Cognitive apprenticeship in clinical practice; Can it be extended to postgraduate psychiatry training programmes?

Introduction: Postgraduate psychiatry training occurs in the workplace or situated learning settings. The Cognitive Apprenticeship Model [CAM] was introduced as an instructional model for situated learning. While undergraduate medical students' experience of the model has been tested, to our knowledge there has been no such reports from postgraduate psychiatry training. Methods: We surveyed 134 Oxford Deanery psychiatry trainees recruited between 2005 and 2013 through an online questionnaire. Respondents identified which CAM components [scaffolding, modelling coaching, articulation, reflection exploration] were the best aspects, and most needing improvement, in their clinical training. Results: Of 57 respondents, 80% were satisfied with and enjoyed [90%] their training. They recognised all individual CAM components; modelling and coaching were identified as the best methods. Exploration was identified as the one most in need of improvement. The behavioural [modelling, coaching and scaffolding] rather than the cognitive methods were identified as the best aspects of their training [54 v 35%, p < 0.001]. Conclusions: The results extend findings from undergraduate students in suggesting that the CAM is a useful model for training strategies. Greater awareness of the cognitive components may be needed. The training methods could be included as indicators of training quality in national quality assurance surveys

The Influence of Rapid Solidification on Corrosion Behavior of Mg60Zn20Yb15.7Ca2.6Sr1.7 Alloy for Medical Applications

Biodegradable magnesium alloys with Zn, Yb, Ca and Sr additions are potential materials with increased corrosion resistance in physiological fluids that ensure a controlled resorption process in the human body. This article presents the influence of the use of a high cooling rate on the corrosion behavior of Mg60Zn20Yb15.7Ca2.6Sr1.7 alloy proposed for medical applications. The microstructure of the alloy in a form of high-pressure die-casted plates was presented using scanning electron microscopy in the backscattered electrons (BSEs) mode with energy-dispersive X-ray spectrometer (EDX) qualitative analysis of chemical composition. The crystallization mechanism and thermal properties were described on the basis of differential scanning calorimetry (DSC) results. The corrosion behavior of Mg60Zn20Yb15.7Ca2.6Sr1.7 alloy was analyzed by electrochemical studies with open circuit potential (EOCP) measurements and polarization tests. Moreover, light microscopy and X-ray photoelectron spectroscopy were used to characterize the corrosion products formed on the surface of studied samples. On the basis of the results, the influence of the cooling rate on the improvement in the corrosion resistance was proved. The presented studies are novel and important from the point of view of the impact of the technology of biodegradable materials on corrosion products that come into direct contact with the tissue environment

Wielonarządowe powikłania odległe po radioterapii i chemioterapii chłoniaka Hodgkina

Forty-nine-year-old woman with a history of long-term complications after radiotherapy and chemotherapy including coronary artery disease and pulmonary fibrosis was admitted to our center. Further complications — pulmonary hypertension, heart failure, and multiple heart valves insufficiency — were diagnosed. Here we present images from diagnostic procedures that allowed us to visualize those disturbances.49-letnia kobieta z historią odległych powikłań po radioterapii i chemioterapii, włącznie z chorobą wieńcową i zwłóknieniem płuc, została przyjęta do naszego ośrodka. Kolejne powikłania – nadciśnienie płucne, niewydolność serca i niedomykalność wielu zastawek serca - zostały zdiagnozowane. Prezentujemy tutaj zdjęcia z procedur diagnostycznych, które pozwoliły na zwizualizowanie tych nieprawidłowości

Proactive and integrated consultation-liaison psychiatry for older medical inpatients: A mixed methods description of training, care provided and clinician experience in the HOME study.

OBJECTIVES: To describe the practical experience of delivering a proactive and integrated consultation-liaison (C-L) psychiatry service model (PICLP). PICLP is designed for older medical inpatients and is explicitly biopsychosocial and discharge-focused. In this paper we report: (a) observations on the training of 15 clinicians (seven senior C-L psychiatrists and eight assisting clinicians) to deliver PICLP; (b) the care they provided to 1359 patients; (c) their experiences of working in this new way. METHOD: A mixed methods observational study using quantitative and qualitative data, collected prospectively over two years as part of The HOME Study (a randomized trial comparing PICLP with usual care). RESULTS: The clinicians were successfully trained to deliver PICLP according to the service manual. They proactively assessed all patients and found that most had multiple biopsychosocial problems impeding their timely discharge from hospital. They integrated with ward teams to provide a range of interventions aimed at addressing these problems. Delivering PICLP took a modest amount of clinical time, and the clinicians experienced it as both clinically valuable and professionally rewarding. CONCLUSION: The experience of delivering PICLP highlights the special role that C-L psychiatry clinicians, working in a proactive and integrated way, can play in medical care