Diverse Integration of Simulated Patients in Medical Education for Communication, Language, and Clinical Skills in Hungary.

Medical education and communication training has been undergoing substantial changes recently in our globalized environment. Multidisciplinary simulation-based methods worldwide focus on improving effective clinical skills including history taking, physical examination, diagnostic skills, critical thinking, therapeutic skills, and others via interactions between medical students, trainees, and patients. Recently, Hungary has joined such global trends. The first simulated patient program in Hungary was developed at the University of Pécs Medical School in 2019 to aid effective patient-interviewing skills in language and communication classes. Under the supervision of linguists, communication specialists and medical professionals, the multidisciplinary program uses lay people to perform as simulated patients while using the languages of Hungarian, German, and English. Our simulated patient program plays a specific role in supporting students to learn languages for medical purposes, aiming to prepare them for handling the medical, linguistic, at the same, time emotional and sociocultural difficulties encountered while taking patient histories. Medical and linguistic experts evaluate student performance, provide feedback, and give tailored instruction so that students can advance their communicative and professional skills. This study discusses working formats and the role of constructive feedback exploring potential advantages and disadvantages, sharing ideas, and proposing recommendations on language- and communication-based integration of simulated patients. In our elective communication courses, undergraduate medical students learn to cope with a variety of patient situations through practicing medical emergencies, misunderstandings, and disagreements in a safe atmosphere provided by the MediSkillsLab. Among the benefits, we should emphasize that any course with a growing number of students can be accommodated by carefully designing the program, which allows for interprofessional collaboration. This program contributes to higher-quality medical education, promoting more skilled and compassionate healthcare specialists.

Volumetric alteration of brainstem in female migraineurs with and without aura.

BACKGROUND AND AIM: Brainstem descending modulatory circuits have been postulated to be involved in migraine. Differences in brainstem volume between migraineurs and healthy controls have been demonstrated in previous research, nevertheless, the effect of migraine aura on brainstem volume is still uncertain. The aim of this study was to investigate the brainstem volume in migraineurs and examine the effect of migraine aura on brainstem volume. METHODS: Our study included 90 female migraine patients without white matter lesions. (29 migraine patients with aura (MwA) and 61 migraine patients without aura (MwoA) and 32 age-matched female healthy controls (HC). Using the FreeSurfer image analysis suite, the volumes of the entire brainstem and its subfields (medulla, pons, and midbrain) were measured and compared between migraine subgroups (MwA vs. MwoA) and the healthy control group. The possible effects of migraine characteristics (i.e., disease duration and migraine attack frequency) on brainstem volume were also investigated. RESULTS: Migraineurs had greater medulla volume (MwoA 3552 ± 459 mm3, MwA 3424 ± 448 mm3) than healthy controls (3236 ± 411 mm3). Statistically, MwA vs. HC p = 0.040, MwoA vs. HC p = 0.002, MwA vs. MwoA p = 0.555. A significant positive correlation was found between disease duration and the volume of medulla in the whole migraine group (r = 0.334, p = 0.001). Neither the whole brainstem nor its subfields were significantly different in volume between migraine subgroups. CONCLUSION: Brainstem volume changes in migraine are mainly localized to the medulla and not specific to the presence of aura.

Differentiation of hemispheric white matter lesions in migraine and multiple sclerosis with similar radiological features using advanced MRI.

Background and aim: White matter hyperintensities (WMHs), presented on T2-weighted or fluid-attenuated inversion recovery magnetic resonance imaging (MRI) sequences, are lesions in the human brain that can be observed in both migraine and multiple sclerosis (MS). Methods: Seventeen migraine patients and 15 patients with relapsing-remitting multiple sclerosis with WMHs, and 17 healthy subjects age-and sex-matched to the migraine group were prospectively enrolled and underwent conventional and advanced MRI studies with diffusion-and perfusion-weighted imaging and single voxel proton magnetic resonance spectroscopy. Results: In both disease groups, elevated T2 relaxation time, apparent diffusion coefficient (ADC) values, and decreased N-acetyl-aspartate levels were found in the intralesional white matter compared to the contralateral normal-appearing white matter (NAWM), while there was no difference between the hemispheres of the control subjects. Migraine patients had the lowest intralesional creatine + phosphocreatine and myo-inositol (mI) values among the three groups, while patients with MS showed the highest intralesional T1 and T2 relaxation times, ADC, and mI values. In the contralateral NAWM, the same trend with mI changes was observed in migraineurs and MS patients. No differences in perfusion variables were observed in any groups. Conclusion: Our multimodal study showed that tissue damage is detectable in both diseases. Despite the differences in various advanced MRI measures, with more severe injury detected in MS lesions, we could not clearly differentiate the two white matter lesion types.