT) to antibiotic stewardship algorithms may improve antibiotic use. However, PCT protocols need to be adapted to clinical settings and patient populations.ObjectivesTo review PCT use in different medical settings and patient populations.SourcesMost recent trials and meta-analyses investigating PCT for antibiotic stewardship were reviewed.ContentSeveral trials found PCT-guided antibiotic stewardship to reduce antibiotic exposure and associated side-effects among patients with respiratory infection and sepsis. Decisions regarding antibiotic use in an individual patient are complex and should be based on the pre-test probability for bacterial infection, the severity of presentation and the results of PCT. In the context of a low pre-test probability for bacterial infections and a low-risk patient, a low PCT level helps to rule out bacterial infection and empiric antibiotic therapy can be avoided. In the context of a high pre-test probability for bacterial infections and/or a high-risk patient with sepsis, monitoring of PCT over time helps to track the resolution of infection and decisions regarding early stop of antibiotic treatment. Although these concepts have been successful in several respiratory infection and sepsis trials, some studies failed to show an added benefit of PCT due to factors such as low protocol adherence and relying on single rather than repeat PCT measurements.ImplicationAs an adjunct to other clinical and laboratory parameters, PCT provides information about risk for bacterial infection and resolution of infection, and improves antibiotic stewardship decisions, thereby offering more individualized treatment courses with overall reduced antibiotic exposure.     

WISC-R verbal-performance IQ discrepancies: A comparison of learning disabled children to the normative sample

Compared the WISC-R Verbal-Performance IQ discrepancies of learning-disabled children (N = 100) and of the normative sample. There were frequent occurrences of statistically significant discrepancies in both groups, as well as similar mean discrepancy scores and distributions of Verbal > Performance and Performance > Verbal patterns. It was concluded that without clinical evidence to suggest otherwise, it cannot be assumed automatically that a child's discrepancy score, unless of extreme magnitude, is related to the learning disability itself. The importance to clinicians of making both normative and statistical interpretations of WISC-R discrepancy scores was stressed.     

How doctors learn: physicians' self-directed learning episodes.

PURPOSE: To qualitatively examine the self-directed learning activities of physicians in light of several lines of research on how doctors learn. METHOD: Under the auspices of the Royal College of Physicians and Surgeons of Canada, the author elicited from physicians narratives about past learning experiences. He analyzed the narratives (1) seeking themes among the doctors' approaches and (2) examining those themes in light of the existing literature. RESULTS: The 32 physicians interviewed described learning experiences, confirming earlier research that two varieties of problems (specific and general) precipitate learning and that learning episodes follow definite stages: scanning for problems, deciding whether to pursue the learning task, acquiring new knowledge and skill, and gaining experience with what has been learned. The latter three stages have been described previously and are expanded upon here. CONCLUSION: This study produced an integrated and elaborated theory of learning in clinical practice with implications for both the education of physicians in training and physicians' continuing professional development. In particular, the theory points to problem areas in teaching medical students and residents to learn in clinical practice, and in matching the learning needs of physicians to organized continuing medical education activities.     

DNA markers associated with high versus low IQ: The IQ quantitative trait loci (QTL) project

General cognitive ability (intelligence, often indexed by IQ scores) is one of the most highly heritable behavioral dimensions. In an attempt to identify some of the many genes (quantitative trait loci; QTL) responsible for the substantial heritability of this quantitative trait, the IQ QTL Project uses an allelic association strategy. Allelic frequencies are compared for the high and low extremes of the IQ dimension using DNA markers in or near genes that are likely to be relevant to neural functioning. Permanent cell lines have been established for low-IQ (mean IQ=82;N=18), middle-IQ (mean IQ=105;N=21), and high-IQ (mean IQ=130;N=24) groups and for a replication sample consisting of even more extreme low-IQ (mean IQ=59;N=17) and high-IQ (mean IQ=142;N=27) groups. Subjects are Caucasian children tested from 6 to 12 years of age. This first report of the IQ QTL Project presents allelic association results for 46 two-allele markers and for 26 comparisons for 14 multiple-allele markers. Two markers yielded significant (p<.01) allelic frequency differences between the high- and the low-IQ groups in the combined sample—a new HLA marker for a gene unique to the human species and a new brain-expressed triplet repeat marker (CTGB33). The prospects for harnessing the power of molecular genetic techniques to identify QTL for quantitative dimensions of human behavior are discussed.     

Continuing education for general practice: a learning system

A learning system for continuing education for general practitioners is described and illustrated by examples from educational programmes held in Doncaster. The work that needs to be done by organizers in planning, organizing, implementing, and evaluating educational programmes is outlined. I hope that this will help other organizers of continuing education.     

Reading on the Wide Range Achievement Test-Revised and parental education as predictors of IQ: comparison with the Barona formula.

It is frequently necessary in research and clinical evaluations to obtain estimates of premorbid intelligence (IQ) which are separate from measured IQ. There is evidence that word reading may be useful in this aim. In order to determine the potential of the Wide Range Achievement Test-Revised (WRAT-R) reading subtest (READ) as an estimate of premorbid IQ, the present study examined the relationship between READ and IQ in healthy subjects. Consistent with other findings, READ accounted for a significant amount of variance in Verbal, Performance, and Full Scale IQ. Race and parental education, the latter being a variable not previously examined in this literature, accounted for incrementally valid variance in IQ beyond READ. The predictive power of these variables compares favorably with estimates made by the Barona IQ estimation formula, which uses only demographic information.     

The general practitioner: How much psychiatric education?

One hundred nine general physicians practicing in small rural communities completed questionnaires regarding the number of patients they saw with psychiatric problems. Respondents were also asked to give details of their psychiatric and medical training, to indicate where they obtained new information about psychiatric topics, and to rate the importance of 36 items in daily medical practice. Over one half felt their medical school training in psychiatry was not on par with that received in internal medicine, OB-GYN, surgery, and pediatrics. We suggest the 36 items they ranked be used as a guide in developing a core curriculum for family practice residency training programs as well as for the design of continuing medical education for general physicians.     

How children with neurofibromatosis type 1 differ from "typical" learning disabled clinic attenders: nonverbal learning disabilities revisited

To further investigate cognitive deficits in children with Neurofibromatosis Type 1 (NF-1), children with NF-1 were compared to typical learning disabled clinic attenders (LD-clinic), all of whom had reading disabilities, as well as to a group with no disabilities (NoDx). Results indicated that both the NF-1 group and LD-clinic group had reading and reading-related deficits when compared to the NoDx group; however, the NF-1 group was more globally language impaired than the LD-clinic group. In addition, the NF-1 group scored significantly lower than the LD-clinic group, but not the NoDx group, on the visuospatial measures, thus confirming that children with NF-1 have visuospatial deficits not typical of a general LD-clinic population. The NF-1 group was not impaired in comparison to the NoDx group on certain language and visuospatial tasks that were previously found to be deficits in sibling pairwise matched designs; thus, the importance of considering genetic and familial context when studying the impact of genetic disorders on cognition was demonstrated.     

How medical education can contribute towards the reduction of maternal mortality in Angola: the teaching/learning process of Gynecology and Obstetrics

Background

In Angola the maternal mortality ratio is among the highest in the world. Medical students are an important target for intervention.

Objectives

To evaluate how students perceive the curricular unit of Gynecology and Obstetrics (G&O) in a public institution of reference in Angola.

Methods

The study involved a sample of 147 students of the faculty of Medicine of the University Agostinho Neto, Luanda, Angola, attending the curricular unit of G&O in the 5th and 6th years of the medical course. Data were obtained through surveys of opinion. The information of the scales was summarized through the construction of scores from the original items using the Principal Components Analysis.

Results

Students evaluated positively the curricular unit although emphasizing the lack of human and physical resources. The 5th year scored with higher values Teacher Performance and 6th year Students'' Performance. Both years considered to have insufficient skills to meet the learning objectives.

Conclusion

Constraints were identified in the outcomes of the teaching/learning program. Several points emerged as crucial from this study: widespread the areas of teaching/learning, increase the number and quality of teaching staff, improve the monitoring of students and provide adequate infrastructures and medical equipment to support the teaching/learning program.