Randomized, controlled trial of a normal pregnancy virtual patient to teach medical students counseling skills.

OBJECTIVE: To determine whether medical students using the Normal Pregnancy Virtual Patient program (Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts) have better knowledge and skills in obstetric counseling than traditional clerkship students. STUDY DESIGN: We performed a randomized, controlled trial of 23 students at Harvard Medical School to determine whether participation in a virtual patient program improves medical student knowledge and skills in obstetric counseling. Students were randomized to the obstetrics/gynecology clerkship (n = 11) or the clerkship plus Normal Pregnancy Virtual Patient (n = 12) in 2006-2008. Students interviewed a standardized patient at the end of the clerkship. Two blinded physicians reviewed the videotaped interview and used a standardized checklist to assess knowledge and counseling skills in preconception, breastfeeding, genetics, postpartum counseling, and overall performance. RESULTS: Stratified analyses indicated the virtual patient group provided significantly better preconception counseling than controls (p = 0.002). Overall, students who completed the Virtual Patient program scored higher than those in traditional clerkship alone, though not significantly (26.0 vs. 22.0, p = 0.25). The study may not have had sufficient numbers of students enrolled to detect a significant difference. CONCLUSION: The use of a virtual patient program in obstetrics improves medical students' preconception counseling skills.

Actinomyces viscosus endocarditis requiring aortic valve replacement.

We report a case of primary Actinomyces viscosus endocarditis, an unusual manifestation of actinomycosis, in a 43-year-old farmer with an indolent febrile illness. As has occurred in previous cases, diagnosis was delayed in part because blood isolates were misidentified. Months later when she required aortic valve and root replacement, histologic exam of the diseased valve revealed branching filamentous organisms and the original blood isolates were retrospectively confirmed to be Actinomyces viscosus.