Évaluation des résultats d’un cours pour les étudiants en médecine axé sur la congruence clinique en pleine conscience

Purpose: We questioned whether an intensive experiential core course would change medical students’ intention to practice mindful clinical congruence. Our primary hypothesis was that we would see more of a change in the intention to practice mindful clinical congruence in those who had taken versus not yet taken our course. Methods: From a class of 179 in second year we recruited 57 (32%) students who had been already divided into three groups that completed the course in successive periods. We measured mindful clinical congruence using a questionnaire developed and evaluated for validity. We also measured students’ level of stress to determine if any effects we saw were related to stress reduction. Results: Students who had just completed the course showed a greater intention to practice mindful clinical congruence than students who had not yet started the course. There was an apparent slight increase in perceived stress in those who had completed our course. Conclusions: We can change students’ intention to practice mindfully and congruently, which we believe will prevent a decline in compassion and ethical values in clerkship. The results did not appear to be explained by a decrease in stress in students who completed the course.Objectif : Nous avons cherché à savoir si un cours de base expérientiel intensif modifierait l'intention des étudiants en médecine de pratiquer la congruence clinique en pleine conscience. Notre hypothèse principale était que nous verrions un changement plus important dans l'intention de pratiquer la congruence clinique en pleine conscience chez ceux qui avaient suivi notre cours par rapport à ceux qui ne l'avaient pas encore suivi. Méthodes : Sur une classe de 179 étudiants en deuxième année, nous avons recruté 57 (32%) étudiants qui avaient déjà été divisés en trois groupes qui ont suivi le cours dans des périodes successives. Nous avons mesuré la congruence clinique en pleine conscience à l'aide d'un questionnaire dont la validité a été évaluée. Nous avons également mesuré le niveau de stress des étudiants afin de déterminer si les effets observés étaient liés à une réduction du stress. Résultats : Les étudiants qui venaient de terminer le cours ont montré une plus grande intention de pratiquer la congruence clinique en pleine conscience que les étudiants qui n'avaient pas encore commencé le cours. On a constaté une légère augmentation apparente du stress ressenti chez ceux qui avaient terminé notre cours. Conclusions : Nous pouvons modifier l'intention des étudiants de pratiquer la pleine conscience et la congruence, ce qui, selon nous, empêchera un déclin de la compassion et des valeurs éthiques au cours de l'externat. Les résultats ne semblent pas s'expliquer par une diminution du stress chez les étudiants qui ont suivi le cours

Using script theory to cultivate illness script formation and clinical reasoning in health professions education

Background: Script theory proposes an explanation for how information is stored in and retrieved from the human mind to influence individuals’ interpretation of events in the world. Applied to medicine, script theory focuses on knowledge organization as the foundation of clinical reasoning during patient encounters. According to script theory, medical knowledge is bundled into networks called ‘illness scripts’ that allow physicians to integrate new incoming information with existing knowledge, recognize patterns and irregularities in symptom complexes, identify similarities and differences between disease states, and make predictions about how diseases are likely to unfold. These knowledge networks become updated and refined through experience and learning. The implications of script theory on medical education are profound. Since clinician-teachers cannot simply transfer their customized collections of illness scripts into the minds of learners, they must create opportunities to help learners develop and fine-tune their own sets of scripts. In this essay, we provide a basic sketch of script theory, outline the role that illness scripts play in guiding reasoning during clinical encounters, and propose strategies for aligning teaching practices in the classroom and the clinical setting with the basic principles of script theory

Using script theory to cultivate illness script formation and clinical reasoning in health professions education

Background: Script theory proposes an explanation for how information is stored in and retrieved from the human mind to influence individuals’ interpretation of events in the world. Applied to medicine, script theory focuses on knowledge organization as the foundation of clinical reasoning during patient encounters. According to script theory, medical knowledge is bundled into networks called ‘illness scripts’ that allow physicians to integrate new incoming information with existing knowledge, recognize patterns and irregularities in symptom complexes, identify similarities and differences between disease states, and make predictions about how diseases are likely to unfold. These knowledge networks become updated and refined through experience and learning. The implications of script theory on medical education are profound. Since clinician-teachers cannot simply transfer their customized collections of illness scripts into the minds of learners, they must create opportunities to help learners develop and fine-tune their own sets of scripts. In this essay, we provide a basic sketch of script theory, outline the role that illness scripts play in guiding reasoning during clinical encounters, and propose strategies for aligning teaching practices in the classroom and the clinical setting with the basic principles of script theory

Reflections on medical education: An innovative near-peer led initiative using online media to teach the neurological exam

The move to virtual learning due to the COVID-19 pandemic has resulted in fewer opportunities for medical students to participate in bedside teaching and encounter patients presenting with characteristic clinical findings of various neurological disorders. We describe an interactive, peer-taught learning-session on Zoom teleconference wherein upper-year students developed learning cases using online videoclips of neurological examinations and corresponding findings. A post-session survey revealed an overwhelmingly positive response, especially regarding the sessions’ case-based and peer-taught structure. Overall, considering the dual benefits of peer-teaching, and the opportunity to see a wide range of findings from the videos, this initiative may be a valuable supplemental learning activity for existing undergraduate neurology rotations

Rheumatoid Meningitis Presenting With Acute Parkinsonism and Protracted Non-convulsive Seizures: An Unusual Case Presentation and Review of Treatment Strategies

Rheumatoid meningitis is a rare complication of rheumatoid arthritis (RA). It is associated with substantial morbidity and mortality. The condition may present in a variety of ways and is therefore diagnostically challenging. Uncertainty still exists regarding the optimal treatment strategy. Herein, we describe the case of a 74-year-old man with a history of well-controlled seropositive RA on low-dose prednisone, hydroxychloroquine, and methotrexate. The patient presented with a several-month history of multiple prolonged episodes of expressive aphasia, right hemiparesis, and encephalopathy. Although no epileptiform activity was recorded on repeated electroencephalography, the symptoms fully resolved following treatment with antiepileptic drugs. He subsequently developed acute asymmetrical parkinsonism of the right hemibody. Magnetic resonance imaging revealed subtle enhancement of the leptomeninges over the left frontoparietal convexity. Cerebrospinal fluid analysis revealed a mild lymphocytic pleocytosis and elevated proteins. Histopathologic analysis of a meningeal biopsy revealed nodular rheumatoid meningitis. The patient was treated with corticosteroids and cyclophosphamide, following which he incompletely recovered. This is the first description of rheumatoid meningitis manifesting with acute parkinsonism and protracted non-convulsive seizures. A summary of cases reported since 2005, including data on pathology, therapy and outcomes, along with a discussion on the efficacy of different treatment strategies are provided

What steps are necessary to create written or web-based selected-response assessments?

Before we work out what constitutes an assessment’s value for a given cost in medical education, we must first outline the steps necessary to create an assessment, and then assign a cost to each step. In this study we undertook the first phase of this process: we sought to work out all the steps necessary to create written selected-response assessments. First, the lead author created an initial list of potential steps for developing written assessments. This was then distributed to the other three authors. These authors independently added further steps to the list. The lead author incorporated the contributions of these others and created a second draft. This process was repeated until consensus was achieved amongst the study’s authors. Next, the list was shared by means of an online questionnaire with 100 healthcare professionals with experience in medical education. The results of the authors’ and healthcare professionals’ thoughts and feedback on the steps, needed to create written assessment, are outlined below in full. We outlined the steps that are necessary to create written or web-based selected-response assessments

What steps are necessary to create written or web-based selected-response assessments?

Before we work out what constitutes an assessment’s value for a given cost in medical education, we must first outline the steps necessary to create an assessment, and then assign a cost to each step. In this study we undertook the first phase of this process: we sought to work out all the steps necessary to create written selected-response assessments. First, the lead author created an initial list of potential steps for developing written assessments. This was then distributed to the other three authors. These authors independently added further steps to the list. The lead author incorporated the contributions of these others and created a second draft. This process was repeated until consensus was achieved amongst the study’s authors. Next, the list was shared by means of an online questionnaire with 100 healthcare professionals with experience in medical education. The results of the authors’ and healthcare professionals’ thoughts and feedback on the steps, needed to create written assessment, are outlined below in full. We outlined the steps that are necessary to create written or web-based selected-response assessments