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Adventure and extreme sports (AESs) are associated with high risk of injury and even death. This has important ramifications for sport, education, medical and health professions and has led to disc...

Andrea Prontera,1 Stefano Baroni,2 Andrea Marudi,2 Franco Valzania,3 Alberto Feletti,1 Francesca Benuzzi,4 Elisabetta Bertellini,2 Giacomo Pavesi1 1Department of Neurosurgery, Nuovo Ospedale Civile SAgostino-Estense, 2Department of Anesthesiology, Nuovo Ospedale Civile SAgostino-Estense, 3Department of Neurology, Nuovo Ospedale Civile S Agostino-Estense, 4Department of Neuroscience, University of Modena and Reggio Emilia, Modena, Italy Introduction: Awake craniotomy allows continuous monitoring of patients’ neurological functions during open surgery. Anesthesiologists have to sedate patients in a way so that they are compliant throughout the whole surgical procedure, nevertheless maintaining adequate analgesia and anxiolysis. Currently, the use of α2-receptor agonist dexmedetomidine as the primary hypnotic–sedative medication is increasing.Methods: Nine patients undergoing awake craniotomy were treated with refined monitored anesthesia care (MAC) protocol consisting of a combination of local anesthesia without scalp block, low-dose infusion of dexmedetomidine, propofol, and remifentanil, without the need of airways management.Results: The anesthetic protocol applied in our study has the advantage of decreasing the dose of each drug and thus reducing the occurrence of side effects. All patients had smooth and rapid awakenings. The brain remained relaxed during the entire procedure.Conclusion: In our experience, this protocol is safe and effective during awake brain surgery. Nevertheless, prospective randomized trials are necessary to confirm the optimal anesthetic technique to be used. Keywords: dexmedetomidine, awake surgery, anesthesia

There are at least 100 entities that present a significative conjunction between skin signs and skeletal or other bony changes that can be detected by radiological means (skin and bones and others). The aim of this article is to underline that sometimes a radiological examination could guide to a correct diagnosis in dermatology. In addition, bloody diagnostic procedures could be avoided in ambiguous skeletal lesions if the radiologist remembers that skin and bone diseases exist. We review the literature and suggest a practical classification, including skin markers of occult radiological changes, skin diseases often associated with skeletal or other bony changes that require a radiological evaluation for a diagnosis, radiological changes mimicking cutaneous diseases, skeletal side effects of dermatological therapies (topical and systemic) and skin lesions occurring as a consequence of bone injury.

Disaster simulation can be a powerful experience for medical students or faculty, in interdisciplinary or multiprofessional teams. This paper illustrates the potential of such simulations for developing, and assessing, the integration of professional competencies. Operation Kauai is a disaster relief simulation which has been used successfully in workshops for multiprofessional faculty development at the University of Hawaii and elsewhere. Its sequence of scenarios uses a variety of stimuli designed to promote or assess teamwork skills as well as individuals performance. This kind of simulation may appeal to medical educators wanting a broader approach to problem-based learning or an interdisciplinary framework for the assessment of clinical competence.

We compared clinical supervisors’ ratings of intern competence in Newcastle University graduates (whose medical school emphasizes community relevance and interpersonal skills) and in medical graduates of the Universities of Sydney and New South Wales, which have more traditional curricula. A 12‐item anchored supervisor rating scale was used to assess the professional competence of 428 interns on five occasions throughout the intern year. Data analysis was performed using two factors of clinical competence and personal characteristics, as well as an average annual total score, linear regression analysis was employed to estimate the adjusted effects of age, sex, and graduating university on the three scores. All three scores were higher for interns who graduated at younger than 25 years, irrespective of university of graduation or sex. Women scored higher on average than men, and Newcastle graduates were rated significantly better on average than Sydney University graduates for the personal characteristics ...

The Triple Jump is a versatile but under‐studied instrument, used both for developing and assessing problem‐based learning (PBL). This paper evaluates its assessment of inquiry‐based learning (IBL) in a graduate course, along with a Group Assessment Task. Students' performance on the Triple Jump was not related to satisfaction with their small‐group discussion prior to completing a self‐directed learning task. Analysis of the self‐directed learning task in terms of academic or pragmatic focus showed consistent differences between two markers — suggesting the need for more research into inter‐rater reliability and other characteristics of the Triple Jump exercise. Some simple strategies are recommended to make this instrument cost‐effective for assessing large classes.

‐‐ Inquiry based learning is evolving as another curriculum model which may help to revitalize nursing and other professions education programs in the same way that problem based learning has rejuvenated medical education in the last 25 years. This paper briefly outlines both PBL and IBL approaches, and compares their philosophies, methods and context. Inquiry based learning may be more attractive to a wider range of vocational training and professions education programs because of its flexibility in choice of methods, less emphasis on teaching specific problem‐solving paradigms, and less reliance on resource‐intensive learning experiences.

Centuries of tradition have instilled in Swiss medical doctors a healthy skepticism for innovations in professional practice. This same attitude seems to apply to medical education, with Swiss medical associations and interest groups taking various initiatives in observing and reporting international changes. Recently, a small delegation of Swiss doctors representing practitioners—and professors from the medical schools in Geneva and Berne— visited selected North American medical schools that have adopted problem‐based curricula. That visit led to insights being discussed at a national conference in Berne in 1989. The conference was well represented—with faculty and students from all five Swiss medical schools, invited health professionals, politicians, and administrators. The main challenge confronting any likely major curriculum reform in Switzerland will be whether faculty can accept the kind of educational principles now being implemented at the University of Berne and those recommended at the 1988 Wo...

In this series, we print evaluation instruments, questionnaires, rating scales and similar resource materials useful to teachers, evaluators and planners. You may wish to adapt such instruments for your own purposes. The feature in this issue has been prepared by Grahame I. Feletti, Nicholas A. Saunders, Anthony J. Smith and Charles E. Engel. Further information is available from Charles E. Engel.

This paper examines the problems of fostering appropriate attitudes towards continuing education in undergraduates. It outlines the obligation for educators in the professions to promote actively progressive independence of student learning. It describes how this has been attempted as part of the undergraduate medical curriculum at the University of Newcastle, Australia. Strategies and problems of implementation in the students’ learning, assessment and evaluation programmes are presented. The paper concludes with a partial answer to the focal question, ‘Can progressive independence of learning be planned as an undergraduate objective, or is it simply an option for some students?’

While the purpose, theory and method of evaluation of educational programmes are well‐documented, there is little published evidence on the actual evaluation of higher professional educational programmes and their outcomes. This paper outlines the background and development of programme evaluation in a new institution of higher professional education. It outlines current programme monitoring activities and their effects, and identifies the urgent and feasible tasks to be undertaken in the methodologically difficult and politically sensitive area of outcome evaluation.

Assessment of student progress and achievement may support or weaken the educational goals of an institution. This paper describes the assessment methods developed so far to support the undergraduate education programme in the Faculty of Medicine at Newcastle, New South Wales. Formative assessment designed for frequent, informal diagnostic feedback to the student is an integral part of the various learning experiences. It requires further development to be a useful guide to the required depth of study. It aims to assist students to integrate and apply their studies. Summative assessment is required for certification and as a formal indicator of cumulative learning. A great deal of effort has been devoted to relate it to higher level intellectual competence, to keep it open to student criticism, to take account of individual rates of learning and to use it diagnostically.

The new Faculty of Medicine at the University of Newcastle, NSW, has introduced an innovative undergraduate education programme. It has been just as determined to set up a comprehensive and systematic programme for evaluation of the effectiveness, efficiency and acceptability of its educational endeavours. This paper outlines these developments and the constraints during the first year of its operation — not only as a record of events, but also a possible guide for similar developments elsewhere.

Educational programmes within the profession need a new approach if graduates are to be adequately prepared for their roles in the twenty‐first century. This approach should emphasize two broad capabilities for professional practice ‐‐ one related to immediate performance after graduation, and the other recognizing the need for further education. Graduates can develop these capabilities if a set of essential competencies is defined, and if their assessment is treated as an integral part of the educational programme. This paper describes new instruments and procedures together with guidelines for ensuring their reliability and validity.

A pilot study recently reported in this journal by Wakeford raised several important issues concerning the measurement and interpretation of students’ perpeption of the learning environment in five British medical schools. Some of those issues are developed in this paper as a result of similar, more comprehensive, research involving students in five Australian medical schools. One issue is the almost inevitable problem of methodology associated with large scale surveys of this kind. Another is the prospect for educational reform within an educational institution based heavily on students’ perceptions alone.

Special care has been taken to promote the educational merit of assessment for students in the new undergraduate medical curriculum at Newcastle University. The main challenge to academic staff has been to develop methods of assessment which are reliable and valid indices of competence within the constraints of the educational programme objectives. Among other things, considerable attention has been given to the assessment of sciences basic to medicine through assessment instruments developed from clinical problems ‐ by no means an easy task.

In this series, we print evaluation instruments, questionnaires, rating scales and similar resource materials useful to teachers, evaluators and planners. You may wish to adapt such instruments for your own purposes. The feature in this issue has been prepared by Nicholas A. Saunders, Charles E. Engel, and Grahame I. Feletti from whom further information is available.

This research looked at students' satisfaction with, and changes in approach to, learning during their first year in problem‐based curricula for agriculture, architecture, medicine and paramedicine. While students at each school showed little change in approach apart from achievement orientation in the six‐month period after entry to the course, there were different patterns of approach at each school. Satisfaction with their respective schools was uniformly high — notably in terms of their emotional climate, supportiveness, student and teacher interaction, and meaningful learning experiences. Correlations between students' approach to learning and degree of satisfaction with their course strongly support earlier claims and research findings on the merits of problem‐based curricula, although they still need more careful definition to be useful to curriculum planners.