The first OSCE; does students' experience of performing in public affect their results?

BACKGROUND: Personal qualities have been shown to affect students' exam results. We studied the effect of experience, and level, of public performance in music, drama, dance, sport, and debate at the time of admission to medical school as a predictor of student achievement in their first objective structured clinical examination (OSCE). METHODS: A single medical school cohort (n = 265) sitting their first clinical exam in 2011 as third year students were studied. Pre-admission statements made at the time of application were coded for their stated achievements in the level of public performance; participation in each activity was scored 0-3, where 0 was no record, 1 = leisure time activity, 2 = activity at school or local level, 3 = activity at district, regional or national level. These scores were correlated to OSCE results by linear regression and t-test. Comparison was made between the highest scoring students in each area, and students scoring zero by t-test. RESULTS: There was a bell shaped distribution in public performance score in this cohort. There was no significant linear regression relationship between OSCE results and overall performance score, or between any subgroups. There was a significant difference between students with high scores in theatre, debate and vocal music areas, grouped together as verbal performance, and students scoring zero in these areas. (p < 0.05, t-test) with an effect size of 0.4. CONCLUSIONS: We found modest effects from pre-admission experience of verbal performance on students' scores in the OSCE examination. As these data are taken from students' admission statements, we call into question the received wisdom that such statements are unreliable.

Training healthcare professionals for the future: internationalism and effective inclusion of global health training.

There has been a continuing rise in recent years of the number of medical schools in the developed world offering 'global health' teaching to its students. Yet, the term itself is used in a number of contexts and as yet no clear consensus on what constitutes an appropriate or successful global health education programme has been reached. Approaches to sustainable internationalisation of medical curricula include the expansion of not only opportunities for training in specific global health topics, but also the development of broader generic graduate attributes including global citizenship and ethical, cultural and social responsibility. Key components for successful implementation of such an educational framework includes a breadth of educational approach to effect truly integrated and effective curricular internationalisation. That such programmes can offer benefits is appreciated by both faculty and students alike, but there is also a burgeoning concern about potential negative effects of socially and culturally insensitive programmes. We explore three potential pedagogic approaches to the subject; Model A: an 'additive' or contributory model of global health content (the commonest current approach), Model B: an 'integrated' approach and Model C: the more challenging 'transformative' approach requiring institutional as well as programme flexibility.

Gluteal nodules in patients with metastatic midgut carcinoid disease treated with depot somatostatin analogs.

CONTEXT AND OBJECTIVES: We were referred a patient with metastatic well-differentiated endocrine tumor of the small intestine (midgut carcinoid) in whom asymptomatic sc gluteal nodules had been identified on routine abdominal computed tomography and labeled as metastases. This prompted us to assess the prevalence and cause of these nodules. DESIGN AND SETTING: This was a retrospective, cross-sectional study at a university teaching hospital. METHODS: Routine abdominal computed tomography scans of 56 patients with metastatic midgut carcinoid were analyzed by two independent radiologists, blinded to treatment status (depot somatostatin analogs). MAIN OUTCOME MEASURES: Number of patients with nodules, number of injections, and duration and total cumulative dose per patient were assessed. RESULTS: No nodules were detected in 13 patients not on depot somatostatin therapy. Nodules were found in 29 of 43 patients (67%) on somatostatin analog therapy: 16 of 22 patients on lanreotide Autogel, five of 12 patients on octreotide LAR only, and eight of nine patients who had been treated with both somatostatin analogs. There was no difference in the clinical state of those with or without nodules. Per patient, the average number was seven, and average size was 1 cm. Presence of nodules was significantly associated with total number of injections (P = 0.024), duration on treatment (P = 0.022), and cumulative dose of lanreotide Autogel (P < 0.001). Nodules underwent involution on follow-up imaging. CONCLUSION: Patients with metastatic midgut carcinoid tumors have large numbers of asymptomatic sc nodules in the gluteal area when on either depot somatostatin analog, but these resolve over time. This clear observation gives reassurance to patients and those managing them that such nodules are unlikely to represent metastases.

Educating undergraduate medical students about patient safety: priority areas for curriculum development.

Learning about patient safety is an important aspect of undergraduate medical curricula but there are no clear priority areas. A recent consensus of international medical educators identified several priority areas and these recommendations include approaches to increase knowledge of patient safety, including the causes and frequency, to develop willingness to take responsibility, to develop self awareness of the situations when patient safety is compromised, to develop communication skills, especially inter-personal, and to develop team working skills.

Discovering professionalism through guided reflection.

Doctors need to identify and understand the professional behaviours of both themselves and others. In order for students to think critically about these issues we encouraged them to use the tenets of the General Medical Council's Duties of a Doctor as a framework in which to reflect on the actions of healthcare professionals at work. Although the critical incident technique is a well-known process for encouraging reflection, little is known about its usefulness for assessment purposes in this setting. We aimed to discover the validity, feasibility and educational impact of the critical incident as an assessment method for first year students undertaking guided reflection in the context of their first exposure to multi-professional health and social care experiences. First year medical students submitted two critical incidents they had observed during multi-professional health and social care attachments and an evaluation of their experiences. Students engaged in the reflective cycle on the professional behaviours of others providing evidence of a varied range of situations. With adequate preparation, junior students are able to reflect on social and healthcare experiences using the Duties of a Doctor as a framework. Critical incidents are a valid and feasible method for assessing students' reflections on professionalism, with good educational impact.

Student doctors taking responsibility.

BACKGROUND: New guidelines require all undergraduate medical students to undertake at least one period of assistantship where they assume most of the responsibilities of a first-year graduate doctor (FY1 doctor in the UK) under supervision. AIM: To investigate the feasibility of these assistantships. METHOD: All UK schools were sent a questionnaire addressing the supervision required and the main barriers around implementation. RESULTS: Competencies that students already engage in as part of existing clinical placements and a number of 'tacit' competencies (e.g. practice and promote infection control) were regarded by most as suitable. Activities that present a clear clinical risk (e.g. prescribing and writing clinical correspondence) were regarded by most as unsuitable or requiring continuous supervision. Some lower risk but hard to measure activities (e.g. responding in practice to audit) were also regarded as unsuitable by some. A competency was usually considered inappropriate for one of three reasons: (1) current clinical governance and patient safety protocols appeared to bar students undertaking the competency; (2) a competency was not considered to be part of the current FY1 doctors' role; or (3) brief assistantships were considered unlikely to create sufficient opportunity for performing the competency. DISCUSSION: The article presents a number of practical issues in relation to assigning responsibility to student doctors. Respondents indicate that successful assistantships will only be possible if the UK National Health Service trusts review their attitude to balancing short- and long-term risks: assistantships need to be long enough to create genuine responsibility opportunities, and will require investment in supervision beyond the current capacity.

Developing an outcome-focused core curriculum.

BACKGROUND: Many UK medical schools have modified their curricula to meet the requirements of the General Medical Council and other external agencies. In particular, efforts have been focused on increasing integration and reducing factual overload through the definition of a core curriculum. Various approaches to curriculum change have been adopted in an attempt to meet such demands. PURPOSE: This paper describes a curriculum development process, which commences with a clear vision, adopts an outcome-based approach and identifies clear statements of learning outcomes. The process led to the development of an outcome-focused core curriculum structured around clinical problems, which is available to all students and staff. CONCLUSION: A model of curriculum development has evolved which is relatively simple in concept, and appears to be easy to comprehend by students, teaching staff and visitors from other institutions. It provides a practical framework for managing the difficult problems of integration and factual overload. It should be of general interest and applicability to other schools with health professional programmes looking for a realistic and acceptable way of defining a core curriculum.

Rapid and sustained relief from the symptoms of carcinoid syndrome: results from an open 6-month study of the 28-day prolonged-release formulation of lanreotide.

This 6-month, open, non-controlled, multicenter, dose-titration study evaluated the efficacy and safety of 28-day prolonged-release (PR) lanreotide in the treatment of carcinoid syndrome. Eligible patients had a carcinoid tumor with > or =3 stools/day and/or > or =1 moderate/severe flushing episodes/day. Six treatments of 28-day PR lanreotide were administered by deep subcutaneous injection. The dose for the first two injections was 90 mg. Subsequent doses could be titrated (60, 90, 120 mg) according to symptom response. Seventy-one patients were treated. Flushing decreased from a mean of 3.0 at baseline to 2.3 on day 1, and 2.0 on day 2, with a daily mean of 2.1 for the first week post-treatment (p < 0.05). Diarrhea decreased from a mean of 5.0 at baseline to 4.3 on day 1 (p < 0.05), and 4.5 on day 2, with a daily mean of 4.4 for the first week post-treatment (p < 0.001). Symptom frequency decreased further after the second and third injections, and reached a plateau after the fourth injection. By month 6, flushing and diarrhea had significantly decreased from baseline by a mean of 1.3 and 1.1 episodes/day, respectively (both p < or = 0.001); 65% of patients with flushing as the target symptom and 18% of diarrhea-target patients achieved > or =50% reduction from baseline. Median urinary 5-hydroxyindoleacetic acid and chromogranin A levels decreased by 24 and 38%, respectively. Treatment was well tolerated. 28-day PR lanreotide was effective in reducing the symptoms and biochemical markers associated with carcinoid syndrome.