Differences between repeated lipid profile measurements in a tertiary hospital over a short time period.

BACKGROUND: Measurement of the plasma lipid profile, mainly low-density lipoprotein cholesterol (LDL-C), is widely used in the management of hospitalized patients as part of their cardiometabolic risk assessment. In common practice, LDL-C is calculated indirectly by the Friedewald equation. For many years, fasting of 8-14 h is needed to obtain an accurate lipid profile measurement, although recent guidelines do not necessitate it. The aim of this study was to find patients with two consecutive LDL-C measurements taken over a short time period on the same admission to see if a significant difference exists and to suggest reasons that may explain it. We also aim to define whether the difference between LDL-C calculated by the Friedewald equation is diminished while using the newer Martin/Hopkins, de Cordova or Sampson/NIH equations. METHODS: This was a retrospective cohort study performed in one medical center in Israel. In a five-year time period, 772 patients with two repeated LDL-C measurements taken on the same admission were found. The median time gap between tests was 2 days. Correlations between laboratory results and LDL-C measurements were determined. RESULTS: A total of 414 patients (53.6%) had a difference greater than the acceptable total error of 8.9% in LDL-C calculation using the Friedewald equation, with a mean 25.8% difference between the two tests. Newer LDL-C calculations showed less diversity. Non-HDL-C was found as the only variable with a major correlation with LDL-C results in all equations. A weaker correlation was found with HDL-C. Triglycerides showed an even weaker correlation, and glucose differences had no correlation with LDL-C differences. CONCLUSIONS: Repeated LDL-C measurements can vary widely, even during a short period of hospitalization. In this study, more than half of the patients had a significant difference between their consecutive LDL-C results. This wide difference between two consecutive tests was diminished using newer calculations, yet not well explained. The fasting state likely has no effect on LDL-C levels. The results of this study might emphasize that many factors influence LDL-C calculation, especially in the disease state. Further research is needed, especially in looking for a more accurate LDL-C calculation from existing formulas.

[Medical students' views on the use of virtual patients for teaching and assessment of clinical knowledge and reasoning].

BACKGROUND: Computerized cLinical cases ["virtual patient" (VP)] provide a useful teaching and assessment tool for clinicaL knowledge and skiLLs. However, the attitude of medical students toward this new modality needs to be evaluated. We examined students' acceptance of a web-based VP system that was deveLoped in the Technion Faculty of Medicine for teaching and assessment purposes. The VP system enables free conversation (in writing) for history taking and listing of disease symptoms. It aLso depicts images and audio-videos of heart and lung sounds, and enables users to order Laboratory and imaging tests. The system was designed to be learnt without instructors and to provide feedback online. Therefore, the process of Learning and practicing with the VP system was performed by the students at home, during their free time. METHODS: At the end of the clinical introductory course to internal medicine, students (n=91) were asked to complete questionnaires and rate multiple aspects of the VP system. RESULTS: Student acceptance of this web-based modality was high: over 95% fully or partially accepted that the VP practice system facilitates Learning the approach to diseases they were not exposed to during the course, practicing differential diagnosis, and improving their knowledge, clinicaL skills and reasoning. A similar percentage of the students agreed that the VP exam assessed their clinical knowledge and comprehension adequately, correctly and objectively. CONCLUSIONS: These results document high acceptance of web-based instruction and assessment by medical students. However, many students expect that a clinical course should also include bed-side assessment.

[Strive, plan and reach the "Summit": the Faculty Development Program at the Ruth & Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology].

BACKGROUND: In recent years, faculty development has turned into a central component of medical education and a primary instrument in qualifying physicians to be teachers and educators. The faculty development program at the Ruth & Bruce Rappaport Faculty of Medicine ("Summit" program) was established in order to improve teaching of the clinical professions, to create a community of medical teachers and educators and to develop leadership in medical education within the Faculty of Medicine. OBJECTIVE: This article aims to describe the design, implementation and evaluation of the faculty development program in the Technion's Faculty of Medicine. METHODS: The program was designed for a group of 20 clinical teachers, of various clinical professions, who had gained at least one year of undergraduate teaching experience and wished to develop a career in medical education. The program included seven monthly, eight-hour meetings throughout the academic year. Learning was based on small group discussions, interactive exercises, role-plays and simulations, self-directed reading and reflective writing. At the end of the final meeting, participants completed an evaluation form. RESULTS: Seventeen of the 20 participants (85%) graduated and received certificates. Learners' overall satisfaction was high. Graduates expressed high motivation to practice medical education within the Faculty of Medicine and reported that they gained new knowledge in medical education and skills regarding various aspects of teaching and learning, such as formulation of learning objectives, designing role plays, and providing effective feedback. CONCLUSIONS: The "Summit" program is an innovative initiative in the field of medical education in Israel. The program had a significant impact on participants' knowledge, teaching skills and attitudes. In order to ensure implementation of the acquired tools and skills, its shortterm and long-term effects on teaching behavior and the learning climate have yet to be demonstrated. In addition, it is necessary to check if the program affected the faculty as an organization, promoted changes in curricula, teaching and evaluation methods.