Test anxiety in medical school is unrelated to academic performance but correlates with an effort/reward imbalance.

PURPOSE: During their early years at medical school, students repeatedly criticize their workload, time constraints and test associated stress. At the same time, depressiveness and anxiety among first and second year medical students are on the rise. We therefore hypothesized that test anxiety may be related to depressiveness and considered cognitive and academic performances as confounders for the former and psychosocial distress for the latter. METHODS: A whole class of 200 second year students was invited to participate in the study. Anxiety as a trait, depressiveness, crystallized intelligence, verbal fluency and psychosocial distress were assessed using validated tests and questionnaires. Acute state anxiety and sympathetic stress parameters were measured in real life situations immediately before an oral and a written exam and paired tests were used to compare the individual anxieties at the various time points. Previous academic performances were self-reported, the results of the impending exams were monitored. Finally, correlations were performed to test for interrelatedness between academic performances and the various personal, cognitive and psychosocial factors. RESULTS: Acute test anxiety did not correlate with depressiveness nor did it correlate with previous nor impending academic performances nor any of the expected confounders on academic performance. However both, depressiveness and test anxiety strongly correlated with the perceived imbalance between efforts spent and rewards received. Moreover, anxiety as a trait not only correlated with acute state anxiety before an exam but was also significantly correlated to the feeling of over-commitment. CONCLUSION: Depressiveness during the early years of medical school seems unrelated to test anxiety and academic performance. Instead, it strongly correlated with the psychosocial distress emanating from attending medical school and points at a perceived imbalance between efforts spent and rewards received.

Hydroxyapatite porous coating and the osteointegration of the total hip replacement.

INTRODUCTION: The main purpose of this study is to evaluate the efficacy of the plasma sprayed, combined porous titanium alloy/HA coating in promoting bony ingrowth and mechanical stabilization of total hip implants. The performance of the titanium alloy/HA type coated hip prostheses and the one of the same shape but without any coating, is compared in this paper. MATERIAL AND METHODS: The implants were manufactured from titanium alloy VT-6 (ASTM F-136). The hip stems utilized in the control group were identical to those subsequently coated. The coating consists of a plasma deposited first layer of porous titanium alloy (TiAl(6)V(4)), similar in composition to the forged substrate and a plasma deposited second layer of over-sprayed hydroxyapatite, Ca(10)(PO(4))6(OH)2. Coating is located in the critical area of the hip stems, where high fixation interface strength is desired, i.e. in the proximal area of the stem where the highest stresses occur. The porous titanium alloy/hydroxyapatite (HA) coated femoral stems were implanted in 50 patients. The results were compared with a control group of 50 patients with the same type of endoprosthesis, but without the porous titanium alloy/HA coating. Both groups of patients were operated on and evaluated by the same orthopedic surgeons with a mean follow up of 11.4 years in the HA group and 10.6 years in the control group. RESULTS: HHS in the control group was preoperatively 35.5 points (range 26-49) and 85.1 points (range 54-100) in the time of the last control. HHS in the HA group was preoperatively 34.1 points (range 27-56) and 94.4 points (range 89-100) in the time of the last control. In 28 cases (56%) of the control group a range of translucencies were obvious. These translucent lines, however, did not appear with any of the patients in the coated implant group except one infection stem migration. CONCLUSION: Experience with the HA-type coated hip implants demonstrates substantially higher degree and quality of osteointegration in the porous titanium alloy/HA type implants.

Evaluation of a Role-Play Learning Exercise in an Ambulatory Clinic Setting.

Learning in ambulatory settings can be aided by teaching activities which do not slow the pace of the clinic. In this study, simulated-parent role-play scripts were developed for use with students prior to seeing actual patients. During the learning exercise, a faculty member role-played various parents, a medical student role-played the physician while another student observed. Students were randomly assigned to either the Treatment Group (participated in role-play exercise) or Control Group (did not participate). Sixteen Treatment Group students completed approximately 20 role-play cases on the first day of the Pediatrics clerkship. Both Treatment and Control Group students were then individually assessed one to two days later using two role-play cases by an examiner blinded to the students' experimental status. Student performance was scored on three criteria: history taking, differential diagnosis, and correct diagnosis. The Treatment Group achieved higher scores than the Control Group for history taking, but not for differential diagnosis or correct diagnosis. Role-play learning exercises can be used to improve student history taking in an ambulatory clinic prior to seeing actual patients. Potential use of role-play cases as a screening exam to exempt some students from the role-play learning exercise is discussed.