Communication skills training in undergraduate medicine.

Good communication with patients is now recognised as the cornerstone in effective medical practice. Medical students do not automatically acquire the art of good communication through clinical training. A new course to promote the development of communication skills at undergraduate level is described. The course was provided at the juncture between pre-clinical and clinical training. Course evaluation illustrated the value of the course as perceived by students themselves and highlighted the areas of greatest need for students in communication skills training

Communication skills training in undergraduate medicine: attitudes and attitude change.

The importance of communication skills training in undergraduate medical education is now widely accepted. However little is known about student attitudes towards their own communication skills and whether their attitudes changes as a result of participating in communication skills courses. The aim of the present study was to identify these attitudes prior to commencing such a course and to further evaluate changes in these attitudes on completion of the course. Results demonstrated an improvement in perceived confidence regarding a number of specific communication skills. The study provides further evidence of the value of such courses in undergraduate medical training

Induction of interferon-stimulated genes on the IL-4 response axis by Epstein-Barr virus infected human b cells; relevance to cellular transformation.

Epstein-Barr virus (EBV) is an oncogenic virus that is associated with the pathogenesis of several human lymphoid malignancies, including Hodgkin's lymphoma. Infection of normal resting B cells with EBV results in activation to lymphoblasts that are phenotypically similar to those generated by physiological stimulation with CD40L plus IL-4. One important difference is that infection leads to the establishment of permanently growing lymphoblastoid cell lines, whereas CD40L/IL-4 blasts have finite proliferation lifespans. To identify early events which might later determine why EBV infected blasts go on to establish transformed cell lines, we performed global transcriptome analyses on resting B cells and on EBV and CD40L/IL-4 blasts after 7 days culture. As anticipated there was considerable overlap in the transcriptomes of the two types of lymphoblasts when compared to the original resting B cells, reflecting common changes associated with lymphocyte activation and proliferation. Of interest to us was a subset of 255 genes that were differentially expressed between EBV and CD40L/IL-4 blasts. Genes which were more highly expressed in EBV blasts were substantially and significantly enriched for a set of interferon-stimulated genes which on further in silico analyses were found to be repressed by IL-4 in other cell contexts and to be up-regulated in micro-dissected malignant cells from Hodgkin's lymphoma biopsies when compared to their normal germinal center cell counterparts. We hypothesized that EBV and IL-4 were targeting and discordantly regulating a common set of genes. This was supported experimentally in our B cell model where IL-4 stimulation partially reversed transcriptional changes which follow EBV infection and it impaired the efficiency of EBV-induced B cell transformation. Taken together, these data suggest that the discordant regulation of interferon and IL-4 pathway genes by EBV that occurs early following infection of B cells has relevance to the development or maintenance of an EBV-associated malignancy

Prevalence rates of childhood trauma in medical students: A systematic review

Abstract Background It is known that medical students suffer from high rates of mental health difficulties. In recent years there has been an increasing focus on the need to improve support and treatment services for those in difficulty. In order to meet these needs it is important to clarify the relevant aetiological factors. There is robust evidence from general population studies that a history of childhood trauma (including physical and sexual abuse and emotional neglect) predisposes to the subsequent development of mental health difficulties in adult life. It has previously been speculated that students with a history of such trauma might preferentially apply to study medicine. Methods This systematic review seeks to examine the existing evidence base with regard to rates of childhood trauma in medical student populations. Articles were identified through a literature search of psychINFO, web of science, Embase and medline. Results This search generated 11 articles which were deemed to meet criteria for inclusion in this review. There is a wide range of results given for rates of childhood trauma in these studies. Conclusions The published research which examines rates of childhood trauma affecting medical students is limited and difficult to generalise from, or to use to draw firm conclusions. Given the possible negative outcomes of a history of childhood trauma in medical students, including that such a history may be associated with difficulties in a student progressing in their undergraduate and postgraduate examinations, well-organised prospective studies are required

A qualitative phenomenological analysis of the subjective experience and understanding of the at risk mental state

Over recent years there has been a growing interest in identifying the early stages of psychosis. The At Risk Mental State (ARMS) is characteristic of the prodromal stages of psychosis and its identification gives rise to a number of clinical and research opportunities including early intervention and prevention of psychosis. This study employs interpretative phenomenological analysis to gain insights into the subjective experience and individuals understanding of the development of their ARMS. Five participants took part and provided information on the experience of symptoms, life prior to onset of their ARMS and their understanding of symptoms and their development through a semi structured interview. From the analysis of transcripts eight themes emerged which were common across participants accounts. Three themes of experience (disturbed world/disturbed self, disconnection with the world, thunderstruck) and five themes of understanding (absence of understanding, use of others, identity, forming links, fragmented understanding) were identified. Themes are explored in detail and discussed in relation to existing literature and theory. Clinical implications, directions for future research, and limitations are discussed within