Prevalence of radiographic findings in chronic osteomyelitis.

BACKGROUND: Simple radiography in conjunction with pertinent medical history and a comprehensive physical examination is typically adequate for diagnosing chronic osteomyelitis (CO). However, radiographic manifestations of CO lack specificity; therefore, the concordance among specialists in this regard has not been systematically assessed. This study aimed to compare and evaluate the proficiency of orthopedic surgeons and radiologists in identifying radiographic indicators present in simple radiographs for diagnosing CO. METHODS: This cross-sectional study was a correlational investigation utilizing plain radiographs obtained from a cohort of 60 patients diagnosed with CO. Comprehensive assessments of the demographic and clinical characteristics, comorbidities, and microbiological parameters were conducted. Additional variables included the anatomical location of the CO, existence of fistulas, disease duration, and presence of pseudoarthrosis. This study meticulously documented the presence or absence of six specific findings: bone destruction, which incorporates erosion and radiolucencies around implants; bone sclerosis; cortical thinning concomitant with erosion; cortical thickening; sequestrum formation; and soft-tissue swelling. RESULTS: Most patients were men (75%), with a mean age of 45.1 years. Hematogenous etiology of CO represented 23%. Bone sclerosis (71.3%) and cortical thickening (67.7%) were the most common radiographic findings, followed by soft-tissue swelling (51.3%), sequestration (47.3%), bone destruction (33.3%), and cortical erosion (30.3%). The mean agreement was 74.2%, showing a marked disagreement rate of 25.8% among all radiographic findings. The presence or absence of soft tissue edema, a prominent radiographic finding that was more important than the other findings, showed the greatest disagreement. CONCLUSIONS: Radiographic findings in CO were universally observed in all patients, demonstrating a high degree of concordance among specialists, with the exception of soft tissue swelling.

Partners in academic endeavour: Characterising student engagement across internationally excellent medical schools.

There is increasing interest in how student engagement can be enhanced in medical schools: not just engagement with learning but with broader academic practices such as curriculum development, research, organisational leadership, and community involvement. To foster evidence-based practice, it is important to understand how institutions from diverse sociocultural contexts achieve excellence in student engagement.We analysed 11 successful applications for an international award in student engagement and interviewed nine key informants from five medical schools across four continents, characterising how and why student engagement was fostered at these institutions.Document analysis revealed considerable consensus on the core practices of student engagement, as well as innovative and creative practices often in response to local strengths and challenges. The interviews uncovered the importance of an authentic partnership culture between students and faculty which sustained mutually beneficial enhancements across multiple domains. Faculty promoted, welcomed, and acted on student inputs, and students reported greater willingness to participate if they could see the benefits. These combined to create self-perpetuating virtuous cycles of academic endeavour. Successful strategies included having participatory values actively reinforced by senior leadership, engagement activities that are driven by both students and staff, and focusing on strategies with reciprocal benefits for all stakeholders.

Self-regulated learning processes across different physiotherapy clinical procedural skills and time intervals: A SRL microanalysis study.

PURPOSE OF THE STUDY: The performance of a clinical procedural skill by an individual student is associated with their use of Self-Regulated Learning (SRL) processes. However, previous research has not identified if an individual student has a similarity in their use of SRL processes across different clinical procedural skill tasks and at a time interval. The aim of this pilot study was to explore the similarity in the use of SRL processes by individual students across different clinical procedural skill tasks and at a time interval. METHODS: SRL-microanalysis was used to collect within-subject data on undergraduate physiotherapy students' use of the two key SRL processes (planning and monitoring) during their performance of different goniometry clinical procedural skills tasks and also at a fourth month interval. RESULTS: An individual student's use of key SRL processes across different clinical procedural skill tasks and at a time interval was similar. Also, this similarity was identified for students with initial successful and unsuccessful performances. CONCLUSION: Our findings have implications for the future wider practical implementation of SRL microanalysis to inform personalised SRL feedback for developing the clinical procedural skills of individual students. Further research with a greater number of students and across a wider range of clinical procedural skills will be required to confirm our findings, and also its effectiveness on feedback and future performance.

Advancements in Phase Change Materials in Asphalt Pavements for Mitigation of Urban Heat Island Effect: Bibliometric Analysis and Systematic Review.

This research presents a dual-pronged bibliometric and systematic review of the integration of phase change materials (PCM) in asphalt pavements to counteract the urban heat island (UHI) effect. The bibliometric approach discerns the evolution of PCM-inclusion asphalt research, highlighting a marked rise in the number of publications between 2019 and 2022. Notably, Chang'an University in China has emerged as a leading contributor. The systematic review addresses key questions like optimal PCM types for UHI effect mitigation, strategies for PCM leakage prevention in asphalt, and effects on mechanical properties. The findings identify polyethylene glycols (PEGs), especially PEG2000 and PEG4000, as prevailing PCM due to their wide phase-change temperature range and significant enthalpy during phase transitions. While including PCM can modify asphalt's mechanical attributes, such mixtures typically stay within performance norms. This review emphasises the potential of PCM in urban heat management and the need for further research to achieve optimal thermal and mechanical balance.

Going virtual and going wide: comparing Team-Based Learning in-class versus online and across disciplines.

Team-based learning (TBL) is an active learning pedagogy developed for in-class sessions and based on the collaborative work of small groups of students. The increasing push to online and blended learning has enhanced the need to expand this pedagogy to a virtual environment, but little evidence has been produced on how students accept online synchronous sessions of TBL. The purpose of this study, that relies on 427 responses, is to present a comparative perspective of traditional in-class versus adapted fully synchronous online TBL and across different disciplinary fields. Students of two different academic years and different programs were surveyed for their acceptance of TBL. They were invited to answer closed-ended questions focused on their engagement in all TBL learning process and the final outcomes provided. Results obtained from this unique comparative study revealed a wide approval of TBL, regardless of the environment (online or in-class TBL sessions), scientific area of courses and student gender. The acceptance of fully online TBL sessions, in a similar way as traditional in-class sessions, could be a rationale for giving more use to the 'virtual' context. Other results corroborated previous researches on TBL, such the need of student awareness of TBL benefits to get more engaged in the process or the impact of student activities overload on the TBL process. Implications are informative for pedagogical practice.

Development of Capacitive-Type Sensors by Electrochemical Anodization: Humidity and Touch Sensing Applications.

This work describes the development of a capacitive-type sensor created from nanoporous anodic aluminium oxide (NP-AAO) prepared by the one-step anodization method conducted in potentiostatic mode and performed in a low-cost homemade system. A series of samples were prepared via an anodization campaign carried out on different acid electrolytes, in which the anodization parameters were adjusted to investigate the effect of pore size and porosity on the capacitive sensing performance. Two sensor test cases are investigated. The first case explores the use of highly uniform NP-AAO structures for humidity sensing applications while the second analyses the use of NP-AAO as a capacitive touch sensor for biological applications, namely, to detect the presence of small "objects" such as bacterial colonies of Escherichia Coli. A mathematical model based on equivalent electrical circuits was developed to evaluate the effect of humidity condensation (inside the pores) on the sensor capacitance and also to estimate the capacitance change of the sensor due to pore blocking by the presence of a certain number of bacterial microorganisms. Regarding the humidity sensing test cases, it was found that the sensitivity of the sensor fabricated in a phosphoric acid solution reaches up to 39 (pF/RH%), which is almost three times higher than the sensor fabricated in oxalic acid and about eight times higher than the sensor fabricated in sulfuric acid. Its improved sensitivity is explained in terms of the pore size effect on the mean free path and the loss of Brownian energy of the water vapour molecules. Concerning the touch sensing test case, it is demonstrated that the NP-AAO structures can be used as capacitive touch sensors because the magnitude of the capacitance change directly depends on the number of bacteria that cover the nanopores; the fraction of the electrode area activated by bacterial pore blocking is about 4.4% and 30.2% for B1 (E. Coli OD600nm = 0.1) and B2 (E. Coli OD600nm = 1) sensors, respectively.

Self-regulated learning microanalysis for the study of the performance of clinical examinations by physiotherapy students.

BACKGROUND: Students require feedback on their self-regulated learning (SRL) processes to improve the performance of clinical examinations. The key SRL processes used by students can be identified by SRL-micro-analysis but, this method has not been previously applied to physiotherapy students. The aim of this pilot study was to test a research design that might allow the evaluation of the potential usefulness of SRL microanalysis for the identification of key SRL processes used by physiotherapy students during the performance of a clinical examination skill. The objectives of the pilot study were: 1) to evaluate whether SRL-microanalysis could identify differences in the use of SRL processes between successful and unsuccessful students; 2) to evaluate the reliability of SRL microanalysis ratings produced by different assessors. METHODS: SRL-microanalysis was used with second year physiotherapy students of a Spanish university (n = 26) as they performed a goniometric task. The task required students to obtain a goniometric measurement of the shoulder joint of a peer. Two assessors evaluated student performance and conducted the SRL- microanalysis with all students. An analysis of inter-rater reliability was performed to evaluate the degree of agreement between assessors. RESULTS: The SRL-microanalysis revealed differences in the use of key SRL processes between successful (n = 15: 57.0%) and unsuccessful performers (n = 11: 43.0%): The differences were particularly evident in strategic planning and self-monitoring skills. There was good inter-rater reliability for scoring of strategic planning (k = 0.792), self-monitoring (k = 0.946) and self-evaluation (k = 0.846). CONCLUSION: The use of SRL microanalysis characterized the key SRL processes of physiotherapy students performing a clinical skill with reliability between the assessors. This pilot study supports the potential usefulness of SRL-microanalysis for the identification of key SRL processes in physiotherapy education. Therefore, this study paves the way to the development of a full study, with a larger number of students and more diverse clinical tasks, to evaluate the SRL processes in successful and unsuccessful students.

Early identification of first-year students at risk of dropping out of high-school entry medical school: the usefulness of teachers' ratings of class participation.

Dropping out from undergraduate medical education is costly for students, medical schools, and society in general. Therefore, the early identification of potential dropout students is important. The contribution of personal features to dropout rates has merited exploration. However, there is a paucity of research on aspects of student experience that may lead to dropping out. In this study, underpinned by theoretical models of student commitment, involvement, and engagement, we explored the hypothesis of using inferior participation as an indicator of a higher probability of dropping out in year 1. Class participation was calculated as an aggregate score based on teachers' daily observations in class. The study used a longitudinal dataset of six cohorts of high-school entry students (N = 709, 67% females) in one medical school with an annual intake of 120 students. The findings confirmed the initial hypothesis and showed that lower scores of class participation in year 1 added predictive ability to pre-entry characteristics (Pseudo-R2 raised from 0.22 to 0.28). Even though the inclusion of course failure in year 1 resulted in higher explanatory power than participation in class (Pseudo-R2 raised from 0.28 to 0.63), ratings of class participation may be advantageous to anticipate dropout identification, as those can be collected prior to course failure. The implications for practice are that teachers' ratings of class participation can play a role in indicating medical students who may eventually drop out. We conclude that the scores of class participation can contribute to flagging systems for the early detection of student dropouts.

Evaluation of new approaches to the access of official monitoring results for live bivalves molluscs.

BACKGROUND: Live bivalve molluscs, echinoderms, tunicates and marine gastropod are referred in EU food laws, and require member states to implement official controls in classified production areas, with the monitoring and classification of those areas. If, due to contaminant tests results, a production area is closed, any product from there is prohibited to be commercialized. Mobile applications optical character recognition (OCR) functionalities could ease the access to contaminant levels and production area classifications. This study verifies what information is available in live bivalves' labels, describes an OCR algorithm for those labels and evaluates it. METHODS: 86 labels were selected from four sale points in Lisbon, and photographed using smartphones. Each label was evaluated by a human to determine what data was available (either required or not). An OCR algorithm was developed and applied on the collected labels and validated against the data extracted by the human analysis. RESULTS: The analysis shows that all the labels included the required information, and 63% of the labels included the identifier for the production zone. The label-reading algorithm performs with an accuracy of 79.85% for the individual values. CONCLUSION: High accuracy of the developed label-reading algorithm shows potential for providing instant automatic access to the date and production area, but is affected by the variability on the label structure. Although not required by food laws, the majority of the sampled labels included complementary information (classified production area) that will allow access to more precise information about the existing biotoxin tests and analysis results.

Twelve tips for enhancing student engagement.

Student engagement refers to a broad range of activities where students participate in management, education, research, and community activities within their institutions. It is a mutually beneficial collaborative approach between students and their institutions. This article provides practical advice for the implementation or further development of student engagement at medical, dental, and veterinary schools. The tips provided are based on the experiences of a group of universities recently recognized for best practice in student engagement, and are supported by evidence from the literature. The tips cover overarching themes which include the creation of an institutional culture and formal framework for student engagement, and maximize communication routes between students with peers and faculty. Tips are for specific areas of active student engagement, covering curriculum design and development, peer teaching, governance processes, research activities, peer support programs, and interaction with the local community.

2018 Consensus framework for good assessment.

Introduction: In 2010, the Ottawa Conference produced a set of consensus criteria for good assessment. These were well received and since then the working group monitored their use. As part of the 2010 report, it was recommended that consideration be given in the future to preparing similar criteria for systems of assessment. Recent developments in the field suggest that it would be timely to undertake that task and so the working group was reconvened, with changes in membership to reflect broad global representation.Methods: Consideration was given to whether the initially proposed criteria continued to be appropriate for single assessments and the group believed that they were. Consequently, we reiterate the criteria that apply to individual assessments and duplicate relevant portions of the 2010 report.Results and discussion: This paper also presents a new set of criteria that apply to systems of assessment and, recognizing the challenges of implementation, offers several issues for further consideration. Among these issues are the increasing diversity of candidates and programs, the importance of legal defensibility in high stakes assessments, globalization and the interest in portable recognition of medical training, and the interest among employers and patients in how medical education is delivered and how progression decisions are made.

Clarifying changes in student empathy throughout medical school: a scoping review.

Despite the increasing awareness of the relevance of empathy in patient care, some findings suggest that medical schools may be contributing to the deterioration of students' empathy. Therefore, it is important to clarify the magnitude and direction of changes in empathy during medical school. We employed a scoping review to elucidate trends in students' empathy changes/differences throughout medical school and examine potential bias associated with research design. The literature published in English, Spanish, Portuguese and French from 2009 to 2016 was searched. Two-hundred and nine potentially relevant citations were identified. Twenty articles met the inclusion criteria. Effect sizes of empathy scores variations were calculated to assess the practical significance of results. Our results demonstrate that scoped studies differed considerably in their design, measures used, sample sizes and results. Most studies (12 out of 20 studies) reported either positive or non-statistically significant changes/differences in empathy regardless of the measure used. The predominant trend in cross-sectional studies (ten out of 13 studies) was of significantly higher empathy scores in later years or of similar empathy scores across years, while most longitudinal studies presented either mixed-results or empathy declines. There was not a generalized international trend in changes in students' empathy throughout medical school. Although statistically significant changes/differences were detected in 13 out of 20 studies, the calculated effect sizes were small in all but two studies, suggesting little practical significance. At the present moment, the literature does not offer clear conclusions relative to changes in student empathy throughout medical school.

Depression in medical students: insights from a longitudinal study.

BACKGROUND: Factors associated with depression of medical students are poorly understood. The purpose of this study is to determine the prevalence of depression in medical students, its change during the course, if depression persists for affected students, what are the factors associated with depression and how these factors change over time. METHODS: A prospective, longitudinal observational study was conducted at the Medical School of the University of Minho, Portugal, between academic years 2009-2010 to 2012-2013. We included students who maintained their participation by annually completing a questionnaire including Beck Depression Inventory (BDI). Anxiety and burnout were assessed using the State Trait Anxiety Inventory and Maslach Burnout Inventory. Surveys on socio-demographic variables were applied to evaluate potential predictors, personal and academic characteristics and perceived difficulties. ANOVA with multiple comparisons were used to compare means of BDI score. The medical students were organized into subgroups by K-means cluster analyses. ANOVA mixed-design repeated measurement was performed to assess a possible interaction between variables associated with depression. RESULTS: The response rate was 84, 92, 88 and 81% for academic years 2009-2010, 2010-2011,2011-2012 and 2012/2013, respectively. Two hundred thirty-eight medical students were evaluated longitudinally. For depression the prevalence ranged from 21.5 to 12.7% (academic years 2009/2010 and 2012/2013). BDI scores decreased during medical school. 19.7% of students recorded sustained high BDI over time. These students had high levels of trait-anxiety and choose medicine for anticipated income and prestige, reported more relationship issues, cynicism, and decreased satisfaction with social activities. Students with high BDI scores at initial evaluation with low levels of trait-anxiety and a primary interest in medicine as a career tended to improve their mood and reported reduced burnout, low perceived learning problems and increased satisfaction with social activities at last evaluation. No difference was detected between men and women in the median BDI score over time. CONCLUSIONS: Our findings suggest that personal factors (anxiety traits, medicine choice factors, relationship patterns and academic burnout) are relevant for persistence of high levels of BDI during medical training. Medical schools need to identity students who experience depression and support then, as early as possible, particularly when depression has been present over time.

Psychometric properties of the Spanish version of the Jefferson Scale of Empathy: making sense of the total score through a second order confirmatory factor analysis.

BACKGROUND: Empathy is a key aspect of the physician-patient interactions. The Jefferson Scale of Empathy (JSE) is one of the most used empathy measures of medical students. The development of cross-cultural empathy studies depends on valid and reliable translations of the JSE. This study sought to: (1) adapt and assess the psychometric properties in Spanish students of the Spanish JSE validated in Mexican students; (2) test a second order latent factor model. METHODS: The Spanish JSE was adapted from the Spanish JSE-S, resulting in a final version of the measure. A non-probabilistic sample of 1104 medical students of two Spanish medical schools completed a socio-demographic and the Spanish JSE-S. Descriptive statistics, along with a confirmatory factor analysis, the average variance extracted (AVE), Cronbach's alphas and composite reliability (CR) coefficients were computed. An independent samples t-test was performed to access sex differences. RESULTS: The Spanish JSE-S demonstrated acceptable to good sensitivity (individual items - except for item 2 - and JSE-S total score: -2.72 < Sk < 0.35 and -0.77 < Ku < 7.85), convergent validity (AVE: between 0.28 and 0.45) and reliability (Cronbach's alphas: between 0.62 and 0.78; CR: between 0.62 and 0.87). The confirmatory factor analysis supported the three-factor solution and the second order latent factor model. CONCLUSIONS: The findings provide support for the sensitivity, construct validity and reliability of the adapted Spanish JSE-S with Spanish medical students. Data confirm the hypothesized second order latent factor model. This version may be useful in future research examining empathy in Spanish medical students, as well as in cross-cultural studies.

Surface roughness and refractive index changes in contact lens induced by lens care systems.

PURPOSE: The aim of this study was to analyze the influence of different lens care systems in surface roughness and refractive index (RI) of contact lenses (CL). This information provides us with a better understanding of how care solutions affect CL materials. METHODS: Several CL and three commercially available and appropriate lens care solutions were used (two polyhexamethylene biguanide and one hydrogen peroxide care systems). Lenses were immersed in the lens care systems, and then measurements with CLR 12-70 digital automated refractometer and atomic force microscopy analysis on Tapping mode were recorded. The measurements were performed before and after the lenses were immersed in each care solution. RESULTS: Significant changes were observed on the CL materials when exposed to lens care systems. All the materials changed, to a greater or lesser extent, their roughness and RI, after being immersed in the different solutions. The water content varied between 0% (Nelfilcon A in ReNu Multiplus, Senofilcon A in AOSEPT Plus, and Methafilcon A in Solocare Aqua) and 4.1% (Hilafilcon B in Solocare Aqua) The higher change in roughness was obtained with ReNu Multiplus in the lens Comfilcon A (with an increase of 27.2 nm) and Senofilcon A (with an increase of 16.7 nm). CONCLUSION: This study suggests that lens care systems play an important role in surface roughness and RI of CL.

[Soil-vegetation relationships in a toposequence of the Guayana Shield, Venezuela]. / Relaciones suelo-vegetación en una toposecuencia del Escudo Guayanés, Venezuela.

The Guayana Shield is one of the oldest territories in the planet and has millions of years subjected to leaching and erosion processes that produce oligotrophic soils. This scarcity of nutrients has not avoided the development of high, diverse and magnificent forests, where plants have adaptations to survive these difficult conditions. The aim of this work was to characterize the physical and chemical parameters of the soils in different forest communities of the Imataca Forest Reserve (IFR), to establish some interpretations on their origin, and some relationships between the edaphic components and the inhabitant species. Terrestrial journeys were carried out and two pathways were traced for the interpretation of forest communities. In each community, three plots (100m x 100m) for the ecological survey were established. In each plot, all trees, palms, and lianas were measured (dbh> or =10cm; dbh: diameter at breast height); four 10m x 10m understory sub-plots were evaluated, and a census of all the spermatophyta species (dbh< 10cm) was made. Soils were evaluated by means of a trial pit in each community, and a bore in each one understory sub-plot. The obtained data were analyzed by both a detrended and a canonical correspondence analysis. Results from a total of 15 plots allowed us to identify three communities: a forest dominated by Mora excelsa located in a narrow valley with high content of silt; a swamp forest dominated by Catostemma commune in a sandy broad valley, and a forest in clay hills dominated by Alexa imperatricis. Most of the soils had a pH between 3.1 and 4.5. Nutrients were in very low concentrations (N: 0-0.2%; P: 0-14ppm; K: 0-0.3 Cmol/kg) and A1 in toxicity quantities. We observed that Ca/A1 relationship greater than 1 meant a neutralization of the toxic effect of Al. Besides, basal area ranged from 20.4 to 32.3m2/ha; the highest level (top local forest development) corresponded with the C. commune community with a Ca/A1 value of 2.5. This research found an adequate relationship between soil and vegetation, as it was able to identify three communities into three distinct soil conditions. Nevertheless, edaphic constraints indicated that high forest cover must be maintained as an essential element for the conservation of these communities.

A school-based physical activity intervention in primary school: effects on physical activity, sleep, aerobic fitness, and motor competence.

Objective: The "Super Quinas" project evaluated the effectiveness of an intervention program to improve physical activity, aerobic fitness, sleep, and motor competence on children in primary school. Methods: The experimental group (n = 19) enrolled in a 12-week intervention program (one more extra-curricular activity class of 60 min per week) compared to the CG (n = 19), all aged 9-10 years. Physical activity (PA) and sleep were measured by accelerometry, and aerobic fitness was measured by Children's Yo-Yo test (YYIR1C) during the 1st week (PRE), the 6th week (DUR), and the 12th week (POST) of the intervention program. Motor Competence in PRE and POST intervention was also assessed by the Motor Competence Assessment (MCA) instrument. Heart rate (HR, assessed using HR monitors), and enjoyment level were recorded during all intervention program classes. A linear mixed model analysis (i.e., within-subject analyses) was performed. Results: Comparing the EG and CG in DUR and POST, the EG spent ~18 min and ~ 34 min more time in moderate to vigorous physical activity (MVPA) per day (p < 0.001); had ~44 min and ~ 203 min less sedentary time per day (p < 0.001); performed more 44 and 128 m in the Children's Yo-Yo test compared to CG (p < 0.001) and slept more 17 and 114 min per night (p < 0.001). In POST motor competence was significantly better (27%) in the EG compared to CG (p < 0.001). The %HRmax during the extra-curricular classes ranged between 65 and 81% (i.e., light to moderate intensities), and the enjoyment between fun and great fun. Conclusion: Our findings suggest that adding one more extra-curricular activity class of 60 min per week for 12 weeks effectively increased the levels of physical activity, aerobic fitness, sleep duration, and motor competence in children aged 9-10 years.

The remediation challenge: theoretical and methodological insights from a systematic review.

OBJECTIVES: Remediation is usually offered to medical students and doctors in training who underperform on written or clinical examinations. However, there is uncertainty and conflicting evidence about the effectiveness of remediation. The aim of this systematic review was to synthesise the available evidence to clarify how and why remediation interventions may have worked in order to progress knowledge on this topic. METHODS: The MEDLINE, EMBASE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), ERIC (Educational Resources Information Centre), Web of Science and Scopus databases were searched for papers published from 1984 to April 2012, using the search terms 'remedial teaching', 'education', 'medical', 'undergraduate'/or 'clinical clerkship'/or 'internship and residency', 'at risk' and 'struggling'. Only studies that included an intervention, then provided retest data, and reported at least one outcome measure of satisfaction, knowledge, skills or effects on patients were eligible for inclusion. Studies of practising doctors were excluded. Data were abstracted independently in duplicate for all items. Coding differences were resolved through discussion. RESULTS: Thirty-one of 2113 studies met the review criteria. Most studies were published after 2000 (n=24, of which 12 were published from 2009 onwards), targeted medical students (n=22) and were designed to improve performance on an immediately subsequent examination (n=22). Control or comparison groups, conceptual frameworks, adequate sample sizes and long-term follow-up measures were rare. In studies that included long-term follow-up, improvements were not sustained. Intervention designs tended to be highly complex, but their design or reporting did not enable the identification of the active components of the remedial process. CONCLUSIONS: Most remediation interventions in medical education focus on improving performance to pass a re-sit of an examination or assessment and provide no insight into what types of extra support work, or how much extra teaching is critical, in terms of developing learning. More recent studies are generally of better quality. Rigorous approaches to developing and evaluating remediation interventions are required.

A latent growth model suggests that empathy of medical students does not decline over time.

Empathy is a relevant attribute in the context of patient care. However, a decline in empathy throughout medical education has been reported in North-American medical schools, particularly, in the transition to clinical training. The present study aims to longitudinally model empathy during medical school at three time points: at the entrance, final of pre-clinical phase and at the beginning of clinical training. Data collected with the adaptation to Portuguese of the Jefferson Scale of Physician Empathy (student version) were analysed with latent growth modelling, conditioned by gender, openness and agreeableness. Empathy scores at all times were higher for females than for males, but only significantly at the end of the preclinical phase. The model showed a satisfactory fit level and the primary finding was that undergraduate medical student's empathy did not decline over time. Empathy scores were significantly and positively related with Openness to Experience and Agreeableness at admission, but the empathy rate of change across time was not significant. The stability of empathy revealed by a longitudinal methodology applied for the first time to empathy studying, contradicts previous results of decline and contributes to the understanding of the empathy development of medical students.