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The authors describe their experience in developing local, institution-based immersion opportunities for Doctor of Philosophy (PhD) experiences in the subdisciplines of laboratory medicine. Topics they cover include the reason they consider the discipline of laboratory medicine as unique among clinical specialties in the U.S., the career-development path of doctor of medicine (MD)- and PhD-trained laboratory directors and examples of nonuniversity-based forums in laboratory medicine.

The titles reviewed in this chapter concern science and medicine studies. They represent work drawn from a variety of contexts and disciplinary perspectives, including science and technology, the history of science, literary studies, critical race theory, medical humanities, cultural anthropology, public health, the philosophy of science, transnationalism, media studies, archive studies, and book history. The chapter opens with 1. Notable Books—extended discussions of three especially significant books. Subsequent sections are dedicated to: 2. Bodies and Embodiment; 3. Epistemology and Dissemination; 4. Institutions and Praxis; and 5. Conversations (Journals). Readers will note certain themes running throughout, which include decolonizing science, embodiment, form, circulation, and praxis. [ABSTRACT FROM AUTHOR]

Early eighteenth-century Edinburgh provided a unique learning environment for aspiring practitioners: one in which the unity of medicine and surgery was appreciated and clinical observations and a reasoning practitioner became the well spring of proper patient care. John Rutherford, a surgical apprentice in this environment, student on the wards of London hospitals and under Boerhaave at Leiden, became one of the original medical professors at the University of Edinburgh medical school in 1726. Rutherford taught the popular, theory-based Practice of Medicine for twenty-two years. Then at the end of 1748 he convinced Royal Infirmary of Edinburgh managers to allow him to begin a new lecture series, entitled Clinical Lectures, conducted at the patient's bedside. Pedagogically, the new lecture series integrated medical theory and its application on the ward. Pragmatically, Rutherford used the Clinical Lectures to transition students into practitioners. He oriented the student to the medical profession at large and placed him simultaneously at the patient-disease-physician interface. He taught that systematic patient observation and examination, when combined with experience and reasoning, were essential to accurate diagnoses and proper therapeutic interventions. Importantly too, Rutherford prepared his students for failure through humility, introspection, and the speculative nature of medical practice. [ABSTRACT FROM AUTHOR]

Pain Medicine; Education; Curriculum; Medical Students Setting and subjects. University-affiliated medical school and its fourth-year medical students. Methods. Analysis of a detailed inventory of firstand second-year curricula. Survey of graduating medical students assessing attitudes, skills, and confidence. Construction of a fourth-year pain education elective and collaboration with enrollees to better integrate pain throughout the four-year curriculum. Results. This student-faculty collaboration produced an evidence-guided proposal to reorganize painrelated content across the longitudinal medical curriculum. An attitudes/skills/confidence survey of graduating medical students (104 respondents of 200 polled) found that 70% believed chances for successful outcomes treating chronic pain were low. Self-evaluated competency was high for evaluating (82%) and managing (69%) acute pain; for chronic pain, both were lower (evaluating538%; managing56%). Self-evaluated knowledge of pain physiology and neurobiology was poor (14%), fair (54%), or good (30%), but rarely excellent (2%). Conclusions. To meet graduating students' desire for increased competency in pain, pain-related curricula can and should be reorganized to include pain as a disease state and a widespread public health burden, not merely a symptom. [ABSTRACT FROM AUTHOR]

Objective. Inventory one medical school's first- and second-year pain-related curriculum in order to explore opportunities to teach about pain both as a social, population-based process and as a neuroncentered phenomenon. Design. Deconstruction of pain-related curricular content through a detailed content inventory and analysis by students and faculty. Setting and Subjects. University-affiliated US medical school. Methods. Detailed inventory and content analysis of first- and second-year curricular materials. Results. The inventory of pain content showed fragmentation, mostly presenting it as a symptom without an underlying framework. Conclusion. Analysis of one medical school's painrelated curricular materials reveals opportunities for a more unified perspective that includes pain as a widespread disease state (not merely a symptom) and to provide an emphasis in the curriculum consistent with pain's public health burden. [ABSTRACT FROM AUTHOR]

Purpose. The implementation of an interprofessional clinical pharmacology selective (CPS) learning experience for pharmacy residents and medical students is described. Summary. The opportunity for pharmacy residents to provide didactic lectures at a college of pharmacy and to develop teaching and preceptor skills with experiential pharmacy students may be limited by institutionspecific affiliations and geographic location. In order to overcome these barriers, the Mayo Clinic Hospital postgraduate year 1 (PGY1) pharmacy residency program implemented an interprofessional learning experience in which pharmacy residents serve the role of preceptors for first- and second-year medical students on a CPS. Medical students at the Mayo Medical School (MMS) work alongside the PGY1 resident to develop patient-specific, medication problem lists and gain an appreciation for pharmacy-focused interventions. Medical students teach pharmacy residents diagnostic, pathophysiologic, and patient-assessment considerations related to the medical school's curriculum. The clinical rounds component of the CPS allows for resident achievement of ASHP competency area R4, which focuses on the design of an effective educational activity; selection of a preceptor role; employment of instruction, modeling, coaching, and facilitation; use of effective presentation skills; generation of objective-based learner assessment questions; and identification of areas for continuous improvement. Conclusion. The Mayo Clinic Hospital PGY1 pharmacy residency program and MMS successfully implemented an innovative learning experience to promote interprofessional education between pharmacy residents and medical students. The program establishes collaborative relationships early in students' professional careers and allows for attainment of the ASHP-required competency area R4 through delivery of a CPS to medical students. [ABSTRACT FROM AUTHOR]

Background: Specialty-specific 'boot camps' boost the competence and confidence of medical school graduates as they prepare to enter a residency programme.Objective: We sought to evaluate the efficacy of a specialty-neutral Internship Preparation Camp (IPC) that we developed and made available to senior medical students at our medical school. The primary goal of the IPC is to educate students in the cognitive and procedural skills that are applicable to postgraduate year 1 trainees in all fields of specialisation.Methods: The curriculum was developed through input from senior medical students and faculty from multiple specialties. The course used small-group sessions and skills labs led by distinguished speakers from various professions (medicine, nursing and pharmacy) to teach senior medical students the information and skills common to the needs of all new physicians, regardless of the specialty they have chosen. The course was presented across 3 half-days and was offered just prior to graduation.Results: Of 166 possible participants, 65 attended the course; 39 (60%) of them completed evaluations immediately following the course and 29 (45%) of participants completed a follow-up evaluation 3 months later. All respondents reported increased confidence in caring for patients in all subject areas taught. In the follow-up survey, 82% of respondents reported using information learned during the course on an hourly, daily or weekly basis in their care of patients.Conclusions: A specialty-neutral IPC is of benefit to its attendees, regardless of the medical specialty in which they train. [ABSTRACT FROM AUTHOR]

Causal inference based on a restricted version of the potential outcomes approach reasoning is assuming an increasingly prominent place in the teaching and practice of epidemiology. The proposed concepts and methods are useful for particular problems, but it would be of concern if the theory and practice of the complete field of epidemiology were to become restricted to this single approach to causal inference. Our concerns are that this theory restricts the questions that epidemiologists may ask and the study designs that they may consider. It also restricts the evidence that may be considered acceptable to assess causality, and thereby the evidence that may be considered acceptable for scientific and public health decision making. These restrictions are based on a particular conceptual framework for thinking about causality. In Section 1, we describe the characteristics of the restricted potential outcomes approach (RPOA) and show that there is a methodological movement which advocates these principles, not just for solving particular problems, but as ideals for which epidemiology as a whole should strive. In Section 2, we seek to show that the limitation of epidemiology to one particular view of the nature of causality is problematic. In Section 3, we argue that the RPOA is also problematic with regard to the assessment of causality. We argue that it threatens to restrict study design choice, to wrongly discredit the results of types of observational studies that have been very useful in the past and to damage the teaching of epidemiological reasoning. Finally, in Section 4 we set out what we regard as a more reasonable 'working hypothesis' as to the nature of causality and its assessment: pragmatic pluralism. [ABSTRACT FROM AUTHOR]

Objectives: The 'gender gap' in academic medicine remains significant and predominantly favours males. This study investigates gender disparities in research performance in an Academic Health Science Centre, while considering factors such as mentoring and scientific collaboration.Materials and Methods: Professorial registry-based electronic survey (n=215) using bibliometric data, a mentoring perception survey and social network analysis. Survey outcomes were aggregated with measures of research performance (publications, citations and h-index) and measures of scientific collaboration (authorship position, centrality and social capital). Univariate and multivariate regression models were constructed to evaluate inter-relationships and identify gender differences.Results: One hundred and four professors responded (48% response rate). Males had a significantly higher number of previous publications than females (mean 131.07 (111.13) vs 79.60 (66.52), p=0.049). The distribution of mentoring survey scores between males and females was similar for the quality and frequency of shared core, mentor-specific and mentee-specific skills. In multivariate analysis including gender as a variable, the quality of managing the relationship, frequency of providing corrective feedback and frequency of building trust had a statistically significant positive influence on number of publications (all p<0.05).Conclusions: This is the first study in healthcare research to investigate the relationship between mentoring perception, scientific collaboration and research performance in the context of gender. It presents a series of initiatives that proved effective in marginalising the gender gap. These include the Athena Scientific Women's Academic Network charter, new recruitment and advertisement strategies, setting up a 'Research and Family Life' forum, establishing mentoring circles for women and projecting female role models. [ABSTRACT FROM AUTHOR]

There is currently wide variation in the structure and content of higher medical training in geriatric medicine across Europe and no common framework within which existing efforts can be compared. We set out to develop an audit tool to compare training between countries. An initial review of indexed and grey literature was used to develop an audit tool which was used as the basis of an Internet-based modified Delphi process incorporating the views of 14 expert geriatricians from across Europe. Items in the audit tool were included or excluded when supported by ≥75% or <50% of respondents, respectively. Items supported by 50-74% of respondents were carried forward with additional suggestions and modifications included following Round 1. Thirteen experts representing 12 countries responded to both rounds. 40/45 items were supported at Round 1. Five items were carried forward. A further 13 elements were introduced for consideration at Round 2. Consensus was gained after the second round. The final tool describes 52 items across four domains: general considerations, topics referring to knowledge in patient care, different roles that should be considered in medical training and topics regarding assessment. The resulting tool can be used as a basis for comparing higher medical training programmes in geriatric medicine between countries. Individual countries can use this to audit current practice. At an European Union level, the insights gained through such audit will form the basis of future work to develop an agreed postgraduate curriculum in the specialty. [ABSTRACT FROM AUTHOR]

Objective. To assess whether a combination of lecture and model simulation improves resident competency and comfort level with needle driving for interventional pain medicine procedures. Design. Prospective, observational study. Method. Trainees who rotated through the University of California, Irvine, outpatient pain medicine clinic were recruited for the study. Subjects were given a brief lecture and completed a survey with questions regarding their level of comfort with interventional pain medicine procedures. This was followed by a timed trial on a training simulator where the objective was to drive a needle to the target. After the trial, the subject was then given a 30-minute practice session with the simulation model. The subject was then asked to repeat the timed trial and complete a post-simulation survey. Results. All measures of the level of comfort increased significantly after subjects underwent the simulation training. In addition, subjects were able to significantly decrease their entrance time (P = 0.002), total time (P = 0.033), and vertical (P ⩽ 0.001) and horizontal deviation (P ⩽ 0.001) from the final target point after the simulation training. Conclusions. Our study demonstrates that simulation training may improve both trainee comfort level and competency with needle driving. After a brief lecture and a 30-minute training session with the simulator, subjective comfort measures and competency measures (more subjects were able to reach the target, vertical and horizontal deviations from the target decreased) were significantly improved. This suggests that simulation may be a helpful tool in teaching needle driving skills. [ABSTRACT FROM AUTHOR]

The General Medical Council (GMC) provides a core curriculum for all medical degrees in the UK. However, these guidelines do not provide in-depth, specific learning outcomes for the various medical specialties. Recognising our ageing population, the British Geriatrics Society in 2013 published their own supplementary guidelines to encourage and further direct teaching on Gerontology and Geriatric Medicine in medical school curricula. Although teaching on Geriatric Medicine, a sub-discipline of Gerontology, has reassuringly increased in UK medical schools, there are convincing arguments for greater emphasis to be placed on the teaching of another sub-discipline: Social Gerontology. Considering the skills and knowledge likely to be gained from the teaching of Social Gerontology, in this paper we argue for the greater universal adoption of its teaching. This would help ensure that the doctors of tomorrow are better equipped to manage more successfully and holistically the growing cohort of older patients. [ABSTRACT FROM AUTHOR]

Objectives. The purpose of this survey was to evaluate attitudes toward acupuncture among pain medicine fellowship directors. Additional goals were to assess the availability of acupuncture at academic medical centers and ascertain the inclusion of this modality in fellowship curricula. Methods. Electronic and paper surveys were distributed to the 97 American College of Graduate Medical Education pain medicine fellowship directors during January and February, 2014. Directors were queried about their referral patterns to acupuncture, as well as their perceptions of the utility of acupuncture for common pain conditions. They were asked about the availability of acupuncture at their institution, and whether acupuncture was included in the fellowship curriculum. Results. Sixty-seven percent of fellowship directors (65/97) completed the questionnaire. A majority of directors (83%) reported acupuncture is available to patients at their institution, and reported that acupuncture is a modality that they discuss with patients when creating a treatment plan for chronic pain (72%). The majority of programs include acupuncture as part of didactic (63%) and clinical (52%) education. Time constraints, lack of qualified teaching personnel, and cost to patients were cited as barriers to inclusion. The majority of fellowship directors considered acupuncture a safe and worthwhile option for common pain conditions. Conclusion. Results from this survey indicate that acupuncture is widely available to patients at academic medical centers, integrated into many pain fellowship curricula, and considered a useful modality by physician leaders in the field of pain medicine. This sentiment, paired with the flexibility of national guidelines for pain fellowship curricula, suggests a trend toward greater inclusion of this modality in academic medicine. [ABSTRACT FROM AUTHOR]

Objective. The Institute of Medicine and the draft National Pain Strategy recently called for better training for health care clinicians. This was the first high-level needs assessment for pain psychology services and resources in the United States. Design. Prospective, observational, cross-sectional. Methods. Brief surveys were administered online to six stakeholder groups (psychologists/therapists, individuals with chronic pain, pain physicians, primary care physicians/physician assistants, nurse practitioners, and the directors of graduate and postgraduate psychology training programs). Results. 1,991 responses were received. Results revealed low confidence and low perceived competency to address physical pain among psychologists/ therapists, and high levels of interest and need for pain education. We found broad support for pain psychology across stakeholder groups, and global support for a national initiative to increase pain training and competency in U.S. therapists. Among directors of graduate and postgraduate psychology training programs, we found unanimous interest for a no-cost pain psychology curriculum that could be integrated into existing programs. Primary barriers to pain psychology include lack of a system to identify qualified therapists, paucity of therapists with pain training, limited awareness of the psychological treatment modality, and poor insurance coverage. Conclusions. This report calls for transformation within psychology predoctoral and postdoctoral education and training and psychology continuing education to include and emphasize pain and pain management. A system for certification is needed to facilitate quality control and appropriate reimbursement. There is a need for systems to facilitate identification and access to practicing psychologists and therapists skilled in the treatment of pain. [ABSTRACT FROM AUTHOR]

Failed perceptions of clinical abnormalities may have a neurophysiological explanation including three major covert eye problems and seven major brain-processing problems. Seven suggestions are made in an attempt to minimise their effect. We see in detail much less than we think and there is no substitute for seeing real-life clinical abnormalities. [ABSTRACT FROM AUTHOR]

Background Musculoskeletal (MSK) conditions affect millions of people around the world. Gait, Arms, Legs and Spine (GALS) is a simple and useful screening tool for routine MSK examination in hospitals and general practice and has been integrated into the undergraduate medical curriculum. Despite this, there is evidence that doctors lack competency in MSK examination and that GALS are underperformed routinely. Objectives The study explored the views of junior doctors ( JDs) on how they were taught MSK examination as undergraduates; the usefulness of GALS as a technique for excluding significant MSK problems; why MSK examination was often poorly carried out and how this could be improved. Methods A qualitative study was performed with data gathered through focus group interviews from 32 JDs working in two acute NHS hospitals. Six interviews were conducted over a 6-week period from mid-June to the end of July in consecutive years 2013 and 2014. Results Ninety JDs were invited to participate in the focus group interviews; 32 (36%) agreed to participate, 28 (88%) of whom had graduated in the UK. The perception of JDs was that undergraduate training for GALS and regional MSK examination was adequate, but reasons for lack of MSK competency in the workplace are multifactorial and complex. Conclusions Proposing more practical and interactive sessions to reinforce MSK skills during postgraduate training may not resolve issues of MSK competency among JDs. Recognition of the complexity of workplace learning and the influence of tacit learning is required if MSK competency is to be enhanced. [ABSTRACT FROM AUTHOR]

Objective In 2010, Pain Medicine was formally recognized as a subspecialty in Canada by the Royal College of Physicians and Surgeons of Canada, a national organization with oversight of the medical education of specialists in Canada. The first trainees began their training at the Western University, London, Canada in July, 2014. This article traces the process of Pain Medicine's development as a discipline in Canada and outlines its multiple entry routes, 2-year curriculum, and assessment procedures. Design The application for specialty status was initiated in 2007 with the understanding that while Anesthesiology would be the parent specialty, the curriculum would train clinicians in a multidisciplinary setting. To receive recognition as a Royal College subspecialty, Pain Medicine had to successfully pass through three phases, each stage requiring formal approval by the Committee on Specialties. The multiple entry routes to this 2-year subspecialty program are described in this article as are the objectives of training, the curriculum, assessment of competency and the practice-eligibility route to certification. The process of accreditation of new training programs across Canada is also discussed. Conclusions The new Pain Medicine training program in Canada will train experts in the prevention, diagnosis, treatment and rehabilitation of the spectrum of acute pain, cancer pain and non-cancer pain problems. These physicians will become leaders in education, research, advocacy and administration of this emerging field. [ABSTRACT FROM AUTHOR]

Introduction Simulation is an evolving aspect of medical education. The role of simulation in training programs is variable, however, in technical specialties such as surgery and anesthesiology its role is quickly becoming a standard part of training programs. Pain fellowship programs must teach clinical diagnostic skills, pharmacology and pathophysiology, in addition to interventional skills to fellows with varying residency backgrounds. Methods The implementation of a hybrid simulation course into the pain fellowship curriculum allows for active learning as fellows experience challenging patient scenarios, stressful periprocedural events, and cases gone awry that require emergency algorithm recall and action. Conclusion This report describes the incorporation of simulation and crucial conversations into a pain fellowship curriculum. [ABSTRACT FROM AUTHOR]

In clinical trials and other medical studies, it has become increasingly common to observe simultaneously an event time of interest and longitudinal covariates. In the literature, joint modelling approaches have been employed to analyse both survival and longitudinal processes and to investigate their association. However, these approaches focus mostly on developing adaptive and flexible longitudinal processes based on a prespecified survival model, most commonly the Cox proportional hazards model. In this paper, we propose a general class of semiparametric hazard regression models, referred to as the extended hazard model, for the survival component. This class includes two popular survival models, the Cox proportional hazards model and the accelerated failure time model, as special cases. The proposed model is flexible for modelling event data, and its nested structure facilitates model selection for the survival component through likelihood ratio tests. A pseudo joint likelihood approach is proposed for estimating the unknown parameters and components via a Monte Carlo em algorithm. Asymptotic theory for the estimators is developed together with theory for the semiparametric likelihood ratio tests. The performance of the procedure is demonstrated through simulation studies. A case study featuring data from a Taiwanese HIV/AIDS cohort study further illustrates the usefulness of the extended hazard model. [ABSTRACT FROM PUBLISHER]

Objective. Pain is one of the most undertreated medical complaints, with barriers to effective pain management lying in poor education of health professionals and misconceptions regarding patients in pain. The aim of this study was to assess whether an elective undergraduate course on chronic pain offered in Greek medical schools influences knowledge and attitudes of medical undergraduates about chronic pain and helps them clarify pain-related concepts. Methods. An electronic questionnaire with 6 demographic and 21 pain-related items was uploaded on SurveyMonkey. The questionnaire was open to medical students in every Greek medical school for 1 month. Students were asked to respond to questions regarding various aspects of pain taught in the aforementioned course. In specific, they were asked to respond to questions regarding the definition, types, and adequacy of treatment of chronic cancer and non-cancer pain. They were queried about their knowledge of pain clinics, health practitioners who run them, and types of treatment available there. There were also questions about opioid use in cancer and non-cancer chronic pain patients and regarding the likelihood of opioid addiction. Results. According to their responses, medical students had good knowledge about the definition and consequences of pain, and those who attended the pain course had greater knowledge regarding the adequacy of treatment of chronic pain and were more familiar with the recent classification of types of pain. Students who did not have exposure to the undergraduate pain course had little information regarding pain clinics and had poor knowledge regarding the use of opioids in cancer and in nonmalignant chronic pain. All students expressed concerns regarding addiction to opioids. Conclusions. Although students enter medical school with little knowledge about pain issues, pain awareness can be positively influenced by education. A curriculum about pain should not only teach the basic science of pain but also present treatment strategies available and address the socioemotional dimensions of pain. Additionally, if misconceptions about opioid use and addiction are properly elucidated early in medical education, the future health practitioners will be one step forward in achieving the goal of alleviating suffering patients' pain. [ABSTRACT FROM AUTHOR]

BACKGROUND: The Montreal Children's Hospital Pediatric Residency Program redesigned its Academic Half-Day based on program concerns consistent with the published literature. These concerns included inadequate preparation for general paediatric practice, gaps in CanMEDS education and exclusive use of didactic lectures. Novel instructional methods included monthly simulation sessions to learn CanMEDS competencies, increased use of general paediatricians as instructors, implementation of a 'systems-based' curriculum and development of self-directed learning skills through activities such as 'Residents as Teachers'. METHOD: A postimplementation online survey was sent to all 18 residents who had been exposed to both curricula. The survey was designed to determine the impact of the new curriculum on their perceived ability to retain information and acquire the competencies of a general paediatrician, and to assess the effect on their self-directed learning. Responses were recorded on a five-point Likert scale ranging from 'strongly disagree' to 'strongly agree'. RESULTS: Fourteen of 18 (78%) residents completed the survey. All residents preferred the 'systems-based' educational program. Seventy-nine percent of all residents agreed that the simulation sessions were an effective method of learning the CanMEDS competencies. Importantly, 64% of residents voluntarily read more about the topics presented and 71% agreed that they retained the content better. Moreover, 79% believed that changes made to the teaching curriculum better prepared them for a general paediatric practice and 64% of residents believed that it better 'supplements' learning in the clinical setting. CONCLUSION: The authors propose that the new curriculum is comprehensive, while developing the skills required for life-long learning as a general paediatrician. [ABSTRACT FROM AUTHOR]

Introduction: the rise in the number of older, frail adults necessitates that future doctors are adequately trained in the skills of geriatric medicine. Few countries have dedicated curricula in geriatric medicine at the undergraduate level. The aim of this project was to develop a consensus among geriatricians on a curriculum with the minimal requirements that a medical student should achieve by the end of medical school.Methods: a modified Delphi process was used. First, educational experts and geriatricians proposed a set of learning objectives based on a literature review. Second, three Delphi rounds involving a panel with 49 experts representing 29 countries affiliated to the European Union of Medical Specialists (UEMS) was used to gain consensus for a final curriculum.Results: the number of disagreements following Delphi Rounds 1 and 2 were 81 and 53, respectively. Complete agreement was reached following the third round. The final curriculum consisted of detailed objectives grouped under 10 overarching learning outcomes.Discussion: a consensus on the minimum requirements of geriatric learning objectives for medical students has been agreed by European geriatricians. Major efforts will be needed to implement these requirements, given the large variation in the quality of geriatric teaching in medical schools. This curriculum is a first step to help improve teaching of geriatrics in medical schools, and will also serve as a basis for advancing postgraduate training in geriatrics across Europe. [ABSTRACT FROM AUTHOR]

A Continuing Medical Examination (CEM) from the American Society for Clinical Pathology (ASCE) on various topics is presented including flow cytometry immunophenotyping of bone marrow, tumor resection and prognosis of double-hit lymphoma.

As the proportion of older patients with frailty presenting to health services increases, so does the need for doctors to be adequately trained to meet their needs. The presentations seen in such patients, the evidence-based models of care and skillsets required to deliver them are different than for younger patient groups—so specific training is required. Several research programmes have used detailed and explicit methods to establish evidence-based expert-validated curricula outlining learning outcomes for undergraduates in geriatric medicine–there is now broad-consensus on what newly qualified doctors need to know. There are, despite this, shortcomings in the teaching of undergraduates about geriatric medicine. National and international surveys from the UK, EU, USA, Canada, Austria and the Netherlands have all shown shortcomings in the content and amount of undergraduate teaching. Mechanisms to improve this situation, aside from specifying curricula, include developing academic departments and professorships in geriatric medicine, providing grants to develop teaching in geriatric medicine and developing novel teaching interventions to make the best of existing resources. Under the last of these headings, innovations have been shown to improve outcomes by: using technology to ensure the most effective allocation of teaching time and resources; using inter-professional education as a means of improving attitudes towards care of older patients; focusing teaching specifically on attitudes towards older patients and those who work with them; and trying to engage patients in teaching. Research areas going forward include how to incentivise medical schools to deliver specified curricula, how to choose from an ever-expanding array of teaching technologies, how to implement interprofessional education in a sustainable way and how to design teaching interventions using a qualitative understanding of attitudes towards older patients and the teams that care for them. [ABSTRACT FROM AUTHOR]

Objectives: Team-based learning (TBL) has been integrated into undergraduate and medical education curricula in many institutions. However, TBL has not been widely introduced into postgraduate medical education. Our study aimed to measure the effect of TBL on promoting learning and teamwork in the setting of pathology residency training. Methods: Four TBL sessions were held and individual and group readiness assurance tests (IRAT/GRATs) were performed; scores were compared using Wilcoxon matchedpairs signed rank tests. Residents completed 18-item validated team performance surveys measuring the quality of team interactions on a scale of 0 (none of the time) to 6 (all of the time). Mean and standard deviation were calculated for each item. Results: Scores on the IRAT vs GRAT were significantly different (P < .05). The team performance survey received mean scores ranging from 5.3 ± 1.1 to 6.0 ± 0.0. Conclusions: The use of TBL promotes teamwork and learning in a pathology residency program. Residents scored higher on the readiness assurance tests when working in teams, demonstrating the effectiveness of team learning and achievement. In addition, the Accreditation Council for Graduate Medical Education competencies of professionalism and interpersonal and communication skills were further enhanced by incorporating TBL into pathology residency training. [ABSTRACT FROM AUTHOR]

STUDY QUESTION How long is the individualized training and the stability of competence for the embryo transfer (ET) technique? SUMMARY ANSWER The embryo transfer technique is easy-to-learn, hardly unlearned, and training should be individualized by monitoring with learning curve-cumulative summation (LC-CUSUM) curves. WHAT IS KNOWN ALREADY Like many medical procedures, embryo transfer is an operator-dependent technique. Individualized or standardized training of these medical procedures should be monitored to determine when competence is acquired. STUDY DESIGN, SIZE, DURATION This prospective, monocentric study involving five embryo transfer trainees was carried out between August 2011 and November 2012. PARTICIPANTS/MATERIALS, SETTING, METHODS The study was carried out in a large private clinic. Five gynaecologist trainees during their first year of assisted reproduction subspecialty performed embryo transfer for patients undergoing either fresh IVF, oocyte donor IVF, or frozen embryo transfer. There were 586 embryo transfers performed in 96 sessions of 3–10 embryo transfers each. An embryo transfer was considered successful if it gave rise to a positive pregnancy test 14 days later. LC-CUSUM and cumulative summation (CUSUM) curves were used to determine when competence was acquired and whether it was maintained over time, respectively. The length of time between two consecutive sessions was assessed for an effect on consolidation of the acquired competence. MAIN RESULTS AND THE ROLE OF CHANCE We observed that all five trainees became proficient in embryo transfer by procedure 15 (after procedure 15, 9, 7, 13 and 9, respectively). Once competence was achieved, one of the five trainees showed a loss of proficiency. After having acquired competence, the median pregnancy rate per embryo transfer session was significantly lower when the interval between consecutive embryo transfer sessions was ≥10 days compared with <10 days (20.0 versus 46.7%; P = 0.006). LIMITATIONS, REASONS FOR CAUTION The patient groups included in the study were heterogeneous (IVF, oocyte donor IVF and frozen embryo transfer) and their outcomes are very variable; thus the distribution and proportion of these groups can determine the timing of competence acquisition. Our data show that low numbers of embryo transfer are needed to acquire competence, but since a relative high percentage of embryo transfers in our practice are from oocyte donor IVF, extrapolation of the findings to other clinical context should be done with caution. WIDER IMPLICATIONS OF THE FINDINGS Personalized embryo transfer training is feasible and useful, allowing clinics, on one hand, to offer a maximum chances of pregnancy with fully trained personnel, and the other hand, to avoid the superfluous and costly overtraining of already proficient trainees. Furthermore, it is advisable to maintain a short interval of time between consecutive embryo transfer sessions after a trainee has acquired competence, to avoid a significant drop in the resulting pregnancy rate. STUDY FUNDING/COMPETING INTEREST(S) This work was supported in part by funding from Fundació Privada EUGIN. There are no conflicts of interest to declare. [ABSTRACT FROM AUTHOR]

Objectives: To suggest a basic new approach for pathology training programs to consider when a resident requires remediation, probation, or dismissal. Methods: Remediation, probation, or dismissal of the poorly performing pathology resident is one of the most difficult and challenging aspects of any pathology training program. The poorly performing resident requires extra time and resources from the faculty and the program and can be disruptive for the entire program. Effective remediation requires faculty development, a well-constructed remediation or probation plan, and documentation. Results: Despite best efforts, not all remediation plans are successful and dismissal of the resident will need to be seriously considered. Conclusions: Approaches to dealing with resident performance issues can be variable and need to be tailored to the issue being addressed. [ABSTRACT FROM AUTHOR]

Introduction: in 2008, the British Geriatrics Society (BGS) developed the Recommended Undergraduate Curriculum in Geriatric Medicine. This was subsequently mapped to the second edition of Tomorrows' Doctors (TD2, 2003). Following the publication of the third edition of Tomorrow's Doctors in 2009 (TD3), the mapping exercise was repeated to verify the extent to which the updated General Medical Council recommendations supported teaching in ageing and geriatric medicine.Method: we analysed TD3 and identified 48 aspects of its general guidance that were relevant to the teaching of medicine for older people. We then mapped these to the 2009 BGS curriculum.Results: the BGS curriculum was supported in full by TD3. However, learning outcomes relating to the interpretation and conduct of research in TD3 had no corresponding outcomes in the BGS curriculum.Conclusion: the BGS curriculum for medical undergraduates continues to provide a specific and complete list of learning objectives, all of which could help to operationalise the general statements made in TD3 with relation to ageing and geriatric medicine. Learning outcomes in research in frail older patients have been added following this mapping exercise. [ABSTRACT FROM AUTHOR]

Introduction: in 2008, a UK national survey of undergraduate teaching about ageing and geriatric medicine identified deficiencies, including failure to adequately teach about elder abuse, pressure ulcers and bio- and social gerontology. We repeated the survey in 2013 to consider whether the situation had improved.Method: the deans of all 31 UK medical schools were invited to nominate a respondent with an overview of their undergraduate curriculum. Nominees were invited by email and letter to complete an online questionnaire quantifying topics taught, type of teaching and assessment undertaken, and the amount of time spent on teaching.Results: one school only taught pre-clinical medicine and declined to participate. Of the 30 remaining schools, 20 responded and 19 provided analysable data. The majority of the schools (95–100%) provided teaching in delirium, dementia, stroke, falls, osteoporosis, extra-pyramidal disorders, polypharmacy, incontinence, ethics and mental capacity. Only 68% of the schools taught about elder abuse. Thirty-seven per cent taught a recognised classification of the domains of health used in Comprehensive Geriatric Assessment (CGA). The median (range) total time spent on teaching in ageing and geriatric medicine was 55.5 (26–192) h. There was less reliance on informal teaching and improved assessment:teaching ratios compared with the 2008 survey.Conclusions: there was an improvement in teaching and assessment of learning outcomes in ageing and geriatric medicine for UK undergraduates between 2008 and 2013. However, further work is needed to increase the amount of teaching time devoted to ageing and to improve teaching around elder abuse and the domains of health used in CGA. [ABSTRACT FROM AUTHOR]

The author reflects on the arguments why pocket-size ultrasound imagers should be employed as an integral part of the physical examination at the point of care, emphasizing the benefits of a more accurate diagnosis, cost reduction and a better patient-doctor rapport. Topics include the historical evolution of the physical examination, the reasons cardiologists increasingly rely on echocardiography, and the training requirements in the effective use of a small-scale imager.

Aims To investigate medical students' experiences and perception of support following a patient's death, contrasting their experiences in the UK, and while overseas during their elective period. Methods An anonymous online questionnaire was distributed to all final year medical students at one UK medical school in November 2009. Results 220 students were contacted, 60% responded. 72% (94) of medical students had been involved in end- of-life care at some point during their course; students on elective experiencing patient death across all ages. Some students saw many patients dying during their elective period. Students had mixed emotions following a patient's death. In the UK, students reported feeling shocked, upset and sad. When overseas, many students were angry or frustrated, and many reported feelings of injustice. Following a death, students found talking to people beneficial, but when overseas they turned to friends and family using email and Facebook, rather than talking to local doctors and nurses. Only 13% (16) of medical students thought their medical training had prepared them sufficiently to deal with death. Of those who did feel prepared some said they had gained this knowledge through working as a healthcare assistant. Conclusions Students feel ill prepared for experiencing the death of a patient. Even though they may have 'medical knowledge' they are still lacking in emotional support and are often inadequately supported around the time of a patient's death. Medical schools should consider their curricula so that students are aware of the possible experiences and emotions which they may face when involved with the death of a patient, and students should be given advice on whom to turn to for support. [ABSTRACT FROM AUTHOR]

Purpose of the study The transition from medical student to junior doctor is a critical stage in career progression. We report junior doctors' views 1 year after graduation on whether their medical school prepared them well for clinical work. Study design Questionnaire surveys of the medical graduates of 2008 and 2009, from all UK medical schools, 1 year after graduation. Responses were compared with those of UK medical graduates of 1999, 2000, 2002 and 2005. The main outcome measure was the doctors' level of agreement that medical school had prepared them well for work. Results 53% of 2008 graduates and 49% of 2009 graduates agreed that their medical school had prepared them well. The percentage who felt unprepared has fallen from 31% of the 1999-2005 graduates, combined, to 19% of the 2008 and 2009 graduates (the remainder gave neutral responses). Combining 2008 and 2009 graduates responses, percentages who agreed that they had been well prepared ranged from 83% (95% CI 78 to 89) at the medical school with the highest level of agreement to 27% (95% CI 20 to 34) at the lowest. 25% of doctors specified that feeling unprepared had been a serious or medium-sized problem for them (only 2.7% regarded it as serious). Conclusions Medical schools need feedback from their graduates about elements of medical school training that could improve preparedness for medical work. It also seems likely that there are some reasonably straightforward lessons that medical schools could learn from each other. [ABSTRACT FROM AUTHOR]

Aims To study the feasibility and reliability of pocket-size hand-held echocardiography (PHHE) by medical residents with limited experience in ultrasound. Methods and results A total of 199 patients admitted to a non-university medical department were examined with PHHE. Six out of 14 medical residents were randomized to use a focused protocol and examine the heart, pericardium, pleural space, and abdominal large vessels. Diagnostic corrections were made and findings were confirmed by standard diagnostics. The median time consumption for the examination was 5.7 min. Each resident performed a median of 27 examinations. The left ventricle was assessed to satisfaction in 97% and the pericardium in all patients. The aortic and atrioventricular valves were assessed in at least 76% and the abdominal aorta in 50%, respectively. Global left-ventricular function, pleural, and pericardial effusion showed very strong correlation with reference method (Spearman's r ≥ 0.8). Quantification of aortic stenosis and regurgitation showed strong correlation with r = 0.7. Regurgitations in the atrioventricular valves showed moderate correlations, r = 0.5 and r = 0.6 for mitral and tricuspid regurgitation, respectively, similar to dilatation of the left atrium (r = 0.6) and detection of regional dysfunction (r = 0.6). Quantification of the abdominal aorta (aneurysmatic or not) showed strong correlation, r = 0.7, while the inferior vena cava diameter correlated moderately, r = 0.5. Conclusion By adding a PHHE examination to standard care, medical residents were able to obtain reliable information of important cardiovascular structures in patients admitted to a medical department. Thus, focused examinations with PHHE performed by residents after a training period have the potential to improve in-hospital diagnostic procedures. [ABSTRACT FROM PUBLISHER]

The article presents views of Giuseppe Mancia, Professor of Medicine at the University of Milano-Bicocca, Milan, Italy who talks about his work in hypertension research. Topics include that his research involves haemodynamic changes during sleep, and intra-arterial blood pressure measurement, and therapy adherence via largescale population studies.

Background: Airway compromise is a contributor to preventable mortality on the battlefield. Supraglottic airway devices are an accepted intervention for these casualties. Combat Medics, civilian prehospital care providers, and lay civilians have demonstrated proficiency with supraglottic airways. However, the Combat Lifesaver (CLS) course includes no instruction on their use. Objective: The purpose of this study was to assess feasibility of instructing CLS students to use a supraglottic airway (the King LT-D); compare their timed performance with that of Special Operations Combat Medics (SOCM); and assess their confidence utilizing the device. Methods: After standardized instruction, students were timed and evaluated in the placement of a King LT-D in a manikin. Student confidence was assessed by Likert-scaled surveys, and free response remarks collected before and after training. Results: 27 of 28 CLS students successfully used a King LT-D airway device in under 60 seconds following brief instruction. Placement times were not significantly different from those of SOCM. Self-rated confidence scores improved from an initial 1.4/5 to 4.9/5 following manikin trials. Both CLS and SOCM recommended the airway for future battlefield CLS use. Conclusions: CLS students are capable and confident in the use of a supraglottic airway device after only brief instruction. [ABSTRACT FROM AUTHOR]

Objective The education of physicians is a fundamental obligation within medicine that must remain closely aligned with clinical care. And although medical education in pain care is essential, the current state of medical education does not meet the needs of physicians, patients, or society. To address this, we convened a committee of pain specialist medical student educators. Methods Tasked with creating systematically developed and valid recommendations for clinical education, we conducted a survey of pain medicine leadership within the American Academy of Pain Medicine ( AAPM). The survey was conducted in two waves. We asked AAPM board members to rate 194 previously published pain medicine learning objectives for medical students; 79% of those eligible for participation responded. Results The ' Top 5' list included the awareness of acute and chronic pain, skillfulness in clinical appraisal, promotion of compassionate practices, displaying empathy toward the patient, and knowledge of terms and definitions for substance abuse. The ' Top 10' list included the major pharmacological classes as well as skills in examination, communication, prescribing, and interviewing. The ' Top 20' list included the pain care of cognitively impaired populations, those with comorbid illness, and older adults. With the survey results in consideration, the committee produced a new recommended topic list for curricula in pain medicine. We strongly recommend that adequate resources are devoted to fully integrated medical curricula in pain so that students will learn not only the necessary clinical knowledge but also be prepared to address the professional, personal, and ethical challenges that arise in caring for those with pain. Conclusions We conclude that improved medical education in pain is essential to prepare providers who manifest both competence and compassion toward their patients. [ABSTRACT FROM AUTHOR]

The study of science and medicine in critical and cultural theory continues to be a vibrant area of research. Work undertaken in this field in 2011 has been distinctive in its fundamental agreement that scientists, medical practitioners and critical and cultural theorists share an understanding of the history of ideas as well as methodological and epistemological innovations that mark current debates as interdisciplinary. Vital transformations and expansions of critical and cultural theory continue to develop out from ‘science and medicine’ under several paradigms, particularly the history of science, science and technology studies, and philosophy of science. This chapter concentrates on nine publications from 2011 that signal emerging trends in the above areas as well as material culture, social history and literary analysis of scientific texts. [ABSTRACT FROM AUTHOR]

Objective. We examined chronic pain management practices and confidence and satisfaction levels in treating chronic pain among primary care providers (PCPs) who cared for high-risk patients in safety net health settings. Design. We recruited PCPs (N = 61) through their HIV-infected patients who were enrolled in a longitudinal study on pain, use, and misuse of opioid analgesics (Pain Study). We asked PCPs to complete a questionnaire about all of their patients in their practice on the prevalence of chronic pain and illicit substance use, use of opioid analgesics, confidence and satisfaction levels in treating chronic pain, and likelihood of prescribing opioid analgesics in response to clinical vignettes. Results. All PCPs cared for at least some patients with chronic pain, and the majority prescribed opioid analgesics for its treatment. All PCPs cared for at least some patients who used illicit substances. PCPs reported low confidence and satisfaction levels in treating chronic pain. The majority (73.8%) of PCPs were highly likely to prescribe opioid analgesics to a patient without a history of substance use who had chronic pain. The majority (88.5%) were somewhat to highly likely to prescribe opioid analgesics to a patient with a prior history of substance use but not active use. Most (67.2%) were somewhat to highly likely to prescribe opioids to a patient with active substance use. Conclusion. In order to improve PCPs' confidence and satisfaction in managing chronic pain, further work should explore the root causes of low confidence and satisfaction and also explore possible remedies. [ABSTRACT FROM AUTHOR]

Self-efficacy is a personal belief in one's capability to successfully execute the behaviors necessary to attain designated types of performances. Sometimes described as task-specific self-confidence, self-efficacy is a key component in many contemporary theories of motivation and learning. The purpose of this study was to develop a survey for measuring students' medical skills self-efficacy and to collect reliability and validity evidence for the instrument. A secondary purpose was to explore differences in students' self-efficacy from year 1 of medical school to year 4. We created 19 survey items based on the 6 core competencies of the Accreditation Council for Graduate Medical Education, and we collected data from 304 medical students. Results from an exploratory factor analysis suggested three interpretable factors: patient care self-efficacy (eight items, Cronbach's α = 0.92), interpersonal skills self-efficacy (three items, Cronbach's α = 0.76), and evidence-based medicine self-efficacy (three items, Cronbach's α = 0.79). We then compared students' self-efficacy at different stages of training using a one-way multivariate analysis of variance. Consistent with our expectations, we found several statistically significant differences, suggesting students' self-efficacy increased considerably from year 1 of medical school to year 4, F(9,725) = 30.58, p < 0.001, Wilks' 7. = 0.46. Using this survey, medical educators and researchers have a psychometrically sound tool for measuring students' medical skills self-efficacy during undergraduate medical education. Practical implications and future directions are discussed. [ABSTRACT FROM AUTHOR]

The work of the Long-Term Career Outcome Study (LTCOS), F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences (USU) has been a multidisciplinary effort spanning more than 5 years. Borrowing from the established program evaluation and quality assurance literature, the LTCOS team has organized its evaluation and research efforts into three phases: before medical school, during medical school, and after medical school. The purpose of this commentary is to summarize the research articles presented in this special issue and to answer two fundamental questions: (1) what has been learned from LTCOS research conducted to date, and (2) where should the LTCOS team take its evaluation and research efforts in the future? Answers to these questions are relevant to USU, and they also can inform other medical education institutions and policy makers. What is more, answers to these questions will help to ensure USU meets its societal obligation to provide the highest quality health care to military members, their families, and society at large. [ABSTRACT FROM AUTHOR]

Background: Clinical reasoning is essential to medical practice, but because it entails internal mental processes, it is difficult to assess. Functional magnetic resonance imaging (fMRI) and think-aloud protocols may improve understanding of clinical reasoning as these methods can more directly assess these processes. The objective of our study was to use a combination of fMRI and think-aloud procedures to examine fMRI correlates of a leading theoretical model in clinical reasoning based on experimental findings to date: analytic (i.e., actively comparing and contrasting diagnostic entities) and nonanalytic (i.e., pattern recognition) reasoning. We hypothesized that there would be functional neuroimaging differences between analytic and nonanalytic reasoning theory. Methods: 17 board-certified experts in internal medicine answered and reflected on validated U.S. Medical Licensing Exam and American Board of Internal Medicine multiple-choice questions (easy and difficult) during an fMRI scan. This procedure was followed by completion of a fonlaal think-aloud procedure. Results: fMRI findings provide some support for the presence of analytic and nonanalytic reasoning systems. Statistically significant activation of prefrontal cortex distinguished answering incorrectly versus correctly (p < 0.01), whereas activation of precuneus and midtemporal gyrus distinguished not guessing from guessing (p < 0.01). Conclusions: We found limited fMRI evidence to support analytic and nonanalytic reasoning theory, as our results indicate functional differences with correct vs. incorrect answers and guessing vs. not guessing. However, our findings did not suggest one consistent fMRI activation pattern of internal medicine expertise. This model of employing fMRI correlates offers opportunities to enhance our understanding of theory, as well as improve our teaching and assessment of clinical reasoning, a key outcome of medical education. [ABSTRACT FROM AUTHOR]

Introduction: Finding ways to improve communication and self-reflection skills is an important element of medical education and continuing professional development. This study examines the relationship between self-reflection and educational outcomes. Methods: We correlate performance in a preclinical course that focuses on self-reflection as it relates to contextual elements of patient care (Human Context of Health Care), with educational measures such as overall grade point average, clinical clerkship scores, and Medical College Admission Test (MCAT) scores. Results: Student performance in Human Context of Health Care correlated with MCAT-Verbal scores, MCAT-writing sample scores, clerkship grades, and overall medical school grade point average (R = 0.3; p < 0.001). Conclusion: Writing and self-reflection skills are often neglected in undergraduate medical curricula. Our findings suggest that these skills are important and correlate with recognized long-term educational outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the association between tertiary reviewer (admissions committee member) comments and medical students' performance during medical school and into internship. Methods: We collected data from seven year-groups (1993-1999) and coded tertiary reviewer comments into 14 themes. We then conducted an exploratory factor analysis to reduce the dimensions of the themes (excluding the Overall impression theme). Subsequently, we performed Pearson correlation analyses and multiple linear regression analysis to examine the relationship between the factors and seven outcome measures: medical school preclinical grade point average (GPA), medical school clinical GPA, cumulative medical school GPA, U.S. Medical Licensing Examination Step 1 and 2 scores, and scores on a program director's evaluation measuring intern professionalism and expertise. Results: We extracted seven factors from the 13 themes and found small-to-moderate, significant correlations between the factors, the Overall impression theme, and the outcome measures. In particular, positive comments on Test and Maturity were associated with higher U.S. Medical Licensing Examination Step 1 and 2 scores. Negative comments on Interview and Recommendations were associated with lower ratings of professionalism during internship. Comments on Overall impression were significantly associated with all the outcome measures. Conclusions: Tertiary reviewer comments were weakly associated with performance in medical school and internship. Compared with positive comments, negative comments had stronger associations with medical school and internship performance measures. [ABSTRACT FROM AUTHOR]

Background: Admissions committees attempt to select the most qualified applicants based on many cognitive and "noncognitive" factors. Purpose: Identify common themes cited in the admissions committee member summaries of medical school matriculants and determine the relative frequency and importance of these themes. Methods: After reviewing a convenience sample of 150 reviewer comments, 14 qualitative themes were identified. Utterances (thematic word strings) from each of the three reviewer comments for each matriculant for 7 academic years (1989-1996) were then categorized and coded as being positive, negative, or neutral. Intra-rater and inter-rater reliabilities were calculated. Results: Utterances (n = 9299) about 981 matriculants were categorized by theme and sorted as being positive, neutral, or negative. Intra-rater reliabilities were excellent (mean K = 0.98, range 0.90-1.00). Similarly, inter-rater reliabilities were also excellent (mean K -- 0.94, range 0.55-1.00 and mean K = 0.90, range 0.08-1.00). Four themes (overall summarizing comments, academic, test scores, and motivation) accounted for more than half (56%) of the utterances. Conclusions: We were able to qualitatively identify themes and provide information about how one committee weighs both cognitive and "noncognitive" factors. Admission committees should consider reexamining their process and potentially expanding, eliminating, or modifying application components. [ABSTRACT FROM AUTHOR]

In 2005, the Long-Term Career Outcome Study (LTCOS) was established by the Dean, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences (USU). The original charge to the LTCOS team was to establish an electronic database of current and past students at USU. Since its inception, however, the LTCOS team has broadened its mission and started collecting and analyzing data on a continuous basis for the purposes of program evaluation and, in some cases, research. The purpose of this commentary is to review the history of the LTCOS, including details about USU, a brief review of prior LTCOS work, and progress made since our last essay on LTCOS efforts. This commentary also provides an introduction to the special issue, which is arranged as a series of articles that span the medical education continuum (i.e., before, during, and after medical school). The relative balance of articles in each phase of training represents the LTCOS team's efforts to address the entire continuum of medical education. [ABSTRACT FROM AUTHOR]

Antimicrobial stewardship programs that target “low-hanging fruit,” which include intravenous-to-oral switch, batching of intravenous antimicrobials, therapeutic substitution, and formulary restriction, can have early success and achieve significant cost savings. We observed cost savings of $832 590 with a staged and systematic approach.A new antimicrobial stewardship program can be overwhelmed at the breadth of interventions and education required to conduct a successful program. The expression “low-hanging fruit,” in reference to stewardship, refers to selecting the most obtainable targets rather than confronting more complicated management issues. These targets include intravenous-to-oral conversions, batching of intravenous antimicrobials, therapeutic substitutions, and formulary restriction. These strategies require fewer resources and less effort than other stewardship activities; however, they are applicable to a variety of healthcare settings, including limited-resource hospitals, and have demonstrated significant financial savings. Our stewardship program found that staged and systematic interventions that focus on obvious areas of need, that is, low hanging fruit, provided early successes in our expanded program with a substantial cumulative cost savings of $832 590. [ABSTRACT FROM AUTHOR]

Objective. The objectives of this study were 1) to determine the level of education around the world and to identify strong evidence upon which future educational initiatives could be established; and 2) to establish a collaboration who could lead the way in terms of recommendations and educational developments for the care of older adults around the world. Design. A two-phase approach was used to achieve the above objectives. Phase I involved a survey conducted through the International Association for the Study of Pain (IASP) Special Interest Group (SIG) to determine the variations and availability of pain education for older adults from around the world. Phase II involved the setting up of an expert panel to review the guidelines on pain management currently available and therefore make some recommendations around the curriculum content. Setting. The small-scale study was conducted within 15 countries through the IASP discussion forum. Subjects. A range of health-care professionals from medicine, nursing, psychology, and allied health professionals were involved in this study. Results. Fifteen countries responded to the survey, providing evidence of huge variation in courses available around the world. Fourteen documents were reviewed by the expert panel, which provided evidence for education, assessment, and management of pain. Conclusion. Several recommendations can be made from this work: 1) establish an expert working group who can provide the experience and skills necessary to develop a multidisciplinary curriculum on pain in older adults-this has been achieved through this current work; 2) conduct a thorough systematic review of the literature around pain assessment and management, which could inform a curriculum; and 3) seek representation for membership of the expert group on the IASP core curriculum working group. [ABSTRACT FROM AUTHOR]

This paper defends an account of compassion and argues for the centrality of compassion to the proper practice of medicine. The argument proceeds by showing that failures of compassion can lead to poor medical treatment and disastrous outcomes. Several case studies are discussed, exemplifying the difference between compassionate and noncompassionate responses to patients seeking help. Arguments are offered in support of approaching reports of persistent pain with a trusting attitude, rather than distrust or skepticism. The article concludes by suggesting educational improvements to encourage compassion. [ABSTRACT FROM PUBLISHER]