Therapeutic Plasmapheresis Enabling Radioactive Iodine Treatment in a Patient with Thyrotoxicosis.

Therapeutic plasma exchange (TPE) is one possible treatment for patients resistant to conventional antithyroid drugs or requiring urgent attention for thyrotoxicosis. We report a 35-yr-old man with thyrotoxicosis, ultimately attributed to Graves' disease in whom antithyroid drug used initially was soon discontinued, due to abnormal liver function, and replaced by Lugol's solution. Three weeks later, an escape phenomenon (to Lugol's solution) was apparent, so we performed TPE to control the thyrotoxicosis. Two courses of TPE by a centrifugal type machine resulted in diminished levels of thyroid hormone levels, which then rebounded after another two courses of membrane filtration type TPE. However, the patient could be treated with radioactive iodine therapy without any complications at present.

Commencing Technical Clinical Skills Training in the Early Stages of Medical Education: Exploring Student Views.

INTRODUCTION: Medical schools are increasingly introducing technical clinical skills training from year 1. However, little research has determined students' views of such training. This study compared the perceptions of student groups which received different levels of technical skills training during the early years of their undergraduate medical degree. METHODS: Medical students from King's College London's Stage curriculum (n = 184) receiving 48 h of technical skills teaching and Phase curriculum (n = 94), receiving 12 h, voluntarily participated. A mixed methods design using a questionnaire and focus groups explored students' views. Stage and Phase student questionnaire responses were compared using Mann Whitney U tests. Focus group transcripts underwent thematic analysis. RESULTS: The majority of Stage (n = 169) and Phase (n = 68) students identified year 1 as the best time to commence technical skills training. For the majority of the technical skills taught, Stage compared to Phase students reported feeling more prepared to perform them. Thematic analysis identified three main themes: Role of technical skills teaching in the early stages of medical education, impact on students' learning and factors to consider when designing a medical undergraduate technical clinical skills programme. CONCLUSIONS: The wide student support and positive impact of technical skills training on students' perceived preparedness for carrying out the techniques taught advocates its addition to the first year of the undergraduate medical curriculum. The identification by students of specific components considered to be fundamental in the effective teaching of technical skills provides guidance when designing future undergraduate clinical skills training.