Genome sequence of an Australian kangaroo, Macropus eugenii, provides insight into the evolution of mammalian reproduction and development.

BACKGROUND: We present the genome sequence of the tammar wallaby, Macropus eugenii, which is a member of the kangaroo family and the first representative of the iconic hopping mammals that symbolize Australia to be sequenced. The tammar has many unusual biological characteristics, including the longest period of embryonic diapause of any mammal, extremely synchronized seasonal breeding and prolonged and sophisticated lactation within a well-defined pouch. Like other marsupials, it gives birth to highly altricial young, and has a small number of very large chromosomes, making it a valuable model for genomics, reproduction and development. RESULTS: The genome has been sequenced to 2 × coverage using Sanger sequencing, enhanced with additional next generation sequencing and the integration of extensive physical and linkage maps to build the genome assembly. We also sequenced the tammar transcriptome across many tissues and developmental time points. Our analyses of these data shed light on mammalian reproduction, development and genome evolution: there is innovation in reproductive and lactational genes, rapid evolution of germ cell genes, and incomplete, locus-specific X inactivation. We also observe novel retrotransposons and a highly rearranged major histocompatibility complex, with many class I genes located outside the complex. Novel microRNAs in the tammar HOX clusters uncover new potential mammalian HOX regulatory elements. CONCLUSIONS: Analyses of these resources enhance our understanding of marsupial gene evolution, identify marsupial-specific conserved non-coding elements and critical genes across a range of biological systems, including reproduction, development and immunity, and provide new insight into marsupial and mammalian biology and genome evolution

Glucosamine for osteoarthritis of the knee

Glucosamine is a normal constituent of the proteoglycans found in joint cartilage and synovial fluid. It has been recommended for many years by practitioners of complementary medicine for the treatment of osteoarthritis. Clinical trials have now shown that the use of oral glucosamine sulphate 1.5 g daily in patients with osteoarthritis of the knee results in a significant reduction in joint pain and an improvement in joint function. In addition, glucosamine appears to reduce the loss of cartilage in the knee joint over at least a three-year period, particularly in those with milder radiological osteoarthritis. It would therefore Seem reasonable to recommend a trial of glucosamine in patients with symptomatic osteoarthritis of the knee

Tumour necrosis factor alpha inhibitors for the treatment of adult rheumatoid arthritis

The management of patients with rheumatoid arthritis now focuses on both the relief of symptoms and the prevention of joint damage. When conventional therapies fail, adalimumab, etanercept and infliximab, inhibitors of the pro-inflammatory cytokine tumour necrosis factor alpha, can be considered. Evidence from randomised controlled studies suggests that many patients who do not respond to conventional therapy improve with adalimumab, etanercept or infliximab, particularly when these drugs are combined with methotrexate. Infusion and injection site reactions occur in some patients and the risks of infection are increased, particularly early in the treatment course. Long-term risks such as an increased risk of malignancy are currently being evaluated

Where is student support most needed?

Barrett and McColl raise the question posed in the title of their commentary to highlight the value of attending to interactions between students and their learning environment

Integrating bioscience and clinical learning through technology

Successfully integrating bioscience and clinical learning is a major challenge for designers of medical curricula. A new learning system being developed at the University of Melbourne will make it easier for medical students to locate, access and utilise bioscience and clinical learning resources to support both formal and informal learning activities. Backed by a comprehensive database of curriculum, bioscience and clinical resources, students will have immediate access to the best available bioscience and clinical resources via interactive activity and search-based interfaces. Student portfolios, based around new patient record and procedural log systems will be fully integrated within the system. Implementation will be supported by an extensive program of evaluation and research, with particular emphasis to be placed on student's selection and use of digital resources and the use of electronic health records to support clinical learning

Feedback Process in The Mini Clinical Evaluation Exercise (Mini-CEX): an Exploratory Study

 In the midst of clinical environment unpredictability, feedback helps students to make the most out of clinical learning opportunities. Mini clinical evaluation exercise (Mini-CEX) is considered to be appropriate for providing feedback to students. This study aims to explore the feedback process within the Mini-CEX at a large Australian medical school. Between year 2011-2012, 23 Mini-CEX sessions, involved 18 final year medical students, were observed, followed by 15-minutes structured interviews. 7 experienced clinical teachers were also interviewed. A questionnaire administered to 274 final year medical students to seek their views on feedback provided in the Mini-CEX. Most feedback has complied with the characteristics of constructive feedback, however the amount of feedback decreased as the quality level of feedback increased. These findings matched students’ perceptions recorded on the questionnaire. The themes derived from the interviews showed that for feedback to be useful, each of feedback process components (feedback provider, types of feedback, feedback recipient and action plans following feedback) need to be attended to. Both tutors and students need to focus on the process of incorporating feedback to inform students’ learning, not only on the feedback characteristics. One of the means to achieve this is by providing reflective feedback where students are considered as active recipients. Keywords: feedback, Mini-CEX, clinical, assessment, learning.     Proses Umpan Balik pada Mini Clinical Evaluation Exercise (Mini-CEX): Studi Eksplorasi   Abstrak Di tengah ketidakpastian lingkungan klinis, umpan balik membantu mahasiswa memaknai kesempatan belajar di tatanan klinis. Mini clinical evaluation exercise (Mini-CEX) cocok untuk memberikan umpan balik kepada mahasiswa. Studi ini bertujuan untuk mengeksplorasi proses umpan balik pada Mini-CEX di sebuah fakultas kedokteran besar di Australia. Antara tahun 2011-2012, 23 sesi Mini-CEX, melibatkan 18 mahasiswa kedokteran tahap akhir, diobservasi dan dilanjutkan wawancara terstruktur selama 15 menit. 7 dosen klinik berpengalaman juga diwawancara. Kuesioner diberikan kepada 274 mahasiswa kedokteran tahap akhir untuk mengetahui pandangan mereka terhadap umpan balik yang diberikan dalam Mini-CEX. Sebagian besar umpan balik telah memenuhi karakteristik umpan balik konstruktif, namun jumlah umpan balik menurun seiring dengan meningkatnya level kualitas umpan balik. Hal tersebut juga ditemukan dalam persepsi mahasiswa yang tercatat sebagai hasil kuesioner. Tema yang diidentifikasi dari wawancara memperlihatkan bahwa agar umpan balik bermanfaat, setiap komponen dari proses umpan balik (pemberi umpan balik, tipe umpan balik, penerima umpan balik, rencana aksi setelah umpan balik) perlu diperhatikan. Baik dosen maupun mahasiswa harus fokus pada proses untuk memastikan bahwa umpan balik dimanfaatkan dalam pembelajaran, tidak hanya pada karakteristik umpan balik semata. Salah satu cara untuk mencapai hal tersebut adalah dengan memberikan umpan balik reflektif yaitu mahasiswa diperlakukan sebagai penerima aktif. Kata kunci: umpan balik, Mini-CEX, klinik, asesmen, pembelajaran.&nbsp

Revisiting the hypothesis-driven interview in a contemporary context

Objective: The "hypothesis-driven interview" was articulated by George Engel as a method of raising and testing hypotheses in the process of building a biopsychosocial formulation and determining the most likely diagnosis. This interview was a forerunner of the modern medical interview as well as the contemporary psychiatric assessment. The objective of this article is to describe the hypothesis-driven interview and to explore its relationship with the contemporary medical interview. Method: The literature on the medical and hypothesis-driven interview was reviewed. Key features of each were identified. Results: The hypothesis-driven interview shares much with the contemporary medical interview. In addition, it enhances the application of communication skills and allows the interviewer to develop a formulation during the course of the assessment. Conclusion: The hypothesis-driven interview is well suited to the aims of a contemporary psychiatric assessment

Measuring medical students' reflection on their learning: modification and validation of the motivated strategies for learning questionnaire (MSLQ)

Background: Reflection on learning is an essential component of effective learning. Deconstructing the components of reflection on learning using a self-regulated learning (SRL) framework, allows the assessment of students' ability to reflect on their learning. The aim of this study was to validate an instrument to measure medical students' reflection on their learning. Methods: A systematic search was conducted to identify the most suitable instrument to measure students' reflection on their learning based on the theoretical framework of SRL. The search identified the Motivated Strategies for Learning Questionnaire (MSLQ) which contained five subscales: internal goal orientation, self-efficacy, critical thinking, metacognitive/self-regulation, help seeking and peer learning. Using the original MSLQ as the foundation, we carried out three phases of a research program to develop a useful set of items: an expert panel's review of items, a substantial pilot study, and a factor analysis of ratings of a modified set of items by preclinical and final year medical students. Results: The factor analysis of the Modified MSLQ extracted four subscales with reasonable internal consistency: self-orientation, critical thinking, self-regulation and feedback-seeking. Each subscale correlates highly with the Modified MSLQ score, with modest inter-correlations between the subscales suggesting that they are measuring different components of the total score. Conclusion: Medical students and their educators need to be able to monitor their learning in their complex academic and clinical environments. The Modified MSLQ provides a means of investigating and tracking individual medical students' reflections on their learning

Assessment of the trauma evaluation and management (TEAM) module in Australia

Aim: To assess the immediate effect on trauma-related knowledge of the trauma evaluation and management (TEAM) program applied to medical students in Australia. Methods: 73 final year medical students from Melbourne were randomly assigned to two experimental groups (E1 and E2 who completed the TEAM program after a 20 item MCQ pre-test on trauma resuscitation and a second MCQ exam after the TEAM program) and two control groups (C1 and C2 who completed the pre- and post-MCQ exams before completing the TEAM module). All 73 students completed an evaluation questionnaire. Paired and unpaired t-tests were used for within and between groups comparisons. Results: Groups C1 and C2 had similar mean scores in pre- and post-tests ranging from 57.2 to 60.5%. Groups E1 and E2 had similar pre-test scores but increased their post-test scores (pre-test range 53.8-57.1% and post-test 68.8-77.4%,

Novice students navigating the clinical environment in an early medical clerkship

Context: The black box that is student learning in clinical environments is an ongoing research project. Our previous research showed that despite the time that students are given to learn with, about and from patients, some lack confidence for those encounters and see few patients. The study reported here investigated individual and environmental factors affecting medical students' self-directed learning time in hospital. Methods: We studied second year students in the four-year postgraduate Melbourne Medical School programme as they undertook the first of their four 9-week hospital placements in medical wards. Each week approximately 10 hours of structured teaching is offered; the remaining time is spent in self-directed learning. Over six weeks, we observed 31 medical students and interviewed 17 of them. The interviews were subjected to content analysis procedures and the observation notes added contextual information to what was said in interviews. We considered the findings through the Experience-based Learning framework. Results: We found four main themes in the data: finding and contacting patients challenges all students and overwhelms some; the educational design of the placement is a flawed navigational device providing inadequate clarity and security; the physical and social terrain of a large tertiary hospital is replete with obstacles making it easy for some students to stumble and retreat; finally, any positive connection with peers, staff and patients is empowering. Conclusions: This study throws light on to the uncertain path of the novice clinical learner illuminating both the intractable aspects of hospital environments and opportunities for pedagogical and affective supports that can compensate. The processes and conditions for self-directed learning time need attention in order to provide for a safe, efficient or successful clerkship experience for all students. Particular effort is needed to sensitively identify those individuals who struggle and suffer on the journey, and provide appropriate support