Essay-writing as a teaching technique.
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The history of medicine is always written from the basis of the historian. Contemporary historiography provides an understanding of the major methods of historical analysis and their influences on the writing of medical history. Medical history in the 20th century has emphasized the historiographic methods of the history of great men, historicism, social history, and intellectual history. Each methodology has inherent biases that influence the historian's analysis of the past. Understanding the historian's biases provides the reader important tools for the interpretation of medical history.
Medication use errors are the largest single source of preventable adverse events. To minimize the risk of medication use errors, obstetrician-gynecologists should focus on several elements of medication order writing, such as the appropriate use of decimals and zeros, standard abbreviations, and assuring legibility. Additionally, it is important to assist the patient in understanding the medical condition for which a medication is prescribed. Focusing on elements that may prevent prescription errors and helping patients understand how to use prescribed medication properly may help lower the occurrence of medication use errors.
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John Gregory (1724-73) wrote the first modern, professional medical ethics in the English language, appearing as Lectures on the Duties and Qualifications of a Physician in 1772. This paper examines Gregory's medical ethics as a blend of modern methods of medical science and ethics with premodern ideas. The paper begins by situating Gregory's medical ethics in the context of both private medical practice and the care of patients at the Royal Infirmary of Edinburgh, focusing on the crisis of intellectual and moral trust that prompted Gregory to lecture and write on medical ethics. Drawing on the modern methods of Francis Bacon's philosophy of medicine, and David Hume's science of morals, Gregory bases his medical ethics on the complementary capacities of openness to conviction and sympathy. His moral exemplars of the virtues of candour, steadiness, and tenderness were women of learning and virtue, reflecting the premodern idea of chivalry in the life of service to the sick.
BACKGROUND: The scientific article in the health sciences evolved from the letter form and purely descriptive style in the seventeenth century to a very standardized structure in the twentieth century known as introduction, methods, results, and discussion (IMRAD). The pace in which this structure began to be used and when it became the most used standard of today's scientific discourse in the health sciences is not well established. PURPOSE: The purpose of this study is to point out the period in time during which the IMRAD structure was definitively and widely adopted in medical scientific writing. METHODS: In a cross-sectional study, the frequency of articles written under the IMRAD structure was measured from 1935 to 1985 in a randomly selected sample of articles published in four leading journals in internal medicine: the British Medical Journal, JAMA, The Lancet, and the New England Journal of Medicine. RESULTS: The IMRAD structure, in those journals, began to be used in the 1940s. In the 1970s, it reached 80% and, in the 1980s, was the only pattern adopted in original papers. CONCLUSIONS: Although recommended since the beginning of the twentieth century, the IMRAD structure was adopted as a majority only in the 1970s. The influence of other disciplines and the recommendations of editors are among the facts that contributed to authors adhering to it.
INTRODUCTION: There is growing interest in methods of teaching critical appraisal skills at undergraduate and postgraduate levels. We describe an approach using a journal club and subsequent letter writing to teach critical appraisal and writing skills to medical undergraduates. METHODS: The exercise occurs during a 3-week public health medicine attachment in the third year of the undergraduate curriculum. Students work in small groups to appraise a recently published research paper, present their findings to their peers in a journal club, and draft a letter to the journal editor. Evaluation took place through: informal and formal feedback from students; number of letters written, submitted and published, and a comparison of marks obtained by students submitting a literature review assignment with and without critical appraisal teaching during the public health attachment. RESULTS: Feedback from students was overwhelmingly positive. In the first 3(1/2) years, 26 letters have been published or accepted for publication, and 58 letters published on the Internet. There were no significant differences in overall marks or marks for the critical appraisal component of the literature review assignments between the two student groups. DISCUSSION: We believe our approach is an innovative and enjoyable method for teaching critical appraisal and writing skills to medical students. Lack of difference in marks in the literature review between the student groups may reflect its insensitivity as an outcome measure, contamination by other critical appraisal teaching, or true ineffectiveness.
Sir Geoffrey Keynes (1887 - 1982), was a pioneer in the surgery of breast cancer and thymic deseases, n.b. in patients suffering from myastenia gravis. He strongly disapproved of the longstanding dogma of so called radical mastectomy in breast cancer, and advocated a more limited surgical approach, followed by radiation therapy. This was done more than fifty years before breastconserving surgery has become the therapy of choice and against considerable opposition from the surgical establishment of his days. He also became a pioneer in the surgical treatment of myastenia gravis by thymectomy, at a time when there was no real understanding of the pathophysiology of the disease and when considerable controversy existed as to the importance or non importance of concomitant tumour formation in the thymus. Besides being a busy surgeon Sir Geoffrey was a medical historian, writing the biography of among others William Harvey, a bibliographer with a special interest in the poet and artist William Blake and a bibliophil with a large book collection of great value to medical history.
Brachial plexus injuries may occur in association with or without recognised shoulder dystocia. Until recently many medico-legal experts argued that these injuries resulted from the negligent use of excessive or misdirected traction. These experts did not accept that the natural forces of labour could cause the injury. In cases of recognised shoulder dystocia, modern obstetric practice has recognised the importance of correct maternal positioning and the need to avoid excessive or misdirected traction, also the importance of not applying a rotational force to the fetal head. Informed practice and the increased use of caesarean section has not reduced the number of brachial plexus injuries. Judges in two recent trials found that the natural forces of labour were the cause of the injury and that the birth assistants had not caused the damage. This has important implications for medical note writing, teachers and risk managers, medico-legal experts and lawyers.
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A randomized, controlled trial compared writing about emotional topics (EMO) to writing about goals as the "best possible self" (BPS; after King, 2001) and evaluated emotional approach coping, i.e., efforts to cope through processing and expressing emotion, as a moderator of writing effects on psychological and physical health in 64 third-year medical students. In participants with higher baseline hostility, the EMO condition was associated with less hostility at 3 months compared to the BPS and control conditions. Emotional processing (EP) and emotional expression (EE) moderated the effect of experimental condition on depressive symptoms at 3 months; high EP/EE participants reported fewer depressive symptoms in the EMO condition, whereas low EP/EE individuals reported fewer depressive symptoms in the BPS condition compared to the EMO and control conditions. A moderating effect of EP on physical health was also identified, such that low EP individuals who wrote about goals (BPS) had fewer health care visits at 3 months compared to low EP participants in the EMO and control conditions.