Assessing the benefits and usefulness of Schwartz Centre Rounds in Second-Year Medical Students using Clinical Educator-Facilitated Group Work Session: not just “A Facilitated Moan”!

Background An experiential curriculum exposing medical students to the clinic early has many benefits but comes with the emotional stress this environment engenders. Schwartz rounds (SR) are an effective means to combat emotional stress and increasingly used in UK and USA hospitals. Recent studies show that the SR format may also provide benefits for medical students. This study aimed to investigate whether the guidance of SR in second year medical students provides the same benefits as to healthcare professionals. Methods SR assessment involved 83 second year MBChB students in facilitated groupwork sessions. Topics discussed were “change and resilience” and “duty of candour”. Students completed a Likert Scale questionnaire evaluating outcomes proffered by the Point of Care Foundation in collaboration with the Schwartz Foundation, with freeform feedback. Results There was an 86% completion rate with 25% providing written feedback. Participants were more likely to agree than disagree that SR were beneficial. SR effectiveness in enhancing students’ working relationship awareness and skills was strongly correlated with understanding the purpose of, and engagement with, the SR (P<0.001). Similarly, engagement with the SR was strongly correlated with self-reporting of enhanced patient-centredness (P < 0.001). Freeform feedback could be grouped into five themes that revolved around understanding of the SR and engagement with the process. Many positive comments regarded the SR as a forum not only to “learn experientially” but to so in a “safe environment”. Many negative comments stemmed from students not seeing any benefits of engagement with the SR, in that sharing experiences was “unbeneficial”, “empathy is inherent and not learnt”, or that sharing emotional problems is simply “moaning”. Conclusion SRs are an effective way of fostering empathy and understanding towards patients and colleagues. However, for the students to benefit fully from the SR it is necessary for them to engage and understand the process. Therefore, for the successful implementation of SR into pre-clinical medical education, it is important to help students realise that SR are not merely a “facilitated whinge”

Balance control in the elderly: do Masters athletes show more efficient balance responses than healthy older adults?

Background and aims: Older adults can improve several components of their balance such as timed stance ability by participating in a short specific exercise program. However, it is not clear whether participation in more frequent and intense training can result in improved reactive balance performance in older adults. Optimal reactive responses are required to prevent falls. This study begins to evaluate this issue by comparing the reactive balance ability of elite older adults (Masters athletes) to that of healthy older adults. Methods: Kinetic and electromyography data were collected from elite older athletes and healthy older adults during backward linear underfoot perturbations at high and low speeds. Behavioral outcomes of postural recovery strategy, timing and levels of muscular activation, and time to stabilize the displaced center of pressure were measured and compared between groups. Results: The elite older athletes were able to more frequently regain balance without stepping, stabilized their center of pressure faster than did healthy older adults and activated their tibialis anterior with a greater magnitude when perturbed at the higher speed. There were no differences between groups in these measures at the lower perturbation speed and no differences in onset latencies at either speed. Conclusions: Older athletes undertaking long-term high intensity training demonstrate better and more rapid stabilization of posture following perturbation than healthy older adults under challenging conditions. Further studies are advocated to determine the relative contribution of processes such as neuromotor adaptation, strength, motivation and arousal to this finding. (Aging Clin Exp Res 2008; 20: 406-411) (c) 2008, Editrice Kurtis