Acad Med Research Articles

Use of Knowledge-sharing Web-based Portal in Gross and Microscopic Anatomy

Changes in worldwide healthcare delivery require review of current medical school curricula structure to develop learning outcomes that ensures mastery of knowledge and clinical competency. In the last 3 years, Mayo Medical School implemented outcomes-based curriculum to encompass new graduate outcomes. Standard courses were replaced by 6-week clinically-integrated didactic blocks separated by student-self selected academic enrichment activities. Gross and microscopic anatomy was integrated with radiology and genetics respectively. Laboratory components include virtual microscopy and anatomical dissection. Students assigned to teams utilise computer portals to share learning experiences. High-resolution computed tomographic (CT) scans of cadavers prior to dissection were made available for correlative learning between the cadaveric material and radiologic images. Students work in teams on assigned presentations that include histology, cell and molecular biology, genetics and genomic using the Nexus Portal, based on DrupalEd, to share their observations, reflections and dissection findings. New generation of medical students are clearly comfortable utilising web-based programmes that maximise their learning potential of conceptually difficult and labor intensive courses. Team-based learning approach emphasising the use of knowledge-sharing computer portals maximises opportunities for students to master their knowledge and improve cognitive skills to ensure clinical competency.

Persistent Secondary Postpartum Hemorrhage after Uterine Artery Embolization

with involvement of hepatic and superior mesenteric arteries. Radiology 1999; 212:359–364. 4. Donmez H, Men S, Dilli A, Soylu SO, Hekimoglu B. Giant gastroduodenal artery pseudoaneurysm due to polyarteritis nodosa as a cause of obstructive jaundice: imaging findings and coil embolization results. Cardiovasc Intervent Radiol 2005; 28:850–853. 5. Nakashima M, Suzuki K, Okada M, Takada K, Kobayashi H, Hama Y. Successful coil embolization of a ruptured hepatic aneurysm in a patient with polyarteritis nodosa accompanied by angioimmunoblastic T cell lymphoma. Clin Rheumatol 2007; 26:1362–1364.

Amebiasis

Amebiasis is defined as infection with Entamoeba histolytica, regardless of associated symptomatology. In resource-rich nations, this parasitic protozoan is seen primarily in travelers to and emigrants from endemic areas. Infections range from asymptomatic colonization to amebic colitis and life-threatening abscesses. Importantly, disease may occur months to years after exposure. Although E histolytica was previously thought to infect 10% of the world's population, 2 morphologically identical but genetically distinct and apparently nonpathogenic Entamoeba species are now recognized as causing most asymptomatic cases. To avoid unnecessary and possibly harmful therapies, clinicians should follow the diagnostic and treatment guidelines of the World Health Organization.

Seeking Better Outcomes in Coronary Artery Bypass Grafting

Are we delivering the safest and most effective care? How best can we learn from our experience? For healthcare professionals who ask these questions, the article by Guru and colleagues in this issue of Circulation is essential reading.1 These Canadian investigators performed an implicit review and retrospective analysis of 347 randomly selected in-hospital deaths after coronary artery bypass grafting (CABG) surgery and determined that approximately one third might have been prevented by better care. The study offers many important lessons with implications far beyond cardiac surgery. Article p 2969 Guru and colleagues uncovered many opportunities for important improvements in a hospital system that could have been content with its successes. Their investigation was conducted in a system with no low-volume hospitals and low risk-adjusted mortality rates and involved the participation of experienced staff surgeons and division chiefs. They found remarkably high percentages of preventable deaths, defined as deaths that could have been avoided had optimal care been delivered. Optimal care was considered to be the best possible care that could be delivered if current resources were operating at peak performance in accordance with the best available evidence at the time of the hospital admission. The investigators found that as many as 107 preventable CABG-related deaths occurred in Ontario in fiscal year 2000 to 2001. These deaths occurred in every institution. In particular, the highest percentages of preventable deaths were not clustered at the institutions with the highest risk-adjusted mortality rates, indicating that even a low mortality rate should not beget complacency. Even in the hospital with the lowest risk-adjusted mortality rate, about 20% of deaths were deemed to be preventable. Guru and colleagues focused specifically on contributing causes of deaths that may have been prevented. In this way, many deaths had more than 1 potential contributing cause. In each …

Inclusion of electric disturbance type cardiomyopathy in the classification of cardiomyopathy: A current review

There are cases of cardiomyopathy which are not easily classifiable into hypertrophic, dilated or restrictive type. They often show ventricular arrhythmia, right or left bundle branch block, intraventricular conduction disturbance, atrioventricular conduction disturbance, and sinus node dysfunction (sick sinus syndrome). Endomyocardial biopsy in such cases reveals advanced myocardial disease, for which we propose the simpler term "electric disturbance type cardiomyopathy (ECM)". In our consecutive series of studies of cardiomyopathy employing endomyocardial biopsy in 573 cases, 264 (46%) were hypertrophic, 224 (39%) were dilated, and 85 (14.8%) were classified into the ECM.

Malignant Syndrome of Two Parkinson Patients due to Withdrawal of Drugs

Background: A novel therapeutic strategy for phenylketonuria (PKU) has been initiated in Japan. Hyperphenylalaninemia (HPA) results from a phenylalanine hydroxylase (PAH) enzyme deficiency or a deficiency of its cofactor, tetrahydrobiopterin (BH 4 ). BH 4 can normalize blood phenylalanine levels in BH 4 deficiency, but typically not in PKU. However, since 1999 it has been reported that many HPA patients (serum phenylalanine <20 mg/dL) showed a gradual decrease of serum phenylalanine levels after 24 hours from BH 4 loading. The BH 4 responsiveness seems to be regulated in mild PKU by PAH mutations, and affected by the BH 4 dose and administration period. Methods and Results: In 2002 we formulated a provisional diagnostic criteria for patients with BH 4 -responsive PAH deficiency, and newly diagnosed 19 patients in 100 HPA cases between 2002 and 2006. The incidence in the recent 5 years for BH 4 -responsive mild PKU among patients with PAH deficiency was 25 %. Conclusion: A total of 31 patients was detected in the past 10 years, and the incidence detected using the provisional diagnostic criteria had increased to 25% among PAH deficient patients. BH 4 treatment for BH 4 -responsive mild PKU is a new and effective pharmacotherapy, which replaces or liberalises the phenylalanine-restricted diets for a considerable number of mild PKU patients. Ann Acad Med Singapore 2008;37(Suppl 3):77-8

&lt;p&gt;Universal newborn hearing screening in Singapore: the need, implementation and challenges&lt;/p&gt;

With about 1 in 1000 born with severe to profound hearing loss and about 5 in 1000 with lesser degrees of loss, congenital deafness is the commonest major birth defect. It is the recommended standard that hearing loss in newborns be detected by 3 months of age and intervention implemented by 6 months of age. Delayed detection and intervention may affect speech, language and psychosocial development, resulting in poor academic achievements. Universal newborn hearing screening (UNHS) is the only effective way of detecting all babies with hearing loss, within the recommended time frame. A survey in Singapore revealed that traditional childhood hearing screening programmes resulted in late detection (mean age, 20.8 months; range, 0 to 86 months) and late intervention (mean age, 42.4 months; range, 1 to 120 months). Increasingly, UNHS is becoming standard medical care in developed countries. In Singapore, UNHS has been implemented in all hospitals with obstetric services. Although a screening rate of more than 99% has been achieved in public hospitals, private hospitals have a screening rate of only about 77%. Parents' awareness and acceptance of early detection is still lacking, and this needs to be addressed by appropriate public education. Support from obstetricians and paediatricians will significantly contribute towards this objective. Effective programme management is essential; this includes the use of data management systems, the maintenance of a team of experienced screeners, and efficient coordination between screening and diagnostic services. Early detection of childhood deafness, together with early and effective intervention, maximises the chances of successful integration into mainstream education and society.&#x0D; Published courtesy of:Ann Acad Med Singapore. 2005; 34(4):301-306

50. Health advocacy in surgical training: A Canadian survey on attitudes and experience in urology residency

We sought to assess surgical residents’ perceptions and attitudes toward health advocacy in residency training and practice by administering an anonymous, cross-sectional, self-report questionnaire to all final year urology residents in Canadian training programs.&#x0D; The survey was closed-ended and employed a 5-point Likert scale designed to assess familiarity with the concept of health advocacy and its application and importance to training and practice. Descriptive and correlative statistics were used to analyze the responses.&#x0D; There was a 93% response rate from the chief residents. Most residents were well aware of the role of health advocate in urology, and a majority (68%) believe it to be important in residency training and in the urologist’s role in practice. However, a minority (7-25%) agreed that formal training or mentorship in health advocacy was available at their institution, and only 21-39% felt that they had employed its principles in the clinic or community. Only 4-7% or residents surveyed were aware of or had participated in local urologic health advocacy groups.&#x0D; Despite knowledge and acceptance of the importance of the health advocate role, there is a perceived lack of formal training and a dearth of participation during urologic residency training.&#x0D; Verma S, Flynn L, Seguin R. Faculty’s and Residents’ Perceptions of Teaching and Evaluating the Role of Health Advocate. Acad Med. 2005; 80:103–108. &#x0D; Oandasen I. Health advocacy: bringing clarity to educators through the voices of physician health advocates. Acad Med. 2005 (Oct); 80(10 Suppl):S38-41.&#x0D; Frank JR. (Ed). The CanMEDS 2005 physician competency framework. Better standards. Better physicians. Better care. Ottawa: The Royal College of Physicians and Surgeons of Canada, 2005.

52. Simulation based training improves resident competence in the performance of critical resuscitation procedures

We sought to assess the impact of procedural skills simulation training on residents’ competence in performing critical resuscitation skills. Our study was a prospective, cross-sectional study of residents from three residency training programs (Family Medicine, Emergency Medicine and Internal Medicine) at the University of Calgary. Participants completed a survey measuring competence in the performance of the procedural skills required to manage hemodynamic instability. The study intervention was an 8 hour simulation based training program focused on resuscitation procedure psychomotor skill acquisition. Competence was criterion validated at the Right Internal Jugular Central Venous Catheter Insertion station by an expert observer using a standardized checklist (Observed Structured Clinical Examination (OSCE) format). At the completion of the simulation course participants repeated the self-assessment survey. Descriptive Statistics, Cronbach’s alpha, Pearson’s correlation coefficient and Paired Sample t-test statistical tools were applied to the analyze the data.&#x0D; Thirty-five of 37 residents (9 FRCPC Emergency Medicine, 4 CCFP-Emergency Medicine, 17 CCFP, and 5 Internal Medicine) completed both survey instruments and the eight hour course. Seventy-two percent of participants were PGY-1 or 2. Mean age was 30.7 years of age. Cronbach’s alpha for the survey instrument was 0.944. Pearson’s Correlation Coefficient was 0.69 (p &lt; 0.001) for relationship between Expert Assessment and Self-Assessment. The mean improvement in competence score pre- to post-intervention was 6.77 (p &lt; 0.01, 95% CI 5.23-8.32).&#x0D; Residents from a variety of training programs (Internal Medicine, Emergency Medicine and Family Medicine) demonstrated a statistically significant improvement in competence with critical resuscitation procedural skills following an intensive simulation based training program. Self-assessment of competence was validated using correlation data based on expert assessments. &#x0D; Dawson S. Procedural simulation: a primer. J Vasc Interv Radiol. 2006; 17(2.1):205-13.&#x0D; Vozenilek J, Huff JS, Reznek M, Gordon JA. See one, do one, teach one: advanced technology in medical education. Acad Emerg Med. 2004; 11(11):1149-54.&#x0D; Ziv A, Wolpe PR, Small SD, Glick S. Simulation-based medical education: an ethical imperative. Acad Med. 2003; 78(8):783-8.

70. Supporting IMG integration into residency trainings

This paper is describes the design, development, implementation and evaluation of a preparatory training program for international medical trainees. The program was offered for one week full time shortly before they begin their residency training programs. First the paper reports on the survey and focus groups that guided the learning objectives and the course content. Next the paper describes the curriculum development phase and reports on the topical themes, session goals and objectives and learning materials. Three main themes emerged when developing the program: understanding the educational, health and practice systems in Canada; development of communication skills; and supporting personal success in residency training including self assessment, reflection and personal wellness. Sample lesson plans and handouts from each of the theme areas are illustrated. The comprehensive evaluation of the sessions and the overall program is then also described. The paper then summarizes the identified key issues and challenges in the design and implementation of a preparatory training program for international medical trainees before they begin their residency training programs.&#x0D; Allan GM, Manca D, Szafran O, Korownyk C. Workforce issues in general surgery. Am Surg. 2007 Feb; 73(2):100-8.&#x0D; Dauphinee, WD. The circle game: understanding physician migration patterns within Canada. Acad Med. 2006 (Dec); 81(12 Suppl):S49-54.&#x0D; Spike NA. International medical graduates: the Australian perspective. Academic Medicine. 2006 (Sept); 81(9):842-6.

2. Use of a health advocacy essay to improve competence

We set out to determine if essay writing on health advocacy could improve scores on a Health Advocacy observed structured clinical exam (OSCE) station.&#x0D; A Health Advocacy station was used as one of ten stations at the annual resident OSCE in 2006. Subsequently, residents were instructed to write an essay regarding their actions as a health advocate, either in general or relating to a specific situation. For the 2007 OSCE, a different Health Advocacy station was used that was similar to the previous year in terms of the issues that residents needed to address and the scoring structure. The results on the OSCE stations between the two years were compared using Student’s T-test. Regression analysis was used to identify any predictors for a higher score.&#x0D; The number of residents taking the OSCE in 2006 and 2007 were 17 and 13, respectively. Nine residents completed the OSCE in both years. The number of PGY-1’s taking the OSCE for the first time in 2006 and 2007 were 8 and 4, respectively. Compliance with the essay writing was 100%. The mean score on the Health Advocacy station was significantly higher in 2007 compared to 2006 (53.0 ± 14.6 compared to 65.6 ± 10.0 vs. 53.0 ± 14.6; p=0.01). The mean score of PGY-1’s in 2007 tended to be higher than PGY-1’s in 2006 (67.5 ± 11.4 vs. 54.5 ± 12.3; p=0.11), suggesting the improvement was not due to having taken the OSCE previously. Regression analysis did not identify and other predictors of higher score on the OSCE station.&#x0D; These results suggest that essay writing by residents about actions they have taken as health advocates improves knowledge about the CanMEDS competency of Health Advocacy, as measured in an OSCE station. The non-randomized design of the study does not exclude the possibility of other factors influencing the improvement in score.&#x0D; Oandasan I, Barker K. Educating for Advocacy: Exploring the Source and Substance of Community-Responsive Physicians. Acad Med 2003; 78(1):S16-S19.&#x0D; Frank J, Langer B. Collaboration, Communication, Management, and Advocacy: Teaching surgeons new skills through the CanMEDS project. World J Surg 2003; 27:972-978.&#x0D; Verma S, Flynn L, Seguin R. Faculty’s and residents’ perceptions of teaching and evaluating the role of health advocate: A study at one Canadian university. Acad Med 2005; 80:103-108.

5. A needs assessment for a CanMEDS-based curriculum in ambulatory care for internal medicine residents in Canada

In Canada, graduates of internal medicine training programs should be proficient in ambulatory medicine and practice. Before determining how to improve education in ambulatory care, a list of desired learning outcomes must be identified and used as the foundation for the design, implementation and evaluation of instructional events. The Delphi technique is a qualitative-research method that uses a series of questionnaires sent to a group of experts with controlled feedback provided by the researchers after each round of questions. A modified Delphi technique was used to determine the competencies required for an ambulatory care curriculum based on the CanMEDS roles. &#x0D; Four groups deemed to be critical stakeholders in residency education were invited to take part in this study: 1. Medical educators and planners, 2. Members of the Canadian Society of Internal Medicine (CSIM), 3. Recent Royal College certificants in internal medicine, 4. Residents currently in core internal medicine residency programs. Panelists were sent questionnaires asking them to rate learning outcomes based on their importance to residency training in ambulatory care. Four hundred and nineteen participants completed the round 1 questionnaire that was comprised of 75 topics identified through a literature search. Using predefined criteria for degree of importance and consensus, 19 items were included in the compendium and 9 were excluded after one round. Forty-two items for which the panel that did not reach consensus, as well as 3 new items suggested by the panel were included in the questionnaire for round 2. Two hundred and forty participants completed the round 2 questionnaire; consensus was reached for each of the 45 items. &#x0D; After two rounds, 21 items were included in the final compendium as very high priority topics (“must be able to”). An additional 26 items were identified as high priority topics (“should be able to”). The overall ratings by each of the four groups were similar and there were no differences between groups that affected the selection of items for the final compendium. To our knowledge this is the first time a Delphi-process has been used to determine the content of an ambulatory care curriculum in internal medicine in Canada. The compendium could potentially be used as the basis to structure training programs in ambulatory care.&#x0D; Barker LR. Curriculum for Ambulatory Care Training in Medical residency: rationale, attitudes and generic proficiencies. J Gen Intern Med 1990; 5(supp.):S3-S14.&#x0D; Levinsky NG. A survey of changes in the proportions of ambulatory training in internal medicine clerkships and residencies from 1986-87 to 1996-97. Acad Med 1998; 73:1114-1115.&#x0D; Linn LS, Brook RH, Clarke VA, Fink A, Kosecoff J. Evaluation of ambulatory care training by graduates of internal medicine residencies. J Med Educ 1986; 61:293-302.

72. Evaluatation of an innovative mentorship program - Multilevel mentorship model - Does it meet the needs of residents?

The UBC community medicine mentorship program was established in 2003 and is continually evaluated. In response to resident feedback, we developed an innovative mentorship model that involves mentorship of junior residents by both mentors from the professional community and senior residents. This new multilevel mentorship model (MMM) was implemented in 2005. It was evaluated for its ability to (1) foster professional and personal relationships among mentors and mentees, (2) help residents develop career goals and (3) support residents who were having challenges in the program. &#x0D; The program was evaluated using an on-line survey, with both Likert scale and short-answer responses. The survey was completed by 10/13 (77%) residents, 7/13 (54%) community medicine professionals (CMPs). For the first level, CMP-resident mentorship, 9/10 residents and 5/7 CMPs agreed that a positive relationship was maintained, and that they benefited from the relationship; 8/10 residents agreed that career counseling occurred. Two of the three residents who had conflict in the program felt that they were supported by their CMP mentor. Mentorship was a positive experience even for two residents who left the program. For the second level, senior-junior resident mentorship, all relationships started within the first month of the program and all residents agreed that a positive relationship was maintained throughout the year. Career counseling occurred in 2/3 junior-senior resident pairs. All three residents agreed that their resident mentor supported them during a conflict. Several resident- and CMP-mentors described heightened awareness of issues that residents face in training. &#x0D; The multilevel mentorship model has considerable potential for fostering mentoring relationships, career planning, and helping residents overcome the challenges of residency.&#x0D; Barondess JA. Mentoring in biomedicine. J Lab Clin Med 1197; 129:487-91.&#x0D; Jackson VA, Palepu A, Szalacha L, Caswell C, Carr PL, Inui T. “Having the right chemistry”: a qualitative study of mentoring in academic medicine. Acad Med 2003; 78:328-334.&#x0D; Williams LL, Levine JB, Malhotra S, Holtzheimer P. The good-enough mentoring relationship. Academic Psychiatry 2004; 28:111-115.

Paradoxical Orthodeoxia in a Patient with a Large Aortic Aneurysm

Double Negatives and Being Not Unambiguous We refer to the case report by Soon et al titled Paradoxical Orthodeoxia in a Patient with a Large Aortic Aneurysm in Ann Acad Med Singapore 2007;36:203-5. The authors report a very interesting case. The elderly man with an aortic aneurysm displayed shunting through a patent foramen ovale in the supine position. The authors cited previous reports of orthodeoxia occurring in association with aortic aneurysms, and emphasise that in their case, instead of orthodeoxia, they demonstrated supine hypoxia. However, we wonder if the label “paradoxical orthodeoxia” coined by the authors would be confusing. Firstly, because it appears ambiguous and, secondly, because it is used to describe what is actually a usual pattern of postural hypoxia. Our comments, of course, do not detract from the important and unique findings in this case. In normal elderly people, PaO2 falls in the supine posture because of the physiological fall in resting lung volume. This phenomenon is more pronounced when there is underlying lung disease. Thus, patients who are breathless and hypoxic usually need to be propped up in bed. In contrast, hypoxia occurs paradoxically upon assuming the upright position in a few rare situations such as pulmonary a-v fistula. This is termed orthodeoxia (and platypnoea when there is accompanying dyspnoea).

Internal Medicine Department Chairs: Where They Come From, Why They Leave, Where They Go

Internal Medicine Department Chairs: Where They Come From, Why They Leave, Where They Go

Green Tea Extract and (−)-Epigallocatechin-3-Gallate Inhibit Mast Cell-Stimulated Type I Collagen Expression in Keloid Fibroblasts via Blocking PI-3K/Akt Signaling Pathways

Keloid, a chronic fibro-proliferative disease, exhibits distinctive histological features characterized by an abundant extracellular matrix stroma, a local infiltration of inflammatory cells including mast cells (MCs), and a milieu of enriched cytokines. Previous studies have demonstrated that co-culture with MCs stimulate type I collagen synthesis in fibroblasts, but the signaling mechanisms remain largely unknown. In this study, we investigated the signaling pathways involved in MC-stimulated type I collagen synthesis and the effects of green tea extract (GTE) and its major catechin, (-)-epigallocatechin-3-gallate (EGCG), on collagen homeostasis in keloid fibroblasts. Our results showed that MCs significantly stimulated type I collagen expression in keloid fibroblasts, and the upregulation of type I collagen was significantly attenuated by blockade of phosphatidylinositol-3-kinase (PI-3K), mammalian target of rapamycin (mTOR), and p38 MAPK signaling pathways, but not by blockade of ERK1/2 pathway. Furthermore, GTE and EGCG dramatically inhibited type I collagen production possibly by interfering with the PI-3K/Akt/mTOR signaling pathway. Our findings suggest that interaction between MCs and keloid fibroblasts may contribute to excessive collagen accumulation in keloids and imply a therapeutic potential of green tea for the intervention and prevention of keloids and other fibrotic diseases.

Veterans Administration physician compensation: past, present, future

Well before the War of Independence, the Pilgrims of Plymouth Colony ruled that soldiers disabled in the battles with the Pequot Indians would be supported by the Colony [ [1] History and Evolution of the Department of Veteran Affairs—VA 75th Anniversary. U.S. Department of Veterans Affairs, Washington, DC2005 Google Scholar ]. Over 100 years later, the Continental Congress of 1776 offered pensions to disabled soldiers as a means of encouraging enlistment in the Revolutionary War [ [1] History and Evolution of the Department of Veteran Affairs—VA 75th Anniversary. U.S. Department of Veterans Affairs, Washington, DC2005 Google Scholar ]. Since the Continental Congress had neither the authority nor the funds to make these payments, the pensions were left up to the individual states, perhaps representing one of Congress’ first “unfunded mandates”! Forty years later, the first domiciliary and medical facility for veterans (the US Naval Asylum in Philadelphia) was authorized by the Federal Government [ 1 History and Evolution of the Department of Veteran Affairs—VA 75th Anniversary. U.S. Department of Veterans Affairs, Washington, DC2005 Google Scholar , 2 Gronvall J.A. The VA’s affiliation with academic medicine: an emergency post-war strategy becomes a permanent partnership. Acad Med. 1989; 64: 61-66 Crossref PubMed Scopus (27) Google Scholar ].

Critical Pathways: The Role of Pharmacy Today and Tomorrow

Critical pathways represent comprehensive management plans that aim to optimize and streamline patient care. Critical pathways have been referred to in the medical literature by a number of different terms, including care path, care map, clinical pathway, critical path of care, case management plan, multidisciplinary action plan, collaborative care track, plan of care, clinical care plans, and care guides. These plans define key steps in disease management not only to improve the quality of health care, but also to reduce resource utilization. Some of the specific goals of critical pathways include providing continuous quality improvement, decreasing service fragmentation through managed care, optimizing cost-effectiveness of health care delivery, guiding the patient and family through expected treatment and progress, and increasing satisfaction of patients, families, staff, physicians, and third-party payers. Critical pathways create targeted patient outcomes and quality end points, which form a foundation for common expectations, shared responsibility, regular communication, and early problem detection and intervention among all members of the health care team. Further, they identify specific time frames and desired outcomes associated with each care step, with the goals of minimizing delays and maximizing resource utilization. The critical pathway can serve not only as a monitoring tool for identifying and addressing quality issues in a timely fashion, but also as a tool for educating health care providers to recognize the efficient and clinically appropriate use of resources. Although the importance of critical pathways remains somewhat controversial, since the first American College of Clinical Pharmacy (ACCP) White Paper was published in 1996 they have been shown to improve patient outcomes and to reduce health care expenses in various settings. Critical pathways should be distinguished from clinical treatment guidelines, as the latter may be intended to define appropriate care for a specific indication (e.g., community-acquired pneumonia). Development of critical pathways has been promoted in evidence-based clinical practice guidelines, as critical pathways include elements meant to track compliance, patient outcomes, or continuous quality improvement. The main difference, therefore, between critical pathways and disease-specific guidelines is that critical pathways focus on targets of care for the clinical management of patient groups instead of addressing decisions regarding individual patient management.

Commentary

Academic Emergency MedicineVolume 13, Issue 7 p. 792-793 Free Access Commentary Jill M. Baren MD, MBE, Jill M. Baren MD, MBE Departments of Emergency Medicine and Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA (barenj@uphs.upenn.edu)Search for more papers by this author Jill M. Baren MD, MBE, Jill M. Baren MD, MBE Departments of Emergency Medicine and Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA (barenj@uphs.upenn.edu)Search for more papers by this author First published: 28 June 2008 https://doi.org/10.1197/j.aem.2006.03.561AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References Nelson KL. Resident Portfolio: “She was hideous”—The effect of negative emotions on physician–patient interaction. Acad Emerg Med. 2006; 13: 791– 2. Branch WT, Paranjape A. Feedback and reflection: teaching methods for clinical settings. Acad Med. 2002; 77: 1185– 8. Brady DW, Corbie-Smith G Branch WT. “What's important to you?” The use of narratives to promote self-reflection and to understand the experiences of medical residents. Ann Intern Med. 2002; 137: 220– 3. Branch WT, Kern D Haidet P, et al. The patient-physician relationship. Teaching the human dimensions of care in clinical settings. JAMA. 2001; 286: 1067– 74. Sklar DP, Doezema D, McLaughlin S, Helitzer D. Teaching communications and professionalism through writing and humanities: reflections of ten years of experience. Acad Emerg Med. 2002; 9: 1360– 4. Plack MM, Greenberg L. The reflective practitioner: reaching for excellence in practice. Pediatrics. 2005; 116: 1546– 52. ACGME Outcome Project. Accreditation Council for Graduate Medical Education. Available at: http:www.acgme.orgoutcomecompcompHome.asp. Accessed Feb 28, 2006. Volume13, Issue7July 2006Pages 792-793 ReferencesRelatedInformation

Professionalism and anatomy: How do these two terms define our role?

Clinical AnatomyVolume 19, Issue 5 p. 391-392 EditorialFree Access Professionalism and anatomy: How do these two terms define our role? Wojciech Pawlina, Corresponding Author Wojciech Pawlina [email protected] Guest Editor, Clinical Anatomy Special Issue on Professionalism, Department of Anatomy, Mayo Clinic College of Medicine, Rochester, MinnesotaDepartment of Anatomy, Mayo Clinic, College of Medicine, 200 First St. SW, Rochester, MN 55905Search for more papers by this author Wojciech Pawlina, Corresponding Author Wojciech Pawlina [email protected] Guest Editor, Clinical Anatomy Special Issue on Professionalism, Department of Anatomy, Mayo Clinic College of Medicine, Rochester, MinnesotaDepartment of Anatomy, Mayo Clinic, College of Medicine, 200 First St. SW, Rochester, MN 55905Search for more papers by this author First published: 08 May 2006 https://doi.org/10.1002/ca.20329Citations: 55AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. REFERENCES Coulehan J. 2005. Today's professionalism: Engaging the mind but not the heart. Acad Med 80: 892– 898. Cruess SR, Cruess RL. 1997. Professionalism must be taught. BMJ 315: 1674– 1677. Cruess SR, Cruess RL. 2005. Teaching professionalism: Old issues, new solutions. Can J Ophthalmol 40: 125– 127. Pangaro LN. 2006. A shared professional framework for anatomy and clinical clerkships. Clin Anat 19: 000– 000. Purpura DP. 2006. Pressure makes diamonds. Clin Anat 19: 2– 3. Citing Literature Volume19, Issue5Special Issue: Professionalism and Anatomy Special IssueJuly 2006Pages 391-392 ReferencesRelatedInformation