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This article provides information on autosomal dominant polycystic kidney disease and presents clinical practice guidelines for primary care physicians. It discusses the ultrasound criteria for its diagnosis, its epidemiology, etiology, pathophysiology, differential diagnosis, complications, prognosis and treatment.

Abstract: Objective: To examine the validity and utility of the Explanation and Planning Scale (EPSCALE) instrument, a widely used scale for teaching and assessment of explanation and planning skills used by clinicians during the medical interview. Methods: Data obtained across 4 OSCE stations during medical student final MB examinations. Exploratory factor analysis, using a single factor and two factor models (based on prior theory) and a six factor empirical model, suggested by parallel analysis. Participants: 124 medical students sitting final MB examinations at the University of Cambridge. Results: A single factor model represented a very poor fit. A two factor model with factors labelled ‘Explanation’ and ‘Planning’ produced an improved fit, but the best was seen with a six factor model, with factors which broadly corresponded to the domains of the Calgary–Cambridge guide. Conclusions: These factor models provide supportive evidence for the construct validity of EPSCALE. Practice implications: EPSCALE can justifiably be used in the assessment of shared-decision making skills. [Copyright &y& Elsevier]

Abstract: Objective: To investigate the use and impact of the micro-skill of summary in clinical encounters, a core skill that has little empirical investigation of its use and outcomes. Methods: This exploratory study used a mixed method design. Video recordings of ten consultations between simulated patients and medical-students were analysed to identify types of summary used. Two contrasting cases were then micro-analysed and follow up interviews held with the 2 students and simulated patients, involved in the consultations, using the video recording as a trigger. Results: Ninety-nine summaries were identified and grouped into six types: reflective, screening, clarifying, paraphrasing, interim and full. Summary appeared to aid accuracy. However, summaries about the patient''s perspective were summarised less frequently than the biomedical perspective. When summaries were repeatedly incorrect they made the simulated patient feel they were not being listened to. Conclusions: The use and effect of summary appears more complex than the medical literature suggests and may have both positive and negative attributes. Further research is needed to investigate whether these preliminary findings are replicated within doctor–patient consultations. Practice implications: When teaching use of summary we need to address: type, purpose, accuracy, effect on patient and flexible use to suit the patient. [Copyright &y& Elsevier]

Abstract: Objective: To evaluate the content validity, internal consistency and generalisability of EPSCALE, a new rating scale to measure communication skills in explanation and planning. Methods: Content validity: consensus exercise and expert review. Internal consistency and generalisability: 124 clinical students undertaking 4 OSCE stations with simulated patients, with one observer (hospital specialist, GP or communication specialist) per station, during finals examinations. Internal consistency estimated by coefficient alpha, generalisability estimated by generalisability coefficient and variance components using EPSCALE. Results: Content validity was supported by consensus exercise and expert review. Internal consistency was high with a coefficient alpha of greater than 0.8 for all four explanation and planning stations in the finals exam. Generalisability coefficient for 4 OSCE stations was 0.50. Conclusions: This paper provides initial evidence that EPSCALE has content validity and high internal consistency when used to assess explanation and planning skills in the consultation. It defines the generalisability of this new rating scale. Further work is needed to explore the scale''s validity by a range of other measures. [Copyright &y& Elsevier]

This plenary presentation from the EACH International Conference on Communication in Healthcare in Oslo 2008, takes an honest look at the present state of communication teaching and considers how to take the next steps to move communication into the very centre of medical education. Although clinical communication teaching has become increasingly accepted as a formal component of the medical curriculum, there is still a problem to be faced. Communication still often appears in medical education to be a peripheral element rather than a mainstream activity truly perceived by schools and learners as central to all clinical interactions. This presentation explores why clinical communication often appears to be a minority sport in medical education, considers how to overcome this via integration throughout the curriculum, looks at five specific examples of integration in action, presents a new UK consensus statement which helps integrate communication into the mainstream, and finally explores the progression to maturity in communication curricula. [Copyright &y& Elsevier]

Study objective: We describe magnetic foreign body injuries among children and obtain national estimates of magnetic foreign body injury incidence over time. Methods: We searched the National Electronic Injury Surveillance System for cases of magnetic foreign bodies in children younger than 21 years in the United States, from 2002 to 2011. Cases were analyzed by location: alimentary or respiratory tract, nasal cavity, ear canal, or genital area. Results: We identified 893 cases of magnetic foreign bodies, corresponding to 22,581 magnetic foreign body cases during a 10-year period (95% confidence interval [CI] 17,694 to 27,469). Most magnetic foreign bodies were ingested (74%) or intranasal (21%). Mean age was 5.2 years for ingested magnetic foreign bodies and 10.1 years for nasal magnetic foreign bodies (difference 4.9; 95% CI 4.1 to 5.6), suggesting different circumstances of injury. The incidence of pediatric magnet ingestions increased from 2002 to 2003 from 0.57 cases per 100,000 children per year (95% CI 0.22 to 0.92) to a peak in 2010 to 2011 of 3.06 cases per 100,000 children per year (95% CI 2.16 to 3.96). Most ingested magnetic foreign bodies (73%) and multiple magnet ingestions (91%) occurred in 2007 or later. Patients were admitted in 15.7% of multiple magnet ingestions versus 2.3% of single magnet ingestions (difference 13.4%; 95% CI 2.8% to 24.0%). Conclusion: Magnet-related injuries are an increasing public health problem for young children, as well for older children who may use magnets for play or to imitate piercings. Education and improved magnet safety standards may decrease the risk small magnets pose to children. [Copyright &y& Elsevier]

Abstract: Objective: Global migration of healthcare workers places responsibility on employers to comply with legal employment rights whilst ensuring patient safety remains the central goal. We describe the pilot of a communication assessment designed for doctors who trained and communicated with patients and colleagues in a different language from that of the host country. It is unique in assessing clinical communication without assessing knowledge. Methods: A 14-station OSCE was developed using a domain-based marking scheme, covering professional communication and English language skills (speaking, listening, reading and writing) in routine, acute and emotionally challenging contexts, with patients, carers and healthcare teams. Candidates (n =43), non-UK trained volunteers applying to the UK Foundation Programme, were provided with relevant station information prior to the exam. Results: The criteria for passing the test included achieving the pass score and passing 10 or more of the 14 stations. Of the 43 candidates, nine failed on the station criteria. Two failed the pass score and also the station criteria. The Cronbach's alpha coefficient was 0.866. Conclusion: This pilot tested ‘proof of concept’ of a new domain-based communication assessment for non-UK trained doctors. Practice implications: The test would enable employers and regulators to verify communication competence and safety in clinical contexts, independent of clinical knowledge, for doctors who trained in a language different from that of the host country. [Copyright &y& Elsevier]

Abstract: Objective: To develop learning objectives for a core communication curriculum for all health care professions and to survey the acceptability and suitability of the curriculum for undergraduate European health care education. Methods: Learning objectives for a Health Professions Core Communication Curriculum (HPCCC) in undergraduate education were developed based on international literature and expert knowledge by an international group of communication experts representing different health care professions. A Delphi process technique was used to gather feedback and to provide a consensus from various health care disciplines within Europe. Results: 121 communication experts from 15 professional fields and 16 European countries participated in the consensus process. The overall acceptance of the core communication curriculum was high. 61 core communication objectives were rated on a five-point scale and found to be relevant for undergraduate education in health care professions. A thematic analysis revealed the benefits of the HPCCC. Conclusions and practice implications: Based on a broad European expert consensus, the Health Professions Core Communication Curriculum can be used as a guide for teaching communication inter- and multi-professionally in undergraduate education in health care. It can serve for curriculum development and support the goals of the Bologna process. [Copyright &y& Elsevier]

Abstract: Objective: To describe a program with integrated learning of communication and consultation skills developed with the intention of preventing deterioration of communication skills, and to present student evaluation data. Methods: Description and evaluation of the program through: (1) monthly student evaluations; (2) questionnaire on student perceptions about the integrated curriculum; (3) a questionnaire about the value of one specific integrated training preceding the pediatric clerkship. Results: Key components of training throughout years 3–6 are reinforcement throughout the clinical years, adapting communication training to the clinical context of clerkships using a sandwich model with cycles of preparation, clerkship, and reflection. Evaluation: response rates were 69%, 93% and 93%, respectively. Students value practicing integration of communication and medical content with SPs who represent the population of their next clerkships. They appreciate the multisource feedback during the training, feedback by clerkship specific specialists and SPs is valued most. Conclusions: This description shows an example of an integrated curriculum that helps students to feel well prepared for their communication tasks in subsequent clerkships. Practice implications: Designing and implementing communication curricula to address the issue of integration is feasible. The effects of such integrated programs should be subject to future studies. [Copyright &y& Elsevier]