RESUMEN
OBJECTIVES: The Bar Ilan Faculty of Medicine places public health as a priority in its medical curriculum, emphasizing its importance by strategically placing the required course as first on entry into medical school. Students are introduced to the importance of population health and community engagement through participatory community learning experiences. This study aims to examine how participatory community teaching methods impact students' understanding and attitudes towards community health. STUDY DESIGN: Mixed quantitative and qualitative design. METHODS: 75 first year students completed the required public health course utilizing participatory community methods, including community visits, Team Based Learning, an ethnic forum, and lifestyle medicine. Evaluation comprised skills assessment through project work, analysis of reflective notes and comparison of assessment scores with students in the previous year who experienced a formal lecture-only based curriculum. RESULTS: Students acquired public health skills, including conducting a needs assessment, searching for research evidence and designing an evaluation framework. Reflective notes revealed in-depth understanding not only of course aims, but an appreciation of the social determinants of health and the local community. Test marks indicated public health knowledge reached a comparable standard (83 ± 7.3) to the previous year (85 ± 9.3; P = 0.431). CONCLUSIONS: Participatory community learning equips students with public health skills, knowledge, and enhanced understanding of communities. It offers a way to effectively teach public health, while emphasizing the extended role and societal responsibilities of doctors.
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Actitud del Personal de Salud , Servicios de Salud Comunitaria , Aprendizaje , Salud Pública/educación , Estudiantes de Medicina/psicología , Adulto , Curriculum , Humanos , Israel , Persona de Mediana Edad , Facultades de Medicina , Estudiantes de Medicina/estadística & datos numéricos , Adulto JovenRESUMEN
BACKGROUND: Medical education faces challenges posed by widening access to training, a demand for globally competent healthcare workers and progress towards harmonisation of standards. AIM: To explore potential challenges arising from variation in diversity and educational background of medical school entrants. METHOD: This study investigated the reported experience and confidence, in a range of 31 generic skills underpinning learning, of 2606 medical undergraduates entering 14 medical schools in England and South Africa, using a validated questionnaire. RESULTS: Responses suggest that there is considerable similarity in prior educational experience and confidence skills profiles on entry to South African and English medical schools. South African entrants reported significantly more experience in 'Technical skills', 'Managing their own Learning', and 'Presentation', while English students reported increased experience in 'IT' skills. South African undergraduates reported more confidence in 'Information Handling', while English students were more confident in 'IT' skills. The most noticeable difference, in 'IT' skills, is probably due to documented differences in access to computer facilities at high school level. Differences between individual schools within each country are noticeable. CONCLUSIONS: Educators need to acquire a good understanding of their incoming cohorts, and ensure necessary tailored support for skills development.
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Aprendizaje , Facultades de Medicina , Estudiantes de Medicina/psicología , Intervalos de Confianza , Educación de Pregrado en Medicina , Inglaterra , Humanos , Autoeficacia , Sudáfrica , Encuestas y CuestionariosAsunto(s)
Competencia Clínica , Pediatría/educación , Evaluación Educacional , Humanos , Modelos EducacionalesRESUMEN
CONTEXT: Educational environment makes an important contribution to student learning. The DREEM (Dundee Ready Educational Environment Measure) questionnaire is a validated instrument for assessing educational environment, but used alone it has little value for identifying means of remediation of poor aspects of environment. AIMS: This study used qualitative analysis, in association with the DREEM questionnaire, to evaluate the educational environment across all five years of a large undergraduate medical school, and identify areas for change to enhance student experience. METHOD: The DREEM questionnaire was administered to 968 undergraduate students, together with an open question asking for suggested changes to current medical school practices. Items of concern highlighted by this study were further defined through qualitative analysis, using focus groups, email questionnaires and introduction of Stressful Incident reporting. RESULTS: Through responses to the open question, two items with low scores on the DREEM questionnaire were identified as requiring remediation. Focus groups and email questionnaires were used to define the underlying causes of poor scores, which varied by student year group. Stress resulting from experiences on clinical placement was highlighted by some students, but on closer investigation found to be rare. Remedial steps to improve student support are described. CONCLUSIONS: The qualitative data have substantially enhanced questionnaire interpretation, and allowed actions to address common causes for student dissatisfaction to be undertaken. This combined methodology is recommended to other institutions wishing to improve the educational environment, and thus the overall quality of educational provision.
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Educación de Pregrado en Medicina , Ambiente , Evaluación de Programas y Proyectos de Salud/métodos , Investigación Cualitativa , Encuestas y Cuestionarios , Retroalimentación , Grupos Focales , Humanos , Apoyo Social , Estrés Psicológico/prevención & control , Reino UnidoAsunto(s)
Educación Médica/normas , Curriculum , Humanos , Aprendizaje , Autoimagen , Estudiantes de Medicina , Encuestas y CuestionariosRESUMEN
Neurological integrity in sick children is difficult to assess clinically. The aim of this study was to determine the predictive value of EEG activity recorded with a bedside EEG analysing monitor in an intensive care unit. EEG activity was monitored in 108 children (age range 2 weeks to 16 years, median 1.7 years) considered at risk for cerebral abnormalities with a cerebral function analysing monitor (CFAM). Recordings were evaluated for features of background EEG activity including mean amplitude, frequencies, and symmetry. Electrical seizure activity was quantified if present. Predictive value of the EEG features was evaluated relative to the clinical neurological outcome after one year. Asymmetrical recordings were not seen in any child with a normal outcome. Suppression of background activity was seen in 75% of the children who died. Seizures were present in 68% of children with a poor outcome. Seventeen of the 32 children (65%) who died had prolonged seizures. Absence of seizures and the presence of superimposed fast EEG activity in response to benzodiazepine infusions correlated with good outcome. A combination of two or more predictive EEG features demonstrated >90% specificity and positive predictive likelihood of poor outcome. EEG features provide information about the functional cerebral integrity of sick children. Changes in cerebral activity detected by the CFAM aid decision making by providing such information readily at the bedside in intensive care.
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Enfermedades del Sistema Nervioso Central/diagnóstico , Corteza Cerebral/fisiología , Electroencefalografía , Adolescente , Enfermedades del Sistema Nervioso Central/mortalidad , Niño , Preescolar , Toma de Decisiones , Femenino , Humanos , Lactante , Recién Nacido , Unidades de Cuidado Intensivo Pediátrico , Masculino , Valor Predictivo de las Pruebas , Pronóstico , Sensibilidad y EspecificidadRESUMEN
Topiramate is a new anti-epileptic drug with proven efficacy against partial seizures in adults. A retrospective assessment of the use of topiramate in drug-resistant childhood epilepsy was undertaken. Thirty-four children (median age of 10 years; range 2-18 years) were treated for a median of 9 months (range 6-18 months). The starting dose was 0.25-2.0 mg/kg/day increasing to a maximum of 13 mg/kg/day. Generalized seizures occurred in 27 patients, partial seizures in 15 and infantile spasms in two. Epilepsies were localization-related in 15 patients and generalized in 18. One patient had severe myoclonic epilepsy in infancy. Two patients had Lennox-Gastaut syndrome, five (two currently and three previously) had West syndrome and one had epilepsy with myoclonic absences. Twenty patients had a substantial (> 50%) reduction in seizure frequency; two of whom became seizure-free. Two-patients had an increase in seizures. Efficacy was seen against simple and complex partial seizures, generalized tonic-clonic seizures (primarily generalized), atonic and tonic seizures, myoclonic seizures and infantile spasms. There was no response in the one patient with myoclonic absence seizures. Adverse effects were reported in nine patients; appetite suppression occurred in five patients, behaviour disturbances in three, somnolence in two and poor concentration in one patient. Topiramate is efficacious in a wide spectrum of childhood epilepsies and is well tolerated.
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Anticonvulsivantes/uso terapéutico , Epilepsias Parciales/tratamiento farmacológico , Fructosa/análogos & derivados , Espasmos Infantiles/tratamiento farmacológico , Adolescente , Adulto , Anticonvulsivantes/efectos adversos , Niño , Preescolar , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Resistencia a Múltiples Medicamentos , Femenino , Fructosa/efectos adversos , Fructosa/uso terapéutico , Humanos , Masculino , Topiramato , Resultado del TratamientoRESUMEN
OBJECTIVES: Undergraduate medical curricula now include increasing amounts of project work aimed at developing skills related to lifelong learning. One course allows students to choose from a wide range of projects, including 'conventional' hospital specialties and also from topics outside the mainstream of medicine. DESIGN: 'Conventional' and 'external' projects were compared in terms of the prior academic abilities of the students undertaking them, the assessment results and student and supervisor feedback, in order to consider whether the unconventional projects were equally valid within the undergraduate medical curriculum. SETTING: School of Medicine, University of Leeds, UK. SUBJECTS: Medical students. RESULTS: No difference between the assessment results of the student groups was present, with over 85% of all students reaching a standard of 'excellent' or 'good' in their overall final grade. There was no difference in prior academic abilities between the student groups. Enjoyment of modules was comparable between student groups ('conventional' 89%, 'external' 93%) with good levels of satisfaction with the quality of supervision. There were no differences in students' self-appraisal of generic skill acquisition. Students who had undertaken 'external' projects felt they had gained less experience in data-handling and problem-solving skills. However, 'external' projects were rated higher by students in terms of having realistic and achievable objectives, and the supervisors of these projects were also more realistic about time commitments involved in project supervision. CONCLUSIONS: 'External' modules were very popular, with over 45% of students requesting places which were available for fewer than 20% of students per year. Concerns regarding the appropriateness of self-directed undergraduate medical student projects outside the mainstream of medical practice were unfounded.
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Curriculum , Educación de Pregrado en Medicina/métodos , Evaluación Educacional , Humanos , Evaluación de Programas y Proyectos de Salud , Reino UnidoRESUMEN
OBJECTIVES: We aimed to evaluate whether a structured teaching technique (the silent run through) was of benefit in the learning of a skill sequence, and whether it would affect students' ability to improve their problem-solving skills or ability to make judgements. DESIGN: Students from one hospital were taught two different complex skills using a highly structured teaching method involving the breakdown of complex tasks into smaller components and the utilization of an internal, silent 'commentary'. Their subsequent ability to reproduce these skills was compared with a second group of students taught at another hospital. All students were assessed during a common end of attachment Objective Structured Clinical Examination on the two skills, by raters blind to the teaching techniques the students had received. SETTING: School of Medicine, University of Leeds, UK. SUBJECTS: Medical students. RESULTS: Students who received the structured teaching were significantly better at reproducing a complex, sequential clinical skill (examination of a squint). There was no demonstrable improvement in problem-solving skills as assessed on an X-ray interpretation station. Students expressed high levels of satisfaction with learning skills in such a structured way and reported increased confidence in their examination skills. CONCLUSIONS: This study provides some evidence to support the hypothesis that different teaching techniques may be more effective for improving different elements of skills learning. In particular, a highly structured technique involving breaking complex tasks down into smaller components and utilizing an internal 'commentary' may be an effective way of teaching the sequential motor components of complex clinical skills.
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Competencia Clínica , Educación de Pregrado en Medicina/métodos , Pediatría/educación , Humanos , Examen Físico/métodos , Solución de Problemas , Radiología/educaciónRESUMEN
The aim of this study was to assess the impact of feedback on the quality of tutorials. Students completed structured feedback questionnaires on the perceived usefulness of teaching sessions. They perceived significant differences in the quality of tutorials delivered by experienced and inexperienced teachers (P < 0.01), although the differences tended to become less throughout the year. In the second year, teachers had advice from an experienced tutor in planning the sessions, in addition to receiving feedback from the students. During the second year, the students did not perceive any difference in the usefulness of these tutorials to them. The study showed that the quality of tutorials can be improved by passing structured feedback to the teacher, but that some skills training was also required to completely eliminate perceived differences.
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Retroalimentación , Pediatría/educación , Enseñanza/normas , Actitud , Inglaterra , Humanos , PercepciónAsunto(s)
Homocistinuria/diagnóstico , Trombosis de los Senos Intracraneales/diagnóstico , Encéfalo/diagnóstico por imagen , Homocistinuria/diagnóstico por imagen , Homocistinuria/genética , Humanos , Lactante , Masculino , Linaje , Trombosis de los Senos Intracraneales/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
Central venous parenteral nutrition (PN) is frequently used in preterm infants. Although central venous catheters (CVC) permit reliable delivery of hypertonic solution, they may be associated with more serious complications than when a peripheral venous infusion is used. The aim of this randomised prospective study was to compare complications of central versus peripheral venous access using Silastic catheters identical expect for intravascular length. Eighty such devices were inserted, 38 central (CVC), 42 peripheral (PVC). Catheter life was not significantly different between groups: median (range) CVC 10d (2-25); PVC 7d (1-22) with no difference in overall complication rate. Although peripherally sited catheters tended not to function for as long as CVCs, they offer a useful alternative to central venous catheterisation.
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Seizures in a term infant with Ohtahara syndrome, associated with polymicrogyria, and a pre-term neonate with similar clinical features, failed to respond to conventional anticonvulsants, but were controlled with vigabatrin monotherapy. Another infant with Aicardi syndrome improved with vigabatrin. Autopsy in the first infant showed no evidence of intramyelinic oedema. The developmental outcome in the two survivors was better than expected for their condition.
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Anticonvulsivantes/administración & dosificación , Encéfalo/anomalías , Enfermedades del Prematuro/tratamiento farmacológico , Espasmos Infantiles/tratamiento farmacológico , Ácido gamma-Aminobutírico/análogos & derivados , Agenesia del Cuerpo Calloso , Anticonvulsivantes/efectos adversos , Atrofia , Corteza Cerebral/anomalías , Corteza Cerebral/patología , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Electroencefalografía/efectos de los fármacos , Femenino , Humanos , Lactante , Recién Nacido , Enfermedades del Prematuro/diagnóstico , Masculino , Recurrencia , Espasmos Infantiles/diagnóstico , Síndrome , Vigabatrin , Ácido gamma-Aminobutírico/administración & dosificación , Ácido gamma-Aminobutírico/efectos adversosRESUMEN
Three cases of athetoid cerebral palsy after hypoxic-ischaemic encephalopathy (HIE) are reported. All three neonates had haemorrhagic lesions in the basal ganglia and thalami on magnetic resonance imaging (MRI). Prior cranial ultrasound had detected the lesions in only two cases. In all three children athetoid movements began within the first year of life. Follow up MRI scans showed bilateral symmetrical cystic lesions in the posterior putamen. Although haemorrhagic lesions within the basal ganglia are a common MRI finding in neonates with HIE, few of these babies develop athetoid cerebral palsy. We believe this to be the first report of discrete cystic lesions found in the basal ganglia of children with athetoid cerebral palsy.
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Enfermedades de los Ganglios Basales/etiología , Isquemia Encefálica/complicaciones , Parálisis Cerebral/etiología , Quistes/etiología , Hipoxia Encefálica/complicaciones , Putamen , Enfermedades de los Ganglios Basales/diagnóstico , Enfermedades de los Ganglios Basales/epidemiología , Encéfalo/diagnóstico por imagen , Encéfalo/patología , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiología , Parálisis Cerebral/diagnóstico , Parálisis Cerebral/epidemiología , Quistes/diagnóstico , Quistes/epidemiología , Ecoencefalografía , Femenino , Humanos , Hipoxia Encefálica/diagnóstico , Hipoxia Encefálica/epidemiología , Recién Nacido , Imagen por Resonancia Magnética , Masculino , Estudios Prospectivos , Putamen/diagnóstico por imagen , Putamen/patología , Enfermedades Talámicas/diagnóstico , Enfermedades Talámicas/epidemiología , Enfermedades Talámicas/etiología , Tomografía Computarizada por Rayos XRESUMEN
Continuous EEG monitoring is considered to be a sensitive indicator of changes in cerebral function. This paper describes a system for cotside display and analysis of EEG discontinuity and amplitude in one-minute epochs, with provision for simultaneous recording of the EEG. It has been successfully used to monitor continuously the EEGs of more than 30 babies in a neonatal intensive care unit for periods of up to nine days. This system rapidly provides indications of changes in cerebral function, which can allow early intervention and possible prevention of morbidity.