Search

Advancements in virtual medical education, particularly the technical advancements, are immediately relevant to other types of post-graduate education and undergraduate education. As future medical experts, medical students need to demonstrate the competencies summarized in the CanMEDS framework (professional, communicator, collaborator, leader, health advocate, scholar, medical expert). This scoping review aims to understand the advantages and the shortcomings of OSCEs in assessing the CanMEDS roles, and the comparative effectiveness of virtual versus in-person OSCEs.

The realm of outer space is becoming increasingly crowded and more contested – conditions that increase the risk that a conflict could arise. Given that there has never been a war in space, countri...

By the end of their medical school training, all physicians no matter which specialty they are heading for, must be competent to prescribe medications. Selecting and prescribing medications will be the most common therapeutic intervention they make in most careers. Multiple choice questions (MCQs), written answer questions, and standardized patients within Objective Structured Clinical Examinations (OSCEs) form the current backbone of medical and other health professional education assessment in Canada and internationally. However, OSCEs are very resource-intense, and written answer questions are used sparingly as they are time-consuming to mark. We will look at the following: which CanMEDS domains have OSCEs been shown to be a superior evaluation method compared to multiple choice or short/long answer written questions? And what are the advantages and disadvantages of virtual OSCEs (examinee, examiner, simulated patient all online and at distance from each other) compared to in-person OSCEs (all 3 in same room)?

Purpose of review This paper reviews the clinical applications, technology, and evidence supporting the use of telemedicine devices and telehealth in neuromuscular disease. Recent findings The COVID-19 pandemic interrupted standard multidisciplinary care of patients with neuromuscular disease and created a need to adapt to remote care. Telemedicine applications were rapidly introduced and have rapidly proved an important tool in maintaining specialist care. This review presents the current data being gathered identifying the patients who benefit from telehealth applications, the appropriate type of telemedicine approach to specific conditions, the conditions needed to optimise telehealth approaches, and potential pitfalls and limitations in their use. Summary Telemedicine is an important tool in providing robust remote care for patients with neuromuscular disorders, but further investigation is needed to optimise applications.

The foundations of the climate regime are under threat, with significant implications for developing countries. This set of essays identifies two main threats to the climate regime. The first is the growing importance of emissions traded across national borders, currently accounting for up to 38% of global emissions, with developed countries being net importers and emerging economies mostly net exporters. The second is the increasing focus on action to reduce the carbon intensity of trade, including, of course, exports from developing to developed countries. The measurement, reporting and certification of carbon emissions plays a key role. In the best case, developing countries may find that the reshaping of the climate regime acts to their benefit, for example encouraging faster progression to low-carbon output and opening new export opportunities for low-carbon products. In the worst case, however, developing countries may find themselves bearing increasing costs for monitoring and certifying carbon content, and perhaps being at a competitive disadvantage in a low-carbon trading system. The essays address five questions: How and why is the geography of carbon emissions changing? How are carbon emissions measured and how are the boundaries set? What are the opportunities and challenges of carbon reporting and certification? What are the implications for developing countries? How should the climate regime adjust to ensure efficient and equitable outcomes? The editors conclude that the fast-growing share of traded emissions in the global total requires a change to the climate regime, giving greater attention to traded emissions and consumption footprints than has been the case to date. Developing countries will require significant support in rolling out accurate accounting and reporting, and in securing a voice that facilitates the co-creation of standards; but, if efforts are successful, they will see lower emissions in both domestic and traded production.

Additional file 4. Further topics in statistics and probability emergent from free text response data and the need for boundaries. Additional file 4 provides: a) a brief narrative synthesis of the free text comments arising from the second part of Q. 2 of the study questionnaire, pertaining to what was missing from the available list of topics and b) recommendations for approaches to teaching statistics suggested by the emergent themes associated with these free text responses.

Additional file 1. Survey for Medical Graduates on Statistical Learning Needs (pdf copy). This is a pdf copy of the original online version of the study questionnaire.

Additional file 2. Further methodological details. Additional file 2 provides further methodological details concerning the procedures for data preparation, model building and model selection used for presentation and statistical analysis of the response data for this study.

Additional file 3: Table S1. Table S1 is a single table including the ranks, frequencies and percentages presented in Table 3 without sub-division of content by general topic.

Patients with acute life-threatening neuromuscular disease require close cooperation between neuromuscular and intensive care specialists to achieve the best possible outcomes. The problems encountered by these patients are different from those in traditional neuromuscular practice, and neurologists consulting in the ICU need a specific skill set to provide useful guidance. However, outcomes can be very good if treatment is instituted effectively. This review aims to provide an overview of the most important neuromuscular conditions encountered in the ICU and enable a practical approach to patient management.New research has provided improved knowledge of the impact of acute neuromuscular failure on the mechanics of respiration, on the categories of neuromuscular disease in the ICU, and on the main factors influencing outcomes. Pitfalls and risks in ICU treatment are better understood.Evidence-based algorithms for monitoring and treatment have been developed. These advances enhance the role of the neuromuscular specialist in acute care. The principles of best practice are discussed in this review.

Harmonizing clinical pharmacology and therapeutics (CPT) education in Europe is necessary to ensure that the prescribing competency of future doctors is of a uniform high standard. As there are currently no uniform requirements, our aim was to achieve consensus on key learning outcomes for undergraduate CPT education in Europe. We used a modified Delphi method consisting of three questionnaire rounds and a panel meeting. A total of 129 experts from 27 European countries were asked to rate 307 learning outcomes. In all, 92 experts (71%) completed all three questionnaire rounds, and 33 experts (26%) attended the meeting. 232 learning outcomes from the original list, 15 newly suggested and 5 rephrased outcomes were included. These 252 learning outcomes should be included in undergraduate CPT curricula to ensure that European graduates are able to prescribe safely and effectively. We provide a blueprint of a European core curriculum describing when and how the learning outcomes might be acquired. publishersversion published

Paleoanthropologists have long been intrigued by the observed patterns of human evolution, including species diversity, and often invoked climatic change as the principal driver of evolutionary change. Here, we investigate whether the early hominin fossil record is of suitable quality to test these climate-forcing hypotheses. Specifically, we compare early hominin diversity to sampling metrics that quantify changes in fossil preservation and sampling intensity between 7 and 1 million years ago. We find that observed diversity patterns are governed by sporadic sampling and do not yield a genuine evolutionary signal. Many more fossil discoveries are required before existing hypotheses linking climate and evolution can be meaningfully tested.The role of climate change in the origin and diversification of early hominins is hotly debated. Most accounts of early hominin evolution link observed fluctuations in species diversity to directional shifts in climate or periods of intense climatic instability. None of these hypotheses, however, have tested whether observed diversity patterns are distorted by variation in the quality of the hominin fossil record. Here, we present a detailed examination of early hominin diversity dynamics, including both taxic and phylogenetically corrected diversity estimates. Unlike past studies, we compare these estimates to sampling metrics for rock availability (hominin-, primate-, and mammal-bearing formations) and collection effort, to assess the geological and anthropogenic controls on the sampling of the early hominin fossil record. Taxic diversity, primate-bearing formations, and collection effort show strong positive correlations, demonstrating that observed patterns of early hominin taxic diversity can be explained by temporal heterogeneity in fossil sampling rather than genuine evolutionary processes. Peak taxic diversity at 1.9 million years ago (Ma) is a sampling artifact, reflecting merely maximal rock availability and collection effort. In contrast, phylogenetic diversity estimates imply peak diversity at 2.4 Ma and show little relation to sampling metrics. We find that apparent relationships between early hominin diversity and indicators of climatic instability are, in fact, driven largely by variation in suitable rock exposure and collection effort. Our results suggest that significant improvements in the quality of the fossil record are required before the role of climate in hominin evolution can be reliably determined.

The abstract is available here: https://uscholar.univie.ac.at/o:1164276

Aim(s)\ud \ud Newly graduated doctors write a large proportion of prescriptions in UK hospitals but recent studies have shown that they frequently make prescribing errors. The Prescribing Safety Assessment (PSA) has been developed as an assessment of competence in relation to prescribing and supervising the use of medicines. This report describes the delivery of the PSA to all UK final-year medical students in 2016 (PSA2016).\ud \ud Methods\ud \ud The PSA is a 2-hour online assessment comprising eight sections which cover various aspects of prescribing defined within the outcomes of undergraduate education identified by the UK General Medical Council. Students sat one of four PSA ‘papers’ which had been standard-set using a modified Angoff process.\ud \ud Results\ud \ud A total of 7,343 final-year medical students in all 31 UK medical schools sat the PSA. The overall pass rate was 95% with the pass rates for the individual papers ranging from 93 to 97%. The PSA was re-sat by 261 students who had failed and 80% of those candidates passed. The internal consistency (Cronbach's alpha) of the four papers ranged from 0.74 to 0.77 (standard error of measurement 4.13 to 4.24%). There was a statistically significant variation in performance between medical school cohorts (F = 32.6, p

Preparing medical students to prescribe is a major challenge of undergraduate education. They must develop an understanding of clinical pharmacology and acquire knowledge about drugs and therapeutics, as well as the skills to prescribe for individual patients in the face of multiple variables. The task of delivering the learning required to achieve these attributes relies upon limited numbers of teachers, who have increasingly busy clinical commitments. There is evidence that training is currently insufficient to meet the demands of the workplace. e-Learning provides an opportunity to improve the learning experience. The advantages for teachers are improved distribution of learning content, ease of update, standardization and tracking of learner activities. The advantages for learners are ease of access, greater interactivity and individual choice concerning the pace and mix of learning. Important disadvantages are the considerable resource required to develop e-Learning projects and difficulties in simulating some aspects of the real world prescribing experience. Pre-requisites for developing an e-Learning programme to support prescribing include academic expertise, institutional support, learning technology services and an effective virtual learning environment. e-Learning content might range from complex interactive learning sessions through to static web pages with links. It is now possible to simulate and provide feedback on prescribing decisions and this will improve with advances in virtual reality. Other content might include a student formulary, self-assessment exercises (e.g. calculations), a glossary and an on-line library. There is some evidence for the effectiveness of e-Learning but better research is required into its potential impact on prescribing.

Clinical pharmacology and therapeutics is the academic discipline that informs rational prescribing of medicines. There is accumulating evidence that a significant minority of prescriptions in the UK National Health Service contain errors. This comes at a time when the approach to and success of undergraduate education in this area has been called into question. Various stakeholders are now in agreement that this challenging area of undergraduate education needs to be strengthened. The principles that should form the basis of future educational strategy include greater visibility of clinical pharmacology and therapeutics in the curriculum, clear learning outcomes that are consistent with national guidance, strong and enthusiastic leadership, a student formulary, opportunities to practice prescribing, a robust assessment of prescribing competencies and external quality control. Important new developments in the UK are Prescribe, a repository of e-learning materials to support education in clinical pharmacology and prescribing, and the Prescribing Skills Assessment, a national online assessment designed to allow medical students to demonstrate that they have achieved the core competencies required to begin postgraduate training.

Prescribing of medicines is the key clinical activity in the working life of most doctors. In recent years, a broad consensus regarding the necessary competencies has been achieved. Each of these is a complex mix of knowledge, judgement and skills. Surveys of those on the threshold of their medical careers have revealed widespread lack of confidence in writing prescriptions. A valid and reliable assessment of prescribing competence, separate from an overall assessment of medical knowledge and skill, would have many benefits for clinical governance and patient safety, and would provide a measure of the success of training programmes in therapeutics. Delivering such an assessment presents many challenges, not least of which are the difficulty in identifying a surrogate marker for competent prescribing in clinical practice and the challenge of ensuring that competence assessed in a controlled environment predicts performance in clinical practice. This review makes the case for an on-line OSCE as the most valid form of assessment and sets out the requirements for its development, scope, composition and delivery. It describes an on-going attempt to develop a national assessment of prescribing skills towards the end of undergraduate medical training in the UK.

Junior doctors feel poorly prepared by their training in Clinical Pharmacology and Therapeutics and commonly make prescribing errors. Since 1993 the General Medical Council's guidance on undergraduate medical education 'Tomorrow's Doctors' has emphasized the integration of Clinical Pharmacology and Therapeutics teaching within the medical curriculum. With the publication of a new version of Tomorrow's Doctors in 2009, medical schools will be further revising their Clinical Pharmacology and Therapeutics teaching.Although we know what the recommendations for undergraduate teaching of Clinical Pharmacology and Therapeutics teaching are, there are no published data describing what is currently happening in UK medical schools. This paper describes the course structures, volume and range of teaching and assessment of Clinical Pharmacology and Therapeutics in the UK in 2009. Our data provide a foundation for schools looking to revise the Clinical Pharmacology and Therapeutics Teaching in the light of Tomorrow's Doctors 2009.To describe the current structure, delivery and assessment of Clinical Pharmacology and Therapeutics (CPT) teaching in UK medical schools.An online questionnaire was distributed to the person with overall responsibility for CPT teaching at all UK medical schools in June 2009.Thirty of the 32 UK medical schools responded. 60% of schools have a CPT course although in 72% this was an integrated vertical theme. At 70% of schools pharmacologists have overall responsibility for CPT teaching (clinical 67%, non-clinical 33%); at 20% teaching is run by a non-specialist clinician and at 7% by a pharmacist. Teaching is commonly delivered by NHS clinicians (87%) and clinical pharmacists (80%) using lectures (90%) but additionally 50% of schools use e-Learning and 63% have a student formulary. CPT is assessed throughout the curriculum at many schools through written, practical examinations and course work. 90% of schools have specific CPT content in their written examinations. 90% of respondents believed that their students were 'fairly' to 'well' prepared for the foundation year but only 37% of schools gather data on the competence of their graduates.CPT teaching in UK medical schools is very diverse. Most schools do not assess the performance of their graduates as prescribers and there is a lack of evidence that many of the teaching approaches employed are suitable for the development of prescribing skills. It is vital that developments in CPT teaching are driven by validated, real-world assessments of the prescribing skills of medical students and newly qualified doctors.

Two future paths are available for European development cooperation: either “cooperation”, in which the European Commission takes on the role of network coordinator and Member States take the lead in delivering aid; or “consolidation”, in which the EC plays a progressively larger role in shaping policy and delivering aid. The development agenda is evolving in a consolidationist direction, with a greater focus on collective solutions to global problems. However, the EU will find it difficult to move in this direction: the core conditions favouring greater consolidation, including the interests of Member States, do not appear to be met. A survey of development policy-makers confirms this view. There is enthusiasm for greater cooperation, but not for greater consolidation. The ‘quick wins’ seem to be in the area of standard-setting and measures to improve aid effectiveness, rather than rebalancing between bilateral programmes and the EC.

We present the results of subcutaneous microdialysis, a new minimally invasive biochemical monitoring technique, in mitochondrial cytopathy. We studied 6 ambulatory patients with mitochondrial cytopathy and 6 controls without mitochondrial disease using a subcutaneous probe for continuous microdialysis, and obtained measurements of lactate, pyruvate, and glucose from samples gathered at 30-60 min intervals during the day and at 3-h intervals at night. The lactate:pyruvate ratio (LPR) was calculated and related to disease severity and metabolic stress. Microdialysis was well tolerated. Controls had stable lactate and pyruvate values in the normal range and a low LPR (average values between 0.0114 and 0.0145). Patients had widely fluctuating lactate and pyruvate values, a higher average LPR between 0.0187 and 0.0724, and marked diurnal variation, especially in the severely affected patients. Increases in the LPR coincided with metabolic stress in individual cases. We conclude that subcutaneous microdialysis is well tolerated and enables continuous metabolic monitoring of patients with mitochondrial cytopathy. It has particular potential for use in the identification of metabolic risk factors and may help to assess the impact of therapeutic regimens.

Voice over internet protocol (VoIP) based telephony has been around for few years, but it is only owing to the widespread availability of broadband access, presence of multitude of VoIP service providers and the appearance of inexpensive VoIP gateway adapters that this technology became interesting for the mainstream academic users, especially those coming from the poorer, developing or transitional countries where a lack of competition on the telephony markets invariably leads to inflated call rates. The example of our medical school demonstrates that with the installation of only one VoIP gateway unit, a significant decrease in the cost of long distance telephony can be achieved, fostering in the process international academic communication and research collaboration with health professionals from around the world.

The limpet gut consists of a long coiled tube lined by a ciliated columnar epithelium, into which open the ducts of the salivary and digestive glands. Six sections can be distinguished: the buccalcavity, oesophagus, stomach, style sac, intestine and rectum. The oesophagus can be subdivided into a dorsal food channel and a series of lateral pouches forming the oesophageal gland. The intestine is divisible into sections designated A, B, C, D and E. Ultrastructural and histochemical analyses revealed nine cell types, seven of them glandular. A single type of gland cell lining the tubules of the salivary gland produces a viscous secretion that lubricates the radula and entraps particles rasped from the substratum. Mucous cells occur in the buccal cavity, dorsal food channel and rectum; in the rectum, mucus aids defaecation, but elsewhere it entraps loose particles that are consequently transported to the stomach. The only extracellular enzyme, an amylase derived from the gland cells of the oesophageal gland, is mixed with the food in the dorsal food channel. Ciliated and unciliated columnar cells lining the ducts of the digestive gland, stomach, style sac and anterior intestine, release blebs of cytoplasm into the lumen to consolidate loose particles into a faecal rod that is rotated along the intestine. Clavate gland cells and possibly basal gland cells in the posterior intestine, cover the faecal rod with their secretion to form a durable rod. The vacuolated digestive cells of the digestive gland, digest food intracellularly releasing undigestible residues in spherules of cytoplasm, these are bound into a liver string by the proteinaceoussecretion of the basophilic cells. Both these cell types and the amylase-secreting cells exhibit phases of activity, but only that of the latter is related to the tidal cycle. Tritiated D-glucose was absorbed by the oesophagus, intestine and digestive gland by a mechanism inhibited by 2,4-DNP and phloridzin. The mechanisms operating in the oesophagus and posterior intestine were sodium-dependent. Fluid movements from the intestinal lumen to the blood occurred.

Hominins (the clade including modern humans and their fossil ancestors) were a taxonomically and morphologically diverse group during the Plio-Pleistocene, and their evolution documents the only known transition to obligate bipedalism in primates. However,many aspects of their shared evolutionary history remain frustratingly unclear due to uncertainty about whether change in the fossil record reflects genuine evolutionary change or variation in our sampling of the rock record. Here, a comprehensive assessment of the quality of the early African hominin fossil record is presented. A specimen database of all early African hominin fossils (>5000) has been compiled including taxonomic, geological, anatomical, and bibliographic information. Using a range of sampling metrics (fossil-bearing formations, collection effort, sampled area, and ghost lineage diversity), it is shown that the pulsedlike pattern of uncorrected (taxic) hominin diversity is almost entirely controlled by rock availability. By contrasting taxic with phylogenetically corrected diversity, hominin diversification appears unconstrained through the lateMiocene and Pliocene, with diversity constantly increasing until a single peak is reached in the early Pleistocene. Phylogenetically corrected diversity shows no discernible link with sampling metrics and there is no direct evidence that shifts in climatic conditions drove diversification. A study of specimen completeness through geological time shows that while sampling metrics (specifically sustained collection effort at rich deposits) have a major influence on patterns of specimen completeness, specimen completeness has only a moderate influence on diversity patterns. It also shows that specimen completeness is poorest during the period most pertinent to human origins, the estimated Pan-Homo divergence date, in large part due to under-sampling (

Photoplethysmography (PPG) is a simple means of measuring the pulse wave in humans, exploitable for the purposes of timing the arrival of the pulse at a particular point in the arterial tree, and for pulse contour analysis. This thesis describes a methodology for measuring arterial pulse transit time (PTT) from cardiac ejection to pulse arrival at the finger. It describes the effect on PTT of drug and exercise induced changes in BP. The nature of the relationship between the PPG and arterial pressure is also examined, and the PTT technique extended to assessment of conduit vessel pulse wave velocity (PWV) during exercise. PTT measured from ECG R-wave to PPG finger wave (rPTT) had a negative correlation (R2=0.39) with systolic BP (SBP), unaffected by vasoactive drugs in some but not all persons. rPTT showed similar beat-to-beat variability to SBP, unaffected by drugs. rPTT correlated weakly with diastolic (DBP) and mean (MAP) pressure. Cardiac pre-ejection period (PEP) formed a substantial and variable part of rPTT (12% to 35%). Transit time adjusted for PEP (pPTT) correlated better with DBP (R2=0.41) and MAP (R2=0.45), than with SBP. The PPG wave tracked changes in the peripheral pressure wave. Drugs had little effect on the generalised transfer function (GTF) describing the association between arterial and PPG waves. Strenuous exercise induced a large decrease in rPTT, mainly accounted for by decreases in PEP (53% of the total change in rPTT) and in transit time from aorta to distal brachial artery (33%). In contrast, minimal change in transit time from wrist to finger tip occurred with exercise. Simultaneous ear-finger PPG signals were used to measure conduit artery PWV during exercise. Ear-finger PWV (PWVef) overestimated carotid-radial PWV throughout exertion (overall bias 0.81±1.05ms-1, p