Clinical history in management of suspected syncope: A powerful diagnostic tool

In this paper, the role of history taking as a diagnostic tool in patients with transient loss of consciousness (TLOC) is addressed. From a literature review it can be demonstrated that, if properly performed, the history is a powerful diagnostic tool, which in the majority of cases proves to be the only ‘test’ necessary to establish a diagnosis other than physical examination and electrocardiogram in patients with TLOC. In order to substantiate this conclusion, we examine the different levels of history taking according to the skills and training of the physician involved, the diagnostic yield of each level, the methodology, and the influence of the venue and urgency of the case

Consensus about GP interprofessional competencies:A nominal group study

BACKGROUND: Since the requirements for collaboration in primary care increase, effective interprofessional teamwork between general practitioners (GPs) and other primary care professionals is crucial. The need for more training in interprofessional collaborative competencies is widely recognised. However, existing competency frameworks do not sufficiently specify interprofessional collaboration to guide interprofessional competency development. AIM: Consensus among GPs and other primary care professionals on interprofessional competencies that GP and GP-trainees should learn. DESIGN & SETTING: Qualitative consensus study among Dutch GPs and other primary care professionals, all with expertise in primary care interprofessional collaborative practice. METHOD: Three nominal group sessions were held, each resulting in its own group consensus on GP interprofessional collaborative competencies. The researchers conducted a content analysis to merge and thematise the prioritised competencies into one list. Participants prioritised this list of competencies. A pre-set cut-off point was applied to determine the overall consensus on core GP interprofessional competencies. RESULTS: Eighteen professionals from nine different disciplines participated. The content analysis resulted in 31 unique competencies of which fourteen competencies were prioritised in the final ranking into three main themes: 1. Professional identity development and role definition by the GP. (three competencies); 2. Developing and executing shared care plans for individual patients (6); 3. Setting up and maintaining interprofessional collaborative partnerships.(5) CONCLUSION: An interprofessional group of experts reached consensus on 14 competencies within 3 themes. This framework provides a steppingstone for GPs to focus on their development regarding interprofessional collaboration

How learning style affects evidence-based medicine:a survey study

BACKGROUND: Learning styles determine how people manage new information. Evidence-based medicine (EBM) involves the management of information in clinical practice. As a consequence, the way in which a person uses EBM can be related to his or her learning style. In order to tailor EBM education to the individual learner, this study aims to determine whether there is a relationship between an individual's learning style and EBM competence (knowledge/skills, attitude, behaviour). METHODS: In 2008, we conducted a survey among 140 novice GP trainees in order to assess their EBM competence and learning styles (Accommodator, Diverger, Assimilator, Converger, or mixed learning style). RESULTS: The trainees' EBM knowledge/skills (scale 0-15; mean 6.8; 95%CI 6.4-7.2) were adequate and their attitudes towards EBM (scale 0-100; mean 63; 95%CI 61.3-64.3) were positive. We found no relationship between their knowledge/skills or attitudes and their learning styles (p = 0.21; p = 0.19). Of the trainees, 40% used guidelines to answer clinical questions and 55% agreed that the use of guidelines is the most appropriate way of applying EBM in general practice. Trainees preferred using evidence from summaries to using evidence from single studies. There were no differences in medical decision-making or in EBM use (p = 0.59) for the various learning styles. However, we did find a link between having an Accommodating or Converging learning style and making greater use of intuition. Moreover, trainees with different learning styles expressed different ideas about the optimal use of EBM in primary care. CONCLUSIONS: We found that EBM knowledge/skills and EBM attitudes did not differ with respect to the learning styles of GP trainees. However, we did find differences relating to the use of intuition and the trainees' ideas regarding the use of evidence in decision-making

Self-regulated learning in the clinical context:A systematic review

OBJECTIVES: Research has suggested beneficial effects of self-regulated learning (SRL) for medical students' and residents' workplace-based learning. Ideally, learners go through a cyclic process of setting learning goals, choosing learning strategies and assessing progress towards goals. A clear overview of medical students' and residents' successful key strategies, influential factors and effective interventions to stimulate SRL in the workplace is missing. This systematic review aims to provide an overview of and a theoretical base for effective SRL strategies of medical students and residents for their learning in the clinical context.METHODS: This systematic review was conducted according to the guidelines of the Association for Medical Education in Europe. We systematically searched PubMed, EMBASE, Web of Science, PsycINFO, ERIC and the Cochrane Library from January 1992 to July 2016. Qualitative and quantitative studies were included. Two reviewers independently performed the review process and assessed the methodological quality of included studies. A total of 3341 publications were initially identified and 18 were included in the review.RESULTS: We found diversity in the use of SRL strategies by medical students and residents, which is linked to individual (goal setting), contextual (time pressure, patient care and supervision) and social (supervisors and peers) factors. Three types of intervention were identified (coaching, learning plans and supportive tools). However, all interventions focused on goal setting and monitoring and none on supporting self-evaluation.CONCLUSIONS: Self-regulated learning in the clinical environment is a complex process that results from an interaction between person and context. Future research should focus on unravelling the process of SRL in the clinical context and specifically on how medical students and residents assess their progress towards goals.</p

Mens, mobiliteit en materiële cultuur: Peter van den Broeke's bijdragen aan de studie van de metaaltijden

Pots, people and prehistoric mobility: Peter van den Broeke’s contributions to the study of Later Prehistoric communities Stijn Arnoldussen, Eugene Ball, Joyce van Dijk, Eric Norde &amp; Nynke de Vries This sixth edition of the ‘Metaaltijden. Bijdragen in de studie van de metaaltijden’ contains more papers than usual. This is due to fact that – upon the retirement of Peter van den Broeke – we have seized the opportunity to get a wide range of colleagues to publish a paper to mark this festive occasion. Due to generous contributions by our sponsors, and this year by the municipality of Nijmegen in particular, we can offer you this broad range of papers that address various of the topics central to Peter’s research (Theunissen, this volume). In the contributions by Bloo, Arnoldussen &amp; De Vries, Taayke and Hermsen &amp; Scholte Lubberink, Later Prehistoric handmade pottery takes center stage. Papers focus on regional fabrics and forms (Hermsen &amp; Scholte Lubberink, this volume; Taayke, this volume, cf. Van den Broeke 1987; 1991a; 2012; 2018), the importance of pottery fragmentation in recognizing depositions (De Vries, this volume, cf. Van den Broeke 2002a; 2015) and remarkable decorations on pottery (cf. Van den Broeke, this volume). Taayke (this volume) tries to determine what the earliest Iron Age pottery of the northeastern Netherlands looked like (cf. Van den Broeke 2012, 133‑136). Bloo (this volume) argues that local Neolithic pottery (cf. Ball &amp; Van den Broeke 2007; Van den Broeke et al. 2010, 54‑55) may have inspired the decorative repertoire of Iron Age vessels, and Geerts (this volume) stresses the role of imitation in the production of handmade Roman wares (cf. Van den Broeke 2005a) to express social identities (cf. Van den Broeke 2000). Drenth &amp; Schut (this volume) also note the importance of imitation in their discussion of a stone hammer-axe (cf. Van den Broeke 2005f, 666‑667) from Putten, whose decoration mimics that seen on antler axes (cf. Van den Broeke 2002b, 25). Other types of material culture (cf. Van den Broeke 2005b) are discussed as well. Verhart (this volume) presents a series of remarkable finds of bone and antler tools (cf. Van den Broeke 1983) from Peter’s place of birth Vlaardingen. Heeren (this volume) uses a previously unknown type of brooch from the Northern Netherlands to outline (supra-)regional contacts, affinities and/or mobility of people and material culture in Later Prehistory (cf. Van den Broeke 2001, 15; 22‑23; 28). Amkreutz, Fontijn &amp; Pots , pe ople and prehistoric mobility 13 Gentile’s case of a Late Bronze Age sword from Limburg shows how wetland landscapes figured as arenas for the deposition of objects (cf. Van den Broeke 2001; 2003, 20‑21; 2004, 1‑3). Access to such wetland zones may have been formalised with infrastructure (cf. Van den Broeke 2017, 34‑40; 93‑94), much like the bog trackway of Valthe discussed by Van der Sanden (this volume). The contributions by Fontijn et al., Jas &amp; Louwe Kooijmans and Eimermann &amp; Zuyderwyk all discuss (material culture originating from) Later Prehistoric funerary landscapes (cf. Van den Broeke 1999; 2005c-d; 2006; 2011; Eimermann &amp; Van den Broeke 2017). Jas and Louwe Kooijmans’ narrative (this volume) tells how urns from the Deelen urnfield travelled about and have only been preserved as a painting but could still – using Peter’s typological schemes – be dated to the Early Iron Age (Van den Broeke 2012, 36; 74; 87). Eimermann and Zuyderwyk (this volume) review the fabrication methods and depositional contexts for Iron Age Wendelringe neckrings (cf. Van den Broeke 2001, 132‑133; 142‑144; Eimermann &amp; Van den Broeke 2016). Settlement research (cf. Van den Broeke &amp; Van Londen 1995; Van den Broeke 1993; 2005; Van den Broeke et al. 2010) also figures amongst the papers presented here. Fokkens (this volume) argues for a more cautionary approach towards the dating of features based on finds recovered from their fills (cf. Van den Broeke 2012, 15‑23). A similarly critical stance is found in Koot’s paper (this volume) on the premises underlying our models of settlement dynamics for Iron Age settlements in the Western Netherlands (cf. Van den Broeke 1990; 1991b; 1993; 1995). From the Late Iron Age onwards, a few of the sites in the Western Netherlands appear to specialise in salt production (cf. Van den Broeke 1986; 2007; 2012, 167), as Van Heeringen (this volume) shows for the Vlaardingen – Claudis Civilislaan site. Daniëls and Van Enckevort (this volume) discuss the prehistoric settlements of both high- (Kops Plateau; cf. Van den Broeke 2014) and low-lying Nijmegen (Waalsprong; Van Den Broeke 2002b, 13; 21‑22; 26; 2017; Van den Broeke &amp; Ball 2012). In Bakels’ paper (this volume), goldof- pleasure is presented as a component to the group of oil-rich plants (comprising also linseed and brassica seeds; Van den Broeke 2005h, 687) that were staples of Iron Age communities. Despite the vast array of topics covered, we consider this to be a far from complete reflection of the scope and extent of Peter’s publications – which we expect not to cease upon retirement. Moreover, many of the authors have fond memories of the ways in which Peter shares his vast knowledge with them: always modest, helpful and witty. His outstanding expertise on later prehistoric pottery, but also his broad and deep knowledge of Later Prehistoric communities in general, means that Peter has been – and will continue to be – a help or mentor to many in their careers. It is therefore fitting, that we in turn dedicate this sixth issue of “Metaaltijden. Bijdragen in de studie van de Metaaltijden” to Peter van den Broeke. We hope you enjoy reading it! On behalf of the editorial team, Stijn Arnoldussen, Eugene Ball, Joyce van Dijk, Eric Norde &amp; Nynke de Vrie