Graduates from a traditional medical curriculum evaluate the effectiveness of their medical curriculum through interviews

<p>Abstract</p> <p>Background</p> <p>In 1996 The University of Liverpool reformed its medical course from a traditional lecture-based course to an integrated PBL curriculum. A project has been underway since 2000 to evaluate this change. Part of this project has involved gathering retrospective views on the relevance of both types of undergraduate education according to graduates. This paper focuses on the views of traditional Liverpool graduates approximately 6 years after graduation.</p> <p>Methods</p> <p>From February 2006 to June 2006 interviews took place with 46 graduates from the last 2 cohorts to graduate from the traditional Liverpool curriculum.</p> <p>Results</p> <p>The graduates were generally happy with their undergraduate education although they did feel there were some flaws in their curriculum. They felt they had picked up good history and examination skills and were content with their exposure to different specialties on clinical attachments. They were also pleased with their basic science teaching as preparation for postgraduate exams, however many complained about the overload and irrelevance of many lectures in the early years of their course, particular in biochemistry. There were many different views about how they integrated this science teaching into understanding disease processes and many didn't feel it was made relevant to them at the time they learned it. Retrospectively, they felt that they hadn't been clinically well prepared for the role of working as junior doctor, particularly the practical aspects of the job nor had enough exposure to research skills. Although there was little communication skills training in their course they didn't feel they would have benefited from this training as they managed to pick up had the required skills on clinical attachments.</p> <p>Conclusion</p> <p>These interviews offer a historical snapshot of the views of graduates from a traditional course before many courses were reformed. There was some conflict in the interviews about the doctors enjoying their undergraduate education but then saying that they didn't feel they received good preparation for working as a junior doctor. Although the graduates were happy with their undergraduate education these interviews do highlight some of the reasons why the traditional curriculum was reformed at Liverpool.</p

The impact of acid deposition and forest harvesting on lakes and their forested catchments in south central Ontario: a critical loads approach

International audienceThe impact of acid deposition and tree harvesting on three lakes and their representative sub-catchments in the Muskoka-Haliburton region of south-central Ontario was assessed using a critical loads approach. As nitrogen dynamics in forest soils are complex and poorly understood, for simplicity and to allow comparison among lakes and their catchments, CLs (A) for both lakes and forest soils were calculated assuming that nitrate leaching from catchments will not change over time (i.e. a best case scenario). In addition, because soils in the region are shallow, base cation weathering rates for the representative sub-catchments were calculated for the entire soil profile and these estimates were also used to calculate critical loads for the lakes. These results were compared with critical loads obtained by the Steady State Water Chemistry (SSWC) model. Using the SSWC model, critical loads for lakes were between 7 and 19 meq m-2yr-1 higher than those obtained from soil measurements. Lakes and forests are much more sensitive to acid deposition if forests are harvested, but two acid-sensitive lakes had much lower critical loads than their respective forested sub-catchments implying that acceptable acid deposition levels should be dictated by the most acid-sensitive lakes in the region. Under conditions that assume harvesting, the CL (A) is exceeded at two of the three lakes and five of the six sub-catchments assessed in this study. However, sulphate export from catchments greatly exceeds input in bulk deposition and, to prevent lakes from falling below the critical chemical limit, sulphate inputs to lakes must be reduced by between 37% and 92% if forests are harvested. Similarly, sulphate leaching from forested catchments that are harvested must be reduced by between 16 and 79% to prevent the ANC of water draining the rooting zone from falling below 0 ?eq l-1. These calculations assume that extremely low calcium leaching losses (9?27 ?eq l-1) from forest soils can be maintained without any decrease in forest productivity. Calcium concentrations in the three lakes have decreased by between ?10 and 25% over the past 20 years and calculations assume that calcium concentrations in lakes can fall to around 30% of their current values without any harmful effects on biota. Both these assumptions require urgent investigation. Keywords: acid deposition, calcium, critical loads, forests, harvesting, lakes</p

Modelling acidification, recovery and target loads for headwater catchments in Nova Scotia, Canada

The response of twenty acid-sensitive headwater catchments in Nova Scotia to acidic deposition was investigated for the period 1850&ndash;2100 using a dynamic hydrochemical model (MAGIC: Model of Acidification of Groundwater in Catchments). To ensure robust model simulation, MAGIC was calibrated to the long-term chemical trend in annual lake observations (13&ndash;20 years). Model simulations indicated that the surface waters of all twenty catchments acidified to the 1970s but showed subsequent recovery (increases in acid neutralising capacity (ANC) and pH) as sulphate deposition decreased. However, under proposed future emissions reductions (approximately 50% of current deposition) simulated ANC and pH will not return to estimated pre-industrial levels by 2100. An ANC of 20 &mu;mol_c L^&minus;1 and pH of 5.4 were defined as acceptable chemical thresholds (or critical chemical limits) for aquatic organisms in the current study. Under the proposed emissions reductions only one catchment is predicted to remain below the critical limit for ANC by 2100; three additional catchments are predicted to remain below the critical limit for pH. Dynamic models may be used to estimate target loads, i.e., the required deposition reductions to achieve recovery within a given time. Setting target loads at approximately 30% of current depositions would allow three of the four lakes to reach the chemical criteria by 2030. In contrast to the generally good prognosis for surface waters, soils lost an average of 32% of estimated initial base saturation and recovery is estimated to be very slow, averaging 23% lower than pre-acidification levels in 2100

An evaluation of the performance in the UK Royal College of Anaesthetists primary examination by UK medical school and gender

<p>Abstract</p> <p>Background</p> <p>There has been comparatively little consideration of the impact that the changes to undergraduate curricula might have on postgraduate academic performance. This study compares the performance of graduates by UK medical school and gender in the Multiple Choice Question (MCQ) section of the first part of the Fellowship of the Royal College of Anaesthetists (FRCA) examination.</p> <p>Methods</p> <p>Data from each sitting of the MCQ section of the primary FRCA examination from June 1999 to May 2008 were analysed for performance by medical school and gender.</p> <p>Results</p> <p>There were 4983 attempts at the MCQ part of the examination by 3303 graduates from the 19 United Kingdom medical schools. Using the standardised overall mark minus the pass mark graduates from five medical schools performed significantly better than the mean for the group and five schools performed significantly worse than the mean for the group. Males performed significantly better than females in all aspects of the MCQ – physiology, mean difference = 3.0% (95% CI 2.3, 3.7), p < 0.001; pharmacology, mean difference = 1.7% (95% CI 1.0, 2.3), p < 0.001; physics with clinical measurement, mean difference = 3.5% (95% CI 2.8, 4.1), p < 0.001; overall mark, mean difference = 2.7% (95% CI 2.1, 3.3), p < 0.001; and standardised overall mark minus the pass mark, mean difference = 2.5% (95% CI 1.9, 3.1), p < 0.001. Graduates from three medical schools that have undergone the change from Traditional to Problem Based Learning curricula did not show any change in performance in any aspects of the MCQ pre and post curriculum change.</p> <p>Conclusion</p> <p>Graduates from each of the medical schools in the UK do show differences in performance in the MCQ section of the primary FRCA, but significant curriculum change does not lead to deterioration in post graduate examination performance. Whilst females now outnumber males taking the MCQ, they are not performing as well as the males.</p

The reaction of Escherichia coli cytochrome bo with H202: Evidence for the formation of an oxyferryl species by two distinct routes

AbstractWe have re-examined the reaction of fast oxidised cytochrome bo with H2O2 in a stopped-flow spectrophotometer. Monitoring the reaction at 582 nm allows us to observe the formation and decay of a spectroscopically distinct intermediate which accumulates transiently prior to the formation of an oxyferryl species previously characterised in this laboratory (Watmough, N.J., Cheesman, M.R., Greenwood, C. and Thomson, A.J. (1994) Biochem. J. 300, 469–475 [1]). The reaction shows three distinct phases of which the fast and intermediate phases are bimolecular and show a marked pH dependence. Initially these results appeared incompatible with the report that only one equivalent of H2O2 is required to generate the oxyferryl species (Moody, A.J. and Rich, P.R. (1994) Eur. J. Biochem. 226, 731–737 [2]). However, these data can be reconciled by a branched reaction mechanism whose contributions differ according to the peroxide concentration used

Views of junior doctors about whether their medical school prepared them well for work: questionnaire surveys

<p>Abstract</p> <p>Background</p> <p>The transition from medical student to junior doctor in postgraduate training is a critical stage in career progression. We report junior doctors' views about the extent to which their medical school prepared them for their work in clinical practice.</p> <p>Methods</p> <p>Postal questionnaires were used to survey the medical graduates of 1999, 2000, 2002 and 2005, from all UK medical schools, one year after graduation, and graduates of 2000, 2002 and 2005 three years after graduation. Summary statistics, chi-squared tests, and binary logistic regression were used to analyse the results. The main outcome measure was the level of agreement that medical school had prepared the responder well for work.</p> <p>Results</p> <p>Response rate was 63.7% (11610/18216) in year one and 60.2% (8427/13997) in year three. One year after graduation, 36.3% (95% CI: 34.6, 38.0) of 1999/2000 graduates, 50.3% (48.5, 52.2) of 2002 graduates, and 58.2% (56.5, 59.9) of 2005 graduates agreed their medical school had prepared them well. Conversely, in year three agreement fell from 48.9% (47.1, 50.7) to 38.0% (36.0, 40.0) to 28.0% (26.2, 29.7). Combining cohorts at year one, percentages who agreed that they had been well prepared ranged from 82% (95% CI: 79-87) at the medical school with the highest level of agreement to 30% (25-35) at the lowest. At year three the range was 70% to 27%. Ethnicity and sex were partial predictors of doctors' level of agreement; following adjustment for them, substantial differences between schools remained. In years one and three, 30% and 34% of doctors specified that feeling unprepared had been a serious or medium-sized problem for them (only 3% in each year regarded it as serious).</p> <p>Conclusions</p> <p>The vast knowledge base of clinical practice makes full preparation impossible. Our statement about feeling prepared is simple yet discriminating and identified some substantial differences between medical schools. Medical schools need feedback from graduates about elements of training that could be improved.</p

Effect of alloying on mechanical properties of as cast ferritic nodular cast irons

The development of low temperature applications for ferritic nodular cast irons calls for improved materials in the as cast state, e.g. for off-shore windmills components. Within this line of work, a series of 68 castings were prepared with the same casting procedure and slight changes in composition. The tensile properties at room temperature, as well as the impact energy for rupture at room temperature, 220 °C and 240 °C, were measured. Outputs from multivariate analysis performed on the data are then discussed and compared to literature results, putting emphasis on the properties of the ferritic matrix

Psychometric and biomedical outcomes of glycated haemoglobin target-setting in adults with type 1 and type 2 diabetes:Protocol for a mixed-methods parallel-group randomised feasibility study

BACKGROUND: The disease burden of diabetes can have wide-ranging implications on patients’ psychological well-being and health-related quality of life. Glycated haemoglobin targets are commonly used to guide patient management in diabetes to reduce the future risk of developing diabetes complications, but little is known of the psychological impact of glycated haemoglobin target-setting. This protocol describes a study to determine the feasibility of evaluating psychological outcomes when setting explicit glycated haemoglobin targets in people with diabetes. METHODS: This single-centre randomised feasibility study will follow a mixed-methods approach across four sub-studies. In sub-study A, eligible adults (aged 18 and over) with type 1 or type 2 diabetes will complete baseline validated psychometric questionnaires evaluating health-related quality of life (EuroQoL-5D-5L), diabetes-related distress (Problem Areas In Diabetes), self-care (Summary of Diabetes Self-Care Activities), well-being (Well-Being Quetionnaire-12) and diabetes-related psychosocial self-efficacy (Diabetes Empowerment Scale-Long Form). Participants will be randomised to receive explicit glycated haemoglobin intervention targets 5mmol/mol above or below current glycated haemoglobin readings. Rates of eligibility, recruitment, retention and questionnaire response rate will be measured. Psychometric outcomes will be re-evaluated 3-months post-intervention. Sub-studies B and C will use qualitative semi-structured interviews to evaluate experiences, views and opinions of diabetes patients and healthcare professionals in relation to the acceptability of study processes, the use of glycated haemoglobin targets, the impact of diabetes on psychological well-being and, in sub-study D, barriers to participation in diabetes research. DISCUSSION: This mixed-methods study aims to provide a novel insight into the psychological implications of glycated haemoglobin target-setting for people with diabetes in secondary care, alongside testing the feasibility of undertaking a larger project of this nature. TRIAL REGISTRATION: The study is registered with the ISRCTN (registration number: 12461724; date registered: 11(th) June 2021). Protocol version: 2.0.5, 26(th) February 2021

Unexpected medical undergraduate simulation training (UMUST): can unexpected medical simulation scenarios help prepare medical students for the transition to foundation year doctor?

BACKGROUND: Preparing medical students with the skills necessary to deal with emergency situations as junior doctors can be challenging due to the complexities of creating authentic ‘real life’ experiences in artificial environments. The following paper is an evaluation of the UMUST (Unexpected Medical Undergraduate Simulation Training) project; a high-fidelity simulation based training programme designed to emulate the experience of dealing with medical emergencies for final year medical students preparing for practice as Foundation Year trainees. METHODS: Final year medical students from Liverpool University who undertake their clinical placements at Blackpool Teaching Hospitals NHS Foundation Trust and St. Helens & Knowsley Teaching Hospitals NHS Trust were randomly allocated into groups and took part in a series of four unexpected simulation based scenarios. At the beginning of the week in which the scenarios ran, participants were issued with a hospital bleep which they carried with them during their placement. At an unknown time to them, the participants were bleeped to attend a simulated emergency scenario, and on arrival to the Clinical Skills and Simulation facility, members of the education team undertook a standardised simulation scenario. Each session was recorded on video which the participants subsequently watched as part of a debriefing process. An assessment tool was developed to gauge whether the participants made progress in their learning over the course of the four sessions. Focus groups were held with the participants in order to evaluate their experience of the programme, and questionnaires were later distributed to all participants once they had begun working as a Foundation Year trainee. The questionnaires asked them how relevant UMUST was in preparing them for dealing with medical emergencies. RESULTS: The questionnaires and the focus groups clearly showed that the doctors felt like UMUST was very valuable in preparing them to work as junior doctors. They had enjoyed taking part in UMUST and thought was a realistic and useful part of their undergraduate training. CONCLUSIONS: The feedback from the focus groups and the subsequent questionnaires clearly demonstrate that participants felt the UMUST programme helped to prepare them as junior doctors in terms of dealing with emergency situations