Teaching and Assessment of Medical Students During Complex Multifactorial Team-Based Tasks: The "Virtual on Call" Case Study.

Abstract: Although considerable efforts have been made to incorporate simulation-based learning (SBL) in undergraduate medical education, to date, most of the medical school curricula still focus on pure knowledge or individual assessment of objective structured clinical examination skills (OSCE). To this end, we designed a case study named "iG4 (integrated generation 4) virtual on-call (iVOC)". We aimed to simulate an on-call shift in a high-fidelity virtual hospital setting in order to assess delegates' team-based performance on tasks related to patient handovers (prioritisation, team allocation). Methods: A total of 41 clinical year medical students were split into 3 cohorts, each of which included 3 groups of 4 or 5 people. The groups consisted of a structured mix of educational and cultural backgrounds of students to achieve homogeneity. Each performing group received the handover for 5 patients in the virtual hospital and had to identify and deal with the acutely unwell ones within 15 minutes. We used TEAMTM tool to assess team-based performances. Results: The mean handover performance was 5.44/10 ± 2.24 which was the lowest across any performance marker. The overall global performance across any team was 6.64/10 ± 2.11. The first rotating team's global performance for each cycle was 6.44/10 ± 2.01, for the second 7.89/10 ± 2.09 and for the third 6.78/10 ± 1.64 (p = 0.099 between groups). Conclusion: This is one of the first reported, high-fidelity, globally reproducible SBL settings to assess the capacity of students to work as part of a multinational team, highlighting several aspects that need to be addressed during undergraduate studies. Medical schools should consider similar efforts with the aim to incorporate assessment frameworks for individual performances of students as part of a team, which can be a stepping-stone for enhancing safety in clinical practice.

Treatment trends in allergic rhinitis and asthma: a British ENT survey.

BACKGROUND: Allergic Rhinitis is a common Ear, Nose and Throat disorder. Asthma and Allergic Rhinitis are diseases with similar underlying mechanism and pathogenesis. The aim of this survey was to highlight current treatment trends for Allergic Rhinitis and Asthma. METHOD: A questionnaire was emailed to all registered consultant members of the British Association of Otorhinolaryngologists - Head and Neck Surgeons regarding the management of patients with Allergic Rhinitis and related disorders. RESULTS: Survey response rate was 56%. The results indicate a various approach in the investigation and management of Allergic Rhinitis compatible with recommendations from the Allergic Rhinitis and Its Impact on Asthma guidelines in collaboration with the World Health Organisation. CONCLUSION: A combined management approach for patients with Allergic Rhinitis and concomitant Asthma may reduce medical treatment costs for these conditions and improve symptom control and quality of life.

Influence of audit on clinical practice: multidisciplinary team data documentation for cutaneous head and neck malignancy.

BACKGROUND: Prognosis of cutaneous head and neck malignant neoplasms is related to type, site, and histologic feature but may also be influenced by delays in the referral process. Treatment aims to address the primary lesion and when necessary the secondary disease but at the same time maintaining quality of life and minimizing cosmetic deformity. The management plan should ideally be the "product" of a multidisciplinary team (MDT) approach of dermatologists, surgeons, oncologists, pathologists, and radiologists. AIMS: The purposes of the study were as follows: (i) to review current documentation practice of cutaneous head and neck malignancies in a district hospital, (ii) to generate an MDT-approved data collection proforma, and finally (iii) to reaudit documentation of head and neck skin lesions based on the "new" standardized proforma. The MDT-approved proforma was instituted in an effort not only to collect data in a coherent and structured way but also to achieve early diagnosis and avoid delays from urgent referral to treatment with the aim of curing disease and restoring patients to as near-normal appearance and quality of life as possible. METHODS: The notes of patients with head and neck cutaneous lesions were prospectively audited for a 6-month period (August 2006-January 2007). The presence and absence of a minimal standardized data set required for MDT discussion and review were recorded. RESULTS: Documentation was deficient and a need for change in practice emerged. An MDT-approved data collection standardized proforma was designed and distributed throughout the hospital departments involved in management of patients with head and neck cutaneous lesions. The notes of these patients were prospectively reaudited through a second cycle for a 6-month period (February 2007-August 2007). The completion and deficiency of sections of the MDT-approved data collection standardized proforma were recorded, resulting in closure of the audit loop. CONCLUSIONS: The data documentation for head and neck cutaneous lesions has significantly improved after the implementation of an MDT-approved data collection standardized proforma. This has resulted in improved patient quality of care and progression on appropriate management plans.

Giant vertebro-basilar aneurysm: an unusual cerebello-pontine angle lesion.

Acoustic neuromas (vestibular schwannomas) comprise more than 90 per cent of all cerebello-pontine angle (CPA) lesions. We present a rare case of a giant vertebro-basilar aneurysm presenting as a CPA lesion. The general condition of the patient precluded the completion of the magnetic resonance (MR) sequences. The clinical and limited radiological results (T2 images alone, the features of which were not specific) initially did not lead to a specific diagnosis. To obtain further radiological information a computed tomography (CT) scan with contrast was performed and this revealed the lesion to be an aneurysm. The diagnostic difficulties and the treatment dilemmas of such a lesion are discussed. The importance of fine, axial, post-contrast CT arteriography with three-dimensional reconstruction, MR angiography and digital subtraction angiography are highlighted. The limitations of MR imaging in patients with CPA lesions are discussed.

Need for an urgent ultrasound examination for neck lump.

Thromboembolic phenomenon is rare but serious consequence of ovarian hyperstimulation syndrome (OHSS) and in vitro fertilization (IVF) treatment. We present a case of thrombosis of the right internal jugular vein presenting as a neck lump to the ENT department. Ultrasonography of the neck and upper extremity revealed thrombosis of right internal jugular vein. The patient was started on low molecular weight heparin, which resulted in resolution of her clinical condition. Interestingly, the majority of cases after OHSS involve thrombosis of the upper extremities. ENT surgeons, general physicians, and infertility experts should consider this in the differential diagnosis of neck swellings, particularly after OHSS and IVF treatment, and in this case report, we emphasis the need for an urgent ultrasound of the neck in such patients.

Lemierre's syndrome: how a sore throat can end in disaster.

Lemierre's syndrome is characterised by a history of recent oropharyngeal infection, clinical or radiological evidence of internal jugular vein thrombophlebitis and isolation of an anaerobic pathogen. We present a case report and review the literature.