New perspectives - approaches to medical education at four new UK Medical Schools

To create more UK doctors, the government has funded an increase in medical student numbers of 57% (from 3749 to 5894)1 between 1998 and 2005. This has been done by increasing student places at existing medical schools; creating shortened programmes open to science graduates; “twinning” arrangements, which host an existing curriculum at a new site; and four entirely new schools (table 1). Through reflection on our experiences and the literature evidence, we examine to what extent these new schools have a common vision and approach to undergraduate medical education, and we discuss the rationale for and likely outcomes of these new ventures

Aberrant Work Environments, Rationed Care as System Failure or Missed Care as Skills Failure?

Missed’ care has emotional, professional and legal connotations because, as one participant from our study noted, the environment can change so quickly and staffing is not allocated to accommodate this. This study used the MISSCARE survey distributed to nurses in New Zealand to find out what care was routinely missed, and why they missed it. The analysis of data returned from 199 nurses revealed that nurses routinely miss care and become frustrated because they are unable to use the knowledge and skill to provide the care; rather they are forced to prioritise care, some of which is either delayed or consciously missed. Whilst this study supported findings of previous research, the emergence of presenteeism as a factor that affects nurses missing care, was highlighted. This has wider implications to the nursing workforce related to their ability to provide safe and effective care, as well as to the organisations in terms of both budget and safety in care provision

Esimulations for blended learning in professional education: capacity building, knowledge transfer and dissemination

A two-year collaborative project by Deakin, RMIT and Charles Sturt universities aims to build in each institution, the academic and professional staff capacities for developing and using a form of online, goal-based, role-play simulation (eSimulation/eSim). While the project embraces 'knowledge transfer', 'capacity building' and 'embedded dissemination', a greater challenge is transforming perceptions of eSims in blended learning contexts to improve flexible learning designs across the higher education sector. The project addresses the need for coordinated research and development in the field of eSimulations in Australian higher education. It aligns the educational, technical, evaluation and research strengths of the three parties to build academic and professional staff capacities for the 'local' development and use of an already successful approach to simulating 'professional workplace experiences' for student learning. This poster presents the ALTC Competitive Grants Program project (2008-2010): 'Building academic staff capacity for using eSimulations in professional education for experience transfer'. The project's website is http://www.deakin.edu.au/itl/insims/altc-project/

Psychosocial impact of undergoing prostate cancer screening for men with BRCA1 or BRCA2 mutations.

OBJECTIVES: To report the baseline results of a longitudinal psychosocial study that forms part of the IMPACT study, a multi-national investigation of targeted prostate cancer (PCa) screening among men with a known pathogenic germline mutation in the BRCA1 or BRCA2 genes. PARTICPANTS AND METHODS: Men enrolled in the IMPACT study were invited to complete a questionnaire at collaborating sites prior to each annual screening visit. The questionnaire included sociodemographic characteristics and the following measures: the Hospital Anxiety and Depression Scale (HADS), Impact of Event Scale (IES), 36-item short-form health survey (SF-36), Memorial Anxiety Scale for Prostate Cancer, Cancer Worry Scale-Revised, risk perception and knowledge. The results of the baseline questionnaire are presented. RESULTS: A total of 432 men completed questionnaires: 98 and 160 had mutations in BRCA1 and BRCA2 genes, respectively, and 174 were controls (familial mutation negative). Participants' perception of PCa risk was influenced by genetic status. Knowledge levels were high and unrelated to genetic status. Mean scores for the HADS and SF-36 were within reported general population norms and mean IES scores were within normal range. IES mean intrusion and avoidance scores were significantly higher in BRCA1/BRCA2 carriers than in controls and were higher in men with increased PCa risk perception. At the multivariate level, risk perception contributed more significantly to variance in IES scores than genetic status. CONCLUSION: This is the first study to report the psychosocial profile of men with BRCA1/BRCA2 mutations undergoing PCa screening. No clinically concerning levels of general or cancer-specific distress or poor quality of life were detected in the cohort as a whole. A small subset of participants reported higher levels of distress, suggesting the need for healthcare professionals offering PCa screening to identify these risk factors and offer additional information and support to men seeking PCa screening

An original phylogenetic approach identified mitochondrial haplogroup T1a1 as inversely associated with breast cancer risk in BRCA2 mutation carriers

Introduction: Individuals carrying pathogenic mutations in the BRCA1 and BRCA2 genes have a high lifetime risk of breast cancer. BRCA1 and BRCA2 are involved in DNA double-strand break repair, DNA alterations that can be caused by exposure to reactive oxygen species, a main source of which are mitochondria. Mitochondrial genome variations affect electron transport chain efficiency and reactive oxygen species production. Individuals with different mitochondrial haplogroups differ in their metabolism and sensitivity to oxidative stress. Variability in mitochondrial genetic background can alter reactive oxygen species production, leading to cancer risk. In the present study, we tested the hypothesis that mitochondrial haplogroups modify breast cancer risk in BRCA1/2 mutation carriers. Methods: We genotyped 22,214 (11,421 affected, 10,793 unaffected) mutation carriers belonging to the Consortium of Investigators of Modifiers of BRCA1/2 for 129 mitochondrial polymorphisms using the iCOGS array. Haplogroup inference and association detection were performed using a phylogenetic approach. ALTree was applied to explore the reference mitochondrial evolutionary tree and detect subclades enriched in affected or unaffected individuals. Results: We discovered that subclade T1a1 was depleted in affected BRCA2 mutation carriers compared with the rest of clade T (hazard ratio (HR) = 0.55; 95% confidence interval (CI), 0.34 to 0.88; P = 0.01). Compared with the most frequent haplogroup in the general population (that is, H and T clades), the T1a1 haplogroup has a HR of 0.62 (95% CI, 0.40 to 0.95; P = 0.03). We also identified three potential susceptibility loci, including G13708A/rs28359178, which has demonstrated an inverse association with familial breast cancer risk. Conclusions: This study illustrates how original approaches such as the phylogeny-based method we used can empower classical molecular epidemiological studies aimed at identifying association or risk modification effects.Peer reviewe

Medical specialty prestige and lifestyle preferences for medical students

In the context of doctor shortages and mal-distributions in many Western countries, prestige and lifestyle friendliness have emerged as significant factors for medical students when they choose a medical specialty. In this study, we surveyed two samples of Australian medical students and had them rank 19 medical specialties for prestige (N = 530) and lifestyle friendliness (N = 644). The prestige rankings were generally consistent with previous ratings by physicians, lay people and advanced medical students, with surgery, internal, and intensive care medicine ranking the highest, and public health, occupational, and non-specialist hospital medicine ranking lowest. This suggests that medical students have incorporated prevailing prestige perceptions of practicing doctors and the community. Lifestyle rankings were markedly different from prestige rankings, where dermatology, general practice, and public health medicine were ranked the most lifestyle friendly, and surgery, obstetrics/gynaecology and intensive care were ranked least friendly. Student lifestyle rankings differed from physician and author-generated rankings, indicating that student preferences should be considered rather than relying on ratings created by others. Few differences were found for gender or year of study, signifying perceptions of prestige and lifestyle friendliness were consistent across the students sampled. Having access to and understanding these rankings will assist career counsellors to aid student and junior doctor decision-making and aid workforce planners to address gaps in medical specialty health services.Australia Medical specialty rankings Prestige Lifestyle friendly