How can we improve teaching of ECG interpretation skills? Findings from a prospective randomised trial.

BACKGROUND: There is an ongoing debate on how ECG interpretation should be taught during undergraduate medical training. This study addressed the impact of teaching format, examination consequences and student motivation on skills retention. METHODS: A total of 493 fourth-year medical students participated in a six-group, partially randomised trial. Students received three levels of teaching intensity: self-directed learning (2 groups), lectures (2 groups) or small-group peer-teaching (2 groups). On each level of teaching intensity, end-of-course written examinations (ECG exit exam) were summative in one group and formative in the other. Learning outcome was assessed in a retention test two months later. RESULTS: Retention test scores were predicted by summative assessments (adjusted beta 4.08; 95% CI 1.39-6.78) but not by the type of teaching. Overall performance levels and motivation did not predict performance decrease or skills retention. CONCLUSIONS: Summative assessments increase medium-term retention of ECG interpretation skills, irrespective of instructional format

Moving Knowledge Acquisition From the Lecture Hall to the Student Home: A Prospective Intervention Study.

BACKGROUND: Podcasts are popular with medical students, but the impact of podcast use on learning outcomes in undergraduate medical education has not been studied in detail. OBJECTIVE: Our aim was to assess the impact of podcasts accompanied by quiz questions and lecture attendance on short- and medium-term knowledge retention. METHODS: Students enrolled for a cardio-respiratory teaching module were asked to prepare for 10 specific lectures by watching podcasts and submitting answers to related quiz questions before attending live lectures. Performance on the same questions was assessed in a surprise test and a retention test. RESULTS: Watching podcasts and submitting answers to quiz questions (versus no podcast/quiz use) was associated with significantly better test performance in all items in the surprise test and 7 items in the retention test. Lecture attendance (versus no attendance) was associated with higher test performance in 3 items and 1 item, respectively. In a linear regression analysis adjusted for age, gender, and overall performance levels, both podcast/quiz use and lecture attendance were significant predictors of student performance. However, the variance explained by podcast/quiz use was greater than the variance explained by lecture attendance in the surprise test (38.7% vs. 2.2%) and retention test (19.1% vs. 4.0%). CONCLUSIONS: When used in conjunction with quiz questions, podcasts have the potential to foster knowledge acquisition and retention over and above the effect of live lectures

Tyrosine Kinase Inhibition at Human Non-Hodgkin s Lymphomas: Preclinical Evaluation of Sorafenib

Ein Großteil der Patienten mit aggressiven Lymphomen kann heute durch den Einsatz einer zytostatischen Therapie von der Erkrankung geheilt werden. Für Patienten mit peripheren T-Zell-Lymphomen oder Patienten mit rezidivierten Lymphomen stehen allerdings meist keine Therapieoptionen mit kurativem Potential zur Verfügung. Kinase-vermittelte intrazelluläre Signalübermittlung ist entscheidend für das Überleben von Lymphomzellen, wobei bisher in der Pathogenese der malignen Lymphome in der Regel mehrere, z.T. überlappende Signaltransduktionswege als aktiviert beschrieben wurden. In dieser Arbeit wurde daher die zytostatische Wirkung eines mehrere Kinasen inhibierenden Moleküls, Sorafenib, bei verschiedenen aggressiven Lymphomen umfassend in vitro analysiert. Es konnte gezeigt werden, dass Sorafenib die Viabilität bereits bei geringen Konzentrationen in Abhängigkeit von Dosis und Zeit signifikant reduzierte. Kurzzeitexposition bewirkte eine Apoptoseinduktion, während Langzeitexposition in geringen Konzentrationen vornehmlich einen proliferativen Arrest induzierte. Diese antiproliferative Wirkung war irreversibel, wie anschließende Klonogenitätsversuche zeigen konnten. Die klassischen Zielstrukturen von Sorafenib, insbesondere die Raf-Kinasen, waren bei den untersuchten Lymphomentitäten zwar konstitutiv aktiviert, wurden aber uneinheitlich durch Sorafenibexposition inhibiert. Mit Hilfe eines globalen Kinase-Arrays wurden die MAP-Kinase p38 und AKT als Zielstrukturen von Sorafenib bei Lymphomen identifiziert. Diese Erkenntnisse zur Wirkung von Sorafenib auf Lymphomzelllinien besaßen auch Gültigkeit für primäres Lymphommaterial, wie anhand von Patientenproben gezeigt werden konnte. Die für diese Effekte notwendigen Sorafenibkonzentrationen lagen dabei deutlich unterhalb der im Plasma von Patienten in bisherigen Studien erreichten, klinisch tolerablen Plasmakonzentrationen. Die zentrale Bedeutung von MAPK p38 und AKT sowie die umfangreichen Erfahrungen mit dem Multi-Kinase-Inhibitor Sorafenib bei anderen Entitätenmaligne r Erkrankungen machen Sorafenib mit den Ergebnissen dieser Arbeit zu einer rationalen Ergänzung der aktuellen Therapie aggressiver Lymphome, die es in weiteren klinischen Untersuchungen zu überprüfen gilt

Training of clinical reasoning with a Serious Game versus small-group problem-based learning: A prospective study.

INTRODUCTION:Serious Games are increasingly being used in undergraduate medical education. They are usually intended to enhance learning with a focus on knowledge acquisition and skills development. According to the current literature, few studies have assessed their effectiveness regarding clinical reasoning (CR). The aim of this prospective study was to compare a Serious Game, the virtual Accident & Emergency department 'EMERGE' to small-group problem-based learning (PBL) regarding student learning outcome on clinical reasoning in the short term. METHODS:A total of 112 final-year medical students self-selected to participate in ten 90-minute sessions of either small-group PBL or playing EMERGE. CR was assessed in a formative examination consisting of six key feature cases and a final 45-minute EMERGE session. RESULTS:Overall, the EMERGE group (n = 78) scored significantly higher than the PBL group (n = 34) in the key feature examination (62.5 (IQR: 17.7)% vs. 54.2 (IQR: 21.9)%; p = 0.015). There was no significant difference in performance levels between groups regarding those cases which had been discussed in both instructional formats during the training phase. In the final EMERGE session, the EMERGE group achieved significantly better results than the PBL group in all four cases regarding the total score as well as in three of four cases regarding the final diagnosis and the correct therapeutic interventions. CONCLUSION:EMERGE can be used effectively for CR training in undergraduate medical education. The difference in key feature exam scores was driven by additional exposure to more cases in EMERGE compared to PBL despite identical learning time in both instructional formats. EMERGE is a potential alternative to intensive small-group teaching. Further work is needed to establish how Serious Games enhance CR most effectively