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BACKGROUND: We administered selected scales from the Cognitive Behavior Survey, Attitudes Toward Social Issues in Medicine survey, and Learning Environment Questionnaire. We gathered data from other medical schools to put our results into context. PURPOSE: To present results on these scales from our own and other medical schools to identify the effects of 'year in school' on the results. METHODS: We searched for articles that had cited the articles that originally presented the scales we used. We organized the results by type of curriculum and presented data from multiple points in each course. RESULTS: With a few exceptions, the data suggest that students' perceptions of their cognitive behaviors, their attitudes to social issues in medicine, and their impressions of the medical school learning environment deteriorate as they proceed through the course. In the case of PBL and hybrid curricula, this may represent a reversal of gains conferred by these curricula during the early phases of the course. CONCLUSIONS: These data provide a starting point for further study of some of the influences on students' perceptions of medical curricula as they proceed through the course. [ABSTRACT FROM AUTHOR]

BACKGROUND: A modular, systems-based preclinical curriculum acceptable to faculty members who had rejected problem-based learning was introduced in 1997. PURPOSE: To evaluate to what extent the new curriculum is meeting some of its major goals. METHODS: We administered selected scales from 3 survey instruments to the last 2 classes in the old curriculum and the first 3 in the new curriculum. We also compared our results with those from other medical schools that had used the same scales. RESULTS: The new curriculum has had positive effects on students' perceptions of the learning environment (effect sizes mostly small to medium, d = .03 to .60) but less effect on their attitudes to social issues in medicine or on their preference for conceptualization versus memorization when studying (most effect sizes below small; largest d = .026). Our results are similar to those for problem-based learning curricula for the learning environment scales and to traditional curricula for the cognitive behavior scales. CONCLUSIONS: Some of the goals for the new curriculum are being achieved almost to the levels reported for problem-based curricula. [ABSTRACT FROM AUTHOR]

Background: This study administered selected scales from the Cognitive Behavior Survey, Attitudes Toward Social Issues in Medicine survey, and the Learning Environment Questionnaire. Data were gathered from other medical schools to put results into context., Purpose: To present results on these scales from other medical schools and to compare the effects of type of curriculum on the results., Methods: Articles that had cited the articles that originally presented the scales used were searched for. Results were organized by type of curriculum and effect sizes were calculated where possible., Results: Within the limits of small numbers of studies so far, problem-based learning (PBL) curricula appear to have much more positive effects on students' reported cognitive behaviors than do hybrid curricula. Both have substantial positive effects on students' perceptions of the learning environment (PBL medium to large; hybrid small to medium). Neither appears to have much effect on students' attitudes toward social issues in medicine., Conclusion: These data provide a starting point for further study of some of the effects of curricular interventions.

Introduction: Medical schools having innovative curricula have been encouraged to ascertain the levels of satisfaction of faculty members with the curriculum. Faculty at schools that employ problem-based learning (PBL) have been shown to have positive perceptions, but not all schools are in a position to adopt PBL on a large scale. This study sought to determine faculty members' opinions about a new curriculum that is less ambitious than one utilizing true PBL. CONTEXT AND SETTING: Since 1997, the University of Otago Medical School (Dunedin, New Zealand) has had an integrated, modular pre-clinical curriculum that emphasizes clinical relevance. It has proved popular with students. This study focused on faculty members' impressions., Methods: We surveyed faculty members' opinions with a questionnaire identical to one used in studies at PBL schools. Faculty compared the students and their own levels of satisfaction in the old and new curricula on 7 to 10 items. The overall response rate was 85.4% (152 of 178)., Results: Perceptions of the new curriculum were positive among teachers who taught during the pre-clinical years and those who taught the students only after they reached the clinical years. Results for individual questions were in the same direction and generally similar in magnitude to those reported on identical items for PBL., Conclusion: We conclude that a hybrid curriculum that is more acceptable to many traditional teachers and students than is PBL has almost as great a positive effect on faculty members' perceptions of students' abilities and of the curriculum as does PBL.

Objective: To compare outcomes when answers to objective type problem-solving questions are marked with and without consideration of students' explanations of their answers., Design: Students answered six multiple-part problem-solving questions on the final examination for a course in clinical biochemistry. Each part required a choice from a list, a number or a few words, plus an explanation or justification. Scores were determined independently for the answers alone and for the answers plus explanations. The outcomes of the two marking methods were compared., Setting: Department of Pathology, University of Otago Medical School, Dunedin, New Zealand., Subjects: Final year preclinical medical students., Results: Marks were slightly higher for answers alone than for answers plus explanations (overall mean, 82.1%; standard deviation, 9.8% vs. 77.1%; 9.3%; P < 0.001 by paired t-test). There was a very high correlation between scores derived from the two methods (r=0. 87). Consideration of the answers alone (without explanations) was about as good as answers plus explanations in identifying students who performed at different levels overall on the examination and in identifying the weakest students., Conclusions: The data suggest that when students arrived at the correct answers, their information and reasons were usually correct and that answers alone discriminate adequately among students with different levels of knowledge and ability. By dispensing with the requirement for explanations, we would be able to ask more questions and mark objectively, so competent students should not be disadvantaged by the lack of opportunity to explain their reasoning.

The University of Otago Medical School, the older of the two medical schools in New Zealand, identified during the 1980s many of the same problems with its undergraduate curriculum as were reported in the United States, Canada, and the United Kingdom. An early, overly ambitious attempt to introduce a full problem-based learning curriculum at Otago failed; however, many piecemeal changes that embodied some of the principles of problem-based learning were successfully implemented. Subsequently, as desire for more coordinated and substantive change grew, Otago's faculty used what they had learned from their first effort to successfully introduce a modular systems-based preclinical curriculum in 1997. The authors describe the features of the new curriculum and discuss two components (a systems-integration course and a large-scale program of computerized in-course testing) that are particularly innovative. The new curriculum is already achieving one of its main goals (increasing the perceived relevance of preclinical teaching) and other outcomes are being evaluated.

Purpose: To test a computer-based method of in-course assessment for a modular, systems-oriented medical curriculum at the University of Otago Medical School., Method: For the in-course assessment in anatomic pathology, 193 students completed five biweekly (i.e., every two weeks), criterion-referenced, computer-based quizzes incorporating many digitized photographs and a variety of question formats. The students signed up to take quizzes at any of ten available times during each quiz week. A score of 70% was required for passing each quiz, but the students could retake quizzes up to two more times in alternative versions. The students' opinions about biweekly testing and computer-based testing were sought., Results: All 193 students satisfactorily completed the assessment program, with no significant problems with hardware, software, or administration during the more than 1,000 computer-based quizzes. The students valued the bi-weekly quizzes as a stimulus for study and for feedback. They strongly supported computer-based quizzes, identifying a variety of benefits in their responses to the questionnaire. The staff found that development of visually rich quizzes was greatly facilitated by the use of computers., Conclusion: The study confirmed the feasibility of using regular, computer-based quizzes for in-course assessment of a large medical school class and demonstrated assessments of a kind that would be difficult to achieve by means other than with computers.

Purpose: To test a paper-based method of in-course assessment for a modular, systems-oriented medical curriculum at the University of Otago Medical School., Method: In 1996, 193 students took paper-based quizzes on the first four topics of a course in clinical biochemistry. A score of 75% was required for passing, but students could retake quizzes. The subsequent test on these four topics was constructed from questions used in previous years. The next four topics were taught without quizzes. The test on these topics was again constructed from questions used in past years. The authors examined the performances on the quizzes and tests and sought the students' opinions about the program., Results: 72.0-95.3% of the students passed the quizzes the first time and 94.8-99.5% passed by the second version. Performance on the subsequent test items was higher than [corrected] when the items had been used previously; so was performance on three of the four questions for the next four topics, none of which had been accompanied by quizzes. Students valued the quizzes as a stimulus to study and as feedback. They preferred the segment of the course with the quizzes to the segment without them., Conclusion: This method of in-course assessment was easy to administer and highly acceptable to the students. Performance on the quizzes was more than satisfactory and a passing score of 75% was reasonable. Such quizzes appeared to be able to replace a test that required explanation of answers while increasing the numbers of questions that could be asked and decreasing the marking time.

We examined 13 patients referred for management of dislocated lens fragments after phacoemulsification. Ocular findings included corneal decompensation, glaucoma, inflammation, and retinal tears and detachments. Eleven of the 13 patients underwent vitrectomy with removal of lens fragments. Surgical indications included the presence of large lens fragments, uncontrolled glaucoma, persistent and severe inflammation, and retinal detachment. Better visual acuity was observed in patients who had smaller lens fragments or when vitrectomy was delayed to allow medical treatment of intraocular inflammation and glaucoma. The results indicate that nucleus dislocation during phacoemulsification is an important visual complication, with seven of the 13 patients having a final visual acuity of 20/80 or less.

Monocular visual loss in four patients was caused by epiretinal macular membranes associated with peripheral retinal capillary angiomas or angioma-like lesions. Three patients had solitary vascular lesions and one had two discrete vascular lesions. All patients were in good health, with no evidence of the von Hippel-Lindau syndrome. In three patients, spontaneous peeling of the macular membranes and visual improvement occurred 2 to 6 months after obliteration of the angioma-like lesions with cryotherapy (two patients), or cryotherapy combined with argon laser (one patient). The fourth patient underwent a vitrectomy 8 months after the macular pucker had failed to respond to treatment of the vascular lesion.

The case histories of 3 elderly patients with senile pigmentary dystrophy of the retina are presented. Recognition of this occult form of retinitis pigmentosa was obscured by the late onset of symptoms, lack of subjective night blindness, subtle fundus abnormalities, and absence of family history of eye disease. Unexplained visual field loss prompted invasive neurologic studies for suspected brain tumor in 2 patients and long-term anticoagulation administration in the third, who was believed to have primary cerebrovascular disease. Retinitis pigmentosa should be considered when evaluating older patients with field defects. Fluorescein angiography and electrophysiologic and psychophysical techniques are helpful in the differential diagnosis.

Two hundred consecutive primary rhegmatogenous retinal detachments repaired with Silastic sponge implants were evaluated. A primary reattachment rate of 94% and an overall reattachment rate of 95% were achieved. Two of the successful repairs became detached after six months giving a redetachment rate of approximately 1%. Eight of the 12 failures were due to massive periretinal proliferation (MPP) (overall incidence of MPP = 4%). To date, only one Silastic sponge has had to be removed because of late infection. No cases of extrusion or erosion occurred. We recommend this procedure as safe and effective.

A 69-year-old black woman had ocular findings consistent with birdshot retinochoroidopathy; these included cream-colored depigmented spots at the level of the retinal pigment epithelium and vitreitis. She also had peripheral retinal neovascularization with localized vitreous hemorrhage. There were no laboratory or systemic findings consistent with other disease entities.

A 50-year-old white woman had bilateral visual loss associated with fever, chills, and myalgias. Her systemic complaints responded to steroid therapy but visual reductions and retinal lesions have persisted for one year. Fluorescein angiographic findings are identical to those seen in acute retinal pigment epitheliitis but the clinical history is more suggestive of acute macular neuroretinopathy. These two entities may represent different clinical expressions of the same disease.

A 62-year-old woman known to have tuberous sclerosis had an ususual peripapillary retinal elevation in her left eye. The patient had no specific ocular symptoms and we considered the diagnosis of papilledema secondary to increased intracranial pressure. Retinal angiography established that she had a peripapillary exophytic retinal angioma associated with an epipapillary astrocytic hamartoma in this eye.

A patient who had been treated for metastatic bladder carcinoma with bacillus Calmette-Guerin (BCG) vaccine subsequently developed bilateral visual loss secondary to an infiltrative retinitis and vitreitis. Although assumed to have candida endophthalmitis, vitrectomy demonstrated mycobacterium bovis. The patient was placed on systemic anti-tuberculous therapy, and there was noted to be a reduction in retinal lesions prior to his death. This is the first report in the literature documenting endogenous endophthalmitis after BCG usage.

Two cases of retinal detachment are presented in which significant scleral ruptures occurred at the time of scleral buckling surgery. Retinal reattachment was achieved and scleral ruptures successfully closed utilizing standard scleral buckling elements. Long-term follow-up of both cases failed to disclose any significant ocular complications occurring at the rupture site. Intraoperative management and techniques recommended for the avoidance of this complication are discussed.

A bullous retinal detachment with breaks in all quadrants developed in the right eye of a 72-year-old man four weeks after he had undergone cataract extraction. The retina was reattached successfully with a 360-degree scleral buckle. Four weeks later, the retina had redetached and developed fixed folds and broad equatorial membranes. These features and the hazy vitreous suggested massive periretinal proliferation. Fourteen days later, the patient's visual acuity suddenly improved and an examination disclosed that the retina had spontaneously reattached. Visual acuity was 6/12 (20/40) and has remained stable for 14 months.

The incidence and predisposing factors for bilateral branch vein occlusions were evaluated in a retrospective study. Complete medical and ocular histories of 49 patients with angiographically proven branch vein occlusion were studied. Nine of these patients had bilateral vein occlusions that were unsuspected clinically. Hypertension was the only significant predisposing risk factor for this occurrence. The relationship between control of the hypertension and retinal vascular disease could not be evaluated in this study.

Ten members of a large family who showed manifestations of either von Hippel-Lindau disease or von Recklinghausen's neurofibromatosis were examined. Three of 10 members were found to have retinal angiomas which had not been present on fundus examination 3 years previously. These angiomas were associated with ocular and systemic signs of neurofibromatosis. These cases show overlapping manifestations of different phakomatoses and provide support for the concept of a common aetiology for these diseases.

A peptide having the reputed essential amino acid sequence to show cataglykin-like effects was prepared from human growth hormone (hGH) by cyanogen bromide cleavage and was tested in two systems in which cataglykin has effects. The peptide prolonged the depression of blood glucose concentration brought about by insulin during intravenous insulin tolerance tests in rats. However, the magnitude of the depression caused by insulin was not increased. There was no stimulation by the peptide of glucose uptake by rat hemidiaphragrams in the presence of insulin in vitro. Thus, this peptide does not duplicate the effects of cataglykin.

It has been suggested that the 'ideal' measure of reliability of an examination is obtained by test and retest using the one examination on the same group of students. However, because of practical and theoretical arguments, most reported reliabilities for multiple choice examinations in medicine are actually measures of internal consistency. While attempting to minimize the effects of potential interfering factors, we have undertaken a study of true test-retest reliability of multiple true-false type multiple choice questions in preclinical medical subjects. From three end-of-term examinations, 363 items (106 of 449 from term 1, 150 of 499 from term 2, and 107 of 492 from term 3) were repeated in the final examination (out of 999 total items). Between test and retest, there was little overall decrease in the percentage of items answered correctly and a decrease of only 3.4 in the percentage score after correction for guessing. However, there was an inverse relation between test-retest interval and decrease in performance. Between test and retest, performance decreased significantly on 33 items and increased significantly on 11 items. Test-retest correlation coefficients were 0.70 to 0.78 for items from the separate terms and 0.885 for all items that were retested. Thus, overall, these items had a very high degree of reliability, approximately the 0.9 which has been specified as the requirement for being able to distinguish between individuals.

Trabeculectomies performed on 33 eyes were compared to 28 standard filtering procedures done at the same institution during a 4 year period. The success rates in the two groups of patients whether white or black were statistically comparable, 92% in the trabeculectomy group and 77% in the standard filtering surgical group. Only cases of phakic open angle glaucoma, chronic angle closure and combined mechanism glaucoma were considered. Cases of secondary glaucoma, previous surgical failure and aphakic nonpupillary block glaucoma did uniformly poorly. When trabeculectomy was performed with "enhanced cyclodialysis" early results in a few cases were successful. The incidence of flat anterior chamber and cataracts with permanent reduction in visual acuity was significantly less in the trabeculectomy group than in the standard filtering procedure group. These results support previous studies which support trabeculectomy as successful as standard filtering procedures with the advantage of having fewer permanent serious complications.

Segmental retinal periarteritis is a relatively rare clinical entity with varied etiologies. This report describes a case of acute toxoplasmosis with segmental periarteritis without concomitant periphlebitis. To my knowledge this has never been reported previously. The diagnosis of toxoplasmosis was proven by both clinical findings and serology.