Does a PBL-based medical curriculum predispose training in specific career paths? A systematic review of the literature

Background North American medical schools have used problem-based learning (PBL) structured medical education for more than 60 years. However, it has only recently been introduced in other medical schools outside of North America. Since its inception, there has been the debate on whether the PBL learning process predisposes students to select certain career paths. Objectives To review available evidence to determine the predisposition of specific career paths when undertaking a PBL-based medical curriculum. The career path trajectory was determined as measured by official Matching Programs, self-reported questionnaires and surveys, and formally defined career development milestones. Methods A systematic literature review was performed. PubMed, Medline, Cochrane and ERIC databases were analysed in addition to reference lists for appropriate inclusion. Results Eleven studies fitting the inclusion criteria were identified. The majority of studies showed that PBL did not predispose a student to a career in a specific speciality (n = 7 out of 11 studies, 64%). However, three studies reported a significantly increased number of PBL graduates working in primary care compared to those from a non-PBL curriculum. Conclusions PBL has been shown not to predispose medical students to a career in General Practice or any other speciality. Furthermore, a greater number of similar studies are required before a definitive conclusion can be made in the future

Impact of COVID-19 pandemic social restriction measures on people with rheumatic and musculoskeletal diseases in the UK: a mixed-methods study

OBJECTIVES: To determine the impact of COVID-19 pandemic social restriction measures on people with rheumatic and musculoskeletal diseases (RMDs) and to explore how people adapted to these measures over time. DESIGN: Mixed-methods investigation comprising a national online longitudinal survey and embedded qualitative study. SETTING: UK online survey and interviews with community-dwelling individuals in the East of England. PARTICIPANTS: People in the UK with RMDs, were invited to participate in an online survey. A subsection of respondents were invited to participate in the embedded qualitative study. PRIMARY AND SECONDARY OUTCOME MEASURES: The online survey, completed fortnightly over 10 weeks from April 2020 to August 2020, investigated changes in symptoms, social isolation and loneliness, resilience and optimism. Qualitative interviews were undertaken assessing participant’s perspectives on changes in symptoms, exercising, managing instrumental tasks such a shopping, medication and treatment regimens, and how they experienced changes in their social networks. RESULTS: 703 people with RMDs completed the online survey. These people frequently reported a deterioration in symptoms as a result of COVID-19 pandemic social restrictions (52% reported increase vs. 6% reported a decrease). This was significantly worse for those aged 18 to 60 years compared to older participants (p=0.017). The qualitative findings from 30 individuals with RMDs suggest that the greatest change in daily life was experienced by those in employment. Although some retired people reported reduced opportunity for exercise outside their homes, they did not face the many competing demands experienced by employed people and people with children at home. CONCLUSIONS: People with RMDs reported a deterioration in symptoms when COVID-19 pandemic social restriction measures were enforced. This was worse for working-aged people. Consideration of this at-risk group, specifically for the promotion of physical activity, changing home-working practices and awareness of healthcare provision is important, as social restrictions continue in the UK

Early sleep and circadian markers of alzheimer's disease:the impact of apoe- epsilon 4 on sleep-wake regulation, brain activity and cognition in humans

Introduction: Sleep deficits have been linked to dementia including Alzheimer's disease (AD). TheAPOE-ε4 allele, the genetic risk factor of AD, has been shown to modulate some of these associations albeit with a considerable discrepancy between studies. Objectives: We set out to investigate the effects of theAPOE-ε4status on sleep-wake regulation using observational and experimental study designs in healthy elderly adults. Methods: In total 161 participants (117 female) between 42 and 90 years old have taken part in extensive screening sessions (51 APOE-ε4+, 110 APOE-ε4-) of which 58 (28APOE-ε4+, 30APOE-ε4-) participated in a 14-days-long actigraphy session. Thirty-five individuals (18APOE-ε4+, 17APOE-ε4-) underwent a 2.5-days-long laboratory session in dim light conditions (<10lx). After a baseline night, participants were randomly assigned to either a 40-h sleep deprivation (SD) or a multi-nap(MN) experimental condition followed by a recovery night. Nine 80-min-long naps were scheduled every 4 h in the MN condition. Vigilance, cognition, EEG activity, and postural control (i.e., measured by posturography) were measured on a 4-hourly basis in both experimental conditions. Results: There were no significant genotype differences in either self-reported or polysomnography measured sleep. There was a significant decrease in the actigraphy-measured circadian rest-activity relative amplitude (RA) in the APOE-ɛ4+ subgroup. The genotype did not significantly modulate the effect of sleep loss and circadian phase on cognition. Interestingly the negative effect of sleep loss on balance control was modulated by both sex and APOE status. Men and APOE-ε4 carriers were more affected after sleep loss when both visual and haptic sensorial feedback was provided. Lower self-reported sleep quality was the strongest predictor of worse mental health, independent of age, sex, APOE-ε4 carriership, and other confounding factors. However, this association was stronger in men and APOE-ε4 carriers compared to non-carriers. The known association between increased eveningness and lower subjective sleep quality was present in non-carriers only. Conclusion: APOE is not linked to individual vulnerability to sleep loss but modulates the amplitude of the circadian rest-activity rhythmicity, the effect of sleep deprivation on postural control, and the associations between sleep, brain activity, and mental well-being and cognition in healthy older adults. Disclosure: N