Medical education--a look into the future.
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Education, Medical↗
Biomedical subjects
K C Calman
Publications and source records attributed to K C Calman.
The pre-registration house officer year: a critical incident study.
To define the major problems faced by pre-registration house officers, 328 critical incidents from 200 house officers and related staff were collected. Each incident was analysed and key words representing the main features were abstracted. These were then aggregated into eight broad categories; personal aspects, clinical skills, communication and relationships, problem-related, organization skills, education, dying patients, and administration. Further analysis of the incidents suggested a series of conclusions which include the need for effective supervision of the house officer with feedback on performance. An induction/orientation period is necessary; there is evidence that a proportion of house officers need additional experience of practical procedures; house officers often have difficulty in setting priorities and they have little experience, prior to qualification, of organizational skills; during the year they are very busy with little time off. Facilities and accommodation may be less than adequate. They perceive a lack of support from senior staff to help with personal problems and career guidance; they are conscious that communication skills are of great importance and would like additional help with this; there is little time for formal education during the year. The range of clinical material presented is enormous, however, and the challenge for medical education is to ensure that the opportunities for learning are not missed.
Clinical Competence↗
The Peter Lowe Lecture--medicine in the 1990s.
This paper set out to examine the role of medicine and medical practice. It has done so by posing a series of questions related to the role of the doctor, health and health care, and the patient-doctor relationship. One of the objectives was to re-examine some of the principles of medical practice, another to consider a vision of medicine for the future. The result of this examination has not turned up anything particularly new or original. What it has done, I believe has been to endorse the principles of medicine which have been established for thousands of years. Yet perhaps in some ways they need to be re-asserted and discussed afresh. Because of the enormous changes in society, in health care and the external and internal pressures on doctors, such values can be forgotten or lost. Change is inevitable and doctors must adapt to meet the changes. They must do so in a positive way and wherever possible take the lead in shaping the health and health care of the future. The values of the future are those of the past, though the setting and context may be quite different. These values include, the importance of caring, the central role of communication, the need to be involved in health as well as illness, the implications of making a diagnosis and the fundamental nature of education and training. There is a need to retain common sense and perspective in making decisions. My vision of the future of medicine is therefore clear.(ABSTRACT TRUNCATED AT 250 WORDS)
Clinical Medicine↗
Information technology in postgraduate medical education.
Information technology in postgraduate medical education has developed rapidly over the last 5 years. This report describes the experience of setting up a computer-based information system in postgraduate centres in the West of Scotland. It includes a viewdata service, library facilities, computer-assisted learning, word processing, and statistics. An electronic mail system provides rapid communication between users. The costing and some of the problems in setting up such systems are discussed.
Education, Medical, Graduate↗
A computerised medical manpower database--an assessment of its value in medical education.
The development of a computerised medical and dental manpower database for medical education in the West of Scotland is described. The purpose of the database is to provide the West of Scotland Committee for Postgraduate Medical Education with information on the career patterns of doctors and dentists, and to assist in the planning of training. Data collection is from a wide variety of sources and confidentiality and security are paramount. A standing committee, representing all professional interests, has been central to the development of the database. It has acted as policy-maker and adviser, and has been concerned with the way in which the data is used. At each stage in the development, this committee has been fully consulted. The data collected is both of a personal and professional nature and is validated annually by sending a copy of the data to each doctor or dentist for checking. This has highlighted some deficiencies in the data, which now contains information on over 6,000 doctors and dentists. Requests for information from the database are carefully scrutinised by the standing committee before the data is released.
Career Mobility↗
Memories: a neglected concept in care.
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Family↗
Influence of whole body protein turnover rate on resting energy expenditure in patients with cancer.
Whole body protein turnover and resting energy expenditure are measured simultaneously in weight stable and weight losing patients with lung (n = 22) or colorectal cancer (n = 38). These results were compared with those from weight stable and weight losing non-cancer controls (n = 22). Rates of whole body protein turnover were calculated from the plateau isotopic enrichment of urinary ammonia and urea following a primed, continuous, 24-h infusion of [15N]glycine. Resting energy expenditure was measured by indirect calorimetry. All groups of cancer patients had significantly elevated rates of whole body protein turnover (P less than 0.05) and synthesized, on average, 1.9 g/kg/day more protein compared with weight stable non-cancer controls. In contrast, the resting energy expenditure of cancer patients and controls was similar. Moreover, there was no correlation between individual rates of whole body protein turnover. Thus, although cancer patients had rates of whole body protein turnover which were 50-70% greater than controls, this did not result in a measurable increase in resting energy expenditure. The assumption that elevation of whole body protein turnover or resting energy expenditure causes weight loss in cancer patients must be an oversimplification. An acute phase protein response was observed in the majority of cancer patients. Although the presence of such an inflammatory response did not correlate with the rate of whole body protein turnover, the role of inflammatory mediators in the pathogenesis of disturbed protein metabolism in cancer patients merits further investigation.
Aged↗
Adriamycin, vincristine and mitomycin C as first and second line therapy for advanced breast carcinoma.
Forty-three patients with advanced breast cancer were treated with adriamycin, vincristine and mitomycin C at 6 week intervals. Adriamycin 40 mg m-2 and vincristine 1 mg m-2 were given on days 1 and 22: patients treated early in the study received 10 mg m-2 mitomycin C, but in view of repeated treatment delays the dose was reduced to 6 mg m-2. Thirty-two women had received prior hormone therapy and 24 previous chemotherapy. Responses were seen in 15 of 38 evaluable patients (40%) with a further 9 (24%) achieving disease stabilization. Median duration of response was 10 months and of disease stabilization was 5 months. Overall median survival for the whole group was 8 months, but 16 months for the 15 responding patients, five of whom survived beyond 2 yr. Responses were seen more frequently in patients who had received no prior chemotherapy. Myelosuppression may have contributed to three of the five early deaths in the non-pretreated group. Other significant side effects were alopecia, gastrointestinal toxicity and malaise.
Adult↗
Results of treatment of non seminomatous germ cell tumours; 122 consecutive cases in the West of Scotland, 1981-1985.
Between January 1981 and December 1985, 122 patients with non-seminomatous germ cell tumours (NSGT) were seen at a regional referral centre. Of these, a total of 98 patients received chemotherapy for metastatic disease. Treatment was given within collaborative EORTC Urology group studies, all of which involved cis-platin-containing schedules. Ninety patients had tumours of testicular origin, and their 2 year actuarial survival rate is 91%; 8 had tumours of extragonadal origin and their 2 year actuarial survival is 25%. Patients with testicular tumours were subdivided by volume of metastatic disease using the recommendations of the Testicular Cancer Subgroup of the MRC Urological Cancer Working Party and survival was significantly worse in the group with very large volume metastatic disease (VLVM, 57%) compared with the groups with large volume metastases (LVM, 100%) and small volume metastases (SVM, 98%). There were 31 patients with Stage I disease at presentation; of these 6 were treated by prophylactic abdominal radiotherapy and 25 were managed by a policy of surveillance only. Seven of these Stage I patients (23%) relapsed with metastatic disease (median 8 months); all have been successfully treated with chemotherapy. These data confirm that the majority of patients now presenting with metastatic NSGCT are curable with chemotherapy, but that a small proportion with very large volume metastases or extragonadal tumours require alternative chemotherapy schedules.
Antineoplastic Combined Chemotherapy Protocols↗
Cancer cachexia: influence of systemic ketosis on substrate levels and nitrogen metabolism.
The aim of this study was to determine whether a ketogenic diet could decrease nitrogen losses in cachectic cancer patients and at the same time reduce the supply of glucose for tumor energy metabolism. Five patients with malignant disease and severe weight loss (mean 32%) were fed via a fine bore nasogastric tube. A normal diet was given for 6 d and this was followed by 7 d of an isonitrogenous, isocaloric, ketogenic diet. Both diets were well tolerated. At 7 d the mean ketone body concentration in the blood of patients fed the ketogenic diet was 1.21 +/- 0.33 mM. This ketosis was associated with a significant reduction of the concentration in blood of glucose, lactate, and pyruvate (p less than 0.05). There was, however, no significant alteration in host N balance or whole-body protein synthesis, degradation, or turnover rates. Whether the change from glucose- to fat-derived energy substrates might reduce tumor growth rates in the long term remains to be determined.
Acidosis↗
Literature and medicine: a short course for medical students.
A course on literature and medicine for medical students is described. A wide range of books, plays and poems were used with medical and non-medical themes. Students enjoyed the course and particularly welcomed the non-medical components. The staff learned at least as much as the students. Several book lists were developed with input from the students. Such a course might have a part to play in several parts of the medical course, such as in the teaching of ethics.
Attitude of Health Personnel↗
Education and training in medicine.
Education and training are terms which are often used loosely, interchangeably, and require definition. Training is often seen as a series of activities which are related to the acquisition of specific skills and may be narrowly based. Education, on the other hand, has an important value base and is broader in concept. The arguments for and against an 'educated' doctor or a 'trained' doctor are considered, and it is concluded that for medical practice both education and training are required. The implication of this for the preparation of doctors and for their continuing learning is considered.
Education, Medical↗
Professionalism in graduate medical education.
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Education, Medical, Graduate↗
Palliative medicine: on the way to becoming a recognized discipline.
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Humans↗
Reduction of the growth rate of the Walker 256 tumor in rats by rhodamine 6G together with hypoglycemia.
Previous attempts to use tumor energy metabolism as a target for antineoplastic therapy have used single agents aimed at inhibiting either glycolysis or oxidative phosphorylation. Since most tumor cells use both pathways for energy production, this approach is unlikely to succeed. The aim of this study was to simultaneously manipulate both sources of intracellular ATP to achieve more selective control of tumor growth. Rhodamine 6G (R6G) is a fluorochrome mitochondrial dye which inhibits oxidative phosphorylation. 3-Mercaptopicolinic acid inhibits gluconeogenesis and is a potent hypoglycemic agent in the fasting state. Dose-response relationships were established for R6G and 3-mercaptopicolinic acid, and a nontoxic dose of the compounds was selected for subsequent experiments. Thereafter, groups of rats (n = 7 per group) underwent s.c. implantation of Walker 256 carcinosarcoma. Following a 24-h fast each group received either saline, R6G (0.8 mg/kg), 3-mercaptopicolinic acid (40 mg/kg), or the combination given i.p. Seven days after tumor implantation animals were sacrificed, and tumors were exercised and weighed. Administration of R6G during a period of hypoglycemia significantly reduced the tumor growth rate when compared to control experiments (3.6 +/- 0.3 g cf. 7.1 +/- 0.7 g, mean +/- SE; P less than 0.05). In contrast, neither R6G nor the period of hypoglycemia alone significantly affected tumor growth. These results suggest that simultaneous manipulation of oxidative phosphorylation and glycolysis may be used to selectively inhibit tumor growth in vivo.
Adenosine Triphosphate↗
Practical problems in the teaching of ethics to medical students.
Some practical problems in the teaching of ethics to medical students are described. The definition of the objectives of the course remains the central aspect, and is more important than the specific content. The use of student projects, buzz groups, case histories and discussion points is described. There is a need for student assessment or examination at the end of the course. The teachers require a broad background in philosophy, clinical medicine and teaching skills. The learning of the teachers may be as important as that of the students.
Curriculum↗
Adjuvant radiotherapy and chemotherapy in breast cancer.
Three hundred and twenty-two women with involvement of axillary lymph nodes following surgery for operable breast cancer were randomized to receive either postoperative radiotherapy, chemotherapy (CMF) or radiotherapy followed by chemotherapy. There was an increase in disease free interval in pre- and postmenopausal patients receiving radiotherapy and chemotherapy regardless of the number of nodes involved. However, there was a trend towards an improvement in disease related survival only in those patients with more than three nodes involved.
Aged↗