Beyond career choice: the role of learning style analysis in residency training.

A recent article in this journal took an important step toward rethinking the utility of behavioural instruments designated as learning style tests (Jewett et al. 1987). The authors of that paper made much of a distinction between the terms 'learning style' and 'learning preference'. However, the results of their study do not seem to substantiate a marked difference between the function of the Rezler Learning Preference Inventory (LPI) and Kolb's Learning Style Inventory (LSI) with which it was contrasted. The most important aspect of their paper was that it rescued the concept of learning style analysis from the arena of career choice prediction at the undergraduate level and applied these ideas to doctors who had already made their specialty selections and were actively engaged in residency training. Clinical instructors in teaching institutions have, for the most part, little or no formal background in educational principles. For these individuals, an easily comprehensible model of resident-instructor psychology can be very useful on a daily basis. This article reviews the authors' experience with the LSI and describes their utilization of Kolb's Experimental Learning Model in the areas of resident counselling and residency curriculum design. The results of two recent studies are also presented in which learning style was examined as a predictor of success in residency, and teacher-resident learning style distributions were shown to exhibit parallel relationships at four different anaesthesiology residency training programmes.

Beneficial effects of ibuprofen in oleic acid induced lung injury.

Metabolites of arachidonic acid, particularly thromboxanes, have been implicated as mediators of lung injury. The formation of thromboxane A2 can be decreased by glucocorticoid steroids by inhibiting the enzyme phospholipase A2 or by ibuprofen which inhibits fatty acid cyclooxygenase. This study was performed to determine if ibuprofen, methylprednisolone, or a combination of both could improve the pulmonary injury induced by oleic acid. Five groups of dogs were instrumented with pulmonary artery and extravascular lung water (EVLW) catheters and ventilated with 100% O2. Serial determinations of hemodynamic and pulmonary parameters were performed before and after oleic acid infusion. Plasma immunoreactive thromboxane B2 (iTxB2) and ibuprofen levels were also determined. Oleic acid rapidly induced a significant pulmonary injury as evidenced by hypoxemia and increases in extravascular lung water. Plasma iTxB2 rose significantly in the control group receiving only oleic acid. Pulmonary function and hemodynamic parameters were not changed by ibuprofen infusion alone. Ibuprofen attenuated the oleic acid induced hypoxemia and increased EVLW but did not significantly reduce plasma iTxB2. Methylprednisolone did not prevent the increase in plasma iTxB2 and was less effective than ibuprofen in preventing hypoxemia and increases in EVLW. The combination of ibuprofen and methylprednisolone did significantly inhibit the production of iTxB2, however in combination they protected less against the hypoxemia and increased EVLW than either agent alone. These results indicate that ibuprofen may have a protective effect in oleic acid induced lung injury that is not mediated through the inhibition of fatty acid cyclooxygenase. The results are also further evidence that thromboxane is probably not a pathogenetic factor in oleic acid induced lung injury.