An analysis of free-choice electives in an undergraduate medical degree.

BACKGROUND: The University College Dublin Elective Programme was introduced in 2005 with the intention of broadening the learning of its undergraduate students. Undergraduate medical students undertake seven free-choice electives during their six-year degree programme. They are permitted to choose electives from any school in the University. Students also have the option of selecting 'In-Programme' electives, which are aligned to medical themes. The purpose of this study is to analyse the electives taken by medical students with a view to better understanding the factors that influence their choices. METHODS: In this mixed methodology study, the quantitative phase consisted of a retrospective analysis of 3318 elective choices associated with 474 medical students between 2006 and 2013. Elective choices were analysed in terms of popularity, difficulty level and subject matter. The prospective qualitative phase consisted of a series of semi-structured focus groups held with current medical students. Discussions from the focus groups underwent thematic analysis with a few to exploring and clarifying the quantitative findings. RESULTS: The most frequently chosen electives were In-Programme (38.6%) and Applied Language (21.6%) electives, with patterns not significantly varying from year to year. Male and female students tended to take the same type of electives. Focus group discussions revealed that the primary factor motivating choice was workload, with students preferring less demanding electives. Participants indicated that elective grading and assessment criteria had a significant impact on their choices. Participants described ways in which the elective selection process could be improved, including a desire for more structured electives and a revision of the elective selection process. CONCLUSIONS: The retrospective data analysis revealed a high level of consistency in medical students' elective choices from stage to stage and between different year cohorts. Qualitative investigation revealed that medical students tend to focus on grading, assessment strategies and skills development when choosing their electives. The implication that students may be reluctant to take more challenging electives despite having an interest in the subject is one that warrants consideration when designing or adapting programmes for the future. Although these findings are associated with a free-choice elective programme, similar strategies are likely to be employed for the more traditional option-based programmes that are associated with the majority of medical degrees internationally.

ICC-dementia (International Centenarian Consortium - dementia): an international consortium to determine the prevalence and incidence of dementia in centenarians across diverse ethnoracial and sociocultural groups.

BACKGROUND: Considerable variability exists in international prevalence and incidence estimates of dementia. The accuracy of estimates of dementia in the oldest-old and the controversial question of whether dementia incidence and prevalence decline at very old age will be crucial for better understanding the dynamics between survival to extreme old age and the occurrence and risk for various types of dementia and comorbidities. International Centenarian Consortium - Dementia (ICC-Dementia) seeks to harmonise centenarian and near-centenarian studies internationally to describe the cognitive and functional profiles of exceptionally old individuals, and ascertain the trajectories of decline and thereby the age-standardised prevalence and incidence of dementia in this population. The primary goal of the ICC-Dementia is to establish a large and thorough heterogeneous sample that has the power to answer epidemiological questions that small, separate studies cannot. A secondary aim is to examine cohort-specific effects and differential survivorship into very old age. We hope to lay the foundation for further investigation into risk and protective factors for dementia and healthy exceptional brain ageing in centenarians across diverse ethnoracial and sociocultural groups. METHODS: Studies focusing on individuals aged ≥95 years (approximately the oldest 1 percentile for men, oldest 5th percentile for women), with a minimum sample of 80 individuals, including assessment of cognition and functional status, are invited to participate. There are currently seventeen member or potential member studies from Asia, Europe, the Americas, and Oceania. Initial attempts at harmonising key variables are in progress. DISCUSSION: General challenges facing large, international consortia like ICC-Dementia include timely and effective communication among member studies, ethical and practical issues relating to human subject studies and data sharing, and the challenges related to data harmonisation. A specific challenge for ICC-Dementia relates to the concept and definition of'abnormal' in this exceptional group of individuals who are rarely free of physical, sensory and/or cognitive impairments.

Risk of complications following surgical fixation of femoral diaphyseal fractures in children aged 4 to 12 years: A systematic review and meta-analysis.

INTRODUCTION: There is debate regarding the optimal surgical technique for fixing femoral diaphyseal fractures in children aged 4 to 12 years. The National Institute for Health and Care Excellence (NICE) and the American Academy of Orthopaedic Surgeons (AAOS) have issued relevant guidelines, however, there is limited evidence to support these. The aim of this study was to conduct a systematic review and meta-analysis to compare the complication rate following flexible intramedullary nailing (FIN), plate fixation and external fixation (EF) for traumatic femoral diaphyseal fractures in children aged 4 to 12. METHODS: We searched MEDLINE, EMBASE and CENTRAL databases for interventional and observational studies. Two independent reviewers screened, assessed quality and extracted data from the identified studies. The primary outcome was the risk of any complication. Secondary outcomes assessed the risk of pre-specified individual complications. RESULTS: Nine randomised controlled trials (RCTs) and 19 observational studies fulfilled the eligibility criteria. Within the RCTs, five analysed FIN (n = 161), two analysed plates (n = 51) and five analysed EF (n = 168). Within the observational studies, 13 analysed FIN (n = 610), seven analysed plates (n = 214) and six analysed EF (n = 153). The overall risk of complications was lower following plate fixation when compared to FIN fixation (RR 0.45, 95% CI 0.28 to 0.73, p = 0.001) in the observational studies. The overall risk of complications was higher following EF when compared to FIN fixation in both RCTs (RR 1.94, 95% CI 1.25 to 3.01, p = 0.003) and observational studies (RR 1.97, 95% CI 1.50 to 2.58, p<0.001). The overall risk of complications was higher following EF when compared to plate fixation in both RCTs (RR 7.42, 95% CI 1.84 to 29.98, p = 0.005) and observational studies (RR 4.39, 95% CI 2.64 to 7.30, p<0.001). CONCLUSION: Although NICE and the AAOS recommend FIN for femoral diaphyseal fractures in children aged 4 to 12, this study reports a significantly decreased relative risk of complications when these injuries are managed with plates. The overall quality of evidence is low, highlighting the need for a rigorous prospective multicentre randomised trial at low risk of bias due to randomisation and outcome measurement to identify if any fixation technique is superior.