Making the neurology clerkship more effective: can e-Textbook facilitate learning?

Abstract

Objective: In 1998, the 4-week neurology elective clerkship was converted into a 2-week required neurology rotation at the University of Illinois at Chicago. We hypothesized that the interactive e-Textbook, a computer-assisted learning tool, could successfully replace a paper-based syllabus and a traditional neurology textbook during a 2-week rotation, while incorporating department teaching conferences to replace the medical student lecture series.

Methods: We created an e-Textbook and made it available simultaneously in a CD-ROM format and on a password-protected website. The online quiz and course assessment were administered by the Blackboard Web Server.

Results: After implementation of the e-Textbook over 6 years, the feedback shows high student satisfaction, and student evaluations of the neurology clerkship have risen. Creation of an e-Textbook for the neurology clerkship made our faculty more productive while increasing student satisfaction and facilitating learning efficacy.

Discussion: The results show that the e-Textbook is an appropriate alternative to facilitate learning of basic and clinical neurology during a 2-week rotation. The students demonstrated successful learning in a computerized environment.     

Educational Inequalities in Post‐Hip Fracture Mortality: A NOREPOS Studys

Hip fractures are associated with high excess mortality. Education is an important determinant of health, but little is known about educational inequalities in post‐hip fracture mortality. Our objective was to investigate educational inequalities in post‐hip fracture mortality and to examine whether comorbidity or family composition could explain any association. We conducted a register‐based population study of Norwegians aged 50 years and older from 2002 to 2010. We measured total mortality according to educational attainment in 56,269 hip fracture patients (NORHip) and in the general Norwegian population. Both absolute and relative educational inequalities in mortality in people with and without hip fracture were compared. There was an educational gradient in post‐hip fracture mortality in both sexes. Compared with those with primary education only, the age‐adjusted relative risk (RR) of mortality in hip fracture patients with tertiary education was 0.82 (95% confidence interval [CI] 0.77–0.87) in men and 0.79 (95% CI 0.75–0.84) in women. Additional adjustments for Charlson comorbidity index, marital status, and number of children did not materially change the estimates. Regardless of educational attainment, the 1‐year age‐adjusted mortality was three‐ to fivefold higher in hip fracture patients compared with peers in the general population without fracture. The absolute differences in 1‐year mortality according to educational attainment were considerably larger in hip fracture patients than in the population without hip fracture. Absolute educational inequalities in mortality were higher after hip fracture compared with the general population without hip fracture and were not mediated by comorbidity or family composition. Investigation of other possible mediating factors might help to identify new targets for interventions, based on lower educational attainment, to reduce post‐hip fracture mortality. © 2015 American Society for Bone and Mineral Research.     

HIV- and AIDS-related (mis)perceptions and (non)responses of school principals in the Eastern Cape,South Africa

Despite various HIV and AIDS training programmes offered for educators by the South African Department of Education, little has been achieved at the level of management in terms of creating a wider understanding of the social and cultural complexities of the condition and its impact on the quality of teaching and learning. Specifically, there is a lack of developmental programmes to help school principals provide leadership that can ensure that teachers and children who live in a context affected by the disease will still find themselves in a school environment of quality, care and compassion. With this in mind, we conducted a qualitative research enquiry among a sample of 12 school principals in the Eastern Cape Province in order to discover their perceptions about the impacts of HIV and AIDS on their schools and to learn how they have responded to the corresponding challenges. Our intention was to use the findings primarily to inform the development of an academic programme and short courses to empower school principals and leadership in this regard, but the findings may also be relevant as a guide for research on a larger scale.     

Is Laparoscopic Adjustable Gastric Banding a Day Surgery Procedure?

Background: Laparoscopic adjustable gastric banding is the least invasive bariatric operation. However, just isolated attempts to perform this procedure as a Day Case have been published. This study highlights some aspects that might contribute to safe patient discharge within 23 hours after LAGB. Methods: Prospective evaluation of 20 consecutive patients was carried out. Patients were indicated for laparoscopic Swedish adjustable gastric banding (SAGB, Obtech, Ethicon Endo-Surgery) in a private Bariatric center in the first 6 months of 2003. The effect of extensive pre- and immediate postoperative education and psychological support, and information on postoperative health consequences delivered through a multi-disciplinary bariatric team effort, was evaluated, regarding the influence of these facilitators in shortening the length of hospital stay. Results: Mean preoperative BMI of the 20 patients entering the study was 42.3. Mean operating-time was 91 minutes (58-112 min). Time spent on information and education of each patient was 60 minutes in total during the preoperative period. Average postoperative hospitalization was 21 hours. There were no intraoperative or early postoperative complications. Excess weight loss was 44% at 12 months after surgery. Conclusion: SAGB performed on a Day Case basis in selected patients who are subjected to intensive pre- and immediate postoperative dedicated education appears to be a feasible alternative.     

Discourses of childhood innocence in primary school HIV/AIDS education in South Africa

This article draws from interview data to examine the meanings that teachers in two race and class-specific contexts in greater Durban, South Africa, may give to children's right to sexual health information as a part of HIV/AIDS education. The article focuses on the regulation and production of childhood innocence by means of the ways the primary school teachers talked about sex in their HIV/AIDS education lessons to grade-four students. I argue that discourses of childhood innocence regulate and limit the possibilities of conversing about sex in such a context. The dominant discourses construct children as 'too young to know' and displace children's right to sexual health information to older children, while stressing anxieties about parent hostility to sex education, which precludes effective coverage of sexual topics in HIV/AIDS education. Showing how race, class and culture are deployed in upholding innocence, I contend that the notion of childhood innocence is embedded within the varying social contexts that make up the South African landscape. But, I suggest that an assumption that primary school teachers will engage with HIV/AIDS education while mediating information about sex in health promotion is simplistic. In conclusion, I propose a need for ongoing theoretical and practical work with teachers and the need to build alliances with parents.     

Short-term effects of a peer group intervention for HIV prevention among trainee teachers in Malawi

This report describes the implementation and short-term results of a peer group intervention for HIV prevention on the HIV-related attitudes, knowledge and behaviours of primary school teachers in Malawi. The intervention, based on the social-cognitive learning model, took place in 2000 at two teacher training colleges with a distance-learning programme. Primary school teachers attending a final six-week training session before certification volunteered to participate. Group leaders were teachers selected by each group, and after training they facilitated the peer group intervention. The teachers completed a pre-test and post-test questionnaire. The 286 trainee teachers whose pre- and post-test samples could be matched, largely reported positive changes in their HIV-prevention-related knowledge, attitudes, self-efficacy, behaviour change and condom-use intentions. However, at post-test immediately after the intervention they did not show a higher level of perceived-risk, a greater hope that people could change their high-risk sexual behaviour, or greater agreement that persons infected with HIV should be allowed in public places. This research demonstrates the feasibility of an HIV-prevention intervention for primary school teachers during their training. The Malawi Ministry of Education has since made the programme available to over 90 per cent of all trainee teachers through an NGO.     

The pre-registration house appointment. A survey in Manchester

The 1977 medical graduates of Manchester University were sent questionnaires towards the end of their pre-registration year. The results show that there is dissatisfaction amongst housemen about the year; in particular, the long hours of duty and the lack of formal teaching. It is suggested that a national survey should be conducted in order to gauge the opinion of housemen throughout the country, and that effort should be made towards improving the hours of duty, and organizing formal teaching programmes.     

Prediction of student clinical performance

The predictive validity of 'traditional' tools utilized in the selection of medical students was evaluated in a 'non-traditional' selection paradigm, where a wide range of previous-academic ability was represented. The validity of the use of pre-academic grades and examination scores in the prediction of success in clinical performance was examined in a medical school which de-emphasizes these indicators and emphasizes personal characteristics assessed via interview ratings in student selection. Grades and examination scores were found to have no relation to clinical ratings which have an added interpersonal and community emphasis during the fourth-sixth years of medical school. A positive trend was found for interview ratings with clinical performance, but the skewed nature of interview scores was seen as limiting investigation of this variable. The meaning of these results vis-à-vis the continued use of academic and examination related selection criteria was discussed.