Basic Science Years Research Articles

Antioxidants, oxidative stress, and degenerative neurological disorders.

Recently, clinical trials of several neurodegenerative diseases have increasingly targeted the evaluation of the effectiveness of various antioxidants. The results so far are encouraging but variable and thus confusing. Rationale for the possible clinical effectiveness of antioxidants in several degenerative conditions has arisen out of the many years of basic science generally showing that reactive oxygen species (ROS) and oxidative damage are important factors in the processes involved. Aging is one of the most significant risk factors for degenerative neurological disorders. Basic science efforts in our laboratory have centered on exploring the role of ROS and oxidative stress in neurodegenerative processes. The present review brings together some of the basic concepts we have learned by following this approach for the last 20 years and specifically the results we have obtained by following up on our serendipitous findings that a nitrone-based free radical trap, alpha-phenyl-tert-butylnitrone (PBN), has neuroprotective activity in several experimental neurodegenerative models. The mechanistic basis of the neuroprotective activity of PBN does not appear to rely on its general free radical trapping or antioxidant activity per se, but its activity in mediating the suppression of genes induced by pro-inflammatory cytokines and other mediators associated with enhanced neuroinflammatory processes. Neuroinflammatory processes, induced in part by pro-inflammatory cytokines, yield enhanced ROS and reactive nitric oxide species (RNS) as well as other unknown components that have neurotoxic properties. Neurotoxic amounts of RNS are formed by the activity of inducible nitric oxide synthase (iNOS). The demonstration of enhanced 3-nitro-tyrosine formation in affected regions of the Alzheimer's brain, in comparison to age-matched controls, reinforces the importance of neuroinflammatory processes. iNOS induction involves activation by phosphorylation of the MAP kinase p38 and can be induced in cultured astrocytes by IL-1beta or H2O2. The action of PBN and N-acetyl cysteine to suppress the activation of p38 was demonstrated in cultured astrocytes. The demonstration of activated p38 in neurons surrounding amyloid plaques in affected regions of the Alzheimer's brain attest to enhanced signal transduction processes in this neurodegenerative condition. The major themes of ROS and RNS formation associated with neuroinflammation processes and the suppression of these processes by antioxidants and PBN continue to yield promising leads for new therapies. Outcomes of clinical trials on antioxidants will become less confusing as more knowledge is amassed on the basic processes involved.

Emergency Medicine in France

The Essonne region of France is situated to the south of Paris. A population of more than 1 million, heavy commercial traffic, and industrial centers mandate first-rate prehospital and hospital emergency medicine. Medical education in France comprises 3 years of basic medical science, followed by 3 years of hospital rotations and a residency of variable length. Emergency medicine is struggling for recognition as a specialty. The ED at the hospital center in Corbeil-Essonnes, France, has 21,000 visits per year, accounting for 30% of hospital admissions. The physical plant is modern and well-organized, with 13 beds. Attention is paid to quality improvement. Prehospital emergency care also receives due attention. A two-tiered system of BLS ambulances run by the fire department and ALS ambulances run by hospitals provide 24-hour emergency coverage. Because of aggressive triage, only 65% of requests for service result in dispatch of an ambulance. Tasks for physicians involved in emergency medicine in France today include further development of firemen's medical skills, development and use of telemedicine, and accreditation of emergency medicine as a recognized specialty. [Nikkanen HE, Pouges C, Jacobs LM: Emergency medicine in France. Ann Emerg Med January 1998;31:116-120.]

Philosophy and Medical Education

This article describes a novel course that was designed to bridge the gap between the basic science years and clinical experiences in medical school by using information science and computer technology as major components of problem-based learning (PBL) sessions. The course, Integrated Case Studies and Medical Decision Making, was first given to second-year students at the University of Pittsburgh School of Medicine in the spring of 1994. It consists of 13 PBL exercises, each of which explores a clinical case. The cases, including images and gated access to information, are housed on a computer. Using one of 16 networked terminals in specially designed small-group rooms, groups of nine students progress through the cases with a faculty facilitator. The responses of students and faculty to the initial year of the course were favorable. In comparison with traditional PBL sessions, enhanced quality of and access to images and accountability for accessing case information in sequential fashion were cited as major strengths of the course. Juxtaposition of basic science and clinical material and utility in reviewing for the United States Medical Licensing Examination were also cited as strengths. The diversity of the basic science material involved in completing the cases drew overwhelming enthusiasm from students and facilitators alike. In conclusion, the course successfully employs computer and information science technology, which will be of increasing importance to future physicians. The course also serves as an effective bridge to the clinical years of medical school and as a study adjunct for the USMLE.

Fundamental Skills in Surgery

After completing the basic science years, the medical student is confronted with patient care. The transition from book learning to actual patient management is a large step. In preparation for clinical surgery rotations, the third-year medical student needs to become acquainted with an adequate amount of practical knowledge and fundamental skills in surgical management. Some students are able to learn many of these procedures through instruction by the house staff, but, with overworked residents, teaching often takes a backseat to sleep and patient care. Fundamental Skills in Surgery will fill in the gaps left by limited teaching, time, and exposure to a variety of patient illnesses. The editors have done an excellent job of explaining the basic techniques in performing surgical procedures and summarizing the pathophysiology of surgical care. The references to the practice of surgery at St Vincent's Hospital and Medical Center of New York add a unique perspective.

Measuring and predicting the performances of practicing physicians

This paper presents the major findings of research carried out by a team of investigators at the University of Utah School of Medicine in the 1960s and 1970s (1) to better understand the multidimensional and complex aspects of practicing physicians' performances, and (2) to investigate relationships between assessments of students in medical school and physicians' performances. The major research began in the 1960s, and data were assembled from a variety of sources to identify factors of physicians' performances. The original study sampled 507 practicing physicians, classified into four highly diverse and representative groups. The team also investigated to what degree these physicians' medical school performances (measured by grades) were predictors of their practice performances. Factor analysis of the data on the physicians' performances resulted in the identification of 25 to 29 factors within each of the four groups. A representative profile of the performances of each physician studied showed how well the physician performed on each of the factors appropriate to his or her specialty and background. Correlation analysis demonstrated that these physicians' performances in medical school, as measured by grade-point averages (GPAs), were almost completely independent of their later performances in their practices, a disturbing finding and one that the team maintained cannot be dismissed by arguments of "restriction of range." In the teams' later studies, 61 measures of physicians' performances were correlated to medical school GPAs in the two basic science years and the two clinical science years. No association beyond chance was observed, and nonsignificant relationships held up regardless of the physicians' specialties or years of experience.(ABSTRACT TRUNCATED AT 250 WORDS)

Medical student culture: Note‐taking cooperatives in basic science curricula

This article examines an aspect of contemporary medical education in the basic sciences—student note‐taking cooperatives that produce written versions of faculty lectures. The phenomenon is analyzed in the context of the educational milieu of the basic science years as described in several recently published first‐person accounts of medical training. Faculty and student perspectives are delineated along with relevant research findings. The concept of a medical student culture that works to control the level and direction of academic effort is proposed as a basis for understanding note‐taking cooperatives.

To Tell the Truth: An In-Class Learning Exercise for Medical Students

The basic science years of medical training have long been dominated by an exam-based and memorization-oriented lecture format. This paper describes the use of a game show format designed to engage students in an active process of exploring their own group-based images, fears, and stereotypes about what it means to be a physician. The article enamines the game's dynamics as well as the preparations necessary to play the game. The article documents potential pitfalls and offers suggestions as to how the game might be adapted for non-medical students or for staging in other settings.

Nutrition education curriculum at the University of Nevada School of Medicine.

This article describes a developing nutrition education curriculum for the University of Nevada School of Medicine, a small and progressive, community-based medical school. The curriculum has been planned to reflect the longitudinal, interdisciplinary, and comprehensive integration of nutrition into new required and existing courses so that timely delivery of knowledge and development of skills will occur in the basic science years followed by direct application in the clinical clerkships. The availability of the "Nutrition and Cancer Education Objectives" is timely and provides overall direction and curricular goals for the simultaneous development of nutrition-cancer education. The coordination of the four-year curriculum of the entire medical school can be specifically targeted for the incorporation of this needed information synergistically at a most opportune time.

Shirley H. Baron, MD, 1904-1979.

Otolaryngology lost one of its distinguished leaders when Shirley Baron died on Dec 19, 1979. Dr Baron was born Oct 22, 1904, in Salt Lake City, and spent his childhood years in Oregon. After high school, he matriculated at the University of California, Berkeley, where he did his premedical studies. In 1923, he was admitted to the University of Oregon School of Medicine, Eugene, where he completed the two years of basic sciences before transferring to Cornell University School of Medicine, New York, to complete his last two clinical years of undergraduate training. He was granted the doctorate in 1927. Dr Baron interned at Mount Sinai Hospital, New York, along with Joseph Goldman, MD, with whom he established a lifelong warm friendship. He took his otolaryngology training at the Presbyterian Hospital, New York, and then entered private practice in New London, Conn. He was certified by the American Board of

Clinical Performance and Specialty Choice of COTRANS Students

The clinical performance and specialty choice of 33 Coordinated Transfer Application System (COTRANS) students accepted with advanced standing into the third year of an American medical school were compared with the performance and choice of students from other American medical schools. The undergraduate grade point average of the COTRANS group was considerably lower than that of the other students. The science Medical College Admission Test scores in science were comparable, and the performance on part I of the National Board of Medical Examiners was considerably higher. Clinical performance, choice of specialty, and affiliation of graduate program of the COTRANS students did not differ from those of students entering the curriculum in year 1. Carefully selected students completing the first two years of basic science in a foreign medical school can successfully compete with students already enrolled in the American medical curriculum.

Teaching psychiatry in a new medical school: a multimedia approach.

As a developing department in a new medical school, we were able to improve our curriculum by using a multimedia approach to teaching psychiatry. We relied heavily on a programmed self-instructional text with videotaped clinical examples (PLS), learning objectives, formal classroom presentations, small group discussions, self-assessment exercises, an affective approach to the patient-doctor relationship using role-playing and videotaped patient vignettes, and finally live patient interviews. We believe we have been able to present the widely agreed upon content in the basic science years, using a wide variety of teaching materials and technics which maintain the interest of most students.

Shortening the medical school curriculum.

To the Editor.— Suggestions that the medical school curriculum should be shortened (eg, from four years to three years) include variants such as contracting the traditional two years of basic science into one year, transferring the freshman medical school year to the premedical curriculum, and the like. Not having seen the following statement published, I shall belabor the obvious and point out that, barring other concomitant changes such as increasing the size of each medical school class, the increase in the number of physicians produced by reducing the medical school course from four years to three would be a one-time bonus equal to one year's class and would not be recurrent. A reduction in course length may be advantageous to the student and it may make medicine more attractive as a profession. Lack of attractiveness as a profession is not a factor in the overall shortage of physicians, however, since

Cinefluorography as a teaching instrument in the undergraduate course in medical pharmacology.

A pilot study of the use of cinefluorography as a teaching instrument in the teaching of pharmacology in the medical curriculum is presented. Its usefulness in the study of drug actions makes it an extremely effective recording medium and[See Figure in the PDF file]provides a very dramatic method of illustrating these effects in experimental animals as well as living subjects. Such techniques can be utilized in bringing Radiology into the basic science years and indoctrinating the student early in his medical curriculum in the roentgen method.