Real Clinical Experience Research Articles

Improving the competency of medical students in clinical breast examination through a standardized simulation and multimedia-based curriculum.

Clinical breast examination (CBE) is an important step in the assessment of patients with breast-related complaints. We developed a standardized simulation and multimedia-based (SSMBI) curriculum using current evidenced-basedrecommendations. This study aimed to determine if SSMBI training resulted in better performance (examination scores and detection of abnormal findings) than thetraditional teaching method. Novice fourth-year medical students were exposed to the SSMBI curriculum (n = 68) or traditional (n = 52) training. The traditional group was taught by a lecture and attending weekly clinics where they had hands-on experience. The SSMBI group underwent a structured lecture followed by an instructional video and dedicated simulated teaching. Both groups were assessed through a written knowledge exam and an objective structured clinical examination (OSCE). Student's t test and χ2 tests were used to assess differences in CBE techniqueand knoweldge. Students who underwent SSMBI training had significantly higher numbers of correct answers describing the different steps and justifications of CBE. OSCE performance was significantly higher in the SSMBI group. SSMBI-trained students were more likely to complete all the necessary CBE steps compared to traditionally-trained students (88.2% vs. 28.2%, p < 0.00001). The SSMBI group was also more systematic and more likely to perform adequate inspection, palpation, examination of the nipple-areolar complex, and identify and characterize a palpable lesion (p < 0.05). Formal SSMBI training is an important asset when teaching medical students how to perform a CBE. Real clinical experience is still necessary to refine this skill and the physician-patient interaction.

Medical education in difficult circumstances: analysis of the experience of clinical medical students following the new innovative medical curriculum in Aksum, rural Ethiopia

BackgroundIn 2012, 12 medical schools were opened in Ethiopia to tackle the significant shortage of doctors. This included Aksum School of Medicine situated in Aksum, a rural town in Northern Ethiopia. The new Innovative Medical Curriculum (NIMC) is a four-year programme designed by the Ethiopian Federal Ministries of Health and Education. The curriculum is designed to train biomedical science graduates to become doctors in 4 years, with a focus on the healthcare needs of rural people living in poverty.MethodsThis research was conducted at Aksum School of Medicine and included two hospitals (Aksum Referral Hospital and St Mary’s District Hospital). This study focused on medical students during their clinical years across multiple specialities (61 Clerkship 1 students and 13 Clerkship 2 students). We used primarily qualitative research methods supplemented with quantitative measures. There were 3 stages of data collection over a 1 month period, this included qualitative group interviews, direct observation of students in a clinical setting and direct observation of skills sessions followed by a questionnaire on the sessions. We analysed the data by reconstructing the student experience and comparing it with the NIMC.ResultsThe proposed typical week set out in the NIMC tended to differ from the real clinical experience of these students. Through qualitative group interview and direct observation of teaching, the main theme that was consistent throughout was the lack of doctors with specialist postgraduate training. Clinical need often took priority over education. However, students enjoyed taking early responsibility and gaining practical experience. Through direct observation of skills sessions and short questionnaires, these sessions were highly valuable to the students and they felt confident in carrying out the taught procedures in the future.ConclusionsThe combination of poorly resourced hospitals and lack of specialist doctors provides a challenging environment for medical students to learn. However, it is a unique clinical experience that is rarely seen in developed countries and facilitates the acquirement of skills from an early stage. Supervision and specialist input is fundamental in enabling students to learn and this is a key area that was lacking in the students’ clinical experience.

Alemtuzumab treatment in Multiple Sclerosis: real clinical experience in the Northwest of Spain (P6.352)

Alemtuzumab treatment in Multiple Sclerosis: real clinical experience in the Northwest of Spain (P6.352)

Interpretation and discussion of 2016 American Association of Clinical Endocrinologists guideline for obesity

In 2016, American Association of Clinical Endocrinologists(AACE) published the guidelines for obesity and defined obesity as an adiposity-based chronic disease and obesity should be managed according to the obesity-related complications (16 complications are listed). Obesity intervention should be transferred from the purpose of weight loss to the intervention of metabolic disorder and its complications. The diagnosis and intervention of obesity in this guideline is sub- classified focus on the gender, region, and combined diseases, which is with more practical and scientific significances. This interpretation is expected to help the professional medical staffs to understand the new strategy in obesity therapy and to combine with the real world and clinical experience. New suggestions should put forward and improve the theories. (Chin J Endocrinol Metab, 2017, 33: 190-193) Key words: Obesity; Complications; Adipose tissue; Guideline; AACE

Current Status and Future Directions of Capsule Endoscopy.

Small bowel capsule endoscopy (CE) is a method of endoluminal examination of the small bowel using a wireless disposable capsule-shaped tool which is swallowed and then propelled by gut motility through the gastrointestinal tract. Since its first use more than 10 years ago, CE has been a first-line diagnostic method for the evaluation of the small bowel. The most common indications for CE include obscure gastrointestinal bleeding (OGIB), suspected Crohn's disease, small bowel tumor, and polyposis syndrome. Up until now, the application of CE has been widened based on the results of many clinical studies. In the current special issue, issues other than OGIB, such as Crohn's disease, ileitis, and portal-hypertensive enteropathy (PHE), have been focused on. However, CE has some limitations, such as inadequate bowel preparation and incompletion. To increase diagnosis yield, adequate bowel preparation and complete examination of the entire small bowel are important. And another important limitation of CE is the risk of retention. As one of the efforts to solve this problem, the real clinical experience with the PillCam patency capsule prior to CE was introduced. D.-H. Yang et al. have extensively reviewed the diagnostic accuracy and the therapeutic impact of CE in Crohn's disease. However, clinical experience with CE for the diagnosis and management of Crohn's disease is still limited despite the advantages of CE over other modalities. The risk of capsule retention, lack of evidence on the clinical benefit, and lack of established indications for CE in Crohn's disease may limit the widespread use of CE in clinical practice for suspected or established Crohn's disease. Ileitis is defined as inflammation of the ileum, and various etiologies are associated with ileitis. However, the differential diagnosis of terminal ileitis can be difficult in many cases. H. S. Lee and Y. J. Lim have described each of the various conditions associated with ileitis and the diagnostic value of CE for ileitis, which may help identify and evaluate these conditions in clinical practice. S. R. Jeon and J.-O. Kim have reviewed that CE has enabled the identification of PHE as a potentially significant complication of portal hypertension. In patients with liver cirrhosis and OGIB, PHE might be a possible cause for GI blood loss. CE can be a useful method for identifying treatable lesions in patients with PHE and can help optimize treatment on a case-by-case basis. Bowel preparation before CE is as essential as bowel preparation before colonoscopy. To date, there have been many comparative studies, consensus, and guidelines regarding different kinds of bowel cleansing agents in bowel preparation for small bowel CE. H. J. Song et al. have reviewed previous studies regarding bowel preparation for small bowel CE and suggested optimal bowel preparation of VCE. C. Rommele et al. have performed a retrospective analysis of 38 patients with risk factors for capsule retention and have indicated that CE could safely be performed even if the patency capsule excretion time is longer than 30 hours and the excreted patency capsule was not screened for damage.

The 'complements' to virtual simulation.

With the advancement of minimally invasive procedures in urology, the goal is to train a urologist who is highly competent and confident in performing these techniques. Because of the specific risks, visuospatial relationships, and the steep learning curve that is unique to laparoscopy, hands-on training on a box or a visual simulator is the recommended way to start learning laparoscopic skills. However, as Preece et al. [1] stated in their interesting article, simulation should complement other essential components of urology training programs such as participation in mentorship schemes and clinical fellowships, which also aid progression along the learning curve. Residents who are willing to perform laparoscopic surgery should train their laparoscopic skills on a regular basis. Previous research by Stolzenburg et al. [2] suggested that those who are willing to learn laparoscopic prostatectomy should practice daily on a pelvic trainer, especially knot tying and suturing. Laguna et al. [3] stated that it is almost impossible to finalize the residency training as a qualified laparoscopic surgeon. Based on the low level of laparoscopic skills displayed by last year's residents, it is advisable that those who are willing to perform laparoscopy as a urologist should improve their training and exposure to laparoscopy during residency or should consider a fellowship in laparoscopic surgery. Cadaveric educational programs are unique programs that may simulate real clinical experience in the operating room. In Turkey, this dedicated educational program consists of 3 main theoretical and practical parts and many subtopics. The cadaveric educational program allows all urology residents to perform basic and complex surgical operations on fresh frozen cadavers. The surgeries that may be performed as an example include simple procedures such as prostatic biopsies to complex laparoscopic procedures such as partial nephrectomy. This program is still in continuous growth and we hope to be able to expand it over all of Europe. There are several circumstances that may reduce the number of procedures according to the training of the surgeons such as: 1) the development of their individual laparoscopic skills, 2) the access to simulator training, 3) animal or cadaveric training and 4) clinical experience with an experienced mentor [4]. Also, the importance of training with animals has been published in the past [5]. Following the La Paz University Hospital training program, every kind of training in laparoscopic surgery is desirable, but a scheduled program with a frequent presence in the operating room and a constant suture training on the simulators, ensures a consistent training in laparoscopic urological surgery.

First Symposium of Ichthyosis Experts

On June 22, 2012 the First Symposium of Ichthyosis Experts in Spain was held at the Hospital Niño de Jesús in Madrid. It was a one-day symposium for dermatologists, pediatricians, and physicians-in-training interested in this disease, as well as for other health care professionals involved in the care of patients with ichthyosis. The aim of the meeting was to try to structure the care of ichthyosis patients in Spain. As happens in other rare diseases, because of the low prevalence of ichthyosis and the absence of designated referral centers, the number of patients treated in each center is very low and few dermatologists have any real clinical experience with this condition or know how to order diagnostic genetic tests. This article summarizes the presentations given at the symposium and is intended as a reference for anyone interested in the subject.

I Jornada de expertos en ictiosis

On June 22, 2012 the First Symposium of Ichthyosis Experts in Spain was held at the Hospital Niño de Jesús in Madrid. It was a one-day symposium for dermatologists, pediatricians, and physicians-in-training interested in this disease, as well as for other health care professionals involved in the care of patients with ichthyosis. The aim of the meeting was to try to structure the care of ichthyosis patients in Spain. As happens in other rare diseases, because of the low prevalence of ichthyosis and the absence of designated referral centers, the number of patients treated in each center is very low and few dermatologists have any real clinical experience with this condition or know how to order diagnostic genetic tests. This article summarizes the presentations given at the symposium and is intended as a reference for anyone interested in the subject.

Aged-Care Residents: A Resource for Student Clinical Experience

With an increase in the number of medical students and a decline in opportunities to access hospital patients means that alternative methods of providing formative year medical students with a real clinical experience have to be found. The aim of the present study was to examine students’ and elderly aged-care residents’ perceptions regarding aged-care residents being interviewed by medical students and whether residents are willing to be physically examined by supervised medical students. Second-year medical students (N = 187) and aged-care residents (N = 24) completed an anonymous survey regarding their perceptions of the interview. Medical students and aged-care residents generally had favorable perceptions of the interview. The majority of aged-care residents indicated that they would be willing to be physically examined by supervised medical students. These findings suggest that engaging aged-care residents may be a suitable avenue to provide opportunities for students to have clinical experiences during their studies.

Renoprevention: A New Concept for Reengineering Nephrology Care—An Economic Impact and Patient Outcome Analysis of Two Hypothetical Patient Management Paradigms in the CCU

Background: The impact of acute kidney injury (AKI) on chronic kidney disease (CKD) progression remains uncertain; the common belief is that AKI in CKD is short-lived with subsequent full recovery. However 25.2% of end-stage renal disease (ESRD) Medicare patients all experienced antecedent AKI. We recently described a new syndrome of ESRD following AKI, the syndrome of rapid-onset end-stage renal disease (SORO-ESRD). Renoprevention, which we described in 2009, is the application of preventative measures to reduce AKI incidence. Methods: This is a descriptive study based on real clinical experience. Two hypothetical 69-year-old Caucasian male patients, A and B, with symptomatic coronary artery disease (CAD) presented for elective cardiac catheterization and subsequent coronary artery bypass graft procedures; renoprevention was applied in patient A but not in B. Results: Aggressive fluid repletion, withholding Lisinopril 40 mg once daily (QD) 1 week before hospitalization (hydralazine substituted) in A—earlier discharge after 6 days, transient minimal change in serum creatinine. Patient B continued on Lisinopril 40 mg QD, experienced prolonged hypotension needing pressors—severe oliguric AKI, volume overload, daily RRT for 6 days, recovered kidney function, was discharged after 20 days. Hospital charges were $68,580 (A) versus $154,650 (B). If patient B had developed ESRD (SORO-ESRD), the savings would be humongous. Conclusion: A more forceful and pragmatic application of renoprevention strategies in the coronary care unit (CCU)—preemptive withholding of nephrotoxics including renin angiotensin aldosterone system (RAAS) blockers, aggressive prevention of perioperative hypotension, avoiding nephrotoxic exposure as contrast, and antibiotics–leads to less AKI, potentially less SORO-ESRD, better patient outcomes, and massive dollar savings. Such paradigm shifts would constitute major rethinking in current nephrology practice, a form of nephrology practice reengineering.

Case Studies in Clinical Biochemistry

The authors of the best-selling “Clinical Biochemistry: An Illustrated Colour Text” from Elsevier have now produced a companion volume. Clinical Biochemistry is about patients- how we investigate their signs and symptoms, how we diagnose their illnesses and how we treat them. In this new book, the authors from the UK present a series of over 50 clinical cases, all based on real patients, and invite the reader to answer key questions using their knowledge and experience of each topic. Topics covered include Fluids and Electrolytes, Acid–Base Balance, Renal and Liver Function, Calcium and Bone Disease, Proteins and Enzymes, Diabetes, Endocrinology, Lipids, Toxicology and Paediatrics. The book also contains a very useful further reading section and links to relevant websites. Each case study consists of a short clinical history accompanied by key clinical findings and laboratory results, and a series of questions. The authors’ detailed answers and explanations to these questions can found by simply turning the page. The case studies and their questions are designed to address key teaching points in Clinical Biochemistry and to do so in the context of real clinical experience. As such it is an ideal revision aid for those studying Medicine, Nursing and Biomedical Sciences and for those preparing for post-graduate membership examinations. As an important added extra, a unique facebook page has been created to allow readers to access additional educational material not found in the book, and to interact directly with the authors, Michael Murphy, Rajeev Srivastava and Allan Gaw. You may find them on www.facebook.com/ClinicalBiochemistry and you can follow them on twitter @SAPress42. The 132 page book is available to purchase on amazon. A kindle version is also available for download at $7.43 from www.amazon.com.

Monitoring the Nervous System for Anesthesiologists and Other Health Care Professionals

Monitoring the Nervous System for Anesthesiologists and Other Health Care Professionals

Patient Simulator for Teaching Heart and Lung Assessment Skills to Advanced Practice Nursing Students

Background Patient simulators are becoming an integral component in the education of nurses because they provide a unique opportunity to practice skills without the anxiety and pressure of a real clinical experience. However, there is a lack of evidence supporting the effectiveness of simulation among advanced practice nursing students. Objective This study's objective is to determine whether the use of an intermediate-fidelity manikin simulator could affect student confidence, knowledge, and satisfaction with physical assessment skills. Method Advanced practice nursing students were randomly assigned to receive either a 1-hour simulator session and the usual teaching and learning strategy of didactic lecture and laboratory practice or only the usual teaching and learning strategy. Following the Nursing Education Simulation Framework, the outcomes of confidence, knowledge, and satisfaction were measured. Results and Conclusions Students in the simulation group had significantly greater ( t(26) = −2.068, p < .05) knowledge of heart and lung assessment following the simulator experience; however, there was no difference in confidence between the 2 groups. Students with fewer years of experience had greater changes in their confidence levels. The current study adds to the growing body of evidence that suggests patient simulation positively affects learning outcomes in advanced practice nurse education.

Heterologous assisted reproduction and kernicterus: The unlucky coincidence reveals an ethical dilemma

Secrecy and anonymity related to heterologous assisted reproduction may hide basic newborn data to neonatologists. Secrecy and anonymity are discussed in view of their possible consequences on relational dynamics and on developmental psychology. Nevertheless, they can also involve the offspring's genetic status regarding inheritable diseases. International guidelines have been recently published on this topic. Because no guidelines are ‘ideal’ unfortunate and possibly dramatic consequences can occur. We aimed to embark on a debate about this matter starting with a real clinical experience. In our case a rarely fatal but widespread disease, together with the lack of knowledge about parental status led, in a fast succession of clinical events, to the unavoidable insurgence of kernicterus.

Nursing students in an expanded charge nurse role: a real clinical management experience.

Ensuring that baccalaureate nursing students obtain a measure of management and leadership proficiency is a challenge for nurse educators. Having senior students manage juniors in a clinical course modeled in a peer hierarchal pattern that emulates advanced beginner practice is a creative approach that is both realistic and achievable. Through specific learning experiences, students are exposed to typical management functions and asked to demonstrate management and leadership skills at an expanded charge nurse level.

Novice and expert perceptions of psychological care and the development of psychological caregiving abilities

Despite the wealth of research pointing to the centrality of psychological care in illness, there appears to be a lack of consensus concerning its nature and the means by which psychological caregiving abilities are acquired. This has an impact on nurse educators, who must identify and harness the perceptions which students hold, and identify the processes which might contribute to their skill development, as they progress from ‘novice’ to ‘expert’.The aims of this small qualitative study were to compare novice and expert perceptions of the nature of psychological care, and to identify those processes that may contribute to nurses’ ability to apply psychological understanding in practice.Data collection methods comprised interactive interviews with qualified and novice student nurses, which were analysed thematically using an adaptation of Colaizzi’s (1978) reductive procedure. Results suggest that, whilst there is considerable overlap in themes identified between the two groups, novices consider a broader range of themes to be central to psychological caregiving than do experts; similarly, novices identify more contributory factors than do experts in explaining the process of acquiring skill in psychological caregiving. Possible reasons for these differences are considered.Whilst this study is limited in size and scope, the ultimate goal is to utilize central themes within a model of psychological caregiving, which might inform nurse education. In this way, educational programmes might be appropriately focused upon students’ needs within the context of real clinical experience.

The clinical skills resource: a review of current practice.

This review is based on the findings of the Southampton Clinical Skills Project, which was a needs assessment and feasibility study to consider the development of a multiprofessional Clinical Skills Resource at Southampton. The project spanned a period of 18 months and used a range of methods of data collection, including visits to 12 clinical skills facilities in the UK. Most existing clinical skills centres have developed in response to changing healthcare policy, curricular initiatives and increasing emphasis on the quality of assessments and competencies. There is also increasing recognition that clinicians are no longer able to teach effectively all skills to students in the traditional ways, and that clinical skills training and assessment, particularly for undergraduates, is an area of deficiency. The potential scope of clinical skills centres is broad and encompasses not only clinical and communication skills but medical informatics, computer assisted learning, multiprofessional learning and assessment. Skills centres can also promote self directed and lifelong learning methods. The planning of skills centres involves a variety of stakeholders and users, including undergraduates, postgraduates, acute and community Trusts, Postgraduate Deans and medical schools. A successful skills centre needs to be flexible in its design, integral to the curriculum and relevant to educational and training requirements. This requires planning, organization and resources. Different organizational models can be used, depending on local factors. The management of skills centres involves consideration of issues such as security, safety, supervision of learners and staff development, informed by a network of experts and everyday users. The development of skills centres should include ongoing educational evaluation of outcomes and educational research. The use of a clinical skills centre has potential benefits for staff and students, including the provision of a safe environment in which to learn and practise skills before using them in the real clinical setting. This can reduce anxiety in students and protect patients from novice practice. Clinical skills centres provide a setting for structured learning with feedback as well as assessment of competence. The limitations of a skills centre are that it can only provide simulated experiences which are an adjunct to, but can never replace real clinical experience.

Making monsters: false memories, psychotherapy, and sexual hysteria

In the last decade, reports of incest have exploded into the national consciousness. Magazines, talk shows, and mass market paperbacks have all jumped into the fray, as many Americans - primarily women - have come forward with graphic and true stories of sexual and psychological abuse. Many of these stories, however, have emerged from recovered memory therapy, a process by which the therapist leads the patient to recall long-buried memories. Now the Pulitzer Prize-winning social psychologist Richard Ofshe and Mother Jones writer Ethan Watters demonstrate that these recovered memories can be false, fabricated in the highly charged atmosphere of therapy, usually through questionable techniques such as hypnosis. Ofshe and Watters not only take to task poorly trained therapists - and in many states no real clinical experience is required to practice - they also show how the mental health establishment has actually added to the confusion. Ofshe and Watters trace the problem back to its source - Sigmund Freud - and illuminate how and why the debate about recovered memories will drive psychology in the future. Making Monsters is groundbreaking science with powerful stories. It comes at a time when parents and friends of recovered memory patients, wrongly accused of violent physical and emotional abuse, are banding together, searching for real answers to difficult questions. Timely and controversial, this book exposes a profound social and psychological crisis, and will curb a popular craze that is destroying thousands of families. Its message cannot be ignored.