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Introduction: To increase students' understanding of what it means to be a physician and engage in the everyday practice of medicine, a humanities program was implemented into the preclinical curriculum of the medical school curriculum. The purpose of our study was to determine how medical students' views of being a doctor evolved after participating in a required humanities course., Methods: Medical students completing a 16-clock hour humanities course from 10 courses were asked to respond to an open-ended reflection question regarding changes, if any, of their views of being a doctor. The constant comparative method was used for coding; triangulation and a variety of techniques were used to provide evidence of validity of the analysis., Results: A majority of first- and second-year medical students (rr = 70%) replied, resulting in 100 pages of text. A meta-theme of Contextualizing the Purpose of Medicine and three subthemes: the importance of Treating Patients Rather than a Disease, Understanding Observation Skills are Important, and Recognizing that Doctors are Fallible emerged from the data., Conclusions: Results suggest that requiring humanities as part of the required preclinical curriculum can have a positive influence on medical students and act as a bridge to contextualize the purpose of medicine.

Background: Human dissection commonly occurs early in the undergraduate medical school curriculum, thus presenting an immediate opportunity for educators to teach and encourage humanistic qualities of respect, empathy, and compassion., Purpose: The purpose of this study was to measure the impact of the Donor Luncheon, a unique program in which medical students meet the families of the anatomical donor prior to dissection in the anatomy course at the University of Oklahoma College of Medicine., Methods: Students were randomized into groups of 8 to attend the luncheon and either met with family of the donor or attended the luncheon with no donor family present. A questionnaire measured students' attitudes at 2 weeks, 6 weeks, and at the conclusion of the anatomy course., Results: Factor analysis revealed 5 scales. Analysis revealed statistically significant differences across time for Donor as Person, Dissection Process, and Donor as Patient and statistically significant differences between groups for Donor as Person and Donor as Patient., Conclusions: These results suggest that this program can provide students with the opportunity to maintain more humanistic attitudes at the beginning of their medical education career.

Objective: We assessed the use of literature to illustrate a postpartum depression lecture., Methods: Medical students and faculty facilitators were surveyed after small group discussions., Results: Students' ratings and comments were positive, and faculty comments were neutral to positive., Conclusion: Students valued this teaching method, while faculty observations reflected challenges of assessing literature's contributions to medical education in improving empathy and treatment outcome.

This past decade the medical community saw an increase of national interest in the training and educating of physicians to provide quality end-of-life care for patients. This article describes the efforts of the University of Oklahoma College of Medicine to respond to the demand for educating medical professionals in end-of-life care. A Palliative Care Program was created to develop and implement new courses, seminars, and lectures for medical students, residents, and practicing physicians. Palliative medicine is in the process of being integrated into the OU academic medical environment so that all trainees, regardless of their educational level, have the opportunity for didactic and clinical exposure to end-of-life care.

This paper discusses the history of the University of Oklahoma College of Medicine. The history from the perspective of the political environment has been published by Mark R. Everett and Alice A. Everett, and the third edition of that series will be published soon by Regents Professor Mark Allen Everett, MD. These volumes are essential reading for a thorough understanding of the history of the college. In this paper, I will concentrate on the history of funding the educational mission. It is an interesting study of the politics of a state institution and reflects the history of the chronic underfunding of higher education in the state of Oklahoma.

Purpose: This randomized controlled study compared the interviewing skills of first-year medical students receiving feedback primarily from standardized patients (SPs) with those of students receiving feedback primarily from faculty., Method: All 154 first-year students at the University of Oklahoma College of Medicine in 1993-94 were video-taped to assess baseline and post-instruction interviewing skills. All the students, randomized to one of three study groups, attended two four-hour workshops on interviewing skills. Instruction in the groups was as similar as possible except in the matter of who provided feedback. Two rating systems were used to rate the videotaped interviews for performances of targeted skills., Results: Complete, usable data were available for 120 (78%) of the students. Skill ratings using the Arizona Clinical Interview Rating Scale were significantly higher for the "types of questions used" and "use of empathy" items in the SP-led feedback group. No significant difference in ratings was detected among the groups as measured by the Rotor Interactional Analysis System., Conclusion: The SPs were at least as effective as the faculty in effecting behavioral changes in the first-year medical students' interviewing skills.

Profound hypophosphatemia developed in a patient with chronic alcoholism. Multiple causative factors were identified and were thought to account for the initial failure of phosphorus repletion. High-dose intravenous phosphorus was effective in restoring serum phosphorus to normal with no observable adverse effects. Because of the high degree of correlation between hypophosphatemia and hypomagnesemia, we recommended that serum magnesium be determined in all hypophosphatemic patients.

Of the three cases of superior mesenteric artery (Wilkie's) syndrome presented, one was associated with anorexia nervosa; this association has not been reported before. Two patients were treated surgically with a duodenojejunostomy, and one was treated medically. Vascular compression of the duodenum is a controversial subject. The syndrome probably is more common than generally recognized and is underdiagnosed due to its exclusion from the differential diagnosis of small-bowel obstruction. Its recognition is important because early diagnosis of a partial obstruction may allow for medical rather than surgical intervention, as exemplified by our third case.

To evaluate the efficacy and safety of a simple approach to intravenous (IV) phosphorus therapy, ten adult patients with severe hypophosphatemia (less than or equal to 1 mg/dL) and normal renal function were studied prospectively. They were treated with a solution containing 9 mmole of phosphorus as monobasic potassium phosphate (KH2PO4), infused continuously every 12 hours. Serum phosphorus, potassium, and calcium levels and urinary excretion of phosphorus were measured every 12 hours. The serum phosphorus level was significantly improved at 12 hours, more than 1 mg/dL in all patients at 36 hours, and normal in six patients at 48 hours. The serum potassium level was never above normal, and serum calcium levels declined in only one patient. Administration of 9 mmole of phosphorus as KH2PO4 every 12 hours is both safe and efficacious IV therapy for severe hypophosphatemia in the adult patient with normal renal function and without hyperkalemia or hypercalcemia.

The influence of severe hypophosphatemia (less than or equal to 1.0 mg/dl) on vitamin D metabolism was prospectively determined in 11 patients before and after intravenous phosphorus administration. Evidence of liver dysfunction was present in ten patients. The mean (+/- SE) plasma 25 hydroxycholecalciferol [25(OH)D] was significantly decreased before phosphorus therapy when compared to control subjects (9.4 +/- 1.3 vs. 17.8 +/- 1.3 ng/ml, P less than 0.001). With phosphorus administration, serum phosphorus increased from 0.59 +/- 0.07 to 2.58 +/- 0.09 mg/dl while 1,25 dihydroxycholecalciferol [1,25(OH)2D] decreased from 34.6 +/- 4.3 to 14.3 +/- 2.9 pg/ml (P less than 0.001). Plasma 25(OH)D, plasma immunoreactive PTH (both amino and carboxyterminal) and serum calcium did not change after phosphorus administration, suggesting that phosphorus alone was responsible for the change in plasma 1,25(OH)2D concentration. An inverse correlation was found between serum phosphorus and plasma 1,25(OH)2D (r = -0.62, P less than 0.005). In addition, a direct correlation was observed between plasma 25(OH)D and 1,25(OH)2D both before (r = 0.66, P less than 0.005) and after (r = 0.74, P less than 0.005) phosphorus administration. Thus, the decrease in 1,25(OH)2D levels with phosphorus therapy suggests a role of serum phosphate in the regulation of this sterol, and hypophosphatemia or phosphorus depletion may change the relationship of substrate [25(OH)D] to product [1,25(OH)2D].

A patient with thrombotic thrombocytopenic purpura had a seizure as the result of a contrast media injection given during computed tomographic examination. To our knowledge, ours is the first such case reported.

To evaluate the efficacy and safety of a simple approach to intravenous phosphorus therapy, we prospectively studied ten adult patients with severe hypophosphatemia (less than or equal to 1 mg/dl), two or more clinical reasons for the hypophosphatemia, and normal renal function. They were treated with a solution containing 0.32 mmol of phosphorus per kilogram of body weight. This amount of phosphorus was infused intravenously over 12 hours and repeated every 12 hours until the serum phosphorus was greater than or equal to 2 mg/dl. The serum phosphorus, potassium, magnesium, and calcium levels were measured at six hours, 12 hours, and every 12 hours thereafter. The serum phosphorus level was greater than or equal to 2 mg/dl in one patient at six hours, three patients at 12 hours, three patients at 24 hours, four patients at 36 hours, and one patient at 48 hours. The serum calcium was measured every 12 hours and at no time was any patient dangerously hypocalcemic. Administration of 0.32 mmol of phosphorus per kilogram of body weight intravenously over a 12-hour period is both efficacious and safe in severely hypophosphatemic patients with multiple causes of hypophosphatemia, normal renal function, and no hypercalcemia.