The Influence of a ‘Gap Year’ on Medical Students

This study reports the views of second year medical students from 6 Universities on the value or not of deferring entry to medical school in order to take a ‘Gap Year’ obtained from an anonymous questionnaire. Data were analysed using Fisher’s exact test to produce a two tailed P value, with significance defined as p <0.05. A total of 184 questionnaires returned, 79 from gap year students and 105 non gap year students. Nearly all who had taken a gap year (77/79) would advise current school leavers to take one, compared to only 48/105 who had not (p <0.0001). A similar difference was observed between the two groups when asked if they thought a gap year helped students become more mature (78/79 v 46/105, p <0.0001). Similarly, gap year students were significantly more likely to consider that a gap year made it easier for them to make friends (70/79 v 26/105, p <0.0001). There was no significant difference between the two groups in finding it difficult to settle into work at University (31/79 v 36/105, p=0.5373). This study shows overwhelming support for deferring entry to medical school and taking a gap year from those students who took one, and nearly half of those students who did not. Medical school entrance committees should re-consider their advice to students who wish to defer entry in order to take a ‘gap year’

Undergraduate medical textbooks do not provide adequate information on intravenous fluid therapy: a systematic survey and suggestions for improvement

&lt;b&gt;Background&lt;/b&gt;&lt;p&gt;&lt;/p&gt; Inappropriate prescribing of intravenous (IV) fluid, particularly 0.9% sodium chloride, causes post-operative complications. Fluid prescription is often left to junior medical staff and is frequently poorly managed. One reason for poor intravenous fluid prescribing practices could be inadequate coverage of this topic in the textbooks that are used.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Methods&lt;/b&gt;&lt;p&gt;&lt;/p&gt; We formulated a comprehensive set of topics, related to important common clinical situations involving IV fluid therapy, (routine fluid replacement, fluid loss, fluids overload) to assess the adequacy of textbooks in common use. We assessed 29 medical textbooks widely available to students in the UK, scoring the presence of information provided by each book on each of the topics. The scores indicated how fully the topics were considered: not at all, partly, and adequately. No attempt was made to judge the quality of the information, because there is no consensus on these topics.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Results&lt;/b&gt;&lt;p&gt;&lt;/p&gt; The maximum score that a book could achieve was 52. Three of the topics we chose were not considered by any of the books. Discounting these topics as “too esoteric”, the maximum possible score became 46. One textbook gained a score of 45, but the general score was poor (median 11, quartiles 4, 21). In particular, coverage of routine postoperative management was inadequate.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Conclusions&lt;/b&gt;&lt;p&gt;&lt;/p&gt; Textbooks for undergraduates cover the topic of intravenous therapy badly, which may partly explain the poor knowledge and performance of junior doctors in this important field. Systematic revision of current textbooks might improve knowledge and practice by junior doctors. Careful definition of the remit and content of textbooks should be applied more widely to ensure quality and “fitness for purpose”, and avoid omission of vital knowledge

A ward-round non-technical skills for surgery (WANTSS) taxonomy.

Background: Around half of surgical adverse events occur outside the operating room. However the majority of non-technical skills (NTS) training programs have been developed for the intra-operative environment. Ward rounds are a crucial part of extra-operative care and to date no specific NTS training manual has been developed targeting emergency general surgical ward rounds. Aim: To develop a NTS taxonomy for emergency general surgical ward rounds that can be used to improve surgical team members’ NTS and improve outcomes. Methods: A literature review of existing NTS taxonomies was conducted, followed by semi-structured interviews and observational data collection, to determine good and poor surgical ward round behaviours. These behaviours were reviewed by a panel of subject matter experts and categorised into a taxonomy, using the Non-Technical Skills for Surgeons (NOTSS) taxonomy framework as a guide. Results: The Ward-round Non-Technical Skills for Surgery (WANTSS) taxonomy includes examples of good and poor ward round specific behaviours, grouped into elements and categories. The taxonomy can be used as both a training and teaching manual for the surgical team. Conclusion: Ward rounds are a crucial part of extra-operative surgical care. The WANTSS taxonomy provides surgical teams with a manual to help them improve their ward round NTS

Leg Fidgeting Improves Executive Function following Prolonged Sitting with a Typical Western Meal: A Randomized, Controlled Cross-Over Trial.

Prolonged uninterrupted sitting and a typical Western meal, high in fat and refined sugar, can additively impair cognitive and cerebrovascular functions. However, it is unknown whether interrupting these behaviours, with a simple desk-based activity, can attenuate the impairment. The aim of this study was to determine whether regular leg fidgeting can off-set the detrimental effects of prolonged sitting following the consumption of a typical Western meal, on executive and cerebrovascular function. Using a randomized cross-over design, 13 healthy males consumed a Western meal and completed 180-min of prolonged sitting with leg fidgeting of 1 min on/4 min off (intervention [INT]) and without (control [CON]). Cognitive function was assessed pre and post sitting using the Trail Maker Test (TMT) parts A and B. Common carotid artery (CCA) blood flow, as an index of brain flow, was measured pre and post, and cerebral (FP1) perfusion was measured continuously. For TMT B the CON trial signifi-cantly increased (worsened) completion time (mean difference [MD]=5.2s, d= 0.38), the number of errors (MD=3.33, d= 0.68) and cognitive fatigue (MD=0.73, d= 0.92). Compared to CON, the INT trial significantly improved completion time (MD=2.3s, d= 0.97), and prevented declines in cognitive fatigue and a reduction in the number of errors. No significant changes in cerebral perfusion or CCA blood flow were found. Leg fidgeting for 1-min on/4-min off following a meal high in fats and refined sugars attenuated the impairment in executive function. This attenuation in executive function may not be caused by al-terations in CCA blood flow or cerebral perfusion

Central and peripheral arterial stiffness responses to uninterrupted prolonged sitting combined with a high-fat meal: a randomized, controlled cross-over trial

Background and aims: Independently, prolonged uninterrupted sitting and the consumption of a meal high in saturated fats acutely disrupt normal cardiovascular function. Currently the acute effects of these behaviours performed in combination on arterial stiffness, a marker of cardiovascular health, is unknown. This study sought to determine the effect of consuming a high-fat meal (Δ= 51 g fat) in conjunction with prolonged uninterrupted sitting (180 min) on measures of central and peripheral arterial stiffness. Methods: Using a randomized crossover design, thirteen young healthy males consumed a high-fat (61 g) or low-fat (10 g) meal before 180 min of uninterrupted sitting. Carotid-femoral (cf-) and femoral-ankle (fa-) pulse wave velocity (PWV), aortic-femoral stiffness gradient (af-SG), superficial femoral PWV beta (β), and oscillometric pulse wave analysis outcomes were assessed pre and post sitting. Results: cfPWV increased significantly more following the high-fat (mean difference [MD]= 0.59 m·s-1) when compared to the low-fat (MD= 0.2 m·s-1) meal, with no change in faPWV in either condition. The af-SG significantly decreased (worsened) (ηp2= 0.569) overtime in high and low-fat conditions (ratio= 0.1 and 0.1 respectively). Superficial femoral PWVβ significantly increased over time in high- and low-fat conditions (ηp2= 0.321; 0.8 and 0.4 m·s-1 respectively). A significant interaction found that triglycerides increased over time in the high fat trial only (ηp2= 0.761). There were no significant changes in blood pressures. Conclusions: Consuming a high-fat meal prior to 180 min of uninterrupted sitting augments markers of cardiovascular disease risk more than sitting following a low-fat meal