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Abstract Background Providing optimal care for critically ill patients is an extremely important but also highly demanding task, both emotionally and physically. The “ICU Support” team meeting concept aims to support intensive care unit (ICU) teams by promoting interprofessional communication, peer support, and patient safety by providing a structure for daily team meetings. This protocol describes a study to explore the effectiveness of “ICU Support” for patient- and staff-centered outcomes. Methods ICU Support will be implemented at nine university hospitals located in Germany, following a two-arm randomized parallel group design with an intervention and a control condition and three data collection periods. In the intervention arm, leading ICU personnel (physicians and nurses) will be trained in ICU Support and implement the ICU Support elements into the daily work routine of their units upon completion of data collection period T0 (baseline). In the control arm, ICU Support will not be implemented until the completion of the data collection period T1 (1 month after study start). Until then, the regular daily schedule of the ICU teams will be maintained. The final data collection period (T2) will take place 4 months after the start of the study. Primary outcomes include the number of intensive care complications per patient during their ICU stay during T1 and the sick-related absence of ICU staff during T1. Secondary outcomes include, among others, the average severity of intensive care complications per patient and employee self-reported data regarding their teamwork and patient safety behaviors. Discussion The need for healthy and well-trained ICU staff is omnipresent; thus, structured and evidence-based interventions aimed at supporting ICU teams and facilitating patient safety are required. This multicenter study aims to explore the effectiveness of ICU Support for patient- and staff-centered outcomes. The insights derived from this study have the potential to significantly improve ICU patient safety, staff communication, and connectedness and decrease sickness-related expenses and social costs associated with high work demands among ICU staff. Trial registration German Clinical Trials Register DRKS00028642 . Registered on 4 April 2022.

Abstract Background Medical research is increasingly interdisciplinary. However, not all projects are successful and cooperation is not always sustained beyond the end of funding. This study empirically assesses the effect of control and trust on the sustainability of interdisciplinary medical research in terms of its performance and satisfaction. Methods The sample consists of 100 German publicly funded medical research collaborations with scientists from medicine, natural and social sciences (N = 364). We develop a system model to analyze the influence of trust and control on performance and satisfaction of the cooperation. Findings Both control and trust are important prerequisites for sustainability, control mainly for the performance of the collaboration, and trust primarily for its satisfaction. While the level of interdisciplinarity is a positive moderator for performance, expectation of continuity is a negative intervening variable for the effect of trust and control on satisfaction. Moreover, trust principally adds to the positive impact of control on sustainability. Conclusions Interdisciplinary medical research requires a participative but systematic management of the respective consortium.

Summary: Background: In patients with idiopathic inflammatory myopathies (IIM), autoantibodies are associated with specific clinical phenotypes suggesting a pathogenic role of adaptive immunity. We explored if autoantibody profiles are associated with specific HLA genetic variants and clinical manifestations in IIM. Methods: We included 1348 IIM patients and determined the occurrence of 14 myositis-specific or –associated autoantibodies. We used unsupervised cluster analysis to identify autoantibody-defined subgroups and logistic regression to estimate associations with clinical manifestations, HLA-DRB1, HLA-DQA1, HLA-DQB1 alleles, and amino acids imputed from genetic information of HLA class II and I molecules. Findings: We identified eight subgroups with the following dominant autoantibodies: anti-Ro52, -U1RNP, -PM/Scl, -Mi2, -Jo1, -Jo1/Ro52, -TIF1γ or negative for all analysed autoantibodies. Associations with HLA-DRB1∗11, HLA-DRB1∗15, HLA-DQA1∗03, and HLA-DQB1∗03 were present in the anti-U1RNP-dominated subgroup. HLA-DRB1∗03, HLA-DQA1∗05, and HLA-DQB1∗02 alleles were overrepresented in the anti-PM/Scl and anti-Jo1/Ro52-dominated subgroups. HLA-DRB1∗16, HLA-DRB1∗07 alleles were most frequent in anti-Mi2 and HLA-DRB1∗01 and HLA-DRB1∗07 alleles in the anti-TIF1γ subgroup. The HLA-DRB1∗13, HLA-DQA1∗01 and HLA-DQB1∗06 alleles were overrepresented in the negative subgroup. Significant signals from variations in class I molecules were detected in the subgroups dominated by anti-Mi2, anti-Jo1/Ro52, anti-TIF1γ, and the negative subgroup. Interpretation: Distinct HLA class II and I associations were observed for almost all autoantibody-defined subgroups. The associations support autoantibody profiles use for classifying IIM which would likely reflect underlying pathogenic mechanisms better than classifications based on clinical symptoms and/or histopathological features. Funding: See a detailed list of funding bodies in the Acknowledgements section at the end of the manuscript.

Abstract Background Fatigue is the most frequent and burdensome symptom of patients with diffuse glioma. It is closely linked to decreased health-related quality of life and symptoms such as depression and sleep disturbances. Currently, there is no evidence-based treatment that targets severe fatigue in patients with brain tumours. Cognitive behavioural therapy is aimed at fatigue-maintaining beliefs and behaviour. This therapy has been proven effective in reducing severe fatigue in cancer survivors and patients with multiple sclerosis. A blended therapy program combines sessions with a therapist with therapist-guided web-based therapy modules. The aim of this randomized controlled trial is to determine the efficacy of blended cognitive behavioural therapy in treating severe fatigue in patients with diffuse glioma. Methods We will include a maximum of 100 patients with diffuse glioma with clinically and radiologically stable disease and severe fatigue (i.e. Checklist Individual Strength, subscale fatigue severity ≥ 35). Patients will be randomized to blended cognitive behavioural therapy or a waiting list condition. The 12-week intervention GRIP on fatigue consists of five patient-therapist sessions and five to eight individualized web-based therapy modules supported by email contact. The primary outcome measure is fatigue severity. Secondary outcome measures include sleep quality, health-related quality of life, depression, anxiety, functional impairment and subjective and objective cognitive functioning. Primary and secondary outcome measures will be assessed at baseline and after 14 and 24 weeks. Magnetoencephalography and MRI will be used to evaluate potential biomarkers for intervention success. This trial has a Bayesian design: we will conduct multiple interim analyses to test for efficacy or futility of the trial. This is the first trial within the GRIP trial platform: a platform developing four to five different interventions for the most common symptoms in patients with diffuse glioma. Discussion The results of the GRIP on fatigue trial will provide information about the efficacy of this intervention on fatigue in patients with diffuse glioma. Multiple other outcomes and possible predictors of treatment success will also be explored. Trial registration Netherlands Trial Register NL8711 . Registered on 14 June 2020.

Abstract The regular overconsumption of energy‐dense foods (rich in lipids and sugars) results in elevated intestinal nutrient absorption and consequently excessive accumulation of lipids in the liver, adipose tissue, skeletal muscles, and other organs. This can eventually lead to obesity and obesity‐associated diseases such as type 2 diabetes (T2D), non‐alcoholic fatty liver disease (NAFLD), cardiovascular disease, and certain types of cancer, as well as aggravate inflammatory bowel disease (IBD). Therefore, targeting the pathways that regulate intestinal nutrient absorption holds significant therapeutic potential. In this review, we discuss the molecular and cellular mechanisms controlling intestinal lipid handling, their relevance to the development of metabolic diseases, and emerging therapeutic strategies.

BackgroundThe status of Safety Management is highly relevant to evaluate an organization's ability to deal with unexpected events or errors, especially in times of crisis. However, it remains unclear to what extent Safety Management was developed and sufficiently implemented within the healthcare system during the COVID-19 pandemic. Providing insights of potential for improvement is expected to be directional for ongoing Safety Management efforts, in times of crisis and beyond.MethodA nationwide survey study was conducted among healthcare professionals and auxiliary staff on German Intensive Care Units (ICUs) evaluating their experiences during the first wave of the COVID-19 pandemic. Error Management and Patient Safety Culture (PSC) measures served to operationalize Safety Management. Data were analyzed descriptively and by using quantitative content analysis (QCA).ResultsResults for n = 588 participants from 53 hospitals show that there is a gap between errors occurred, reported, documented, and addressed. QCA revealed that low quality of safety culture (27.8%) was the most mentioned reason for errors not being addressed. Overall, ratings of PSC ranged from 26.7 to 57.9% positive response with Staffing being the worst and Teamwork Within Units being the best rated dimension. While assessments showed a similar pattern, medical staff rated PSC on ICUs more positively in comparison to nursing staff.ConclusionThe status-analysis of Safety Management in times of crisis revealed relevant potential for improvement. Human Factor plays a crucial role in the occurrence and the way errors are dealt with on ICUs, but systemic factors should not be underestimated. Further intensified efforts specifically in the fields of staffing and error reporting, documentation and communication are needed to improve Safety Management on ICUs. These findings might also be applicable across nations and sectors beyond the medical field.

IntroductionA high-quality education of future physicians is essential. Modern approaches interlock the acquisition of theoretical knowledge and practical skills in a spiral curriculum, leading to a mutual learning benefit for knowledge and application. This model was challenged by the elimination of hands-on trainings during the pandemic, which were often replaced by purely digital teaching models. Given the holistic nature of the spiral curriculum, we assumed that a purely digital model would have an impact on knowledge acquisition due to missing hands-on learning opportunities. The aim of the study was to investigate, using an emergency seminar as an example, whether purely digital training leads to a difference in theoretical knowledge compared to the traditional model.Materials and methodsStudy design: We used a two-groups design comparing a sample of medical students taught in 2020 with a purely digital teaching format (DF; n = 152) with a historical control group taught with a traditional format (TF; n = 1060). Subject of investigation was a seminar on emergency medicine, taking place in the 4th year. Outcome parameters: The primary outcome parameter was the students' acquired knowledge, measured by the score achieved in the final exams. Students' evaluation of the seminar was used as a secondary outcome parameter.ResultsStudents in the DF group scored significantly lower than students in the TF group in the final exams. Students in the DF group rated the course significantly worse than students in the TF group.DiscussionThe study results illustrate that purely digital education leads to inferior knowledge acquisition compared to the traditional spiral curriculum. A possible explanation may lie in a deeper processing of the information (e.g., understanding the information by experience and analysis) and accordingly a better memory recall. Moreover, the students' critical appraisal of the DF may have had an unfavorable effect on learning performance. Moderating factors may be lower learning motivation or the “zoom fatigue” effect.ConclusionThese study results clearly illustrate the importance of hands-on teaching for knowledge acquisition. The interlocking of theoretical knowledge and practical skills, as ensured by the spiral curriculum, is essential.

Abstract Lipids are the most energy‐dense components of the diet, and their overconsumption promotes obesity and diabetes. Dietary fat content has been linked to the lipid processing activity by the intestine and its overall capacity to absorb triglycerides (TG). However, the signaling cascades driving intestinal lipid absorption in response to elevated dietary fat are largely unknown. Here, we describe an unexpected role of the protein kinase D2 (PKD2) in lipid homeostasis. We demonstrate that PKD2 activity promotes chylomicron‐mediated TG transfer in enterocytes. PKD2 increases chylomicron size to enhance the TG secretion on the basolateral side of the mouse and human enterocytes, which is associated with decreased abundance of APOA4. PKD2 activation in intestine also correlates positively with circulating TG in obese human patients. Importantly, deletion, inactivation, or inhibition of PKD2 ameliorates high‐fat diet‐induced obesity and diabetes and improves gut microbiota profile in mice. Taken together, our findings suggest that PKD2 represents a key signaling node promoting dietary fat absorption and may serve as an attractive target for the treatment of obesity.

Wer in Deutschland an „Big Data“ oder „Künstliche Intelligenz“ denkt, hat vielleicht zuerst Prof. Dr. Gerd Antes „Spurious Correlations“ (MVF 05/18) im Sinn. Oder an den in diesem Zusammenhang gern benutzten und sicher auch nicht falschen Satz „Garbage in, garbage out“, den der IBM-Programmierer George Fuechsel so um das Jahr 2004 in die Welt gesetzt hat. Seitdem hat sich viel getan, wohl mehr als in all den Jahren davor, was insbesondere seit 2007 gilt, als das erste iPhone das Licht der Welt erblickte: Seitdem verdoppelt sich das verfügbare Wissen Jahr für Jahr. Einen tiefen Einblick in das, was im Bereich der Gesundheitsbranche passiert, gibt seit 2004 der zuerst in Cambridge, dann in Basel stattfindende „BioData World Congress“, der sich selbst stolz als „Europas größter Kongress zu Big Data in der pharmazeutischen Entwicklung und im Gesundheitswesen“ bezeichnet. 2021 besuchten ihn immerhin rund 2.000 Teilnehmer, die den Worten von über 350 Vortragenden lauschten, um – so die Kongressankündigung – „part of the story“ zu sein. Frappierend dabei: Teilnehmer wie Redner kamen fast aus der ganzen Welt, nur aus Deutschland waren ganz, ganz wenige dabei. Dabei hätte es sich gelohnt.

BackgroundSustaining Basic Life Support (BLS) training during the COVID-19 pandemic bears substantial challenges. The limited availability of highly qualified instructors and tight economic conditions complicates the delivery of these life-saving trainings. Consequently, innovative and resource-efficient approaches are needed to minimize or eliminate contagion while maintaining high training standards and managing learner anxiety related to infection risk.MethodsIn a non-inferiority trial 346 first-year medical, dentistry, and physiotherapy students underwent BLS training at AIXTRA—Competence Center for Training and Patient Safety at the University Hospital RWTH Aachen. Our objectives were (1) to examine whether peer feedback BLS training supported by tele-instructors matches the learning performance of standard instructor-guided BLS training for laypersons; and (2) to minimize infection risk during BLS training. Therefore, in a parallel group design, we compared arm (1) Standard Instructor Feedback (SIF) BLS training (Historical control group of 2019) with arm (2) a Tele-Instructor Supported Peer-Feedback (TPF) BLS training (Intervention group of 2020). Both study arms were based on Peyton's 4-step approach. Before and after each training session, objective data for BLS performance (compression depth and rate) were recorded using a resuscitation manikin. We also assessed overall BLS performance via standardized instructor evaluation and student self-reports of confidence via questionnaire. Non-inferiority margins for the outcome parameters and sample size calculation were based on previous studies with SIF. Two-sided 95% confidence intervals were employed to determine significance of non-inferiority.ResultsThe results confirmed non-inferiority of TPF to SIF for all tested outcome parameters. A follow-up after 2 weeks found no confirmed COVID-19 infections among the participants.ConclusionTele-instructor supported peer feedback is a powerful alternative to in-person instructor feedback on BLS skills during a pandemic, where infection risk needs to be minimized while maximizing the quality of BLS skill learning.Trial registrationhttps://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00025199, Trial ID: DRKS00025199.

Camptodactyly is a relatively rare hand deformity presenting as the proximal interphalangeal joint’s nontraumatic and progressive flexion contracture. Most cases are limited to the fifth finger. The severity and type of camptodactyly should be considered to optimize treatment. Since many structures at the finger base can be involved in the pathogenesis of the deformity, surgical treatment for this particular type of deformity is challenging. This paper aims to bring insight into camptodactyly’s pathogenesis and treatment options. We discuss the indication and pitfalls of surgical treatment options for particular camptodactyly types and present a case of a fourteen-year-old boy who was admitted to our department with proximal interphalangeal joint flexion contracture of the left fifth digit.

Background: Clinical handovers have been identified as high-risk situations for medical treatment errors. It has been shown that handover checklists lead to a reduced rate of medical errors and mortality. However, the influence of handover checklists on essential patient outcomes such as prevalence of sepsis, mortality, and length of hospitalization has not yet been investigated in a randomized controlled trial (RCT).Objectives: The aim of the present pilot study was to estimate the effect of two different handover checklists on the 48 h sepsis-related organ failure assessment (SOFA) score and the feasibility of a respective clinical RCT.Methods: Outcome parameters and feasibility were investigated implementing and comparing an intervention with a control checklist.Design: Single center two-armed cluster randomized prospective crossover pilot study.Setting: The study took place over three 1-month periods in an intensive care unit (ICU) setting at the University Hospital Aachen.Patients/Participants: Data from 1,882 patients on seven ICU wards were assessed, of which 1,038 were included in the analysis.Intervention: A digital standardized handover checklist (ISBAR3) was compared to a control checklist (VICUR).Main Outcome Measures: Primary outcome was the 2nd 24 h time window sepsis-related organ failure assessment (SOFA) score. Secondary outcomes were SOFA scores on the 3rd and 5th 24 h time window, mortality, reuptake, and length of stay; handover duration, degree of satisfaction, and compliance as feasibility-related outcomes.Results: Different sepsis scores were observed only for the 1st 24 h time window after admission to the ICU, with higher values for ISBAR3. With respect to the patient-centered outcomes, both checklists achieved similar results. Average handover duration was shorter for VICUR, whereas satisfaction and compliance were higher for ISBAR3. However, overall compliance was low (25.4% for ISBAR3 and 15.8% for VICUR).Conclusions: Based on the results, a stratified randomization procedure is recommended for following RCTs, in which medical treatment errors should also be investigated as an additional variable. The use of control checklists is discouraged due to lower acceptance and compliance among healthcare practitioners. Measures should be undertaken to increase compliance with the use of checklists. Clinical outcome parameters should be carefully selected.Trial Registration:ClinicalTrials.gov, Identifier [NCT03117088]. Registered April 14, 2017.

Predicting disease severity in patients infected with SARS-CoV-2 is difficult. Soluble angiotensin-converting enzyme 2 (sACE2) arises from the shedding of membrane ACE2 (mACE2), which is a receptor for SARS-CoV-2 spike protein. We evaluated the predictive value of sACE2 compared with known biomarkers of inflammation and tissue damage (CRP, GDF-15, IL-6, and sFlt-1) in 850 patients with and without SARS-CoV-2 with different clinical outcomes. For univariate analyses, median differences between biomarker levels were calculated for the following patient groups (classified by clinical outcome): RT-PCR-confirmed SARS-CoV-2 positive (Groups 1–4); RT-PCR-confirmed SARS-CoV-2 negative following previous SARS-CoV-2 infection (Groups 5 and 6); and ‘SARS-CoV-2 unexposed’ patients (Group 7). Median levels of CRP, GDF-15, IL-6, and sFlt-1 were significantly higher in hospitalized patients with SARS-CoV-2 compared with discharged patients (all p < 0.001), whereas levels of sACE2 were significantly lower (p < 0.001). ROC curve analysis of sACE2 provided cut-offs for predicting hospital admission (≤0.05 ng/mL (positive predictive value: 89.1%) and ≥0.42 ng/mL (negative predictive value: 84.0%)). These findings support further investigation of sACE2, as a single biomarker or as part of a panel, to predict hospitalization risk and disease severity in patients with SARS-CoV-2 infection.

The invention of such state-of-the art microscopic techniques like atomic force microscopy with a resolution of fractions of a nanometer, and the overall current level of knowledge in morphological disciplines have brought about a widespread impression, that identifying a new cell population in the 21st century is highly unlikely [...]

Hirschsprung’s disease is a neurocristopathy, caused by defective migration, proliferation, differentiation and survival of neural crest cells, leading to gut aganglionosis. It usually manifests rapidly after birth, affecting 1 in 5000 live births around the globe. In recent decades, there has been a significant improvement in the understanding of its genetics and the association with other congenital anomalies, which share the pathomechanism of improper development of the neural crest. Apart from that, several cell populations which do not originate from the neural crest, but contribute to the development of Hirschsprung’s disease, have also been described, namely mast cells and interstitial cells of Cajal. From the diagnostic perspective, researchers also focused on “Variants of Hirschsprung’s disease”, which can mimic the clinical signs of the disease, but are in fact different entities, with distinct prognosis and treatment approaches. The treatment of Hirschsprung’s disease is usually surgical resection of the aganglionic part of the intestine, however, as many as 30–50% of patients experience persisting symptoms. Considering this fact, this review article also outlines future hopes and perspectives in Hirschsprung’s disease management, which has the potential to benefit from the advancements in the fields of cell-based therapy and tissue engineering.

Introduction In the context of an opioid public health crisis, U.S. medical schools have been called upon to strengthen curricula on the appropriate use of opioids, with an emphasis on maximizing benefits while utilizing risk-mitigation strategies to prevent addiction and overdose. Methods This self-contained module provides an overview of the opioid crisis and presents recent clinical guidelines on opioid risk mitigation, as well as information regarding prevention and treatment of opioid overdose. This module then gives learners the opportunity to practice these skills by solving an evolving case of back pain. Results Verbal and written feedback on the module from students revealed that the majority strongly agreed that, overall, the module was valuable as an educational tool. Discussion This module was created to help medical educators update the training of students in risk mitigation strategies and the steps of opioid overdose resuscitation. The feedback to date from students and faculty has been positive and supports its use in undergraduate medical education.

In recent years, the interstitial cells telocytes, formerly known as interstitial Cajal-like cells, have been described in almost all organs of the human body. Although telocytes were previously thought to be localized predominantly in the organs of the digestive system, as of 2018 they have also been described in the lymphoid tissue, skin, respiratory system, urinary system, meninges and the organs of the male and female genital tracts. Since the time of eminent German pathologist Rudolf Virchow, we have known that many pathological processes originate directly from cellular changes. Even though telocytes are not widely accepted by all scientists as an individual and morphologically and functionally distinct cell population, several articles regarding telocytes have already been published in such prestigious journals as Nature and Annals of the New York Academy of Sciences. The telocyte diversity extends beyond their morphology and functions, as they have a potential role in the etiopathogenesis of different diseases. The most commonly described telocyte-associated diseases (which may be best termed “telocytopathies„ in the future) are summarized in this critical review. It is difficult to imagine that a single cell population could be involved in the pathogenesis of such a wide spectrum of pathological conditions as extragastrointestinal stromal tumors (“telocytomas„), liver fibrosis, preeclampsia during pregnancy, tubal infertility, heart failure and psoriasis. In any case, future functional studies of telocytes in vivo will help to understand the mechanism by which telocytes contribute to tissue homeostasis in health and disease.

Abstract The Liaison Committee on Medical Education standards mandate that medical schools identify clinical conditions that students must experience during required clerkships. If a given clerkship site is unable to provide one or more of the required clinical experiences, it is permissible to provide an alternative clinical experience such as a simulated or case-based alternative that parallels the level of student involvement (for example, observation vs. participation in management decisions) specified for the condition. This resource provides a case study of personality disorders and is a self-contained module utilizing Articulate software; it can be viewed on any computer, and the instructor/student can navigate at will through the interactive quizzes, text, and embedded video clips. The video clips demonstrate the evolution of a clinical case from presentation to follow-up over three years. A focus is on differential diagnosis and treatment, with intermittent self-assessment quizzes and references to American Psychiatric Association Practice Guidelines and other evidence-based literature. Rather than providing a comprehensive didactic on personality disorders, this module is intended as a clinical application exercise after medical student completion of the recommended reading. An earlier version of this module has been utilized since 2012 by faculty members of the Association of Directors of Medical Student Education in Psychiatry and others. This new 2015 revision has been updated and somewhat streamlined, and quiz questions have been made more directly relevant to the presented case. Student and faculty feedback on the 2012 module and related psychiatry teaching modules has been obtained by the Clinical Simulation Initiative Task Force of the Association of Directors of Medical Student Education in Psychiatry. Study data demonstrated student satisfaction with the modules and positive impact on students' confidence in disorder-specific knowledge, diagnosis, and treatment.

Abstract Introduction Liaison Committee on Medical Education standards mandate that medical schools identify clinical conditions students must experience during required clerkships. If a given clerkship site is unable to provide one or more of the required clinical experiences, it is permissible to provide an alternative clinical experience such as a simulated or case-based alternative that parallels the level of student involvement (e.g., observation vs. participation in management decisions) specified for the condition. This resource provides a case study of neurocognitive disorders/dementia. It was originally developed in 2012 and updated in 2015. Methods This resource is a self-contained module that can be viewed on any computer. The instructor/student can navigate at will through interactive quizzes, text, and imbedded video clips. The video clips demonstrate the evolution of a clinical case from presentation to follow-up over 5 years. The focus is on differential diagnosis and treatment planning, with intermittent self-assessment quizzes and references to American Psychiatric Association Practice Guidelines and other evidence-based literature. Results Student feedback has been generally positive. Satisfaction and confidence items for the 2012 version of this module were rated on 5-point Likert scales (1 = strongly disagree, 5 = strongly agree). Student surveys (N = 49) yielded mean ratings of 4.2-4.6 on items measuring general feedback about satisfaction with the module (relevant clinical content, video quality, audio quality, navigational ease of interactive features, value as an educational tool, effectiveness of quizzes, effectiveness of simulation exercise). Students' ratings of their own confidence about disorder-specific knowledge, diagnosis, and treatment were significantly higher postmodule compared to premodule (p < .001). Discussion Rather than providing a comprehensive didactic on neurocognitive disorders, this module is intended as a clinical application exercise after medical student completion of the recommended readings. An earlier version of the module has been utilized extensively since 2012 by faculty members of the Association of Directors of Medical Student Education in Psychiatry and others. This 2015 revision has been somewhat streamlined, quiz questions have been made more directly relevant to the presented case, and the module has been updated for DSM-5 terminology and other evidence-based literature.

Abstract Introduction The Liaison Committee on Medical Education (LCME) standards mandate that medical schools identify clinical conditions that students must experience during required clerkships. If a given clerkship site is unable to provide one or more of the required clinical experiences, it is permissible to provide an alternative clinical experience such as a simulated or case-based alternative. Self-learning modules (SLMs) have the potential to improve understanding, facilitate learning, and possibly improve medical students' test performance. Methods This module is intended as a clinical application exercise after student completion of preparatory recommended reading, thereby providing for an alternative clinical experience for third-year medical students who do not encounter a patient with an anxiety disorders during their psychiatry clerkship. It is not meant to replace actual clinical experience but, rather, to provide a meaningful learning experience if the ideal of direct exposure to the desired clinical condition is not possible. Results This module has been successfully utilized in the University of Central Florida College of Medicine Psychiatry Clerkship didactics with a total of 66 students to date. Anonymous, written (nonresearch) survey feedback was solicited from an initial pilot group of 9 medical students. Using a 5-point Likert scale, students responded pre- and postmodule to a total of 20 survey statements, including ratings of the quality of the module and their confidence in knowledge, diagnosis, and treatment of anxiety disorders. Discussions This early, preliminary feedback was quite positive but included criticisms and recommendations for revisions which helped lead to the current iteration of the module.

Abstract This resource for third-year medical students is a self-learning module on dementia which demonstrates the evolution of a clinical case from presentation to follow-up over 5 years. It can be viewed on any computer and the instructor/student can navigate at-will through the interactive quizzes, text, and imbedded video clips. The focus is on differential diagnosis and treatment planning, with intermittent self-assessment quizzes and references to American Psychological Association Practice Guidelines and other evidenced-based literature, for further study. Based on student and faculty feedback on the length of the module, the audio narration, video clips, and text have been shortened. It now takes approximately 30 minutes to complete the module, but the length of the session will be longer if it is used for small-group discussion and interaction.

Abstract This resource is a self-learning module (SLM) intended to provide an alternative clinical experience for third-year medical students who do not encounter a patient with personality disorders during their psychiatry clerkship. SLMs have the potential to improve understanding, facilitate learning, and possibly improve medical students' test performance. This current module is part of a collaborative, multi-institutional effort to develop web-based SLMs with a consistent pedagogical approach. This SLM is not meant to replace actual clinical experience but, rather, to provide a meaningful learning experience if the ideal of direct exposure to the desired clinical condition is not possible. This SLM has been implemented in the University of Central Florida College of Medicine psychiatry clerkship didactics. Anonymous verbal and written feedback from medical students, as well as from faculty, has been positive.