Diagnostic Delay in Paediatric Inflammatory Bowel Disease-A Systematic Investigation.

Diagnostic delays (time from the first symptoms to diagnosis) are common in inflammatory bowel disease (IBD) and may lead to worse disease progression and treatment outcomes. This study aimed to determine the duration of diagnostic delays (DD) and to explore associated factors in a cohort of children with IBD in New Zealand. In this study, patients with IBD diagnosed as children and their parents/caregivers completed questionnaires on the patients' medical history, diagnostic experience, and demographic characteristics. The parent/caregiver questionnaire also included the Barriers to Care Questionnaire (BCQ). Patients' healthcare data was reviewed to summarise the history of clinical visits and determine symptoms. Total DD, healthcare DD, patient DD and parent DD were derived from the primary dataset. Factors associated with the different types of DD were explored with a series of simple linear and logistical ordinal regressions. A total of 36 patients (Crohn's disease 25, ulcerative colitis 10; male 17) were included. They were diagnosed at a median age of 12 years (interquartile range (IQR) 10−15 years). Total healthcare delay (from first healthcare visit to formal diagnosis) was median (IQR) 15.4 (6.5−34.2) months. The median (IQR) specialist-associated delay was 4.5 (0−34) days. Higher household income was associated with shorter healthcare delay (p < 0.018), while lower overall BCQ scores (indicating more barriers experienced) were associated with longer total healthcare DD. Higher scores in each subscale of BCQ (Skills; Pragmatics; Expectations; Marginalization; Knowledge and Beliefs) were also significantly associated with shorter total healthcare delay (p < 0.04). This study found substantial diagnostic delays in paediatric patients with IBD and identified significant associations between longer total healthcare diagnostic delays and overall household income and higher self-reported barriers to accessing healthcare.

The responsibilities of medical students in providing advice on the COVID-19 vaccination programme.

The COVID-19 global pandemic has highlighted the potential roles and responsibilities of medical students in healthcare systems. Senior clinical students may be able to contribute practically, but all medical students, regardless of their level of training have the opportunity to assist public health measures, eg supporting vaccination uptake. Medical students may tread a difficult line in such situations. On one hand, students are advised not to act beyond their level of expertise, yet they can feel an expectation to be authoritative by the community. Navigating these spaces can be challenging for medical students and an important part of their professional development.

Coeliac disease: where are we in 2014?

BACKGROUND: Coeliac disease (CD) is an autoimmune condition affecting at least 1% of the population, many of whom remain undiagnosed. It is characterised by chronic inflammation of the small-intestinal mucosa and triggered by eating gluten. It is challenging to diagnose be-cause of the many and varied ways in which it may present. OBJECTIVE: To present up-to-date information on CD as we now understand it, with recommendations on whom to test and how to test them, and how to manage patients once they are diagnosed. DISCUSSION: Primary care practitioners have a crucial role in improving rates of CD diagnosis, and in the ongoing care of patients with CD. A blood test for coeliac-specific antibodies will identify most patients who need to undergo duodenal biopsy to make the diagnosis. Management encompasses supporting patients with adherence to the gluten-free diet and conducting a CD-focused clinical review every 1-2 years.

The Safe and Effective Clinical Outcomes (SECO) clinic: learning responsibility for patient care through simulation.

BACKGROUND: This article describes a simulated General Practice clinic for medical students, which incorporates specific features to aid learning of clinical problem solving. DESCRIPTION: We outline the overall objectives of the simulation, explain the concept, and describe how the clinic works. The clinic is novel in that it utilises clinical outcomes as measures for student success in the consultation. There are no time restrictions on a consultation. Students are unobserved and have open access to clinical information and telephone advice from a senior colleague. EVALUATION: The achievement of the case-specific outcomes is assessed by reference to students' clinical notes and the responses of the simulated patients to specific scenario-related questions. Following the clinic there is a debrief session, and students are provided with the evidence base and outcomes for each scenario. CONCLUSIONS: The clinic has been part of our undergraduate curriculum since 2004. Collectively, students rate it as their most effective learning experience.

Teaching the Y generation obstetrics and gynaecology skills: a survey of medical students' thoughts on a new program.

BACKGROUND: Delivering undergraduate obstetrics and gynaecology teaching to classes of increasing size in ways which will foster student interest in the discipline is becoming increasingly challenging. With major curriculum change implemented at Otago Medical School in 2008, we had the opportunity to rise to this challenge. AIM: To assess an innovative obstetrics and gynaecology history-taking and examination skills unit, introduced to third-year medical students. METHOD: A survey of medical students and pregnant women who participated in the unit. RESULTS: There was a 92% response rate from students and a 73% response from the pregnant women who took part. Overall feedback was positive from both groups, with the unit being highly rated across a number of parameters. CONCLUSION: Despite increasing limitations on staffing, obstetric clinical skills can be taught to large class sizes with close contact between students and specialists, safely incorporating the use of 'real patients'. Students are very positive about this exposure to O&G, and we hope that this may result in increased student confidence and interest in O&G, with a subsequent improvement in recruitment.