Trends in clinical education of medical students: implications for pediatrics

OBJECTIVES: To describe current educational imperatives and trends for curricular changes in the clinical education of medical students and to delineate the nature and extent of participation in these curricular trends by departments of pediatrics. METHODS: Site visits to 26 representative US medical schools and a review of detailed information from 12 additional schools. Evaluation of the core curriculum was developed by the Council on Medical Student Education in Pediatrics within the context of the major curricular trends observed. RESULTS: The major observed curricular trends emphasized community-based ambulatory experiences, continuity of care, integration, and population-based experiences. Supporting educational principles included student-directed learning and performance-based assessments. The 3 major curricular changes were early clinical experiences (longitudinal preceptorships), community-oriented/ population-based experiences, and multispecialty clerkships. The focus of the Council on Medical Student Education in Pediatrics objectives was the year 3 clerkship, and substantive participation by pediatric faculty in the overall curriculum was primarily related to the pediatric clerkship. CONCLUSIONS: Revising the clerkship-based Council on Medical Student Education in Pediatrics guidelines according to the new educational trends will extend clinical curricular opportunities for pediatrics beyond the traditional boundaries of the clerkship. The discipline of pediatrics will, as a consequence, be able to achieve enhanced partnership in the planning, conduct, and evaluation of a clinical curriculum for medical students that is relevant to child health issues and that extends across all 4 years.     

Enhanced isolation of Mycoplasma pneumoniae from throat washings with a newly-modified culture medium.

Two hundred throat washings, previously screened and presumed negative for Mycoplasma pneumoniae in conventional mycoplasma culture media, were retested for the organism in a modified medium (PS-4) initially developed for cultivation of a tick-derived Mycoplasma (spiroplasma). The organism was rapidly identified with an agar plate immunofluorescence procedure. M. pneumoniae was isolated from 69 (34.5%) of the 200 "negative" specimens cultured on a diphasic SP-4 medium, in contrast to 10 isolations (5%) made on conventional diphasic mycoplasma medium. This enhanced recovery of M. pneumoniae represented a combination of a superior culture medium and a more efficient identification technique. The findings suggest that these procedures might be effectively applied to the recovery of M. pneumoniae from all likely host and that improved recovery of the organism may aid in the interpretation of a number of puzzling questions about the epidemiology of M. pneumoniae infections.     

Methotrexate pneumonitis: case report and review of the literature

Methotrexate has been recommended for long-term therapy of an increasing number of diseases including acute lymphoblastic leukaemia, psoriasis and other chronic dermatoses, Wegener's granulomatosis, and multiple solid tumours. Acute pneumonitis is a known complication of methotrexate therapy. An additional case is reported and the clinical features of the 13 previous cases are summarized. Clinical and radiographic evidence of acute pneumonitis associated with eosinophilia and a rapid clearing with steroid treatment is the characteristic syndrome.     

Mine Blast Injuries - Our Experience

Background

The sudden increase in incidence and magnitude of mine blast injuries prompted us to highlight the problem and its management.

Methods

The cases of mine blast injuries occurring during mining and demining in a particular geographical area were analysed. Total 27 cases of mine blast injuries occurred during mining or demining operations in a period of 13 months.

Results

Various body regions were involved in the mine blast injuries but the main brunt was borne by feet and legs followed by multiple body regions due to splinters. 14 patients underwent below knee (BK) amputation while 4 patients required through knee (TK) amputations. The effect of blast was so severe that most of the cases required 2 to 5 times wound debridements. The initial aggressive debridement / open stump amputation saved the limb and life of all patients.

Conclusion

A mine blast causes extensive injuries and psychological trauma. Management is needed urgently, surgery is difficult, and amputation is often inevitable. Maximum lives and limbs can be saved with aggressive debridement, repeated inspections and dressings under anaesthesia and definitive closure at optimum time.Key Words: Amputation, Antipersonnel mine, Crush syndrome, Debridements, Mine blast injury, Secondary missiles, Shrapenels     

Lightning injuries

Lightning strikes may cause a constellation of injuries. Blunt head trauma, neurologic injury, and cardiac injury are common in these patients. In contrast to high-voltage electrocutions, blunt trauma after a lightning strike is common. Thorough evaluation of all organ systems is crucial. This report discusses mechanism of injury and describes initial evaluation and treatment of lightning strike victims.     

Passing the clinical baton: 6 principles to guide the hospitalist

Hospitalist systems make it increasingly common for responsibility for a patient to be passed from one physician to another. During such transfers, patients' outcomes and satisfaction can benefit from better communication between hospitalists and the primary care physicians whose patients they care for. We propose 6 principles to guide such communication, to ensure that critical information about patients is not lost and to optimize the quality of care. We also discuss special considerations for patients discharged to a skilled nursing facility or to home with home care.