ABSTRACT
Antecedentes y objetivos La pandemia de la COVID-19 ha obligado a completar los estudios universitarios online. La Conferencia Nacional de Decanos de Facultades de Medicina coordina una prueba de evaluación de competencias clínicas objetiva y estructurada (ECOE) de 20 estaciones presenciales a los estudiantes de sexto del grado. Como consecuencia de la pandemia se ha diseñado una ECOE sustitutoria con casos-clínicos computarizados simulados (ECOE-CCS). El objetivo del artículo es describir la elaboración, la ejecución y el desarrollo de la prueba. Materiales y métodos Estudio descriptivo de la ECOE-CCS conjunta desde su gestación en abril 2020 hasta su ejecución en junio 2020. Resultados La ECOE-CCS evaluó las competencias de anamnesis, exploración, juicio clínico, aspectos éticos, relaciones interprofesionales, prevención y promoción de la salud. No se evaluaron habilidades técnicas ni de comunicación. La ECOE-CCS consistió en 10 estaciones de 12 minutos de duración, con un número de preguntas de seis a 21 (media: 1,1 minutos/pregunta). En la ECOE-CCS se utilizó la plataforma virtual del campus de cada una de las 16 facultades de Medicina que participaron, con un total de 2.829 estudiantes de sexto curso. Se realizó de una forma conjunta en dos fechas de junio del 2020. Conclusiones La experiencia de la ECOE-CCS permitió llevar a cabo una integración y el trabajo interdisciplinar de las diferentes facultades de Medicina. La ECOE-CCS realizada podría asemejarse al Step 3 CCS de la United States Medical Licensing Examination (AU)
Background and objectives The COVID-19 pandemic has forced universities to move the completion of university studies online. Spain's National Conference of Medical School Deans coordinates an objective, structured clinical competency assessment called the Objective Structured Clinical Examination (OSCE), which consists of 20 face-to-face test sections for students in their sixth year of study. As a result of the pandemic, a computer-based case simulation OSCE (CCS-OSCE) has been designed. The objective of this article is to describe the creation, administration, and development of the test. Materials and methods This work is a descriptive study of the CCS-OSCE from its planning stages in April 2020 to its administration in June 2020. Results The CCS-OSCE evaluated the competences of anamnesis, exploration, clinical judgment, ethical aspects, interprofessional relations, prevention, and health promotion. No technical or communication skills were evaluated. The CCS-OSCE consisted of ten test sections, each of which had a 12-minutes time limit and ranged from six to 21 questions (mean: 1.1 minutes/question). The CCS-OSCE used the virtual campus platform of each of the 16 participating medical schools, which had a total of 2,829 students in their sixth year of study. It was jointly held on two dates in June 2020. Conclusions The CCS-OSCE made it possible to bring together the various medical schools and carry out interdisciplinary work. The CCS-OSCE conducted may be similar to Step 3 of the United States Medical Licensing Examination (AU)
Subject(s)
Humans , Clinical Competence/standards , Computer Simulation , Educational Measurement/methods , Schools, Medical , SpainABSTRACT
BACKGROUND AND OBJECTIVES: The COVID-19 pandemic has forced universities to move the completion of university studies online. Spain's National Conference of Medical School Deans coordinates an objective, structured clinical competency assessment called the Objective Structured Clinical Examination (OSCE), which consists of 20 face-to-face test sections for students in their sixth year of study. As a result of the pandemic, a computer-based case simulation OSCE (CCS-OSCE) has been designed. The objective of this article is to describe the creation, administration, and development of the test. MATERIALS AND METHODS: This work is a descriptive study of the CCS-OSCE from its planning stages in April 2020 to its administration in June 2020. RESULTS: The CCS-OSCE evaluated the competences of anamnesis, exploration, clinical judgment, ethical aspects, interprofessional relations, prevention, and health promotion. No technical or communication skills were evaluated. The CCS-OSCE consisted of ten test sections, each of which had a 12-min time limit and ranged from six to 21 questions (mean: 1.1â¯min/question). The CCS-OSCE used the virtual campus platform of each of the 16 participating medical schools, which had a total of 2829 students in their sixth year of study. It was jointly held on two dates in June 2020. CONCLUSIONS: The CCS-OSCE made it possible to bring together the various medical schools and carry out interdisciplinary work. The CCS-OSCE conducted may be similar to Step 3 of the United States Medical Licensing Examination.
Subject(s)
COVID-19 , Clinical Competence/standards , Computer Simulation , Educational Measurement/methods , Schools, Medical , Humans , SpainABSTRACT
BACKGROUND AND OBJECTIVES: The COVID-19 pandemic has forced universities to move the completion of university studies online. Spain's National Conference of Medical School Deans coordinates an objective, structured clinical competency assessment called the Objective Structured Clinical Examination (OSCE), which consists of 20 face-to-face test sections for students in their sixth year of study. As a result of the pandemic, a computer-based case simulation OSCE (CCS-OSCE) has been designed. The objective of this article is to describe the creation, administration, and development of the test. MATERIALS AND METHODS: This work is a descriptive study of the CCS-OSCE from its planning stages in April 2020 to its administration in June 2020. RESULTS: The CCS-OSCE evaluated the competences of anamnesis, exploration, clinical judgment, ethical aspects, interprofessional relations, prevention, and health promotion. No technical or communication skills were evaluated. The CCS-OSCE consisted of ten test sections, each of which had a 12-minutes time limit and ranged from six to 21 questions (mean: 1.1 minutes/question). The CCS-OSCE used the virtual campus platform of each of the 16 participating medical schools, which had a total of 2,829 students in their sixth year of study. It was jointly held on two dates in June 2020. CONCLUSIONS: The CCS-OSCE made it possible to bring together the various medical schools and carry out interdisciplinary work. The CCS-OSCE conducted may be similar to Step 3 of the United States Medical Licensing Examination.
ABSTRACT
BACKGROUND: A task force of MEDINE (Thematic Network on Medical Education in Europe) organized a survey of European Medical Schools. AIM: To investigate the link between education and biomedical research in the medical curriculum questioning university staff responsible for the curriculum. METHOD: The survey was online between 10/2006 and 3/2007. Answers pertained to the situation in the academic year 2005/06. RESULTS: Ninety-one medical schools/faculties in 26 countries participated, but response rates to some questions were lower due to incomplete responses. In undergraduate programs, 3/4 of the schools offer research courses and in 2/3 students can do research themselves. However, in most schools, fewer than 10% students choose this option. In about half the medical schools writing a thesis is a requirement for graduation, although the term "thesis" is interpreted broadly. Color map analysis revealed the link between medical education and biomedical research: about 25% of the medical schools had little emphasis on research in their undergraduate curriculum. CONCLUSIONS: We identified the curriculum elements most suitable to improve the link between medical education and research for the initial stage (years 1-3) as literature search techniques, statistics and epidemiology, while for the advanced stage (years 4-6), writing a thesis was most relevant.
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Biomedical Research/education , Education, Medical, Undergraduate/organization & administration , Curriculum , Europe , Humans , Surveys and QuestionnairesABSTRACT
No disponible
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Competency-Based Education/organization & administration , Universities/ethics , Universities/history , Universities/organization & administration , Competency-Based Education/ethics , Competency-Based Education/standards , Competency-Based Education/trends , FeedbackABSTRACT
Las nuevas necesidades en la formación de los futuros médicos, particularmente aquellas relacionadas con la definición, adquisición y evaluación de competencias, necesitan una potente estructura hospitalaria que soporte la docencia práctica en habilidades clínicas. El trascendente papel reservado a los hospitales universitarios significa que la institución sanitaria debe adaptarse para facilitar la implantación de una enseñanza de calidad, en aspectos estructurales y en el proceso de definición de objetivos y de evaluación de resultados a través de pruebas objetivas. Ellos implica cambios en la estructura, en la organización y en la gestión (AU)
The training of future doctors entails a series of new needs, especially in relation to the definition, acquisition and evaluation of abilities, and this requires the backing of a powerful hospital structure that ist capable of offering the practical teaching and learning of clinical skills. The fundamental role played by university hospitals means that the health care institution must adapt itself to facilitate the implementation of high quality teaching, both as regards structural aspects and in the process of defining aims and evaluationg results by means of objective testing. This involves changes in the structure, the organisation and management (AU)
Subject(s)
Humans , Schools, Medical , Hospitals, University , Teaching/methods , Clinical CompetenceABSTRACT
Connections between human temporal and frontal cortices were investigated by intracranial electroencephalographic responses to electrical stimulation with 1-ms single pulses in 51 patients assessed for surgery for treatment of epilepsy. The areas studied were medial temporal, entorhinal, lateral temporal, medial frontal, lateral frontal and orbital frontal cortices. Findings were assumed to be representative of human brain as no differences were found between epileptogenic and non-epileptogenic hemispheres. Connections between intralobar temporal and frontal regions were common (43-95%). Connections from temporal to ipsilateral frontal regions were relatively uncommon (seen in 0-25% of hemispheres). Connections from frontal to ipsilateral temporal cortices were more common, particularly from orbital to ipsilateral medial temporal regions (40%). Contralateral temporal connections were rare (< 9%) whereas contralateral frontal connections were frequent and faster, particularly from medial frontal to contralateral medial frontal (61%) and orbital frontal cortices (57%), and between both orbital cortices (67%). Orbital cortex receives profuse connections from the ipsilateral medial (78%) and lateral (88%) frontal cortices, and from the contralateral medial (57%) and orbital (67%) frontal cortices. The high incidence of intralobar temporal connections supports the presence of temporal reverberating circuits. Frontal cortex projects within the lobe and beyond, to ipsilateral and contralateral structures.
Subject(s)
Brain Mapping , Epilepsy/pathology , Frontal Lobe/physiopathology , Neural Pathways/physiopathology , Temporal Lobe/physiopathology , Adolescent , Adult , Electric Stimulation , Electroencephalography/methods , Epilepsy/physiopathology , Female , Functional Laterality , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
OBJECTIVE: To assess the value of single-pulse electrical stimulation (SPES) to identify frontal epileptogenic cortex during presurgical assessment. METHODS: SPES (1-millisecond pulses, 4 to 8 mA, 0.1 Hz) has been used during chronic recordings in 30 patients with intracranial electrodes in the frontal lobes. As a result of presurgical assessment, 17 patients were considered to have frontal epilepsy and 13 extrafrontal epilepsy. RESULTS: Two types of responses to SPES were seen: 1) early responses: starting immediately after the stimulus and considered as normal responses; 2) late responses: two types of responses seen in some areas after the initial early response: a) delayed responses: spikes or sharp waves occurring between 100 milliseconds and 1 second after stimulation. Frontal delayed responses were seen in 11 frontal patients and 1 extrafrontal patient, whereas extrafrontal delayed responses were seen in 1 frontal and 10 extrafrontal patients. b) Repetitive responses: two or more consecutive sharp-and-slow-wave complexes, each resembling the initial early response. Repetitive responses were seen only when stimulating the frontal lobes of 10 frontal patients. Among the 17 frontal patients, 13 had late responses exclusively in the epileptogenic frontal lobe, whereas only 3 showed them in both frontal lobes. Frontal late responses were associated with neuropathologic abnormalities, and complete resection of abnormal SPES areas was associated with good postsurgical seizure outcome. CONCLUSIONS: Single-pulse electrical stimulation (SPES) could be an important additional investigation during presurgical assessment to identify frontal epileptogenicity. SPES can be useful in patients who have widespread or multiple epileptogenic areas, normal neuroimaging, or few seizures during telemetry.
Subject(s)
Electrodiagnosis/methods , Epilepsy/diagnosis , Epilepsy/physiopathology , Frontal Lobe/physiopathology , Preoperative Care/methods , Adolescent , Adult , Electric Stimulation/instrumentation , Electric Stimulation/methods , Electrodes, Implanted/standards , Electrodiagnosis/instrumentation , Electroencephalography , Epilepsy/surgery , Evoked Potentials/physiology , Female , Frontal Lobe/surgery , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Patient Selection , Predictive Value of Tests , Preoperative Care/instrumentation , Reaction Time , Stereotaxic Techniques , Treatment OutcomeABSTRACT
Lithium enhances excitatory synaptic transmission in CA1 pyramidal cells, but the mechanisms remain unclear. The present study demonstrates that lithium enhances the N-methyl-D-aspartate (NMDA) and alpha-amino-3-hydroxy-5-methyl-isoxazole propionic acid (AMPA) receptor-mediated components of the excitatory postsynaptic current (EPSC). Lithium decreased the magnitude of paired-pulse facilitation and presented an inverse correlation between the lithium-induced enhancement of synaptic transmission and initial paired-pulse facilitation, which is consistent with a presynaptic mode of action. The enhancement of synaptic strength is likely to act, at least in part, by increasing the amplitude of the presynaptic Ca2+ transient. One mechanism which could account for this change of the presynaptic Ca2+ transient is an increase in the duration of the action potential. We investigated action potential in hippocampal pyramidal neurons and found that lithium (0.5-6 mM) increased the half-amplitude duration and reduced the rate of repolarization, whereas the rate of depolarization remained similar. To find out whether the lithium synaptic effects might be explained by spike broadening, we investigated the field recording of the excitatory postsynaptic potential (EPSP) in hippocampal slices and found three lines of evidence. First, the prolongation of the presynaptic action potential with 4-aminopyridine and tetraethylammonium blocked or reduced the synaptic effects of lithium. Second, the lithium-induced synaptic enhancement was modulated when presynaptic Ca2+ influx was varied by changing the external Ca2+ concentration. Finally, both effects, the synaptic transmission increment and the action potential broadening, were independent of inositol depletion. These results suggest that lithium enhances synaptic transmission in the hippocampus via a presynaptic site of action: the mechanism underlying the potentiating effect may be attributable to an increased Ca2+ influx consequent to the broadening effect of lithium on the action potential.
Subject(s)
Animals, Newborn/physiology , Hippocampus/drug effects , Lithium/pharmacology , Presynaptic Terminals/drug effects , Synaptic Transmission/drug effects , Action Potentials/drug effects , Action Potentials/physiology , Animals , Excitatory Postsynaptic Potentials/drug effects , Female , Hippocampus/cytology , Hippocampus/physiology , In Vitro Techniques , Male , Pyramidal Cells/drug effects , Pyramidal Cells/physiology , Rats , Rats, Wistar , Reaction Time/drug effects , Second Messenger Systems/physiologyABSTRACT
The effects of lithium on excitatory synaptic transmission were studied in the CA1 region of hippocampal slices taken from 14- to 30-day-old rats using extracellular recording techniques. Lithium (2-18 mM) reversibly increased the field excitatory postsynaptic potentials in a concentration-dependent manner. Application of lithium for 6-15 min had no effect on the synaptic input-output function, while application of lithium for 20-35 min shifted this curve to the left. Lithium reversibly increased the amplitude of the presynaptic fibre volley in a concentration- and calcium-dependent manner. Lithium decreased paired-pulse facilitation measured at 50-ms interstimulus intervals. The results indicate that lithium enhances excitatory synaptic transmission in CA1 pyramidal cells by at least two different actions.
Subject(s)
Animals, Newborn/physiology , Hippocampus/physiology , Lithium/pharmacology , Synaptic Transmission/drug effects , Animals , Axons/drug effects , Axons/physiology , Evoked Potentials/drug effects , Hippocampus/drug effects , In Vitro Techniques , Rats , Rats, Wistar , Receptors, Presynaptic/drug effects , Stimulation, ChemicalABSTRACT
Although acute electrocorticography (ECoG) is routinely performed during epilepsy surgery there is little evidence that the extent of the discharging regions is a useful guide to tailoring the resection or that the findings are predictive of outcome or pathology. Patterns of discharge propagation have, however, rarely been considered in assessing the ECoG. We hypothesize that regions where discharges show earliest peaks ('leading regions') are located in the epileptogenic zone, whereas sites in which late, secondary, propagated activity occurs have less epileptogenic potential and do not need to be excised. To allow intraoperative topographic ECoG analysis, a computer program has been developed to identify leading regions and the sites showing greatest rates or amplitudes of spikes. Their topography has been compared retrospectively with pathology and seizure control in 42 consecutive patients following temporal lobe surgery. Leading regions were most often found in the hippocampus, the subtemporal cortex and the superior temporal gyrus. The most common propagation patterns were from hippocampus to subtemporal cortex and vice versa. There was no association between seizure outcome and the location of regions with greatest incidence or amplitude of spikes or location of leading regions. There was, however, a strong and significant association between poor outcome and non-removal of leading regions other than those in the posterior subtemporal cortex. All leading regions (other than posterior subtemporal) were resected in 27 patients of whom 25 had a favourable outcome. Leading regions (other than posterior subtemporal) remained in 14 patients of whom only four had a good outcome. One patient had no epileptiform activity in the ECoG and good outcome. Persistent posterior subtemporal leading regions remained in nine subjects; all had favourable outcome (Grades I or II) but only three were seizure free. These results suggest that: (i) interictal epileptiform discharges may originate from a complex interaction between separate regions, resulting in propagation and recruitment of neuronal activity along specific neural pathways; (ii) removal of all discharging areas appears unnecessary to achieve seizure control provided that leading regions (other than posterior subtemporal) are removed; and (iii) identification of such leading regions could be used to tailor resections in order to improve seizure control and reduce neurological, neuropsychological and psychiatric post-surgical morbidity.
Subject(s)
Brain/physiopathology , Cerebral Cortex/physiopathology , Electroencephalography , Epilepsy, Temporal Lobe/physiopathology , Epilepsy, Temporal Lobe/surgery , Temporal Lobe/surgery , Adolescent , Adult , Algorithms , Brain Mapping , Child , Child, Preschool , Diagnosis, Computer-Assisted , Female , Hippocampus/physiopathology , Humans , Male , Middle Aged , Monitoring, IntraoperativeABSTRACT
Harmonic distortion (HD) from 1,055 responses of muscle spindles sensory endings to sinusoidal stretches (frequency range 0.0008 to 0.8333 Hz, amplitude range 0.019 to 3.09 mm) has been studied in the cat soleus muscle. Sixty-six per cent were primary afferents (Ia) and 34% secondary (II). HD mean value (0.28) did not show any significant differences between both types of endings. Analysis of variance for HD versus stimulation amplitude showed a greater HD when stretch amplitudes were beyond 1.599 mm or less than 0.031 mm on primary afferents (p less than 0.001) and less than 0.070 mm on secondary (p less than 0.001). The effect of stimulus frequency was also significant (p less than 0.01 Ia and p less than 0.001 II), however only at 0.8333 Hz and in secondary endings HD was significantly higher. The silent period in the response, at release of stretch, caused by half wave rectification could explain about 50% of measured HD.
Subject(s)
Motor Endplate/physiology , Neuromuscular Junction/physiology , Neurons, Afferent/physiology , Synaptic Transmission , Analysis of Variance , Animals , Cats , Electric StimulationABSTRACT
A general purpose analog-to-digital conversion system and its interface for a low-cost personal computer (Commodore 64) are described. Special emphasis has been put on achieving a high sampling frequency rate (up to 20,000 samples/s) and a high discrimination (12 bits). It has likewise been attempted to increase the number of input channels (up to 8, by means of a multiplexer) and averaging capability since such features may be useful in a great number of neurobiological studies. Commercially available hardware elements have been employed and software has been developed in BASIC and 6510 Machine Code.
Subject(s)
Computers , Microcomputers , Neurophysiology , Software , Analog-Digital Conversion , AnimalsSubject(s)
Echinococcosis/epidemiology , Adolescent , Adult , Age Factors , Child , Child, Preschool , Echinococcosis/pathology , Female , Hospitalization , Humans , Infant , Infant, Newborn , Male , Middle Aged , Sex Factors , SpainSubject(s)
HLA Antigens/genetics , Heart Block/genetics , Female , Humans , Infant, Newborn , PregnancyABSTRACT
Out of 23 cases with a final diagnosis of idiopathic fever, 20 had self-limited fever with complete resolution. Comparing the cases of self-limited fever with other groups of patients with fever of unknown origin, the following differences were apparent: compared with tumoral and collagen diseases, self-limited fever occurred more frequently below age 40, the difference being significant (p less than 0.01). Chills occurred more frequently in self-limited fever than in tumoral and collagen diseases, while the incidence was similar in infectious diseases. Infectious, tumoral and collagen diseases presented with significantly greater weight loss (p less than 0.01) than self-limited fever. A greater incidence of hepatosplenomegaly was noted in self-limited fever than in infectious diseases. Hemoglobin and erythrocyte sedimentation rate (ESR) were significantly higher in self-limited fever than in the other illnesses. The NBT test was positive, with a reduction superior to 30% in the six cases in whom it was performed. In nine cases various invasive procedures were utilized: radiology, biopsy, laparoscopy (two cases), and laparotomy (one case). The data on the present series of self-limited idiopathic fever support an infectious origin of the disease because of the following: absence of an age difference with the group with a demonstrated infectious cause; fever of less than two months duration in most cases; presence of chills and less incidence of weight loss, anemia, and elevated ESR in relation to the other groups of fever of unknown origin; a positive NBT test; and spontaneous evolution to complete resolution of the disease.
Subject(s)
Fever of Unknown Origin , Adolescent , Adult , Anemia/etiology , Blood Sedimentation , Body Weight , Child , Child, Preschool , Collagen Diseases/complications , Female , Fever/etiology , Fever of Unknown Origin/etiology , Humans , Infections/complications , Male , Neoplasms/complications , Time FactorsABSTRACT
This report concerns the analysis of 100 cases of fever of unknown origin, defined according to the criteria of Petersdorf and Beeson. An etiological diagnosis could be reached in 77 cases, distributed as follows: infections, 32 cases; tumors, 14 cases; collagen diseases, 13 cases; various etiologies, 18 cases; and idiopathic, 23 cases of whom 20 had selflimited fever. There were 51 male and 49 female. The incidence of infectious diseases was significantly higher below age 40 when compared with the group of collagen diseases. Recurrent fever was common (43 cases) while continuous fever was unusual (3 cases). Recurrent fever was most frequent in neoplastic diseases, the difference in relation to the other groups being statistically significant (p less than 0.05). Chills, diffuse perspiration and myalgia were more frequent in infectious diseases (p less than 0.01) than in the other groups. Collagen diseases had significantly higher (p less than 0.05) white blood cell counts than neoplastic diseases, while the latter had significantly higher (p less than 0.01) serum lactic-dehydrogenase and alpha 2 globulin levels than infectious and collagen diseases. Hepatosplenomegaly was present more frequently in neoplastic than in infectious diseases. When evaluating diagnostic procedures it was noted that invasive techniques (arteriography, biopsy, laparoscopy, laparotomy) were essential to arrive to the final diagnosis in 47 cases, while noninvasive procedures (serological and immunological tests, bacteriology, conventional radiology, clinical course, and response to therapy) were sufficient in 22 cases. In eight cases the etiology of the fever could only be determined by post-mortem examination.
