Senior medical students' appraisal of CanMEDS competencies

CONTEXT: In 2003 the Dutch Central College of Medical Specialties presented guidelines for the modernisation of all medical specialty training programmes in the Netherlands. These guidelines are based to a large extent on the CanMEDS (Canadian Medical Education Directives for Specialists) 2000 model, which defines 7 roles for medical specialists. This model was adjusted to the Dutch situation. The roles were converted to 7 fields of competency: Medical Performance; Communication; Collaboration; Knowledge and Science; Community Performance; Management, and Professionalism. OBJECTIVE: As changes in postgraduate training will probably be most effective if future trainees recognise their value, we set out to determine how senior medical students rated these fields of competency in terms of their importance. METHODS: We carried out a study at University Medical Centre (UMC) Utrecht, the Netherlands, in which 80 Year 6 medical students answered a questionnaire in which they rated the importance of each of 28 key competencies within the 7 competency fields. RESULTS: Although all key competencies were regarded as important (averages > or = 3.8), Professionalism and Communication scored highest on the student ratings. Management was assessed as least important. CONCLUSIONS: It is interesting that medical students acknowledged the importance of competencies other than those involving medical expertise and performance. It confirms the opinion that educating doctors is currently viewed as much more than providing theoretical and clinical knowledge and skills. The CanMEDS framework is appreciated by Dutch medical students. The fact that all competencies are seen as important adds to their face validity and therefore to their usefulness as a basis for postgraduate training.     

Career preferences of graduate and non-graduate entrants to medical schools in the UK

OBJECTIVE: Recent UK policy has been to increase substantially the number of graduate entrants to medical schools. Our aim was to study whether graduate and non-graduate entrants have different long-term career preferences. METHODS: We conducted postal questionnaire surveys of medical qualifiers from all UK medical schools in 1999, 2000 and 2002, surveyed 1 year after qualification, and qualifiers of 1999 and 2000, surveyed 3 years after qualification. RESULTS: By Year 3 after qualification, general practice was the choice of 33% of men graduate entrants and 21% of men non-graduates ( = 12.5, P < 0.001) and of 43% of women graduates and 38% of women non-graduates ( = 1.6, P = 0.2). Surgery was a much less popular choice for men graduate entrants than for men non-graduates; but similar percentages of women graduate and non-graduate entrants chose surgery. A lower percentage of graduate entrants than of non-graduates favoured paediatrics. Other differences between graduates and non-graduates were generally small. General practice was the preferred career for a much lower percentage of those who took an intercalated degree while at medical school, than of those who did not. CONCLUSIONS: Increasing graduate entry to medical school is likely to increase the percentage of doctors who want to become general practitioners, but only modestly so. It may also lead to a decline in the percentages choosing surgery and paediatrics. Otherwise, at least on the current criteria used for selecting students, increasing graduate entry will probably not make much difference to the percentage of newly qualified doctors seeking careers in different branches of practice.     

Teaching undergraduate psychiatry in primary care: the impact on student learning and attitudes

OBJECTIVE: To explore the impact of undergraduate psychiatry placements in primary care settings on students' learning and attitudes to mental illness. DESIGN: Questionnaire survey and qualitative in-depth interviews. SETTING: A primary care-based psychiatry undergraduate teaching programme at Royal Free and University College Medical School, London. PARTICIPANTS: A total of 145/183 (79.2%) students attending the primary care-based programme over 2 academic years completed a questionnaire survey. In-depth interviews were conducted with 14 students, 12 general practitioner (GP) tutors and 20 patients participating in the course. RESULTS: In the questionnaire survey, 121/144 (84.0%) students valued the primary care-based teaching highly. In total, 87/139 (62.6%) students felt their attitudes to mental illness had changed as a result of the course. In-depth interviews demonstrated 4 key benefits of the teaching programme: increasing breadth of experience, understanding the patients' experience, learning about mental illness from a GP's perspective and changing students' attitudes towards mental illness. The students' attitudinal shift comprised 2 main dimensions; 'normalisation' of mental illness and increased empathy. CONCLUSIONS: Learning psychiatry in primary care settings offers students a broader experience of a range of patients than in hospital settings and encourages a 'person-centred' approach, which in turn can have a positive impact on their attitudes to mental illness, reducing stereotyping and increasing empathy.     

Altruism revisited: a comparison of medical, law and business students' altruistic attitudes

OBJECTIVE: Although the concept of altruism in medicine has a long tradition in Western thought, little empirical research has been carried out recently in this area. This study compares the altruistic attitudes of medical, legal and business students. METHODS: We used a cross-sectional survey to compare the altruistic attitudes of 3 types of contemporary 'professional' students, those in medicine, law and business. RESULTS: The results suggest that medical students report more altruistic attitudes than legal students, but not than business students. Overall, female students reported stronger attitudes consistent with altruism compared with males; African-American and Hispanic students reported more altruistic attitudes compared with White students. CONCLUSIONS: Our results suggest that the recent trend in recruiting more women and under-represented minority group members into medicine may have a positive impact on altruism in the profession, if we can assume that attitudes correlate with behaviours.     

Removal of specific antibody in vivo by whole blood immunoadsorption: preliminary results in dogs

Effective immunoadsorption for removal of anti-red cell antibodies from plasma using affinity columns has been demonstrated. However, the requirement of a continuous-flow centrifuge to separate plasma increases the cost and complexity of the procedure. We have adapted red cell antigen immunoadsorption columns for use with whole blood. Effective and specific removal of anti-red cell antibodies was achieved in actively immunized dogs.     

Semen analysis in laboratory practice: an overview of routine tests

Semen analysis is a basic step in the investigation of several disturbances affecting the male genital tract. Analysis of seminal parameters provides important clinical information on the spermatogenesis and functional competence of spermatozoa, as well as on the secretory pattern of the accessory genital glands. Semen analysis is particularly useful in the evaluation of couples requiring fertility investigation (to detect genital infections and pathologies) and in verifying the influence of environmental factors, drugs, lifestyle, chemical products, and professional activities on several diseases affecting male reproductive health. Measure of semen quality is of substantial interest for diagnoses in clinical urology, andrology, and gynecology. Currently, basic requirements for semen analysis are standardized by World Health Organization (WHO) guidelines that describe several procedures for an objective evaluation of the semen quality with diagnostic purposes. These guidelines include: parameters for the physical and biochemical evaluation of semen; parameters for the analysis of sperm characteristics; and other seminal parameters that can be easily adopted in any laboratory. This report summarizes current concepts on semen analysis and the significance of the seminal parameters for reaching a diagnosis based on the procedures recommended by WHO guidelines.     

乌司他丁干预重症有机磷农药中毒的临床研究

目的 评价乌司他丁干预在防治急性有机磷农药中毒（AOPP）引发的多器官功能障碍综合征（MODS）及降低其病死率方面的作用。方法 45例重症AOPP患者随机分为鸟司他丁干预组（n=23）和非乌司他丁干预组（n=22），观察两组治疗前后全血胆碱酯酶和肌酸激酶同工酶、动脉血气及血流动力学的变化，比较两组患者肺及肺外器官功能改善率、并发症发生率、ICU病死率度其死亡的原因等。结果 两组患者的年龄、全血胆碱酯酶和APACHEⅡ评分比较，差异无统计学意义（P〉0．05）。乌司他丁干预组对重症AOPP患者的全血胆碱酯酶、肌酸激酶同工酶、动脉血气及血流动力学的影响均优于对照组，肺及肺外器官功能改善率明显优于对照组，机械通气相关肺炎（VAP）、心肌缺血和心律失常的发生率也均明显下降；乌司他丁干预组因多器官功能衰竭（MOF）的ICU病死率为4．35％，明显优于对照组（27．27％，P〈0．05），使重症AOPP患者ICU救治的痊愈率从72．73％提高到95．65％（P〈0．05）。结论 乌司他丁干预能改善重症AOPP患者全血胆碱酯酶、肌酸激酶同工酶、动脉血气及血流动力学，降低VAP、心肌缺血和心律失常的发生率，在防治AOPP引发的MODS及降低其病死率方面有很好的临床效果。     

Neuromuscular adaptations in older males and females with knee osteoarthritis during weight-bearing force control

Background

Females exhibit significantly greater incidence, prevalence, and severity of osteoarthritis (OA) compared to males. Despite known biological, morphological, and functional differences between males and females, there has been little sex-related investigation into sex-specific biomechanical and neuromuscular responses to OA.

Paroxysmal Severe Mitral Regurgitation

ObjectiveTo investigate the clinical presentation, pathophysiology, and treatment for "paroxysmal severe mitral regurgitation" (MR), which is an underappreciated cause of heart failure with preserved left ventricular ejection fraction.MethodsWe retrospectively reviewed cases of transient severe MR that were evaluated at Mayo Clinic in Rochester, Minnesota, between January 1, 2006, and December 31, 2019. Paroxysmal severe MR was defined as the appearance of transient severe MR in patients with mild MR at rest, normal left ventricle (LV) size, left ventricular ejection fraction greater than 40%, and absence of obstructive coronary artery disease.ResultsWe identified 6 patients (5 women) with a median age of 68 years. There were 3 distinct mechanisms of paroxysmal severe MR, which we labeled types 1, 2, and 3. Type 1 MR was caused by LV dyssynchrony from a rate-dependent left bundle branch block, which led to apical leaflet tenting and incomplete coaptation. Type 2 MR occurred from mitral annular dilatation during maneuvers that increased left-sided volume. Type 3 MR was caused by coronary artery vasospasm with apical leaflet tenting. Treatments varied depending on the underlying cause and included cardiac resynchronization therapy for type 1, surgical valve replacement for type 2, and medical therapy for type 3.ConclusionParoxysmal severe MR is a rare cause of heart failure in patients with preserved LV function. We have identified 3 distinct mechanisms that can lead to this dynamic process, with treatments varying based on the underlying cause.     

第二产程分阶段自由体位在产妇分娩中的应用效果

目的探究第二产程分阶段自由体位在产妇分娩中的应用效果。方法选择于我院分娩的88例产妇作为研究对象,采用数字随机表法将其分为对照组和观察组,各44例。对照组第二产程取常规仰卧位或半卧截石位,观察组第二产程选择分阶段自由体位。比较两组的分娩方式、第二产程时间、自主用力时间、产后出血量、生殖道损伤及新生儿窒息发生情况。结果观察组的自然分娩率高于对照组,第二产程时间和自主用力时间短于对照组,产后出血量少于对照组,会阴侧切、宫颈裂伤、会阴裂伤发生率低于对照组(P<0.05)。两组的新生儿窒息发生率无显著差异(P>0.05)。结论在第二产程实施分阶段自由体位分娩可提高产妇的阴道分娩率,缩短产程时间,降低生殖道损伤的发生风险,值得推广。