Transition from Longitudinal to Block Structure of Preclinical Courses: Outcomes and Experiences

Aim

To evaluate the transition from a longitudinal to block/modular structure of preclinical courses in a medical school adapting to the process of higher education harmonization in Europe.

Methods

Average grades and the exam pass rates were compared for 11 preclinical courses before and after the transition from the longitudinal (academic years 1999/2000 to 2001/2002) to block/modular curriculum (academic years 2002/2003 to 2004/2005) at Zagreb University School of Medicine, Croatia. Attitudes of teachers toward the 2 curriculum structures were assessed by a semantic differential scale, and the experiences during the transition were explored in focus groups of students and teachers.

Results

With the introduction of the block/modular curriculum, average grades mostly increased, except in 3 major courses: Anatomy, Physiology, and Pathology. The proportion of students who passed the exams at first attempt decreased in most courses, but the proportion of students who successfully passed the exam by the end of the summer exam period increased. Teachers generally had more positive attitudes toward the longitudinal (median [C]±intequartile range [Q], 24 ± 16) than block/modular curriculum (C±Q, 38 ± 26) (P = 0.001, Wilcoxon signed rank test). The qualitative inquiry indicated that the dissatisfaction of students and teachers with the block/modular preclinical curriculum was caused by perceived hasty introduction of the reform under pressure and without much adaptation of the teaching program and materials, which reflected negatively on the learning processes and outcomes.

Conclusion

Any significant alteration in the temporal structure of preclinical courses should be paralleled by a change in the content and teaching methodology, and carefully planned and executed in order to achieve better academic outcomes.The adoption of the Bologna Declaration on the European Higher Education Area in 1999 (1) initiated a wave of curriculum reforms at universities across Europe (2). The process of modernization of higher education supported by the European Commission has begun in countries surrounding the European Union even earlier, in the beginning of 1990s, and has since expanded to a total of 27 countries, including some in Central Asia, North Africa, and Middle East (3). Medical schools joined the process at a slower pace (4), taking into account their specifics, such as costliness of medical education and the long, one-tier structure of medical curricula (5). Changes in the curriculum design mostly related to the integration of preclinical and clinical courses and the introduction of problem-based learning (PBL) (6).While an increasing number of European medical schools accepted a combination of subject-based and integrated problem-based approaches (6), medical schools in the Southeast Europe mostly retained the traditional curricula with Anatomy, Physiology, and Pathology as dominant courses in the first 3 years of medical study (7). The School of Medicine at the University of Zagreb, Croatia, was the only school in the region delivering some case-based modules with a degree of integration, but only in the last (clinical) year of the study (7). Despite the expected reluctance of the teaching staff to accept reforms of the curriculum (8), the leadership of the Zagreb University School of Medicine decided in 2001 to change the structure of preclinical courses in the first 3 years of study from the longitudinal, spread-out form to block/modular form. Clinical courses in the last 3 years of study had already been taught in blocks. The change in the structure of preclinical courses was intended to be the first step in a broader process of the curriculum reform initiated and conducted in cooperation with the Harvard Medical International and the Ludwig Maximilian University from Munich, Germany (9) and a part of the general modernization of medical curricula in Croatia (10).Many reports have dealt with the curricular reforms in medical schools, mostly describing the introduction of PBL (11,12) and integration of preclinical and clinical courses (13). Previous studies have compared PBL and traditional curriculum (14,15), PBL and a hybrid form of curriculum (16,17), or PBL and some other type of interactive learning (18). No study has yet explored the effects of the transition from the longitudinal to block/modular structure of preclinical courses, without any other substantial change in the curriculum design or content. The case of University of Zagreb School of Medicine is representative of adjusting traditional curriculum to the requirements of the Bologna Process doing the least changes possible. As this phenomenon may occur in other medical schools, especially in the Southeast Europe, it is important to explore its effects and the related experiences of all involved educational actors.The first aim of our study was to compare the outcomes of 2 curriculum structures (the longitudinal vs block/modular) in the preclinical years of medical study and to identify their advantages and drawbacks. The second aim was to assess the attitudes of the teaching staff toward the longitudinal and block/modular form of teaching.     

Postnatal changes in the styloid process,vagina processus styloidei,and stylomastoid foramen in relation to the function of muscles originating from the styloid process

We investigated age-related changes in the styloid process in 88 skulls, aged from 5 months to 85 years of age. The osseous styloid process was not well developed in children. Its length increased significantly with age (from 2.3 mm in 11–20 age group to 16.3 mm in 61–85 group). In adolescent specimens (11–20 years of age), the median distance from the styloid process to the stylomastoid foramen was 0.7–0.8 mm, whereas in adult and old age specimens the two structures were completely adjacent or very close, usually less than 0.2 mm. The process was missing in 5% of the adult specimens. There was a statistically significant positive association between the length of the styloid process with age (r = 0.3210, 95% CI 0.0817–0.5254; P = 0.0097), whereas the distance from the styloid process to the stylomastoid foramen significantly decreased with age (r = −0.4518, 95% CI −0.6167 to −0.2490; P = 0.0001). Changes in the length and shape of the styloid process reflected altered function of the three muscles originating from the styloid process—m. stylopharyngeus, m. stylohyoideus and m. styloglossus. They have a common function of lifting the aerodigestive elements upward and backward, after the descent of the aerodigestive tract and final morphological differentiation of the vocal system during puberty. Relationship between altered muscle function and the morphology of the styloid process are important for understanding the clinical syndromes related to the styloid process, such as Eagle’s syndrome. Presented as a poster at the 78 Jahresversammlung 2007 der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie e.V., Munich, 17–20 May 2007.     

Identification of differential and functionally active miRNAs in both anaplastic lymphoma kinase (ALK)+ and ALK? anaplastic large-cell lymphoma

Aberrant anaplastic lymphoma kinase (ALK) expression is a defining feature of many human cancers and was identified first in anaplastic large-cell lymphoma (ALCL), an aggressive non-Hodgkin T-cell lymphoma. Since that time, many studies have set out to identify the mechanisms used by aberrant ALK toward tumorigenesis. We have identified a distinct profile of micro-RNAs (miRNAs) that characterize ALCL; furthermore, this profile distinguishes ALK⁺ from ALK⁻ subtypes, and thus points toward potential mechanisms of tumorigenesis induced by aberrant ALK. Using a nucleophosmin-ALK transgenic mouse model as well as human primary ALCL tumor tissues and human ALCL-derived cell lines, we reveal a set of overlapping deregulated miRNAs that might be implicated in the development and progression of ALCL. Importantly, ALK⁺ and ALK⁻ ALCL could be distinguished by a distinct profile of “oncomirs”: Five members of the miR-17–92 cluster were expressed more highly in ALK⁺ ALCL, whereas miR-155 was expressed more than 10-fold higher in ALK⁻ ALCL. Moreover, miR-101 was down-regulated in all ALCL model systems, but its forced expression attenuated cell proliferation only in ALK⁺ and not in ALK⁻ cell lines, perhaps suggesting different modes of ALK-dependent regulation of its target proteins. Furthermore, inhibition of mTOR, which is targeted by miR-101, led to reduced tumor growth in engrafted ALCL mouse models. In addition to future therapeutical and diagnostic applications, it will be of interest to study the physiological implications and prognostic value of the identified miRNA profiles.     

Chemokine production and chemokine receptor expression by human glioma cells: role of CXCL10 in tumour cell proliferation

The expression of chemokine receptors and chemokine production by adult human non-transformed astrocytes, grade III astrocytoma and grade IV glioblastoma tumour cell lines were determined. Here, we show an increased expression of CXCR3 and CXCR4, and a decreased expression of CXCR1 and CCR4 by glioma cells compared to adult human astrocytes. Glioma cells showed increased production of CXCL10, whereas production of other chemokines was decreased (CXCL8, CCL2, CCL5, and CCL22). CXCL10 induced an ERK1/2-dependent increase in [(3)H] thymidine uptake. These results suggest that expression of chemokine receptor/ligand pairs such as CXCR3/CXCL10 have an important role in the proliferation of glioma cells.     

Phyllodes tumors of the breast diagnostic and therapeutic dilemmas

BACKGROUND: This article compares experiences in the diagnosis and treatment of phyllodes tumors from 2 regional institutions with the relevant literature. PATIENTS AND METHODS: From 1991 to 2005, 2,848 breast cancer patients were treated in our institutions, 36 (1.44%) for phyllodes tumors. The average tumor size was 5.1 cm (range 1.4-19.6). Triple assessment was the standard diagnostic algorithm. Wide excision with tumor-free margins was carried out in 29 (80.5%) cases and mastectomy in 7 (19.4%) cases. Axillary lymphadenectomy was performed in patients with positive lymph nodes. RESULTS: Histology showed the phyllodes tumors to be benign in 27 (75.0%), malignant in 6 (16.6%), and borderline in 3 (8.3%) cases. Follow-up was from 5 months to 16 years. In this period, recurrences of 3 (8.3%) malignant and 2 (5.6%) benign phyllodes tumors were diagnosed and treated. 10 (27.7%) patients treated with wide local excision showed deformities in the form of scarring. The steroid receptor status was of no prognostic value in our patients, and chemotherapy was used in only 1 (2.7%) patient. 5-year survival was 86.2%. CONCLUSION: Our study shows that tumor size, margin infiltration, mitotic activity and degree of cellular atypia are important prognostic factors. Problems in diagnosing this condition arise from its similarity to fibroadenoma. Although wide local excision is usually the treatment of choice, tumor recurrence is common. Axillary lymphadenectomy in malignant phyllodes tumors is, in our opinion, still controversial.     

Quantification of hepatitis C virus by TaqMan PCR: comparison with HCV Amplicor Monitor assay.

The quantitation of serum levels of hepatitis C virus RNA in chronic hepatitis C has been regarded as one of the most important indicators for the outcome of interferon therapy. A new method was used for quantitating the copy number of hepatitis C virus RNA using TaqMan polymerase chain reaction and for comparing the ability and usefulness of this assay with Amplicor Monitor assay in 138 patients. The detection range of hepatitis C virus RNA by TaqMan polymerase chain reaction was from 2 x 10(3) to 2 x 10(8) copies/ml. Hepatitis C virus RNA was detectable in 128 cases (92.8%) and undetectable in 10 cases (7.2%) by this method. The RNA levels measured by Amplicor Monitor assay correlated significantly with those measured by TaqMan polymerase chain reaction assay and the sensitivity of the two assays was almost equal. Thus, TaqMan polymerase chain reaction assay appears sufficiently sensitive for the evaluation of hepatitis C virus RNA and would be useful for the diagnosis and management of hepatitis C virus infection.     

Preliminary observations on interaction of 14C-metronidazole with macromolecules in vivo and in vitro

Preliminary studies on the in vivo and in vitro interactions of 14C-metronidazole with macromolecules showed that the agent or its metabolite(s) can interact with nucleic acids and proteins in vivo. In vitro studies suggest that in absence of DNA synthesis trace amount of metronidazole does bind to DNA/protein and addition of metabolic activation system (from mouse liver) generates more reactive species from metronidazole.