Relevant Basic Science Research Articles

Seeking the Optimal Time for Integrated Curriculum in Jinan University School of Medicine

The curricular integration of the basic sciences and clinical medicine has been conducted for over 40 years and proved to increase medical students’ study interests and clinical reasoning. However, there is still no solid data suggesting what time, freshmen or year 3, is optimal to begin with the integrated curriculum. In this study, the integrated courses on cardiovascular and respiratory systems were performed to part of year 1 and year 3 medical students while non-participant students acted as control. We tried to explore the optimal time through comparison of the exam results and questionnaire of participated students. It was demonstrated that year 3 participant students got better exam score than year 1 students did, and the questionnaire showed that it might be due to the year 1 participants difficultly caught up with the contents of integrated courses without appropriate background knowledge. Three years later, the participant students got higher ability to analytical thinking of clinical diseases in comparison to non-participant students, while it did not improve the acquirement of their clinical practical skills. Taken together, our study in Jinan University School of Medicine indicated that the integrated courses would be approximately effective if combined to conventional medical teaching at year 3 after the students obtain relevant basic sciences knowledge.

Clinician's Commentary on Farrell et al.(1).

Clinically based anatomy is a foundational science for musculoskeletal (MSK) physiotherapists. Best practices are based on informed treatment strategies that rely heavily on an extensive and up-to-date knowledge of MSK anatomy. The results of this novel study by Farrell and colleagues,1 which investigated the use of clinical anatomy resources by outpatient physiotherapists, are important in identifying the extent of self-directed learning that is taking place in this area after graduation. The finding that more experienced physiotherapists used resources significantly less frequently than their less experienced colleagues can be interpreted in many ways. Perhaps more experienced physiotherapists do not see a need for further clinical anatomy education and view anatomy as a “textbook science,” to be studied from textbooks rather than from the research literature. On the opposite end of the spectrum, it may be that current clinical literature, including relevant basic science studies, is relatively inaccessible as a result of high subscription rates. Open-access papers are readily available, but obtaining articles from many specialty-specific journals requires access to a library that subscribes to these journals or purchasing or renting articles from the publisher. This can be costly, as students' library privileges are terminated on graduation. Canada, unlike Australia (where Farrell and colleagues practise), does not have a “statewide health department online resource portal,” which may further limit the number of physiotherapists who can access online library resources. Encouraging students to become lifelong learners is an important goal of professional programmes. Farrell and colleagues state that “clinical reasoning demands a thorough understanding of the appropriate clinical subject matter,” but the results of their study suggest that gaining deeper insight into pathology-specific MSK anatomy may not be a high priority for some practitioners. Clinical anatomy is a living and evolving science, and all practitioners should therefore strive to keep abreast of the current literature, with a view to integrating the findings into their clinical practice. Textbooks are useful references, but the research literature provides the key to advance evidence-based practice. I congratulate the authors on their excellent study exploring physiotherapists' behaviour and attitudes toward clinical anatomy. Their findings support the development of better resources with greater accessibility to the physical therapy community, enabling lifelong learning and the integration of research findings into clinical practice.

A risk and maintenance model for bulimia nervosa: From impulsive action to compulsive behavior.

This article offers a new model for bulimia nervosa (BN) that explains both the initial impulsive nature of binge eating and purging, as well as the compulsive quality of the fully developed disorder. The model is based on a review of advances in research on BN and advances in relevant basic psychological science. It integrates transdiagnostic personality risk, eating-disorder-specific risk, reinforcement theory, cognitive neuroscience, and theory drawn from the drug addiction literature. We identify both a state-based and a trait-based risk pathway, and we then propose possible state-by-trait interaction risk processes. The state-based pathway emphasizes depletion of self-control. The trait-based pathway emphasizes transactions between the trait of negative urgency (the tendency to act rashly when distressed) and high-risk psychosocial learning. We then describe a process by which initially impulsive BN behaviors become compulsive over time, and we consider the clinical implications of our model. (PsycINFO Database Record

The relevance of basic sciences in undergraduate medical education.

Evolving and changing undergraduate medical curricula raise concerns that there will no longer be a place for basic sciences. National and international trends show that 5-year programmes with a pre-requisite for school chemistry are growing more prevalent. National reports in Ireland show a decline in the availability of school chemistry and physics. This observational cohort study considers if the basic sciences of physics, chemistry and biology should be a prerequisite to entering medical school, be part of the core medical curriculum or if they have a place in the practice of medicine. Comparisons of means, correlation and linear regression analysis assessed the degree of association between predictors (school and university basic sciences) and outcomes (year and degree GPA) for entrants to a 6-year Irish medical programme between 2006 and 2009 (n = 352). We found no statistically significant difference in medical programme performance between students with/without prior basic science knowledge. The Irish school exit exam and its components were mainly weak predictors of performance (-0.043 ≥ r ≤ 0.396). Success in year one of medicine, which includes a basic science curriculum, was indicative of later success (0.194 ≥ r (2) ≤ 0.534). University basic sciences were found to be more predictive than school sciences in undergraduate medical performance in our institution. The increasing emphasis of basic sciences in medical practice and the declining availability of school sciences should mandate medical schools in Ireland to consider how removing basic sciences from the curriculum might impact on future applicants.

Review of Human Pathogenic Fungi: Molecular Biology and Pathogenic Mechanisms

Review of Human Pathogenic Fungi: Molecular Biology and Pathogenic Mechanisms

The role of vitamin D in psoriasis: a review.

Psoriasis is a common, chronic autoimmune inflammatory skin disorder, which has potential systemic complications and is clinically defined by sharply demarcated, erythematous patches and plaques covered by a characteristic silvery white scale. Topical corticosteroids have widely been regarded as the mainstay first line of treatment. Recently, topical vitamin D analogs have been added to the first-line treatment repertoire as well, either as monotherapy or in combination with topical steroids due to synergistic, complementary effectiveness. In this paper, we review the role of vitamin D in the pathophysiology and treatment of psoriasis. A comprehensive search of the Cochrane Library, MEDLINE, and PUBMED databases were performed to identify relevant basic science and clinical trial literature investigating the role of vitamin D in psoriasis. Primary endpoints in clinical trials were largely based on clinical improvement as assessed by the psoriasis area severity index score or physician's global assessment. The role of vitamin D in psoriasis is complex and extensive. Oral and topical vitamin D therapies provide comparable efficacies to corticosteroids when used as monotherapy and may be superior when used in combination with a potent topical steroid. Additionally topical vitamin D analogs demonstrate a favorable safety profile with "steroid-sparing" effects. Thus, topical vitamin D derivatives should be considered an indispensable component of the current physician's arsenal in the treatment of psoriasis.

Students' Attitude and Perception towards Basic Sciences in a Medical School of Nepal: A Cross-sectional Study

Background: The learning process of medical students is influenced by their attitude and perception towards different subjects. In conventional curriculum, basic medical sciences generally provide basement for students to construct the mansion of clinical knowledge and skills. Objective: We aimed to assess the first and second year medical students’ attitudes and perception towards the learning of basic sciences. Materials and methods: The questionnaire (nine items) designed by West and coworkers was distributed among 240 students and they were asked to denote their opinions using a five-point Likert scale, which ranges from “strongly agree” to “strongly disagree”. First five items measured the perceived importance and relevance of basic sciences to clinical medicine, and last four items measured the students’ attitudes toward, and perceived effectiveness of their education in basic sciences. The median score of statements were compared between subgroups of respondents using Mann-Whitney and Chi-square tests, wherever applicable. Results: Mean age of students was 19.8± 1.2 years; 58.2% and 41.8% were male and female respectively. Most of the respondents though disagreed with first statement and were neutral for second statement, agreed with all the remaining statements. The median scores were 12 and 9 for combination of first five statements and last four statements respectively. Significant level (p=0.003) of disagreement was shown by scholarship students than self-financed on the effectiveness of their education in basic sciences. Students’ curiosity through teaching of basic sciences was found to be significantly decreased (p=0.035) in second year students. Conclusion: Students acknowledged the importance and relevance of basic sciences to clinical medicine and showed overall positive attitude toward, and perceived effectiveness of their education in basic sciences.

Diagnosing and predicting outcome in leptospirosis: the need for clinically relevant basic sciences research.

Diagnosing and predicting outcome in leptospirosis: the need for clinically relevant basic sciences research.

Building a Pediatric Neurocritical Care Program: A Multidisciplinary Approach to Clinical Practice and Education from the Intensive Care Unit to the Outpatient Clinic

We describe our 10-year experience developing the Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program at Northwestern University Feinberg School of Medicine. The neurocritical care team includes intensivists, neurologists, and an advanced practice nurse who have expertise in critical care neurology and who continue care in long-term follow-up of intensive care unit patients in a dedicated neurocritical care outpatient clinic. Brain-directed critical care requires collaboration between intensivists and neurologists with specific expertise in neurocritical care, using protocol-directed consistent care, and physiological measures to protect brain function. The heterogeneity of neurologic disorders in the pediatric intensive care unit requires a background in the relevant basic science and pathophysiology that is beyond the scope of standard neurology or critical care fellowships. To address this need, we also created a fellowship in neurocritical care for intensivists, neurologists, and advanced practice nurses. Last, we discuss the implications for pediatric neurocritical care from the experience of management of pediatric stroke and the development of stroke centers.

Informing and inspiring

This second issue of Neurology® Neuroimmunology & Neuroinflammation incorporates examples of the types of reports that incarnate our mission: to inform and inspire the community of neuroinflammation and neuroimmunology researchers. Tran et al.1 report a phase I trial of LINGO antibodies, inaugurating clinical development of remyelination therapy for multiple sclerosis (MS), and the attainment of this goal is discussed by Brugarolas and Popko,2 authorities on the relevant basic science. Radke et al.3 describe 2 adult patients with a histologic variant of dermatomyositis, 1 in whom formation of secondary lymphoid-like structures is observed. Lymphoneogenesis is a poorly understood feature of chronic inflammatory disorders, but it could potentially be unraveled by applying knowledge of immune system ontogeny. Mir et al.4 report evidence for chronic oxidative stress in the tissues of patients with progressive MS. Oxidative stress is a prominent topic of speculation in discussions of the pathogenesis of MS progression, so it's doubly rewarding to have tangible evidence for this process coming from living patients. Furthermore, this observation may provide a foundation for monitoring hoped-for treatment trials for this obdurate condition. Li et al.5 describe how to monitor macular edema in a patient with MS receiving fingolimod, thereby enabling the continuation of a therapeutic modality considered by the treating physicians to be useful for this clinical circumstance. A novel presentation of neurotransmitter receptor antibody–mediated neurologic disease comes from Zuliani et al.6: adult patients with new-onset epilepsy were found to harbor glycine receptor antibodies. Zhang et al.7 describe an unprecedented case of paraneoplastic cerebellar disease and voltage-gated calcium channel antibodies in an individual with a neuroendocrine (Merkel cell) cancer. Prüss and coworkers8 report a case which suggests another potential mechanism for inducing NMDA receptor antibody–mediated encephalitis. This contribution adds insight into a mysterious, tantalizing condition.

Berek and Novak’s Gynecology 15th Edition

The gold-standard text in gynecology has been published in its 15th edition, thoroughly revised and updated and now in full color throughout. This edition continues to uphold the goals of Emil Novak’s original 1941 publication: to provide a comprehensive yet accessible overview of the expanding field of gynecology, serving as a gold-standard reference for private practitioners as well as an excellent teaching tool for those in training. In comparing this book to Stenchever’s Comprehensive Gynecology, 4th edition (Mosby, 2001), which has been touted by some as the “Bible” of gynecology for residents, Berek and Novak’s textbook seems to be at least as good as the former. The 15th edition is structurally sound, comprehensive, and accessible. The book covers the entire spectrum of women’s healthcare, tidily yet comprehensively, organized into eight sections. This comprehensive and general gynecological textbook provides guidance for the management of specific gynecological conditions. The first two sections cover principles of practice and initial assessment and the relevant basic science. The third section is on preventive and primary care for women, and the remaining five sections are directed at methods of diagnosis and management in general gynecology, operative general gynecology, urogynecology and pelvic reconstructive surgery, reproductive endocrinology, and gynecologic oncology. In this edition, there is an update on robotics in gynecology as well. The text covers the basics of anatomy and physiology of the female reproductive tract to the management of complicated gynecologic conditions. The book goes above and beyond the objectives to provide a thorough and current review of gynecology. The book covers a wide range of topics, from anatomy and embryology to gynecologic malignancies and everything in between. It is a fantastic review of the current literature, and the color art is a great complement to the text. This should be on every gynecologist’s bookshelf. It is an essential reference that covers all components of the practice. This edition’s structure represents an improvement over the 14th edition, appropriately mirroring the expansion of the field and its subspecialties over the past few years. Specifically, a separate section now covers urogynecology and three separate chapters now cover lower urinary tract disorders, pelvic organ prolapse, and anorectal dysfunction, topics previously compressed into one chapter. The family planning chapter now includes newer contraceptive options such as vaginal rings, subcutaneous depomedroxyprogesterone acetate, the implanon subdermal implant, and Essure sterilization. The addition of a complementary therapy chapter is unique, and will serve as an important reference as more and more patients make use of alternatives to mainstream healthcare. The addition of multicolored figures and tables will facilitate quicker access during a busy clinic and can serve as a teaching tool on the hospital floor. This will allow the book to continue to be of use for an increasingly Internet-savvy generation of physicians, while other books without these features may fall out of use.

Introducing First Aid Skills to Pre-Clerkship Medical Students While Reinforcing Basic Science Concepts

The benefit of exposing medical students throughout their medical training to emergency medicine concepts, including basic first aid knowledge, has been established [1]. The American College of Emergency Physicians (2008) called for introduction and integration of basic first aid skills throughout the 4 years of medical school [2]. Teaching clinical skills to preclinical students has the benefit of enhancing learning by providing meaningful clinical relevance to basic science learning, is motivating for learning, and is beneficial for reviewing and reinforcing basic science concepts [3]. It is often assumed that entering medical students have knowledge and skills to provide essential medical care; however, many are unfamiliar with even very basic first aid skills. A 2-hour workshop to teach first aid procedures was developed and presented to 25 volunteer first (M1) and second year (M2) students at Rutgers Robert Wood Johnson Medical School (RWJMS). The workshop covered procedures for wound care, hemorrhage control, and treatment of burns. Relevant basic science content (musculoskeletal anatomy and physiology, microbiology of tetanus and skin infections, and antibiotic pharmacology) was presented, followed by demonstrations and hands-on practice sessions. The practice sessions included procedures for applying direct pressure to a wound, dressing a wound, and wrapping burns with sterile gauze. Workshop evaluations via pre and post-surveys measured knowledge acquisition, comfort in providing first aid, and overall effectiveness of the session. Evaluation results were very positive. The mean score (12 questions) of first aid knowledge increased from 38.3 % to 81.7 % (p<0.001). On a Likert scale measuring student comfort in providing care to a bleeding patient (1=very uncomfortable to 5=very comfortable), scores increased from 2.68 to 4.36 (p<0.001); comfort for providing burn care increased from 2.28 to 4.48 (p<0.001). On additional posttest Likert scale questions (1=strongly disagree to 5=strongly agree), students also responded very positively to the integration of basic science content (4.72), hands-on practice sessions (4.58), usefulness of information (4.76), and interest level and quality of presentation (4.76). There were no significant differences between M1 and M2 students; at least one semester of medical school basic science material is recommended. Based on this initial success, another workshop about limb injuries and cervical spine injury care is being developed as another optional student experience, and will include both basic science correlations and hands-on practice sessions.

Interactive computer-assisted instruction in acid-base physiology for mobile computer platforms

In this project, the traditional lecture hall presentation of acid-base physiology in the first-year medical school curriculum was replaced by interactive, computer-assisted instruction designed primarily for the iPad and other mobile computer platforms. Three learning modules were developed, each with ∼20 screens of information, on the subjects of the CO2-bicarbonate buffer system, other body buffer systems, and acid-base disorders. Five clinical case modules were also developed. For the learning modules, the interactive, active learning activities were primarily step-by-step learner control of explanations of complex physiological concepts, usually presented graphically. For the clinical cases, the active learning activities were primarily question-and-answer exercises that related clinical findings to the relevant basic science concepts. The student response was remarkably positive, with the interactive, active learning aspect of the instruction cited as the most important feature. Also, students cited the self-paced instruction, extensive use of interactive graphics, and side-by-side presentation of text and graphics as positive features. Most students reported that it took less time to study the subject matter with this online instruction compared with subject matter presented in the lecture hall. However, the approach to learning was highly examination driven, with most students delaying the study of the subject matter until a few days before the scheduled examination. Wider implementation of active learning computer-assisted instruction will require that instructors present subject matter interactively, that students fully embrace the responsibilities of independent learning, and that institutional administrations measure instructional effort by criteria other than scheduled hours of instruction.

Continuous Curricular Feedback

Curriculum evaluations are used to plan future revisions and other improvements in curriculum design. Most models are summative and occur at the end of a course, so improvements in instruction may be delayed. In this article, the authors describe the formative curriculum evaluation model adopted at the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania. In their model, representative student feedback is gathered in real time and used to modify courses and improve instruction. The central features of their continuous feedback model include developing a small cadre of preclinical and clinical student evaluators who are trained to obtain classwide input regarding all aspects of the curriculum, including teacher effectiveness, and meet regularly (weekly or monthly) with relevant faculty and administrators. The authors show how this curriculum evaluation approach maximizes student involvement in course development and provides opportunities for rapid improvements in course content and instruction as well as for the identification of barriers to effective clinical and preclinical educational experiences.

RELATING MOTOR AND COGNITIVE INTERVENTIONS IN ANIMALS AND HUMANS.

Cognition and motor performance are essential components of human functioning. Recent research has provided evidence that these two domains are more interrelated than previously thought. This is a potentially important area of research with many questions that warrant further exploration and have practical implications to the field of neurological rehabilitation. In this review of literature we included animals and humans in healthy conditions as well as pathological conditions affecting the central nervous system. Our primary goal was to comprehensively review the relevant basic science and clinical literature on the effects of motor interventions on cognitive function and vice versa. We found more evidence supporting positive effects of exercise on cognition than effects of cognitive training on motor function. In addition, we examined the extent to which findings from animal literature have been or can be translated to humans. We found that, with the exception of one study in monkeys, most animal studies which investigate rodents are somewhat challenging to translate to human studies, independent of the intervention employed. It is difficult to find a human parallel to exercise in rodents, because both the voluntary and forced exercise paradigms used in rodents happen in a different context than humans. In addition it is difficult to find an animal parallel to cognitive training in humans, because the environmental enrichment intervention cannot be considered "purely" cognitive stimulation as it also involves sensory, motor and social components. We conclude the review by suggesting avenues for future research and intervention strategies.

Addendum: Reducing Diagnostic Error by Using Educational Milestones to Organize Curricula and Assessment

The Rip Out on approaches to reduce diagnostic error in this issue of the Journal of Graduate Medical Education offers practical strategies for defining, teaching, and assessing critical thinking.1 Valuable by itself, this approach can be applied in greater detail to inform curricula, teaching strategies, and resident assessment, using a crosswalk between curricular Milestones2 and the Trowbridge3 12 concepts to avoid errors in clinical reasoning. The detailed curricular Milestones developed by the internal medicine community in 2009 are not the reportable components of the Next Accreditation System currently being implemented by the Accreditation Council for Graduate Medical Education. They represent a very detailed framework of the attainment of competence and can be used to inform curricula and approaches to resident evaluation. Mapping the Trowbridge concepts against the Curricular Milestones identifies at least 28 milestones that capture the knowledge, skills, or attitudes relevant to teaching and assessing critical reasoning (box). Given the relevance of critical reasoning and avoiding diagnostic errors to the range of clinical specialties, the applicability of these concepts goes far beyond internal medicine. Box Crosswalk of the Trowbridge 12 Tips to Avoid Diagnostic Error and the Internal Medicine Milestones •Understand heuristics 1. Medical Knowledge (MK)–A4: Demonstrate sufficient knowledge to diagnose and treat undifferentiated and emergent conditions •Use “diagnostic timeouts” 1. Patient Care (PC)–C3: Modify differential diagnosis and care plan based upon clinical course and data as appropriate 2. Practice-Based Learning and Improvement (PBLI)–F2: Actively seek feedback from all members of the health care team 3. PBLI-F3: Calibrate self-assessment with feedback and other external data 4. PBLI-F4: Reflect on feedback in developing plans for improvement •Think “worst-case scenario medicine” 1. MK-A8: Understand the relevant pathophysiology and basic science for uncommon or complex medical conditions 2. MK-A7: Demonstrate sufficient knowledge to evaluate complex or rare medical conditions and multiple coexistent conditions •Approach common problems systematically 1. PC-C1: Synthesize all available data, including interview, physical examination, and preliminary laboratory data, to define each patient′s central clinical problem 2. MK-A3: Demonstrate sufficient knowledge to evaluate common ambulatory conditions 3. MK-A2: Demonstrate sufficient knowledge to diagnose and treat common conditions that require hospitalization •Ask why 1. PBLI-B2: Classify and precisely articulate clinical questions 2. PBLI-B3: Develop a system to track, pursue, and reflect on clinical questions •Teach/emphasize physical examination 1. PC-A3: Obtain relevant historical subtleties that inform and prioritize both differential diagnoses and diagnostic plans, including sensitive, complicated, and detailed information that may not often be volunteered by the patient 2. PC-B4: Routinely identify subtle or unusual physical findings that may influence clinical decision making, using advanced maneuvers where applicable •Teach Bayesian theory 1. MK-B3: Understand prior probability and test performance characteristics 2. Systems-Based Practice (SBP)—E2: Minimize unnecessary care including tests, procedures, therapies, and ambulatory or hospital encounters 3. SBP-D2: Understand how cost-benefit analysis is applied to patient care (ie, via principles of screening tests and the development of clinical guidelines) •Acknowledge your emotions 1. Professionalism (P)—F4: Recognize and address personal, psychologic, and physical limitations that may affect professional performance 2. P-I2: Recognize and manage conflict when patient values differ from your own 3. P-E3: Recognize and manage subtler conflicts of interest •Identify what doesn′t fit 1. PBLI-E1: Determine whether clinical evidence can be generalized to an individual patient 2. PC-C4: Recognize disease presentations that deviate from common patterns and that require complex decision making •Embrace zebras 1. MK-A8: Understand the relevant pathophysiology and basic science for uncommon or complex medical conditions 2. PC-F9: Manage complex or rare medical conditions •″Slow down″ 1. PBLI-G1: Maintain awareness of the situation in the moment and respond to meet situational needs 2. PBLI-G2: Reflect (in action) when surprised, apply new insights to future clinical scenarios, and reflect (on action) back on the process •Admit mistakes 1. P-A3: Accept personal errors and honestly acknowledge them The added detail provides a framework that identifies granular examples of specific knowledge, skills, and attitudes or behaviors for use in curriculum development and resident assessment. The concepts at the intersection of the Trowbridge more general concepts and the curricular milestones lend themselves to (1) the design of teaching vignettes, (2) drawing attention to particular aspects of these 28 milestones in discussions about the care of patients to avoid diagnostic errors, and (3) using these milestones to inform resident formative assessment, with the added benefit of enhancing the utility and richness of feedback to residents. In summation, the detailed milestones related to critical thinking can serve as the foundation for a more detailed curriculum for critical thinking, as well as provide formative feedback to learners as they develop competence in this vitally important clinical skill.

The Relevance of Basic Sciences and Common Technical Courses in Undergraduate Agricultural Curricula in Kenya

Achieving balance between basic sciences, extension methodology and technical subject matter in the pre-service curriculum for agricultural extension staff has been a challenge in the process of curriculum reform. This study sought to determine the adequacy of basic sciences and common technical courses in the undergraduate agricultural curricula through a training needs analysis of 440 extension staff in the public and private agricultural extension service sector. The study also explored differences in training needs between Front line Extension Worker (FEW) and Subject Matter Specialists (SMS). A crosssectional survey was used and training need were determined and prioritized using Borich’s Needs Discrepancy Model (BNDM) using a Mean Weighted Discrepancy Score (MWDS). The basic sciences with the highest training needs were Basic Computer applications, Research Methods and Seminars while the common technical courses with the highest training need were Agricultural Law, Financial and Human resource management and Rural Development. In the basic sciences only Basic computer applications yielded significant differences between the training needs of Public and Private extension agents and between FEW and SMS. Significant differences in the MWDS ratings of Public and Private Extension Agents were obtained in; Agricultural Economics, Principles of Marketing, Engineering/Technical Drawing and Workshop Technology. Respondents from the Public sector had higher MWDS ratings indicating greater training needs than those from the Private sector. Between FEW and SMS, Field Attachment, Engineering/Technical drawing and Extension Education courses were significantly different. All the basic and common technical courses had positive MWDS warranting their inclusion in the undergraduate agriculture curricula. This also implies that there is need to review the content and instructional methodology to ensure the relevance of these courses as core prerequisites that provide basic information and foster critical skills necessary to the understanding of technical courses in the various areas of specialization in agriculture. DOI: 10.5901/ajis.2013.v2n2p71

Medical Education Reform in Wuhan University, China: A Preliminary Report of an International Collaboration

Background : In 2008 Wuhan University Medical School in China proposed to reform its curriculum by adapting the curriculum of the University of Chicago Medical School. Description : An assessment of Wuhan University Medical School's traditional curriculum conducted in 2009 informed the reform directions, which included course integration, use of clinical cases, improved relevance of basic sciences to clinical medicine, reduction of lecture time, increase in group and independent learning, and the use of formative assessments. Fifty student volunteers per year were chosen to participate in the reform, and the rest remained in the traditional curriculum. Evaluation : A student survey was conducted in 2011 to evaluate the reform by comparing the attitudes of those in the reform and standard curricula. Conclusions : The reform met the needs of the school, was generally well received, improved satisfaction in reform participants, and had a positive impact on students. Areas needing improvement were also identified.

Integration and timing of basic and clinical sciences education

Background: Medical education has traditionally been compartmentalized into basic and clinical sciences, with the latter being viewed as the skillful application of the former. Over time, the relevance of basic sciences has become defined by their role in supporting clinical problem solving rather than being, of themselves, a defining knowledge base of physicians.Methods: As part of the national Future of Medical Education in Canada (FMEC MD) project, a comprehensive empirical environmental scan identified the timing and integration of basic sciences as a key pressing issue for medical education. Using the literature review, key informant interviews, stakeholder meetings, and subsequent consultation forums from the FMEC project, this paper details the empirical basis for focusing on the role of basic science, the evidentiary foundations for current practices, and the implications for medical education.Findings: Despite a dearth of definitive relevant studies, opinions about how best to integrate the sciences remain strong. Resource allocation, political power, educational philosophy, and the shift from a knowledge-based to a problem-solving profession all influence the debate. There was little disagreement that both sciences are important, that many traditional models emphasized deep understanding of limited basic science disciplines at the expense of other relevant content such as social sciences, or that teaching the sciences contemporaneously rather than sequentially has theoretical and practical merit. Innovations in integrated curriculum design have occurred internationally. Less clear are the appropriate balance of the sciences, the best integration model, and solutions to the political and practical challenges of integrated curricula.Discussion: New curricula tend to emphasize integration, development of more diverse physician competencies, and preparation of physicians to adapt to evolving technology and patients’ expectations. Refocusing the basic/clinical dichotomy to a foundational/applied model may yield benefits in training widely competent future physicians.

Migration of “bioabsorbable” screws in ACL repair. How much do we know? A systematic review

Although bioabsorbable screws promise to degrade within months up to several years after implantation, often this does not happen. In fact, other problems such as screw breakage, tunnel enlargement, allergic or foreign body reactions, cyst or abscess formation, and delayed migration of "biodegradable" screws have been reported. This study aims to provide relevant basic science knowledge and recent insights concerning "biomaterials" currently used in fixation devices for anterior cruciate ligament (ACL) repair. A systematic review on the topic of screw "migration" is provided. A PubMed search combining all the key terms was done looking for complications related to late migration of "bioabsorbable" screws used in ACL reconstruction without inferior time limitation up to January 2012. Only clinical reports were included. Reference lists of reports were checked to detect others not identified by the original search. A pre-publication search was performed to identify the most recent relevant articles. A total of ten articles referred to migration of "bioabsorbable" interference screws. Most cases reported on poly-L-lactic acid-based screws. Migration was noticed between 3 and 22 months postoperatively. It was noticed both in the tibia and the femur and with the application of several types of graft. Migration is a possible complication of "bioabsorbable" interference screws. The information related to all clinical implications of the so-called "biodegradable screws" remains scarce and probably suffers from the phenomenon of publication bias. The complexity of possible reactions occurring in the human body is difficult to reproduce under controlled laboratory conditions.