Medical countermeasures during the 2018 Ebola virus disease outbreak in the North Kivu and Ituri Provinces of the Democratic Republic of the Congo: a rapid genomic assessment.

BACKGROUND: The real-time generation of information about pathogen genomes has become a vital goal for transmission analysis and characterisation in rapid outbreak responses. In response to the recently established genomic capacity in the Democratic Republic of the Congo, we explored the real-time generation of genomic information at the start of the 2018 Ebola virus disease (EVD) outbreak in North Kivu Province. METHODS: We used targeted-enrichment sequencing to produce two coding-complete Ebola virus genomes 5 days after declaration of the EVD outbreak in North Kivu. Subsequent sequencing efforts yielded an additional 46 genomes. Genomic information was used to assess early transmission, medical countermeasures, and evolution of Ebola virus. FINDINGS: The genomic information demonstrated that the EVD outbreak in the North Kivu and Ituri Provinces was distinct from the 2018 EVD outbreak in Équateur Province of the Democratic Republic of the Congo. Primer and probe mismatches to Ebola virus were identified in silico for all deployed diagnostic PCR assays, with the exception of the Cepheid GeneXpert GP assay. INTERPRETATION: The first two coding-complete genomes provided actionable information in real-time for the deployment of the rVSVΔG-ZEBOV-GP Ebola virus envelope glycoprotein vaccine, available therapeutics, and sequence-based diagnostic assays. Based on the mutations identified in the Ebola virus surface glycoprotein (GP12) observed in all 48 genomes, deployed monoclonal antibody therapeutics (mAb114 and ZMapp) should be efficacious against the circulating Ebola virus variant. Rapid Ebola virus genomic characterisation should be included in routine EVD outbreak response procedures to ascertain efficacy of medical countermeasures. FUNDING: Defense Biological Product Assurance Office.

Dundee's Longitudinal Integrated Clerkship: drivers, implementation and early evaluation.

Dundee University School of Medicine established a pilot for a 40 week long comprehensive Longitudinal Integrated Clerkship (LIC) in 2016. Ten places for year 4 students are available which are shared between two regions of Scotland which are largely rural areas by UK definitions. This paper describes the drivers for the pilot, its implementation and early evaluation. For the evaluation, data were collected using focus groups and semi-structured interviews from the first cohort of seven students, four health service employed staff (two with leadership roles and two with regional student facing roles), 21 General Practitioner tutors, and from reflective audio-diaries kept by all students. Analysis was thematic, the themes being identified from the data. Summative assessment data were collated. Students reported positive learning experiences though access to secondary care learning linked to their patients was sometimes problematic. GP tutors were positive and enthusiastic about the programme and could see the potential benefits on recruitment to GP careers. Pre-existing workload pressures were a challenge. Summative assessment results were encouraging. The Dundee LIC is successful in delivering Dundee's year 4 curriculum. Ongoing development has been focused on improving awareness of the programme in secondary care services.

Utility of an app-based system to improve feedback following workplace-based assessment.

OBJECTIVES: To determine whether an app-based software system to support production and storage of assessment feedback summaries makes workplace-based assessment easier for clinical tutors and enhances the educational impact on medical students. METHODS: We monitored our workplace assessor app's usage by Year 3 to 5 medical students in 2014-15 and conducted focus groups with Year 4 medical students and interviews with clinical tutors who had used the apps. Analysis was by constant comparison using a framework based on elements of van der Vleuten's utility index. RESULTS: The app may enhance the content of feedback for students. Using a screen may be distracting if the app is used during feedback discussions.    Educational impact was reduced by students' perceptions that an easy-to-produce feedback summary is less valuable than one requiring more tutor time and effort. Tutors' typing, dictation skills and their familiarity with mobile devices varied. This influenced their willingness to use the assessment and feedback mobile app rather than the equivalent web app. Electronic feedback summaries had more real and perceived uses than anticipated both for tutors and students including perceptions that they were for the school rather than the student. CONCLUSIONS: Electronic workplace-based assessment systems can be acceptable to tutors and can make giving detailed written feedback more practical but can interrupt the social interaction required for the feedback conversation. Tutor training and flexible systems will be required to minimise unwanted consequences. The educational impact on both tutors and students of providing pre-formulated advice within the app is worth further study.

The investment of a new medical school in its local primary care community.

BACKGROUND: Keele School of Medicine has an innovative new MBChB curriculum with a strong focus on primary care. Our students spend a minimum of 115 days in general practice. AIM: To describe the investment by the school in the local primary care community. METHOD: We collated data on list sizes of current undergraduate teaching practices, county populations and the investment in practices' teaching skills and physical premises. RESULTS: Between academic years 2010-11 and 2012-13 a total of 118 (annual mean of 99) practices contributed to teaching across six counties, providing care for 655 229 people. Forty-five per cent of 243 practices in Staffordshire and Shropshire teach. They serve 51% of the two counties' population. We have invested £1.62 million in the premises of 25 practices providing services for 18% of people in Staffordshire and Shropshire, £273 000 in a rural campus in Shropshire, and £99 387 in set-up grants. We have conducted 249 practice development visits. There were 540 attendances at tutor development sessions. We have had a total of 2300 hours of face-to-face contact with our practices. CONCLUSION: The school has made a major investment in general practice in its area, contributing to the development of general practitioners and investing in practice premises.