Direct Measurement of Veterinary Student Learning Outcomes for the NAVMEC Professional Competencies in a Multi-User Virtual Learning Environment.

Education in veterinary medicine, as in other allied health care-health science professions and academia in general, has been subject to the public call for accountability for the quality of its student learning outcomes. A principal stakeholder in veterinary medicine is the American Veterinary Medical Association-Council on Education (AVMA-COE). AVMA-COE has adopted program accreditation standards requiring veterinary colleges to provide evidence that they are measuring and assessing the clinical competency of students before graduation and again shortly after graduation. Schools and colleges are required to develop relevant measures to validate scientific knowledge, skills, and values aligned with North American Veterinary Medical Education Consortium (NAVMEC) core competencies. Beginning in May 2012, the College of Veterinary Medicine and Biomedical Sciences at Texas A&M University modified the professional veterinary medical curriculum by including a required clinical rotation centered on veterinary emergency preparedness and response. A distinguishing major component of the instructional design of the clinical rotation includes Second Life, a commercially obtained computer-generated multi-user virtual simulation learning environment. The virtual reality situations require high-volume, mass-casualty medical triage decision making. The interpersonal communications and interactivity among students, faculty, and third-party actors enable faculty and instructor observers and simulation facilitators to evaluate students actively engaged in critical thinking and complex problem solving while demonstrating skill in the NAVMEC professional competencies. The Second Life virtual simulation has been adopted as a primary tool for direct measurement of student learning objectives outcomes achieved in this clinical rotation and is being implemented in other clinical teaching platforms.

SHOX haploinsufficiency presenting with isolated short long bones in the second and third trimester.

Haploinsufficiency of the transcription factor short stature homeobox (SHOX) manifests as a spectrum of clinical phenotypes, ranging from disproportionate short stature and Madelung deformity to isolated short stature. Here, we describe five infants with molecularly confirmed diagnoses of SHOX haploinsufficiency who presented in utero with short long bones during routine antenatal scanning from as early as 19 weeks gestation. Other foetal growth parameters were normal. The molecular basis of SHOX haploinsufficiency was distinct in each case. In four cases, SHOX haploinsufficiency was inherited from a previously undiagnosed parent. In our de novo case, SHOX haploinsufficiency reflected the formation of a derivative sex chromosome during paternal meiosis. Final adult height in the SHOX-deficient parents ranged from -1.9 to -1.2 SDS. All affected parents had disproportionately short limbs and two affected mothers had bilateral Madelung deformity. To our knowledge, SHOX haploinsufficiency has not previously been reported to present in utero. Our experience illustrates that SHOX deficiency should form part of the differential diagnosis of foetal short long bones and suggests a low threshold for genetic testing. This should be particularly targeted at, but not limited to, families with a history of features suggestive of SHOX deficiency. Data on the postnatal growth of our index cases is presented which demonstrates that antenatal presentation of SHOX haploinsufficiency is not indicative of severe postnatal growth restriction. Early identification of SHOX deficiency will enable accurate genetic counselling reflecting a good postnatal outcome and facilitate optimal initiation of growth hormone therapy.