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Undergraduate medical education is too long; it does not meet the needs for physicians' workforce; and its content is inconsistent with the job characteristics of some of its graduates. In this paper we attempt to respond to these problems by streamlining medical education along the following three reforms. First, high school graduates would be eligible for undergraduate medical education programs of 4 years duration. Second, medical school applicants would be required to commit themselves to a medical specialty and choose one of four undergraduate paths: (1) "Interventions/consultations" path that would prepare its graduates for residencies in secondary and tertiary specialties, such as cardiology and surgery, (2) "continuous patient care" path for primary care specialties, such as family medicine and psychiatry, (3) "diagnostic laboratory medicine and biomedical research" path that would prepare for either laboratory-based careers, such as pathology, biochemistry and bacteriology, or research in e.g., immunology and molecular genetics, and (4) "epidemiology and public health" path that would include population-based research, preventive medicine and health care administration. Third, the content of each of these paths would focus on relevant learning outcomes, and medical school graduates would be eligible for residency training only in specialties included in their path. Hopefully, an early commitment to a medical specialty will reduce the duration of medical education, improve the regulation of physicians' workforce and adapt the curricular content to the future job requirements from medical school graduates.

The objective of this paper is to draw attention to four features that distinguish the pedagogy of patient interviewing from the teaching of other clinical skills: (a) students are not naive to the skill to be learned, (b) they encounter role models with a wide variability in interviewing styles, (c) clinical teachers are not usually specialists in the behavioral sciences, including patient interviewing, and (d) the validity of the methods used for assessment of interviewing skills is uncertain. We propose to adjust the teaching of patient interviewing to these features by (a) gaining an insight into the students' views and using these views as a point of departure for discussions of patient interviewing; (b) helping students to understand why different clinicians use different communication styles; (c) providing the clinical tutors with additional training that will help them function as both specialists who share their expertise with the students and facilitators of small-group learning; and (d) using assessment methods that encourage joint deliberation by the learner and the examiner, rather than a judgmental right-wrong dualism by the examiner alone. The teaching approach that we suggest is consistent with current theories of adult learning, and it occurs in an egalitarian rather than a hierarchical environment. Hopefully, students will also adopt such egalitarian attitudes toward patients, thereby reducing the tendency to a paternalistic communication style.

Decisions about admissions to medical school are based on assessments of the applicants' cognitive achievements and non-cognitive traits. Admission criteria are expected to be fair, transparent, evidence-based and legally defensible. However, unlike cognitive criteria, which are highly reliable and moderately valid, the reliability and validity of the non-cognitive criteria are low or uncertain. Their uncertain predictive value is due not only to their limited validity, but also to the unknown prevalence of the desirable non-cognitive traits in the applicants' pool. Consequently, the use of non-cognitive admission criteria inevitably leads to rejection of an unknown proportion of applicants who have a desirable trait and selection of applicants who lack this trait. We propose that, rather than using non-cognitive admission criteria, admission officers should assist prospective applicants to make informed decisions based on a reflective self-appraisal whether or not to apply to medical school. To this end, medical schools should disseminate information on the strains of medical training and practice, the frequency of medical errors and the most common causes of dissatisfaction and burn-out among practicing physicians. Such information may improve the self-selection process and thereby enrich the applicants' pool for individuals with appropriate motivation. The final selection of medical students may then be based either on past academic achievements, or on a lottery, or on various combinations thereof.

External accreditation reviews of undergraduate medical curricula play an important role in their quality assurance. However, these reviews occur only at 4–10-year intervals and are not optimal for the immediate identification of problems related to teaching. Therefore, the Standards of Medical Education in Israel require medical schools to engage in continuous, ongoing monitoring of their teaching programs for compliance with accreditation standards. In this paper, we propose the following: (1) this monitoring be assigned to independent medical education units (MEUs), rather than to an infrastructure of the dean's office, and such MEUs to be part of the school governance and draw their authority from university institutions; and (2) the differences in the importance of the accreditation standards be addressed by discerning between the "most important" standards that have been shown to improve student well-being and/or patient health outcomes; "important" standards associated with student learning and/or performance; "possibly important" standards with face validity or conflicting evidence for validity; and "least important" standards that may lead to undesirable consequences. According to this proposal, MEUs will evolve into entities dedicated to ongoing monitoring of the education program for compliance with accreditation standards, with an authority to implement interventions. Hopefully, this will provide MEUs and faculty with the common purpose of meeting accreditation requirements, and an agreed-upon prioritization of accreditation standards will improve their communication and recommendations to faculty. [ABSTRACT FROM AUTHOR]

Studies on male dogs reveal a mutation in the alpha 5(W) gene suggesting that Canine X-linked hereditary nephritis (HN) can function as an animal model for human X-linked HN. This provides an animal model for a mutated basement-membrane collagen gene. The mutation leads to a premature stop codon that does not express the alpha 5(IV) gene.

Deferoxamine is a drug that rids the body of excess iron by binding the metal to another chemical; treatment with this drug is known as chelation therapy. Excess iron in the body can be produced by accidental swallowing of iron pills or by iron overload from multiple transfusions to treat blood diseases such as thalassemia. Patients with thalassemia have nightly infusions of deferoxamine to control iron overload. Although deferoxamine therapy is thought to be safe, some patients have encountered some adverse effects, such as hearing and vision loss and kidney damage. A study of three patients, two with thalassemia and one with iron tablet overdose, who were each receiving deferoxamine therapy, revealed that the drug increased the level of creatinine, a by-product of metabolism, by two to eight times. When the drug was discontinued, the clearance of creatinine resolved. The two patients with thalassemia had an increase in sodium, potassium, chloride and phosphate in the urine, which caused them to lose a large amount of fluid. Although each patient's experiences were different, it is thought that deferoxamine played a role in causing kidney failure. The toxic effects of deferoxamine on the kidneys should be considered when caring for patients undergoing chelation therapy. Increased fluids and constant monitoring of kidney functioning are suggested. (Consumer Summary produced by Reliance Medical Information, Inc.)

The distribution of S100 protein in normal skin and various tumors involving skin was assessed using rabbit antibody to S 100 protein in an immunoperoxidase reaction. In normal skin. S 100 protein was detected in the epidermis melanocytes and Langerhans cells, dermis Schwann cells, Pacinian and Meissner's corpuscles, and interdigitating reticulum cells cells of the sweat gland apparatus, and in chondrocytes. In tumors involving skin, S 100 protein was present in nevi, maligant melanomas, histiocytosis X, mixed sweat gland tumors, neural tumors, chondromas, and chondrosarcomas. Detection of S 100 protein by immunostaining was useful in understanding the histogenesis of various skin tumors and in assessing the diagnosis and prognosis of a variety of skin lesions encountered in surgical pathology. [ABSTRACT FROM AUTHOR]