Evaluation of on-campus continuing medical education programs in Alberta

Seven on-campus continuing medical education programs offered during the 1971-72 academic year were evaluated. A multiple-choice examination was taken by the participants before each course; the same examination was administered immediately after the course was completed, and a third examination was taken three to five months later. It was found that for each course there was a significant increase in knowledge at both post-testing periods. A questionnaire developed for the purpose of determining the effectiveness of the courses was also administered at the time of the third test, and exhibited reasonable degrees of reliability and validity. A large proportion of the participants indicated the content of their courses was relevant and necessary, and was being used in their medical practice. It was concluded that the effectiveness of these programs justified their continuation.     

网络云交互技术辅助外科实践教学的创新应用探索

目的:探索传统教学模式结合网络云交互技术在外科实践教学中的应用效果。方法:于我校2011级五年制临床医学专业本科生中选取76人,随机平均分为两组,分别采取单纯传统大课教学模式、传统教学结合网络云交互技术教学模式;课程结束后进行闭卷理论考试和实践操作考试,综合两项成绩进行评定。同时向两组学员发放调查问卷,以此评价使用网络云交互技术辅助教学的效果。结果:采取传统教学结合网络云交互技术教学模式组的成绩优于采取单纯传统教学模式组,两组成绩差异具有统计学意义(P0.05)。结论:在传统教学模式的基础上添加网络云交互技术更能激发学生的学习兴趣,大大提高了学习效率,更有利于本科生外科实践的教学以及教学资源的整合及教学档案的建立。     

医学检验专业实践教学改革与毕业生质量评价

目的：寻求医学检验专业教学改革新方案。方法：以我校检验专业2000、2001届毕业生为对照组,以2002、2003届毕业生为实验组,对实验组进行实践教学改革。毕业前分别进行综合实践技能考核,并对部分毕业生进行了追踪调查。结果：实验组的技能考核成绩明显高于对照组,毕业生质量明显提高。结论：实践教学改革有利于提高医学检验专业教学质量。     

Cytologic detection of cervical cancer; four years' experience with routine smear examination in private practice

Simplified Papanicolaou smear techniques appear to be adaptable to private clinical practice when experienced cytodetection laboratory facilities are available. A private physician's office seems potentially an efficient, economical and practical place for detection of cervical cancer by use of the smear technique as a routine part of examination of patients. In a series here reported upon, examination of 11,207 cervical smears taken at the first examination of patients of all ages led to diagnosis of unsuspected malignant disease in 80 cases-in all instances at a stage when it should be easily curable. Cancer was not detected in examination of 6,060 smears taken later from women who had had a "negative" smear at the time of first examination, which seems to indicate that the first screening was reasonably accurate. In a few cases, early cancer was detected when smears were reported as "atypical" or "suspicious." Such reports demand as careful follow-up as do "positive" reports. There are dangers and limitations in wide-spread clinical application of screening by this method. Care must be observed in the development of programs for its use lest the potential benefits in early detection be outweighed by the dangers from misuse.     

基层医院哮喘的规范化治疗初探

目的:了解临床工作实践中支气管哮喘防治指南(GINA方案)在基层医院的实施情况及遇到的问题并提出今后解决办法。方法:对门诊及病房住院的患者进行调查研究,采用统一设计的表格、问卷及必要的检查,对结果进行统计和分析。结果:正规治疗与非正规治疗的患者的花费情况具有明显差别,差异具有统计学意义。当地91.2%支气管哮喘曾经误诊为慢性支气管炎。治疗不规范,曾吸入激素治疗的占全部患者的18.1%,曾经和正在口服私人配制的平喘药物(粉剂或胶囊)的占65.8%;病情复发时给予输液、利用抗生素治疗的占73.6%;给予大剂量激素、不规范治疗(包括长期用激素治疗、不逐渐减量)治疗的78.7%;结论:当地哮喘治疗还存在很多问题,形式非常严峻,有待于进一步加大GINA治疗方案的推广。     

呼吸内科临床实习中的问题与对策探析

目的:研究呼吸内科临床实习中的问题与对策。方法:查询我院对实习生的管理相关文件、现场考核带教老师,最后对85名在医院已经结束呼吸内科实习的本科同学进行问卷调查,包括实习目的、实习态度、实习效果以及实习与就业和考研的关系等项目,对问卷结果进行分析。结果:现今在呼吸内科临床实习的医学生面临着一些问题,如实习管理松懈;带教老师因工作、患者等原因忽视教学;大部分实习生实习目的不明确、实习主动性较差、实习效果不佳;因"择业"、"考研"压力等外界因素以及呼吸内科学科自身的一些原因轻视呼吸内科实习。结论:影响呼吸内科临床实习教学质量的因素有多方面,可针对"教"与"学"提出解决其临床实习的一些对策。     

Can students learn clinical method in general practice? A randomised crossover trial based on objective structured clinical examinations.

OBJECTIVE: To determine whether students acquired clinical skills as well in general practice as in hospital and whether there was any difference in the acquisition of specific skills in the two environments. DESIGN: Randomised crossover trial. SUBJECTS AND SETTING: Annual intake of first year clinical students at one medical school. INTERVENTION: A 10 week block of general internal medicine, one half taught in general practice, the other in hospital. Students started at random in one location and crossed over after five weeks. OUTCOME MEASURES: Students'' performance in two equivalent nine station objective structured clinical examinations administered at the mid and end points of the block: a direct comparison of the two groups'' performance at five weeks; analysis of covariance, using their first examination scores as a covariate, to determine students'' relative improvement over the second five weeks of their attachment. RESULTS: 225 students rotated through the block; all took at least one examination and 208 (92%) took both. For the first half of the year there was no significant difference in the students'' acquisition of clinical skills in the two environments; later, however, students taught in general practice improved slightly more than those taught in hospital (P = 0.007). CONCLUSIONS: Students can learn clinical skills as well in general practice as in hospital; more work is needed to clarify where specific skills, knowledge, and attitudes are best learnt to allow rational planning of the undergraduate curriculum.     

Detection and management of hypertension in general practices in north west London.

An examination of the practice notes and attached correspondence of 900 patients aged 30 to 65 years in a random sample of 18 general practice in north west London showed that 340 (47%) of 716 patients consulting in a 10 year period had no blood pressure readings in their records. The blood pressure was equal to or above 160 mm Hg systolic or 95 mm Hg diastolic, or both, in 115 (31%) of those whose blood pressures were recorded; 18 (16%) of these were not followed up. Seventy four patients were being treated for hypertension. Diuretics were the most commonly prescribed drugs. Treatment was started after one blood pressure reading in 34 (46%). Nine of those who had an initial raised blood pressure reading were normotensive on follow up. A further 14 patients had subsequent raised blood pressure readings but were not treated. Sixty one (69%) of the 88 patients with hypertension did not have a blood pressure recording after diagnosis for one or more periods exceeding 12 months. Of 84 hypertensive patients with complete records, 62 (74%) apparently had had no physical examination performed by the general practitioner and 61 (72%) did not seem to have had any investigations initiated by the general practitioners. Fifteen (35%) of 43 patients taking oral contraceptive pills apparently had no blood pressure recordings during the time they were taking these. The results of this study suggest that there are still deficiencies in the detection and management of hypertension in general practice.     

Intraoperative cytologic diagnosis of symptomatic carcinoma (pulmonary small cell carcinoma) metastatic to the pituitary gland: a case report

BACKGROUND: Carcinoma metastatic to the pituitary gland is infrequent and has been reportedly detected in approximately 1% of pituitary surgical cases. It may masquerade as a pituitary adenoma both clinically and radiologically. CASE: A 49-year-old man presented with a 1-month history of severe headache, diplopia and blurred vision. Neurologic examination revealed bitemporal hemianopsia and left sixth nerve palsy. The initial radiologic diagnosis based on magnetic resonance imaging was pituitary adenoma. A biopsy of the lesion was performed. While intraoperative frozen section examination could not completely exclude an "atypical" pituitary adenoma, cytologic touch imprint findings were diagnostic of metastatic small cell carcinoma. Subsequently, additional workup revealed that the patient had a mass lesion in the right lung and right-sided mediastinal lymphadenopathy on chest computed tomography. This was a rare case of pituitary metastasis as the first manifestation of an occult malignancy. CONCLUSION: For intraoperative diagnosis at the time ofpituitary surgery, cytologic imprints can be used reliably to make a diagnosis not only of pituitary adenoma but also of metastatic lesions. It is appropriate in current neuropathology practice that the imprint method be used as the sole modality for intraoperative consultation for pituitary lesions.     

CYTOLOGIC DETECTION OF CERVICAL CANCER—Four Years' Experience with Routine Smear Examination in Private Practice

Simplified Papanicolaou smear techniques appear to be adaptable to private clinical practice when experienced cytodetection laboratory facilities are available. A private physician''s office seems potentially an efficient, economical and practical place for detection of cervical cancer by use of the smear technique as a routine part of examination of patients.In a series here reported upon, examination of 11,207 cervical smears taken at the first examination of patients of all ages led to diagnosis of unsuspected malignant disease in 80 cases—in all instances at a stage when it should be easily curable. Cancer was not detected in examination of 6,060 smears taken later from women who had had a “negative” smear at the time of first examination, which seems to indicate that the first screening was reasonably accurate.In a few cases, early cancer was detected when smears were reported as “atypical” or “suspicious.” Such reports demand as careful follow-up as do “positive” reports.There are dangers and limitations in wide-spread clinical application of screening by this method. Care must be observed in the development of programs for its use lest the potential benefits in early detection be outweighed by the dangers from misuse.     

Clinical versus laboratory detection of alcohol abuse: the alcohol clinical index.

To determine reliable indicators of alcohol abuse a comprehensive set of clinical and laboratory information was acquired from three groups of subjects with a wide range of drinking histories: 131 outpatients with alcohol problems, 131 social drinkers, and 52 patients from family practice. Findings from clinical examination provided greater diagnostic accuracy than laboratory tests for detecting alcohol abuse. Logistic regression analysis produced an overall accuracy of 85-91% for clinical signs, 84-88% for items from the medical history, and 71-83% for laboratory tests in differentiating the three groups. Further analyses showed 17 clinical signs and 13 medical history items that formed a highly diagnostic instrument (alcohol clinical index) that could be used in clinical practice. A probability of alcohol abuse exceeding 0.90 was found if four or more clinical signs or four or more medical history items from the index were present. Despite recent emphasis on the laboratory diagnosis of alcohol abuse simple clinical measures seem to provide better diagnostic accuracy.     

Provision of preventive care to unannounced standardized patients

OBJECTIVE: To examine the relation between physician, training and practice characteristics and the provision of preventive care as described in the guidelines of the Canadian Task Force on the Periodic Health Examination. DESIGN: Cross-sectional study. SETTING: Family practices open to new patients within 1 hour''s drive of Hamilton, Ont. PARTICIPANTS: A total of 125 family physicians were randomly selected from respondents to an earlier preventive care survey. Of the 125, 44 (35.2%) declined to participate, and an additional 19 (15.2%) initially consented but later withdrew when they closed their practices to new patients. Sixty-two physicians thus participated in the study. INTERVENTION: Unannounced standardized patients posing as new patients to the practice visited study physicians'' practices between September 1994 and August 1995, portraying 4 scenarios: 48-year-old man, 70-year-old man, 28-year-old woman and 52-year-old woman. OUTCOME MEASURES: Proportion of preventive care manoeuvres carrying grade A, B, C, D and E recommendations from the Canadian Task Force on the Periodic Health Examination that were performed, offered or advised. A standard score was computed based on the performance of grade A and B manoeuvres (good or fair evidence for inclusion in the periodic health examination) and the non-performance of grade D and E manoeuvres (fair or good evidence for exclusion from the periodic health examination). RESULTS: Study physicians performed or offered 65.6% of applicable grade A manoeuvres, 31.0% of grade B manoeuvres, 22.4% of grade C manoeuvres, 21.8% of grade D manoeuvres and 4.9% of grade E manoeuvres. The provision of evidence-based preventive care was associated with solo (v. group) practice and capitation or salary (v. fee-for-service) payment method. Preventive care performance was unrelated to physician''s sex, certification in family medicine or problem-based (v. traditional) medical school curriculum. CONCLUSIONS: Preventive care guidelines of the Canadian Task Force on the Periodic Health Examination have been incompletely integrated into clinical practice. Research is needed to identify and reduce barriers to the provision of preventive care and to develop and apply effective processes for the creation, dissemination and implementation of clinical practice guidelines.     

Trichomonal vaginitis; the problem of chronic or recurring infection

In general practice and in gynecology, vaginal trichomoniasis is a frequent and troublesome problem. However, the trichomonas vaginalis organism is frequently found in an apparently healthy vagina, indicating that symptoms, recurrences, or exacerbations may depend on local changes in secretions, probably due in part to emotional stress. Therapy must, therefore, include not only the topical use of an effective trichomonacidal drug, but also sympathetic and considerate listening by the physician. The combination of furazolidone and nifuroxime in vaginal suppositories and vaginal insufflation powder was found to be an effective trichomonacidal compound. A total of 56 patients with trichomonal, monilial and nonspecific bacterial vaginitis was treated with this nitrofuran combination with good results. In topical therapy, powders seem more effective, probably because a dry environment is unfavorable to the flagellates. The patient should be instructed to insert two vaginal suppositories daily for the first week, then to decrease the dosage gradually as indicated by the physician after clinical examination and microscopic examination of vaginal secretions each week. Of great importance is the fact that some patients may need long-term maintenance therapy-one or two suppositories weekly-especially if the emotional difficulties appear to be insurmountable.     

Self examination of the breast: is it beneficial? Meta-analysis of studies investigating breast self examination and extent of disease in patients with breast cancer.

The question whether the aggregated published research suggests that breast self examination is beneficial was explored in a meta-analysis of 12 studies including a total of 8118 patients with breast cancer that related the practice of breast self examination to regional lymph node state or tumour diameter. Based on the six studies for which data were available, 39% of patients (1115/2852) who reported having done breast self examination at least once before their illness had evidence of cancer in the lymph nodes compared with 50% of women (1348/2713) who had not done the examination. Logistic regression analysis showed this difference to be significant (odds ratio 0.66, confidence interval 0.59 to 0.74). Combining six studies which reported the circumstances of detection disclosed that 42% of women (272/652) who found their tumour while doing breast self examination had evidence of cancer in the nodes compared with 46% of women (871/1901) who found the tumour accidentally; this difference was not significant. Analysis of eight studies which used the diameter of the tumour to indicate the extent of disease tended to confirm the findings on lymph node state, in particular the benefit of premorbid breast self examination. Significantly fewer women who had practised the examination before the illness (56%; 1205/2137) had tumours of 2 cm or more diameter compared with women who had not practised the examination (66%; 1500/2260). The combined odds ratio for that analysis was 0.56, confidence interval 0.38 to 0.81. These findings appear to be good evidence of the benefit of encouraging women to practise self examination of the breasts regularly.     

Practice research. Training for general practice: clinical behaviour in trainers and trainees.

A study of 20 trainers and their trainees in general practice showed that trainees had a statistically significant improvement in their diagnosis of otitis media during their trainee year and also became quicker in the time taken for history taking and examination. There was a fall in trainees'' prescribing of antibiotics for otitis media during the study but this was accompanied by a notable rise in prescribing of decongestant-antihistamine mixtures to a level similar to that of the trainers. Trainees seemed to accept readily their trainers'' prescribing policies and were hesitant to challenge them. An important finding was that trainees had little influence on trainers'' prescribing, the latter showing no appreciable changes during the study.     

基于问题教学法在骨科实习医生教学中的应用

摘要目的：通过基于问题教学方法（problem based learning,PBL）对骨科临床实习医师教学培训,探索提高实习医师临床实践的能力。方法：在骨科临床实习过程中,我们根据学生实习前平均成绩将实习医生分为2组,对18名实习医生采用传统教学模式,而对另18名实习医生采用基于问题教学模式,在临床实习过程进行问诊、初步诊断和分析、治疗处理、写病历、查房,骨科实习结束进行临床基本技能考核比较。结果：在体格检查、辅助检查、问题回答和患者评价项目考核比较,实验组实习医生出科成绩优于对照组;病历书写和病史采集两组没有区别。结论：通过对两组实习医师的临床实践成绩比较,在临床教学实践中,采用基于问题教学方法能够更好地提高实习医师掌握临床知识和技能的能力。     

医学模拟教学结合以问题为导向的教学模式在重症医学教学中的应用研究

目的:探讨医学模拟教学结合以问题为导向(PBL)的教学模式在重症医学教学中的应用价值。方法:选取2015年1月~2017年1月在我院重症医学科轮转实习的五年制医学生64人作为研究对象。按随机数字表法将64名医学生分为PBL组(n=32)和结合教学组(n=32)。PBL组采用PBL教学,结合教学组采用医学模拟结合PBL教学。分别在入科时和轮转实习结束时对两组学员进行理论考试和技能操作考核,记录成绩并比较。理论考试和技能操作考核后采取发放问卷进行调查的形式获得学员对教学效果的主观评价。结果:轮转实习结束时,两组理论考试分数差异无统计学意义(P0.05);而结合教学组技能操作考核成分数显著高于PBL组,差异具有统计学意义(P0.05)。两组学员在教学方法接受度高、学习兴趣提升、自学能力提升和临床诊疗水平提高所占比例差异无统计学意义(P0.05);结合教学组学员在团队协作能力提高、沟通能力与人文关怀提高和技能操作水平提高所占比例高于PBL组,差异有统计学意义(P0.05)。结论:与单独PBL教学相比较,医学模拟教学结合PBL的教学模式应用于重症医学教学对学员技能操作的掌握有更好的效果,同时能提高学员团队协作能力、沟通能力以及对患者的人文关怀,且受到学员的认同与喜爱,应在重症医学的教学实践中逐步完善并进一步推广应用。     

提高临床实习教学质量的实践与体会

临床实习是医学生大学教育阶段的重要组成部分,是医学生向临床医生转型的过渡时期。临床实习质量的高低直接关系到医学生的培养质量。在实习期间培养出扎实的临床基本功、科学的临床思维和高尚的医德医风对于医学生而言是非常重要的。同时,临床实习教学也是医学院校及教学医院的工作重心。作为教学医院,我院多年来积极推进教学改革,不断探索提升临床实习质量的方法,部分科室率先开展了PBL等新的教学模式,并取得了卓越的成效。我院领导阶层也通过抓好教学准备、提升带教质量、严格实习考核等方面的工作,全面提升了临床实习教学质量,从而提高了医学生的综合素质,也为提高执业医师考试通过率打下了坚实的基础。     

TRICHOMONAL VAGINITIS—The Problem of Chronic or Recurring Infection

In general practice and in gynecology, vaginal trichomoniasis is a frequent and troublesome problem. However, the trichomonas vaginalis organism is frequently found in an apparently healthy vagina, indicating that symptoms, recurrences, or exacerbations may depend on local changes in secretions, probably due in part to emotional stress. Therapy must, therefore, include not only the topical use of an effective trichomonacidal drug, but also sympathetic and considerate listening by the physician.The combination of furazolidone and nifuroxime in vaginal suppositories and vaginal insufflation powder was found to be an effective trichomonacidal compound. A total of 56 patients with trichomonal, monilial and nonspecific bacterial vaginitis was treated with this nitrofuran combination with good results.In topical therapy, powders seem more effective, probably because a dry environment is unfavorable to the flagellates. The patient should be instructed to insert two vaginal suppositories daily for the first week, then to decrease the dosage gradually as indicated by the physician after clinical examination and microscopic examination of vaginal secretions each week. Of great importance is the fact that some patients may need long-term maintenance therapy—one or two suppositories weekly—especially if the emotional difficulties appear to be insurmountable.     

Matching lung volume data sets--a novel approach

There is a significant demand in matching CT datasets of the lung. The increasing number of CT slices per examination due to the higher resolution of modern CT scanners and the need for quantification of the progress of disease and healing processes in follow-up studies. A volunteer's lung was scanned by the means of multidetector CT in two different states of ventilation. The necessary lung structures for the matching procedure like lung surface and branching points were segmented. A thin-plate spline method was used to calculate the matched lung volume. The preliminary results show an average error of 2 voxel, i.e. 2mm. The calculation of the transformation matrix takes about one second on a conventional PC, which is considerably faster than other methods described in literature. The method described may be apt to be introduced in radiological practice when it comes to compare high resolution CT scans in follow-up studies quantitatively.