Incorporating patient partner scores into high stakes assessment: an observational study into opinions and attitudes.

BACKGROUND: Volunteer patients (also known as patient partners (PPs)) play a vital role in undergraduate healthcare curricula. They frequently take part in objective structured clinical examinations (OSCE) and rate aspects of students' performance. However, the inclusion and weighting of PP marks varies, while attitudes and opinions regarding how (and if) they should contribute towards the pass/fail outcome are uncertain. METHODS: A prospective observational study was conducted to explore beliefs of PPs regarding inclusion of their scores in a high stakes undergraduate OSCE in a single UK medical school. All PPs delivering components of the local MBChB curriculum were asked to participate in the questionnaire study. Quantitative and qualitative data were analysed using descriptive statistics and framework analysis respectively. RESULTS: Fifty out of 160 (31% response rate) PPs completed the questionnaire; 70% had participated in a final year OSCE. Thirty (60%) felt their marks should be incorporated into a student's overall score, while 28% were uncertain. The main reasons for inclusion were recognition of the patient perspective (31%) and their ability to assess attitudes and professionalism (27%), while reasons against inclusion included lack of PP qualification/training (18%) and concerns relating to consistency (14%). The majority of PPs were uncertain what proportion of the total mark they should contribute, although many felt that 5-10% of the total score was reasonable. Most respondents (70%) felt that globally low PP scores should not result in an automatic fail and many (62%) acknowledged that prior to mark inclusion, further training was required. CONCLUSION: These data show that most respondents considered it reasonable to "formalise their expertise" by contributing marks in the overall assessment of students in a high stakes OSCE, although what proportion they believe this should represent was variable. Some expressed concerns that using marks towards progress decisions may alter PP response patterns. It would therefore seem reasonable to compare outcomes (i.e. pass/fail status) using historical data both incorporating and not incorporating PP marks to evaluate the effects of doing so. Further attention to existing PP training programmes is also required in order to provide clear instruction on how to globally rate students to ensure validity and consistency.

Optimization and Reproducibility of Aortic Valve 18F-Fluoride Positron Emission Tomography in Patients With Aortic Stenosis.

BACKGROUND: 18F-Fluoride positron emission tomography (PET) and computed tomography (CT) can measure disease activity and progression in aortic stenosis. Our objectives were to optimize the methodology, analysis, and scan-rescan reproducibility of aortic valve 18F-fluoride PET-CT imaging. METHODS AND RESULTS: Fifteen patients with aortic stenosis underwent repeated 18F-fluoride PET-CT. We compared nongated PET and noncontrast CT, with a modified approach that incorporated contrast CT and ECG-gated PET. We explored a range of image analysis techniques, including estimation of blood-pool activity at differing vascular sites and a most diseased segment approach. Contrast-enhanced ECG-gated PET-CT permitted localization of 18F-fluoride uptake to individual valve leaflets. Uptake was most commonly observed at sites of maximal mechanical stress: the leaflet tips and the commissures. Scan-rescan reproducibility was markedly improved using enhanced analysis techniques leading to a reduction in percentage error from ±63% to ±10% (tissue to background ratio MDS mean of 1.55, bias -0.05, limits of agreement -0·20 to +0·11). CONCLUSIONS: Optimized 18F-fluoride PET-CT allows reproducible localization of calcification activity to different regions of the aortic valve leaflet and commonly to areas of increased mechanical stress. This technique holds major promise in improving our understanding of the pathophysiology of aortic stenosis and as a biomarker end point in clinical trials of novel therapies. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02132026.

Twelve tips for enhancing anatomy teaching and learning using radiology.

Anatomy is a keystone of many healthcare curricula and its understanding fundamental to patient care. The close relationship between clinical radiology and anatomy is well recognised and expanding. Imaging resources can be effectively integrated alongside traditional methods for learning anatomy in a resource efficient manner in order to enhance anatomy teaching. The following 12 tips have been divided into imaging tips, clinical tips and educational tips and offer practical advice and suggestions for designing and integrating radiological resources across the curriculum.

Cardiac sarcoid or arrhythmogenic right ventricular cardiomyopathy: a role for positron emission tomography (PET)?

We present a case of cardiac sarcoidosis of insidious onset mimicking arrhythmogenic right ventricular cardiomyopathy. Our patient initially presented with systemic sarcoidosis but later developed palpitations. The similarity in clinical presentation and cardiac magnetic resonance findings in both conditions posed a challenge in differentiating between the two in the absence of histological diagnosis. We highlighted the role of positron emission tomography in aiding a diagnosis.

A novel 3D stereoscopic anatomy tutorial.

BACKGROUND: Advancement in technology is an important driver for the evolution of the medical curriculum. With continued criticism of medical students' knowledge of anatomy, further investigation into adjuncts for anatomy teaching seems appropriate. This project sought to create an interactive 3D stereoscopic tutorial to bridge the teaching of anatomy and pathology. METHODS: Anonymised computed tomography (CT) scans were collected of a normal aorta and a ruptured abdominal aortic aneurysm. These scans were rendered into 3D stereoscopic images using open-source software. These images were then annotated with interactive labels and buttons to access information on normal aortic anatomy and the clinical details of abdominal aortic aneurysms. A total of 183 first-year medical students viewed the tutorial, and 160 gave feedback (87%). RESULTS: The students found the 3D system aided their understanding of anatomy and pathology (93 versus 3%), and provided an advantage when compared with current anatomy classes (93 versus 1%). The students highlighted the musculoskeletal system and cerebral vasculature as areas for future 3D visualisation. Of the responders, 96 per cent felt that the curriculum would benefit from further 3D stereoscopic anatomy/pathology tutorials. DISCUSSION: This technology has the exciting potential to use the radiographic libraries in hospitals for medical education. The computer software, however, has some limitations at present. It is not able to effectively distinguish between tissues of similar densities. Furthermore, not all tissues are amenable to CT scanning of a high enough resolution for presentation. Despite these limitations, the software continues to advance and is capable of producing very high quality anatomy images.

A survey of clinical teaching fellowships in UK medical schools.

CONTEXT: Undergraduate medical education in the UK has changed considerably over the last decade. One development has involved the creation of teaching-specific posts for junior doctors by medical schools. These posts are generally termed 'clinical teaching fellowships', but it is not known how many of them exist, or whether they are similar in terms of educational activities, professional development, and research and clinical experience opportunities. METHODS: Teaching deans in all UK medical schools were sent a questionnaire relating to clinical teaching fellowships, and were asked to distribute a second set of different questionnaires to their clinical teaching fellows, which were to be returned to the authors separately. RESULTS: A total of 28 deans and 46 fellows responded. Fifteen medical schools had clinical teaching fellows and there appeared to be a total of 77 such posts in the UK. There was little uniformity in the activities undertaken within the posts. Deans who employed clinical teaching fellows were unanimously positive regarding the posts. Fellows were generally positive but expressed reservations relating to approval for postgraduate training, career development, deterioration in clinical skills, financial disincentives, credibility within one's own specialty, and provision of training and support. CONCLUSIONS: Clinical teaching fellow posts are generally enjoyed by fellows and valued by deans. Fellows carry out differing duties and their training in medical education is variable. The posts can be unstructured and may lack credibility to doctors outside medical education. Providing specific structured training in medical education, recognised at a national level, would help deal with these concerns.

Good for them or good for us? The role of academic guidance interviews.

CONTEXT: Weak students may pass unnoticed through their undergraduate programme until they fail a summative assessment. Early recognition and support of struggling students is crucial if they are to avoid subsequent failure at high stakes assessments. METHODS: We introduced a whole-class formative assessment 5 months before a summative assessment. Subsequently, we supported poorly performing students with academic guidance interviews and remedial support. RESULTS: The programme was evaluated by questionnaires issued to staff and students involved in the guidance interviews, and by recording the performance of students who had failed the formative assessment in the subsequent summative assessment. CONCLUSIONS: We conclude that the rescue of failing students requires early recognition and tailored intervention, with support for all participants.