UK recommendations on undergraduate medical education and the Flying Wallendas.
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Curriculum↗
Biomedical subjects
M H Davis
Publications and source records attributed to M H Davis.
Leadership in education and the strategy of the dolphin.
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Administrative Personnel↗
Susceptibility-induced loss of signal: comparing PET and fMRI on a semantic task.
Functional magnetic resonance imaging (fMRI) has become a popular tool for investigations into the neural correlates of cognitive activity. One limitation of fMRI, however, is that it has difficulty imaging regions near tissue interfaces due to distortions from macroscopic susceptibility effects which become more severe at higher magnetic field strengths. This difficulty can be particularly problematic for language tasks that engage regions of the temporal lobes near the air-filled sinuses. This paper investigates susceptibility-induced signal loss in the temporal lobes and proposes that by defining a priori regions of interest and using the small-volume statistical correction of K. J. Worsley, S. Marrett, P. Neelin, A. C. Vandal, K. J. Friston, and A. C. Evans (1996, Hum. Brain Mapp. 4: 58-83), activations in these areas can sometimes be detected by increasing the statistical power of the analysis. We conducted two experiments, one with PET and the other with fMRI, using almost identical semantic categorization paradigms and comparable methods of analysis. There were areas of overlap as well as differences between the PET and fMRI results. One anticipated difference was a lack of activation in two regions in the temporal lobe on initial analyses in the fMRI data set. With a specific region of interest, however, activation in one of the regions was detected. These experiments demonstrate three points: first, even for almost identical cognitive tasks such as those in this study, PET and fMRI may not produce identical results; second, differences between the two methods due to macroscopic susceptibility artifacts in fMRI can be overcome with appropriate statistical corrections, but only partially; and third, new data acquisition paradigms are necessary to fully deal with susceptibility-induced signal loss if the sensitivity of the fMRI experiment to temporal lobe activations is to be enhanced.
Adult↗
An evaluation of CASES--an educational audit programme for orthodontists.
A regional approach to a national clinical audit programme in orthodontics in the UK is described and evaluated. The programme was designed using the CRISIS criteria for effective continuing education. Programme participants completed duplicate questionnaires on 6 simulated patient scenarios, chosen for their relevance to everyday practice while posing important clinical dilemmas. The participation rate was 77% from hospital-based practitioners and 29% from specialist practitioners. Feedback to programme participants was given in the form of histograms, and provided a snapshot of national approaches to patient investigation, treatment and expected outcomes. A commentary on the data and references to appropriate articles in the literature were included. Evaluation of the programme by questionnaire survey showed that it was extensively used by hospital-based practitioners. It is concluded that the model used provided an effective and efficient framework for conducting clinical audit and delivering continuing education to the hospital-based group.
Adult↗
Task-based learning: the answer to integration and problem-based learning in the clinical years.
INTRODUCTION: Integrated teaching and problem-based learning (PBL) are powerful educational strategies. Difficulties arise, however, in their application in the later years of the undergraduate medical curriculum, particularly in clinical attachments. Two solutions have been proposed - the use of integrated clinical teaching teams and time allocated during the week for PBL separate from the clinical work. Both approaches have significant disadvantages. Task-based learning (TBL) is a preferred strategy. In TBL, a range of tasks undertaken by a doctor are identified, e.g. management of a patient with abdominal pain, and these are used as the focus for learning. Students have responsibility for integrating their learning round the tasks as they move through a range of clinical attachments in different disciplines. They are assisted in this process by study guides. METHOD: The implementation of TBL is described in one medical school. One hundred and thirteen tasks, arranged in 16 groups, serve to integrate the student learning as they rotate through 10 clinical attachments. RESULTS: This trans-disciplinary approach to integration, which incorporates the principles of PBL offers advantages to both teachers and students. It recognizes that clinical attachments in individual disciplines can offer rich learning opportunities and that such attachments can play a role in an integrated, as well as in a traditional, curriculum. In TBL, the contributions of the clinical attachments to the curriculum learning outcomes must be clearly defined and tasks selected which will serve as a focus for the integration of the students' learning over the range of attachments.
Clinical Clerkship↗
Approaches to eliminating sociocultural disparities in health.
The recent flurry of studies documenting the presence of racial, ethnic, and socioeconomic disparities in health care and health have outpaced articles that describe effective strategies to eliminate disparities. Through literature review and informal interviews with research, policy, and program experts, we developed a framework of programs that address disparities through targeting clinicians, patients and communities, and health systems. We found that the lack of technical expertise, resources, and sensitive tools are all common barriers to evaluating programs. To stimulate more effective programs and rigorous evaluations, we describe specialized implementation and evaluation techniques programs can use, and make recommendations for future efforts.
Cultural Diversity↗
Empathy, expectations, and situational preferences: personality influences on the decision to participate in volunteer helping behaviors.
Although considerable evidence indicates that dispositional empathy is associated with the degree of help that observers will offer needy targets, little is known about the effect of empathy on one's initial willingness to enter situations in which such needy targets might be found. Three studies were conducted to evaluate two related propositions: (1) that dispositional empathy influences such situational preferences, and (2) that this influence is mediated by the expectancies one holds regarding the emotions likely to occur in those situations. Using hypothetical judgments, Study 1 found support for both propositions. Study 2, in which participants believed that their responses actually committed them to encountering needy targets, provided further support for the model, as did Study 3, which examined the experiences of actual community volunteers. The theoretical and practical implications of these findings are discussed.
Adult↗
Relationship-specific and global perceptions of social support: associations with well-being and attachment.
Is one's global sense of social support largely a summation of the support perceived to exist within current social relationships, or is it a trait-like construct independent of current support levels? To address this issue, 183 college students completed measures of global support, support from four different social domains, attachment style, and several measures of well-being. Hierarchical regression analyses revealed that for two well-being measures (global and social loneliness), both global and domain support displayed significant unique associations; for emotional loneliness, only domain support had a significant unique influence. For the well-being measure reflecting generalized negative affect, only global support displayed such a unique association. Thus, global and domain support appear to be, to a considerable degree, independent constructs, each with its own sphere of influence in affecting well-being.
Adaptation, Psychological↗
An adult with a severe Class II division 1 malocclusion: Frances' case.
This article describes treatment options for an adult with a severe Class II division 1 malocclusion. The opinions of British orthodontists, as obtained through the CASES project, are summarized and the patient's actual treatment is discussed.
Adult↗
An adolescent with a Class II division 2 malocclusion complicated by unerupted palatal canines: Linda's case.
This article describes treatment options for a teenager with a class II division 2 malocclusion complicated by unerupted and palatally displaced upper canines. The opinions of British orthodontists, as obtained through the CASES project, are summarized and the patient's actual treatment is discussed.
Child↗
CASES--clinical audit; scenarios for evaluation and study.
CASES, an audit and continuing education programme, evaluated aspects of current orthodontic practice and allowed orthodontists to identify areas where their practice differed from regional and national results. Evaluation of the CASES programme verified its value in audit and continuing education and the authors hope it will encourage similar projects in other disciplines too.
Adolescent↗
A physics-based coordinate transformation for 3-D image matching.
Many image matching schemes are based on mapping coordinate locations, such as the locations of landmarks, in one image to corresponding locations in a second image. A new approach to this mapping (coordinate transformation), called the elastic body spline (EBS), is described. The spline is based on a physical model of a homogeneous, isotropic three-dimensional (3-D) elastic body. The model can approximate the way that some physical objects deform. The EBS as well as the affine transformation, the thin plate spline [1], [2] and the volume spline [3] are used to match 3-D magnetic resonance images (MRI's) of the breast that are used in the diagnosis and evaluation of breast cancer. These coordinate transformations are evaluated with different types of deformations and different numbers of corresponding (paired) coordinate locations. In all but one of the cases considered, using the EBS yields more similar images than the other methods.
Brain↗
The new Dundee medical curriculum: a whole that is greater than the sum of the parts.
The medical undergraduate curriculum at the University of Dundee has evolved in response to changing needs. The new curriculum, introduced in 1995, combines idealism and pragmatism. Underpinning it is the concept that the curriculum is an educational programme where the whole is greater than the sum of the parts. The concepts contributing to this are: the spiral nature of the curriculum, with its three interlocking phases; a body-system-based approach, with themes running through the curriculum, providing a focus for the students' learning; a core curriculum with special study modules or options; the educational strategies adopted, including elements of problem-based and community-based learning and approaches to teaching and learning that encourage the students to take more responsibility for their own learning; an approach to assessment which emphasizes the overall objectives of the course; an organization and management of the curriculum; and an allocation of resources designed to support the educational philosophy.
Community Medicine↗
How to do it: making audit work.
The orthodontic Audit Working Party of the Faculty of Dental Surgery, Royal College of Surgeons of England, in collaboration with the Centre for Medical Education, Ninewells Hospital and Medical School, Dundee developed an audit project entitled 'Clinical Audit: Scenarios for Evaluation and Study'. The aim of the project was to contribute to the construction of clinical guidelines for orthodontists. This article, the first of a short series, describes the background to and general results of the study. Further articles will study individual aspects of the project.
Adult↗
Early treatment of Class III malocclusion? Colin's case.
This is the first of six simulated case reports accompanying the questionnaire detailed in the article 'How to Do It: Making Clinical Audit Work' found earlier in this issue. You will find comprehensive discussion of the problem of making a decision about the early treatment of Class III malocclusion.
Age Factors↗
An extraction dilemma: Cheryl's case.
This article describes treatment options for a teenager with a mild, although aesthetically unpleasing, malocclusion. The opinions of British orthodontists, as obtained through the CASES project, are summarized and the patient's actual treatment is discussed.
Adolescent↗
Hypodontia: George's case.
Five questions are posed regarding the treatment of a patient with hypodontia. The treatment options are discussed, and the actual treatment carried out demonstrated. The treatment preferences of British Orthodontists, elicited through the CASES project, are also included.
Anodontia↗
Electroconvulsive therapy in the very old.
At least one study has questioned the safety of electroconvulsive therapy (ECT) in the very old. In this study, the authors reviewed a 5-year experience with ECT at two university psychiatric services for patients 75 years of age or older. Both outcomes and complications were reviewed. Nineteen of 22 patients (86.3%) were ECT responders. Five patients (22.7%) suffered complications which varied from minor to substantial. ECT was found to be an effective and reasonably safe treatment for depression in the very old.
Aged↗