Development and implementation of an innovative intern training programme

The quality of medical education during internship is a cause for concern. This paper describes a structured educational programme for interns that was based around learning modules, clinical attachments and bedside teaching. The programme was incorporated into the term rotation of interns within an Area Health Service, and evaluated. Learning modules were timetabled by a Programme Coordinator and interns were reminded to attend. Clinical attachments were organized by the interns from a list of willing supervisors. Attendance at timetabled learning modules averaged 67%, which was greater than the 27% attendance at clinical attachments. Both sessions received high ratings for quality and clinical relevance. This structured education programme was based upon adult learning methods and was both feasible and well received by interns. Intern training programmes need to be programmed into the working week to ensure attendance, and modified following evaluation by interns. Such programmes should be considered by all hospitals to which interns are allocated.     

Teaching medical students about the appropriateness of social and sexual contact between doctors and their patients: evaluation of a programme

The purpose of this study was to assess the impact of an educational intervention on medical students' attitudes toward social and sexual contact with patients by doctors from three medical specialties (general practice, obstetrics/gynaecology and psychiatry). Medical students from two consecutive fifth year classes at one medical school participated in one 3 hour session that included instruction on the standards of the profession that prohibit doctor–patient sexual contact. Students were assigned to either intervention groups or control groups and responded to an anonymous questionnaire (overall response rate 66·8% ; n=141). As many as 14·5% of control group students thought it was (sometimes or usually) appropriate for general practitioners to date their own patients and at least 3% thought it appropriate for members of any of these three medical specialties to engage in sexual contact with their own patients. However, there were no significant differences in attitudes toward hugging, dating or sexual contact with current patients between those who had attended the seminar and the control groups. The session significantly influenced attitudes regarding obstetrician/gynaecologists and psychiatrists hugging and having sexual contact with former patients. These findings are discussed in relation to a need for expansion of such instruction.     

Teaching sociology of medicine: the group process

As a part of any curriculum reorganization, new instructional methods are also tested. When the University of Turku sociology of medicine course was found to need renovation, its goals and objectives, content and instructional methods were closely examined and modified, in order to strengthen institutional and multiprofessional relations and reinforce sociocultural issues in doctors' competence with the patient. This paper discusses this change, emphasizing teaching and learning methodology.     

An analysis of paediatric diagnostic decision-making: how should students be taught?

This study assesses the relative importance of history, examination and investigations in paediatric diagnosis, in the Paediatric Out-patient Department of the Central Middlesex Hospital, London, by means of a questionnaire-based record of 94 consecutive referrals. A diagnosis identical to the final diagnosis was made in 76% of referrals after taking a history. The general practitioner had proposed a diagnosis in 45% in the referral letter. Clinical examination changed the diagnosis in only 15% but increased diagnostic confidence in 33%. Ninety-one per cent of cases were diagnosed without recourse to investigations. Forty-two per cent of children referred had investigations performed. In the majority of paediatric cases the provisional diagnosis reached after taking a history was identical to that after examination or results of investigations were known. Although examination provided a final diagnosis in only 15% of all cases it played an important role in adding confidence in 33%. More educational effort should therefore be directed at clinical history-taking skills and the subsequent purpose of examination.     

Discriminant analysis of macrocytic red cells

Summary. Laboratory classification of red cell disorders uses the red cell indices (MCV, MCH, MCHC, RDW) and information gleaned from microscopic evaluation of a blood film. Additional red cell information is now available using the H series of automated blood cell analysers (Ames Technicon Division of Bayer Diagnostics). This study involved the development of a discriminant rule which would differentiate between three causes of macrocytosis (vitamin B₁₂/folate deficiency, alcohol excess/liver disease and a reticulocytosis) using the information available on Research Screen 1 and Report Screen 3 of the H*1 instrument (Report Screen 3 is a graphical display of the trimmed scattergram of red cell volume and red cell haemoglobin concentration and Research Screen 1 displays the associated numerical data). Three methods of analysis were assessed to define a suitable discriminant rule. The percentages of patients correctly classified by the three methods were: 92.1%, 82.0% and 89.2% for Methods 1, 2 and 3 respectively. Method 1 involved the application of quadratic discrimination to transformed variables and produced the best results. Although complex, it could easily be applied using the microprocessor capability of the average multiparameter haematology analyser.     

Assessment in undergraduate psychiatric education

An assessment of medical students' psychiatric performance demonstrated no association between the ability to rate psychopathology or to observe interview behaviour and traditional written methods of academic achievement. This is in accordance with those few studies which have addressed this issue and indicates that there may well be at least three independent skills involved in clinical decision-making: the ability to engage in interpersonal interaction and elicit information; and the ability to acquire and use academic knowledge. This is consistent with work suggesting that maturational and learning processes influence clinical reasoning, and demonstrates that each component should be addressed in assessing students in psychiatry.     

Attitudes of the 1984 medical graduates of Sri Lanka to anaesthesia

A total of 196 intern medical officers who had graduated from the four medical schools in Sri Lanka in 1984 indicated their attitudes towards anaesthesia as a medical specialty in response to a postal questionnaire. Eighty per cent of the graduates considered anaesthesia to be an established specialty in Sri Lanka, while 17% felt that the specialty had limited clinical application. A total of 62% of the graduates were not aware, prior to their entry to medical school, that anaesthesia was related to medical practice. All the graduates indicated that the intra-operative role of the anaesthetist was on a par with that of the surgeon, but 40% felt that the pre- and post-operative roles were of a secondary nature. Overall, 42% considered that an anaesthetist acts as an assistant to the surgeon. The graduates were of the opinion that only 35% of the patients undergoing surgery were appreciative of the services rendered by an anaesthetist. Fifty per cent of the graduates considered exposure to the specialty in the undergraduate curriculum as inadequate. Anaesthesia was chosen as the first career preference by 1.5%. The dominant reasons for not selecting anaesthesia as a career specialty were: minimal patient contact and patient recognition (62%), and lack of recognition of the specialty by society (54%). Anaesthetists in Sri Lanka are challenged to alter the perceptions associated with the specialty, which are probably a result of chronic staff shortages restricting practice to the confines of operating theatres.     

Integrating human factors into the medical curriculum

Background  The study of human factors is a scientific discipline that deals with the interactions between human beings and the elements of a system. This is important because shortcomings in these areas, if unchecked, can result in adverse outcomes. Research into human factors in industries where safety is paramount has provided the basis of countermeasures against human error. Adverse outcomes in medicine resulting from human error exact a high cost in both patient suffering and financial outlay.
CRM training  One of the approaches used to minimise the effect of human error is to train people in a set of knowledge, skills and attitudes that underpin the domain-specific competencies for that profession. These are referred to as non-technical skills (NTS). In aviation, such an approach has been shown to be both translatable from the training environment to the workplace and effective in reducing adverse outcomes.
Discussion  Medicine has incorporated this style of training, usually centred around simulator-based courses, but as yet in a piecemeal, episodic fashion which relies on participants volunteering to attend courses. Unlike other industries there is no systematic approach to linking the content of this teaching with the more conventional range of topics. As a consequence it is difficult to assess the impact of human factors training in medicine. This is partly because very little work has been done to date in identifying the key non-technical skills required in medicine, and the overall experience of workplace based assessment is limited. Lessons from other high reliability organisations may help to address the main challenges of developing the content, integrating it into the curriculum, reinforcing the concepts in the workplace through staff development and establishing its role in summative assessment.     

^60Co消毒与高温高压消毒胚胎骨的实验研究

在12只健康家兔下颌骨体部的两侧各造成0.7cm×0.5cm×0.3cm的骨缺损区，分别置入^60Co消毒的胚胎骨和高温高压消毒的胚胎骨，发现高温高压消毒可以替代^60Co消毒胚胎骨进行移植，为临床提供了一种新的用作同种异体移植胚胎骨的消毒方法。