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[School medicine: dynamic aspects of a discipline].

School health is evolving according to new knowledge, variations of pathology and epidemiology, scattering of responsabilities as to diagnosis and treatment, progressive coverage of school career, and diverse professional training of the physicians involved. As part of social and preventive medicine does it still correspond to a common denominator? If we pretend so we give the school physician "sensu stricto" a primordial position. But then we ought to formulate new directions inspired by the light of permanent reflexion what youth are expecting from the physician in their situation of students. Today pupil adaptation to school and adaptation of the latter to our young pupils ranks first, with a specific medico-social and pedagogical assistance focused on primary prevention. Therefore collective awareness of school physicians under the auspices of the Swiss Society of Social and Preventive Medicine is welcome.

Communicable Disease Control↗

Full time adult credential students' instructional preferences at California State University, Long Beach: pedagogy orandragogy?

This study investigated the instructional preferences of full time adult credential students after they took a live course called Principles of Adult Education at California State University, Long Beach (CSULB) in the fall semester of 2002. These full time adult credential students had been working on their adult teaching credentials to meet the competencies specified by the California Commission on Teacher Credentialing. The course introduced students to Andragogy developed by Malcolm Knowles out of the andragogical model developed by Lindeman (1926). The study used Principles of Adult Learning Scales (PALS), advanced by Gary Conti in 1983 to measure instructional preferences. Data were collected from 30 (100% of 30) full time adult credential students enrolled in a live course to determine their instructional preferences of helping adults learn. The results of the study showed in most cases these adult learning professionals taught adult students andragogically; in some cases they taught adult students pedagogically.

California↗

The excitability of plant cells: with a special emphasis on characean internodal cells.

This review describes the basic principles of electrophysiology using the generation of an action potential in characean internodal cells as a pedagogical tool. Electrophysiology has proven to be a powerful tool in understanding animal physiology and development, yet it has been virtually neglected in the study of plant physiology and development. This review is, in essence, a written account of my personal journey over the past five years to understand the basic principles of electrophysiology so that I can apply them to the study of plant physiology and development. My formal background is in classical botany and cell biology. I have learned electrophysiology by reading many books on physics written for the lay person and by talking informally with many patient biophysicists. I have written this review for the botanist who is unfamiliar with the basics of membrane biology but would like to know that she or he can become familiar with the latest information without much effort. I also wrote it for the neurophysiologist who is proficient in membrane biology but knows little about plant biology (but may want to teach one lecture on "plant action potentials"). And lastly, I wrote this for people interested in the history of science and how the studies of electrical and chemical communication in physiology and development progressed in the botanical and zoological disciplines.

Action Potentials↗

'Miracle in Iowa': metaphor, analogy, and anachronism in the history of bioethics.

The term 'bioethics' is commonly associated with debates prompted by innovations in medical technology, yet the issues raised by bioethics are not that new. They concern the extent to which medicine and social morality exist in harmony or opposition--issues routinely addressed in the social history of medicine. This paper will argue that historical thinking, understood broadly, has a significant role to play in understanding relations between medicine and social morality, and therefore in contemporary bioethics. It explores past and present uses of metaphor and analogy in shaping perceptions of scientific innovation, and argues for the validity of apparently anachronistic thinking in our judgments of the past. The aims of this paper are ultimately pedagogical: to enable students to look at media reports about developments in medicine and biotechnology in order to problematise what are presented as the self-evident terms of current debate.

Bioethics↗

[Evaluation of traditional German undergraduate surgical training. An analysis at Heidelberg University].

BACKGROUND: The medical faculty of Heidelberg University implemented a new problem-based clinical curriculum (Heidelberg Curriculum Medicinale, or Heicumed) in 2001. The present study analyses the evaluation data of two student cohorts prior to the introduction of Heicumed. Its aim was to specify problems of the traditional training and to draw conclusions for implementation of a new curriculum. METHODS: The evaluation instrument was the Heidelberg Inventory for the Evaluation of Teaching (HILVE-I). The data were analysed calculating differences in the means between defined groups, with the 13 primary scales of the HILVE I-instrument as dependent variables. RESULTS: Teaching method and subject had no systematic influence on evaluation results. Thus, didactic lecture in orthopedic surgery achieved better results than small group tutorials, while the data on vascular and general surgery showed opposite results. Major factors for success were continuity and didactic training of lecturers and tutors. This is convincingly reflected by the results of the lecture course "Differential diagnosis in general surgery". The good evaluation data on small group tutorials resulted largely from the "participation" and "discussion" scales, which represent interactivity in learning. CONCLUSION: The results of the present study suggest the importance of two major pedagogic ideas: continuity and didactic training of lecturers and tutors. These principles were widely implemented in Heicumed and have contributed to the success of the new curriculum.

Attitude of Health Personnel↗

[Koenen, Kothe and peri-ungual fibroma in tuberous sclerosis].

The periungual fibromas in tuberous sclerosis are also known as Koenen tumors. Joannes Henricus Maria Koenen was born on March 10, 1893, in Eindhoven and died in Bois-le-Duc May 29, 1956. From 1910 to 1918 he studied medicine at the University of Amsterdam. Then he worked as a physician at the "Coude-water" asylum in Rosmalen and from 1929 in the "Voorburg" asylum in Vught. In 1932 he published his publication concerning a family with tuberous sclerosis in which photographs of periungual fibromas are shown. His thesis in 1933 at the University in Leiden was titled "Imbecility in children. Its Importance in pedagogic and social regard, by reason of an investigation in some communities in Noord-Brabant". Later he was appointed director of a state mental institution. The periungual fibromas in tuberous sclerosis were first described by Richad Kothe in Munich in 1903.

Fibroma↗

[Migrant patients in forensic psychiatry. An epidemiological survey from Baden-Württemberg].

The treatment of mentally ill migrants is being increasingly discussed in general psychiatry and psychotherapy. Most studies show that this group under-utilizes the mental health system. This first epidemiological survey of the German forensic system shows a higher percentage of migrant patients than in the general population. Reasons for this development are discussed. In clinical practice, the migrant patients require special therapeutic and pedagogic options including specific legal advice.

Crime↗

[Therapeutic possibilities in functional disorders of micturition].

Functional voiding disturbances can be due to failure of the detrusor or to discoordinated sphincter function during micturition. Therapeutical options are directed either to strengthening the contraction up to an adequate magnitude or to lowering the voiding resistance or can be aimed at influencing both. In a brief survey mechanical, pedagogical, electrotherapeutical, and surgical measures as well as drug treatment are critically examined. Conservative methods should always be attempted before surgical procedures are performed. Depending on the degree of severity and the etiology of the disease, a combined therapy can be useful. In the case of resistance to therapy, intermittent autocatheterism is to be preferred to permanent deviation via an indwelling catheter.

Humans↗

Social phobia in Swedish university students: prevalence, subgroups and avoidant behavior.

BACKGROUND: Public speaking is a common situation that university students have to endure. This situation is feared or avoided by most individuals with social phobia, which has been associated with low levels of educational attainment. However, epidemiological data on social phobia in university students are scarce. The present study examined the prevalence of social phobia and its subgroups in a university student population. Demographic characteristics and avoidant behavior in educational settings were also examined. METHODS: The Social Phobia Screening Questionnaire (SPSQ)--a validated and DSM-IV compatible instrument, was distributed as a postal survey to 753 randomly selected university students in Sweden. Interpretable questionnaires were obtained from 523 students (69.5%). To investigate subgroups, students who met the SPSQ diagnostic criteria of social phobia were analyzed by hierarchical cluster analysis. RESULTS: The point prevalence of social phobia among the Swedish university students was 16.1%, comparable with 15.6% previously reported for the general population. Two clusters were distinguished consisting of students scoring either low (discrete subgroup) or high (generalized subgroup) on all cluster variables. The discrete subgroup was more common representing 83% of the cases. Social phobia was associated with use of dysfunctional avoidant strategies in educational situations and in anticipation of public speaking. The disorder was less common among students following a pedagogic university program. CONCLUSIONS: Social phobia was highly prevalent among Swedish university students, most cases pertaining to a mild or discrete form of the disorder. The commonness and severity of social phobia in students did not deviate significantly from the general population suggesting that socially anxious individuals do apply for higher education. However, since avoidance and low educational attainment are commonly reported features, future studies should investigate whether sufferers of social phobia underachieve or abolish their studies prematurely.

Adolescent↗

Computer-based learning--an aid to successful teaching of pharmacology?

Various types of software have been developed for use in pharmacology courses. These include: simple drill (question and answer) software; electronic books; video material; tutorial type programs; simulations; and electronic learning environments for course organisation and delivery. These different types of software can be used in different ways to achieve very different learning objectives and gains in teaching efficiency. For example, software can be used: in tutorial and small group teaching; in lectures; to better prepare students for practical work; as a replacement for practicals; to provide options within a limited course structure; to supplement lectures and enable students to work at their own pace; to provide ongoing access to self-assessment throughout a course; to aid distance learning; as remedial teaching and to extend the student learning experience in areas which are too expensive or too time consuming or for which staff expertise does not exist. Evidence indicates that it is insufficient simply to make computer based learning material available to students. Like a laboratory class, it must be fully integrated into a module if real benefits are to be obtained. Students need to be taught how to learn from computer-based learning materials and how to integrate this learning tool in their learning strategy. Teachers need to be supported not only with information about the availability of software but, equally importantly, about how it can be integrated into modules. We are all delivering teaching and facilitating learning in a changing environment and subject to a variety of increasing pressures. It may well be that computer based learning materials may help to maintain a high quality of pharmacology teaching within this changing environment but we need more pedagogical research at the discipline level to establish how this can best be done.

Animals↗

Inclusion of a competency-based curriculum in medical pharmacology.

Medical education programs have emphasized the acquisition of basic scientific knowledge and practical skills in well-defined subject areas using lecture and role modeling as the principle means of instruction. The need to address changes in the practice environment, the recognition that alternative instructional models may be desirable in some cases, and the fact that instruction in the traditional subject areas does not prepare students for all aspects of medical practice have driven recent curricular changes at many schools. Indiana University School of Medicine, with multiple instructional sites distributed throughout the state, has adopted a school-wide plan that specifies desired educational outcomes and provides an instrument for rating student achievement. In this report we describe the implementation of new media and pedagogical methods in a two-semester medical pharmacology course with the goal of fostering and assessing competency in the nine areas outlined in this educational plan. The general conclusion is that these changes not only furthered the broader educational goals of the competency-based curriculum, but also may exert a positive influence on student learning of discipline-specific material.

Competency-Based Education↗

Problem-based learning and teaching of medical pharmacology.

In the Faculty of Health Sciences at McMaster University, the traditional discipline-based boundaries dividing the teaching and learning of basic medical sciences, such as physiology and pharmacology, do not exist. For more than 3 decades, student-centered, self-directed problem-based learning (PBL) has been the main form of instruction for students learning pharmacology within the medical curriculum and the pharmacological issues are always embedded within a health-care problem, with consideration of many other relevant non-pharmacological issues. In PBL, pedagogic emphasis is placed on the process of learning via constructive inquiry rather than cumulative acquisition of factual knowledge. For the science students, typically in the Biology/Pharmacology cooperative courses, both student-centered learning and teacher-centered teaching approaches are being used. In this case, the PBL approach is adopted to complement the conventional lectures at the course level. For medical students, PBL continues to be the major form of instruction in a small-group tutorial setting at the curricular level. The PBL curriculum is integrated across organ systems (cardiovascular, renal, respiratory, gastrointestinal, neural, etc) and across the life cycle, spanning population- and behavior-related perspectives, rather than being recreated from discrete disciplinary areas (such as physiology, anatomy, biochemistry, pharmacology, and community medicine). Those students who lack a pharmacology background or wish to enhance their pharmacological knowledge can take a block elective or horizontal elective in pharmacology. Unlike science students, medical students need to sort out pharmacological principles from the overload of information, to integrate them into the clinically relevant situations, and to ultimately apply them to the management of patients' illness. This is most effectively achieved in a student-centered environment conducive to life-long learning.

Education, Medical, Undergraduate↗

Curricular approaches to research ethics training for psychiatric investigators.

RATIONALE: Training in research ethics is crucial for psychiatric investigators. Addressing ethical dimensions of human subjects research requires knowledge about the rules and norms governing research; sensitivity to ethical implications of actions; and skills in ethics problem solving. Investigators in training who are physicians have the additional challenge of developing identities as investigators that sometimes conflict with their identities as physicians. OBJECTIVES: To propose a curriculum for psychiatric research ethics training. METHODS: Review of literature on ethics education and presentation of a curricular approach to research ethics training for psychiatric investigators. RESULTS: Research ethics can be learned and should be taught. Involvement of active investigators in teaching research ethics is important. While core topics of psychiatric research ethics training have not yet been identified, there are available models from which to draw. Research ethics should be introduced early and integrated throughout the research training period. Lack of resources and institutional support can be obstacles to development of comprehensive research ethics curricula. Small-group, case-based discussion is best for teaching ethics problem-solving skills. Examples of teaching module ideas and a fully developed sample teaching module are presented. CONCLUSIONS: There is opportunity for creative models for teaching psychiatric research ethics. Work is needed to identify core topics, target pedagogical strategies to trainees at different levels, and develop evaluation methods.

Bioethics↗

Experimental study of the subtalar joint axis: preliminary investigation.

An experimental study of the subtalar joint has been conducted with the aim of establishing its axis of movement as well as analysing the associated movement. For description of the axis, CT data for five positions of a single foot were reconstructed using a 3D programme, the 3D data was processed by Patran software. Measures of angular displacements were made from three amputated feet placed in a specially constructed foot frame. Four instantaneous axes of movement could be defined. Calculation of displacements showed an important rolling of the calcaneus (45 degrees). Tacking was evident in inversion, with an opposite displacement between the front and rear part of the calcaneus, whereas during eversion tacking affected only the rear part of the bone: these results were confirmed by 3D reconstructions. Henke's axis was described as that for the talonavicular joint, but acceptable for the subtalar joint. Several authors investigating the coordinates of this axis have reported large differences and described screw-like movements, the latter being incompatible with a fixed axis: instantaneous axes, however are compatible with a screw-like movement. The subtalar joint appears to work as a pivot joint during inversion and as a plane joint during eversion. Although Henke's axis has pedagogical value the subtalar joint has a series of instantaneous axes.

Adult↗

Validation and learning in the Procedicus KSA virtual reality surgical simulator.

BACKGROUND: Advanced simulator training within medicine is a rapidly growing field. Virtual reality simulators are being introduced as cost-saving educational tools, which also lead to increased patient safety. METHODS: Fifteen medical students were included in the study. For 10 medical students performance was monitored, before and after 1 h of training, in two endoscopic simulators (the Procedicus KSA with haptic feedback and anatomical graphics and the established MIST simulator without this haptic feedback and graphics). Five medical students performed 50 tests in the Procedicus KSA in order to analyze learning curves. One of these five medical students performed multiple training sessions during 2 weeks and performed more than 300 tests. RESULTS: There was a significant improvement after 1 h of training regarding time, movement economy, and total score. The results in the two simulators were highly correlated. CONCLUSION: Our results show that the use of surgical simulators as a pedagogical tool in medical student training is encouraging. It shows rapid learning curves and our suggestion is to introduce endoscopic simulator training in undergraduate medical education during the course in surgery when motivation is high and before the development of "negative stereotypes" and incorrect practices.

Computer Simulation↗

[Ethical aspects of pharmacological cognition enhancement and the use of psychostimulants by children and young persons].

DEFINITION OF THE PROBLEM: Pharmacological cognition enhancement aims at an improvement of cognitive activity and performance in healthy people by means of appropriate drugs. Ethical implications of this kind of cognition enhancement stand in need of reflection. ARGUMENTS: For a number of reasons, the distinction between treatment and enhancement is fuzzy with regard to Attention Deficit Hyperactivity Disorder (ADHD). In consideration of the growing number methylphenidate prescriptions, one question addressed in this article is whether or not psychostimulants are used not only for therapy but also for cognitive enhancement by children and young people. The possibility of a "grey zone" between treatment and enhancement seems to open the field for medicalization of social and pedagogical problems as well as for "hidden enhancement." In clinical practice, the use of stimulants is associated with certain ethical problems concerning diagnosis, treatment and prevention of ADHD. Some of these problems are associated with the possibility of cognition enhancement. In order to evaluate ethical problems of pharmacological cognition enhancement, short-term and long-term consequences of stimulant use need to be taken into account. This refers to the level of transmitter balance in the learning process, to the level of individual learning strategies as well as to the level of interaction. This raises the question (1) of how well adapted the means of enhancement are with regard to the end of a comprehensive education and socialization, and (2) whether there are justifiable limits to the standardization of behavior and knowledge. (3) Moreover, stipulating an autonomous decision as a minimum prerequisite for legitimate cognition enhancement seems inadequate in the case of children and young persons. CONCLUSION: Considering the evidence and the many open questions associated with pharmacological cognition enhancement for children and young persons, it is concluded that it is indeed a morally problematic technique.

Adolescent↗

[Excessive computer usage in adolescents--results of a psychometric evaluation].

Excessive computer and video game playing among children is being critically discussed from a pedagogic and public health point of view. To date, no reliable data for this phenomenon in Germany exists. In the present study, the excessive usage of computer and video games is seen as a rewarding behavior which can, due to learning mechanisms, become a prominent and inadequate strategy for children to cope with negative emotions like frustration, uneasiness and fears. In the survey, 323 children ranging in age from 11 to 14 years were asked about their video game playing behavior. Criteria for excessive computer and video game playing were developed in accordance with the criteria for dependency and pathological gambling (DSM-IV, ICD-10). Data show that 9.3% (N = 30) of the children fulfill all criteria for excessive computer and video game playing. Furthermore, these children differ from their class mates with respect to watching television, communication patterns, the ability to concentrate in school lectures and the preferred strategies coping with negative emotions. In accordance with findings in studies about substance-related addiction, data suggest that excessive computer and video game players use their excessive rewarding behavior specifically as an inadequate stress coping strategy.

Adolescent↗

LONI visualization environment.

Over the past decade, the use of informatics to solve complex neuroscientific problems has increased dramatically. Many of these research endeavors involve examining large amounts of imaging, behavioral, genetic, neurobiological, and neuropsychiatric data. Superimposing, processing, visualizing, or interpreting such a complex cohort of datasets frequently becomes a challenge. We developed a new software environment that allows investigators to integrate multimodal imaging data, hierarchical brain ontology systems, on-line genetic and phylogenic databases, and 3D virtual data reconstruction models. The Laboratory of Neuro Imaging visualization environment (LONI Viz) consists of the following components: a sectional viewer for imaging data, an interactive 3D display for surface and volume rendering of imaging data, a brain ontology viewer, and an external database query system. The synchronization of all components according to stereotaxic coordinates, region name, hierarchical ontology, and genetic labels is achieved via a comprehensive BrainMapper functionality, which directly maps between position, structure name, database, and functional connectivity information. This environment is freely available, portable, and extensible, and may prove very useful for neurobiologists, neurogenetisists, brain mappers, and for other clinical, pedagogical, and research endeavors.

Brain Mapping↗