[Introduction of a brief Problem-Based-Learning (PBL) experience in traditional medical faculty curriculum].

BACKGROUND: For medical students studying in a traditional medical curriculum, advancement from the pre-clinical years to clinical clerkships requires a conceptual move from disease-oriented thinking to problem-oriented medicine. OBJECTIVE: To implement an educational tool in the introductory course of clinical medicine that will assist students in the development of comprehensive medical reasoning, including the generation of a dynamic problem list, its assessment and the construction of investigative and treatment plans. METHODS: Since 2001 a novel brief Problem-Based Learning (PBL) experience has been offered as a component of the Introduction to Medicine course given to 4th year medical students prior to the start of their clinical years at the Hebrew University Medical School. The brief experience consists of daily meetings given to small groups of students at the final stages of the pre-clinical courses. Each PBL day covers a single clinical case revealed sequentially over 3-5 structured sessions, interspersed with periods of self-directed learning. Cases are highly structured and contain all of the required information pertaining to the clinical problems presented. RESULTS: Evaluations of this course over 4 years by both students and teachers have been outstanding, with students consistently stating in their written comments that the PBL experience was one of the most meaningful learning experiences they have encountered during the pre-clinical phase of their training. CONCLUSIONS: This brief PBL experience appears to help in building up the students' clinical competence during their first clerkship experiences. It may be especially useful for medical schools using the traditional medical curriculum.

Prognosis of symptomatic versus asymptomatic autoimmune hepatitis: a study of 68 patients.

BACKGROUND: Autoimmune hepatitis (AIH) is a chronic liver disorder of unknown etiology. Disease presentation ranges from asymptomatic to symptomatic onset, fulminant, acute, or chronic. GOALS: To evaluate the prognosis of patients with asymptomatic versus symptomatic AIH and to determine the role of early treatment and prognostic factors in this subgroup of patients. METHODS: Sixty-eight patients with AIH were retrospectively evaluated for clinical presentation, liver function tests, autoantibody profile, liver biopsy, treatment, and long-term prognosis. RESULTS: Twenty-three patients were classified as having asymptomatic AIH. They were compared with the 45 AIH patients with symptomatic onset. Patients with symptomatic and asymptomatic presentations were indistinguishable by age, but there was a relative male predominance in the asymptomatic group. Aminotransferase and immunoglobulin levels were lower in the asymptomatic group. In contrast, the histopathologic picture was indistinguishable between the two groups. Lobular hepatitis of a moderate to severe degree, portal fibrosis, and bridging fibrosis were detected in similar frequencies in both groups. Asymptomatic onset led to a delay in diagnosis and, consequently, in the initiation of treatment and was associated with use of relatively lower doses of corticosteroids. Response to treatment and long-term prognosis of asymptomatic patients was better than that observed in the symptomatic group. CONCLUSIONS: Asymptomatic onset of AIH is relatively common. The clinical presentation appears in correlation with liver functions tests but not with liver histology. This subgroup of AIH carries a better response to treatment and a favorable prognosis.