Clinical pharmacology becomes a specialty in South Africa.

South Africa recently became the first African country where clinical pharmacology has been approved as a specialty. This article outlines the need for clinical pharmacologists, their role in advancing public health, the potential benefits to the country, and recommendations for ensuring a healthy future for the discipline.

Profiling undergraduates' generic learning skills on entry to medical school; an international study.

BACKGROUND: Medical education faces challenges posed by widening access to training, a demand for globally competent healthcare workers and progress towards harmonisation of standards. AIM: To explore potential challenges arising from variation in diversity and educational background of medical school entrants. METHOD: This study investigated the reported experience and confidence, in a range of 31 generic skills underpinning learning, of 2606 medical undergraduates entering 14 medical schools in England and South Africa, using a validated questionnaire. RESULTS: Responses suggest that there is considerable similarity in prior educational experience and confidence skills profiles on entry to South African and English medical schools. South African entrants reported significantly more experience in 'Technical skills', 'Managing their own Learning', and 'Presentation', while English students reported increased experience in 'IT' skills. South African undergraduates reported more confidence in 'Information Handling', while English students were more confident in 'IT' skills. The most noticeable difference, in 'IT' skills, is probably due to documented differences in access to computer facilities at high school level. Differences between individual schools within each country are noticeable. CONCLUSIONS: Educators need to acquire a good understanding of their incoming cohorts, and ensure necessary tailored support for skills development.

Correlation between Different PBL Assessment Components and the Final Mark for MB ChB III at a Rural South African University

Problem-based learning (PBL) is now an accepted component of many medical school programmes worldwide. Our university also follows the PBL `SPICES' model for MB ChB III. The assessment modalities used are the modified essay questions (MEQ); objective structured practical examination (OSPE); individualised process assessment (IPA) and tutorial continuous assessment (TUT). This study was done to compare the students' performances in individual assessment components with the final mark to determine the correlation between these parameters. Materials and methods. The study was retrospective; descriptive and analytical; based on the integrated marks of all the MB ChB III students at Walter Sisulu University (WSU) in 2007. Assessment marks were stratified according to blocks and different types of assessment (MEQ; TUT; OSPE; IPA). Regression analysis was used to compute and scrutinise these vis-a-vis their correspondence with the final marks for each block.Results. Three hundred and seventy-nine block assessment marks of 96 students from 4 blocks of MB ChB III were analysed and the correlation between the assessment components and final mark were compared. Regression analysis showed good correlation when analysing the assessment modality versus the final mark for the MEQs (r=0.93; 0.93; 0.94; 0.96); followed by OSPEs (r=0.71; 0.70; 0.76; 0.77) and IPAs (r=0.62; 0.51; 0.68; 0.77). However; correlation was not significant with the TUT. Conclusion. There was good correlation between the students' performance in the majority of assessment modalities and the final mark in the different blocks of the MB ChB III examination. There may be a need to make tutorial assessment methods more objective; partly by additional tutor training

Does tutor subject-matter expertise influence student achievement in the problem-based learning curriculum at UNITRA Medical School?

OBJECTIVE: To establish whether or not tutor subject-matter expertise influences student achievement in content-based examinations in the problem-based learning (PBL) curriculum at the University of Transkei (UNITRA) Medical School. DESIGN: A retrospective study of MB ChB III student achievement in end-of-block modified essay questions (MEQ) examinations in microbiology, pathology and pharmacology for the years 1994-1999, inclusive. Pooled scores from the expert-tutored groups were compared with those from the groups tutored by non-experts using analysis of variance (ANOVA) or t-test. Subject expert tutors were those with postgraduate specialisation in the given discipline. SETTING: The Medical School, Faculty of Health Sciences, UNITRA, Umtata. OUTCOME MEASURES: Whether pooled mean MEQ scores in end-of-block examinations for microbiology, pathology or pharmacology differ according to the subject-matter expertise of the tutor. RESULTS: There were no significant differences in mean scores obtained for pharmacology (51.1 +/- 0.6 versus 52.6 +/- 0.7, P = 0.109) and pathology (49.8 +/- 0.6 versus 49.9 +/- 0.8, P = 0.919). The difference between the scores in microbiology was small (3 percentage points) but statistically significant, with the groups tutored by microbiologists scoring higher than those tutored by pathologists or pharmacologists (54.1 +/- 1.0 versus 51.2 +/- 0.8, P = 0.032). CONCLUSIONS: These data demonstrating that in the UNITRA Medical School PBL curriculum tutor subject-matter expertise has little or no influence on student achievement in the discrete areas of tutor expertise.

Assessment of heavy metal nephrotoxicity in vitro using isolated rat glomeruli and proximal tubular fragments.

Nephrotoxic metals are thought to affect mainly the proximal tubule, but the pathophysiology of acute renal failure (ARF) caused by some of these compounds cannot be explained by damage to this part of the nephron alone. To compare toxic effects on different parts of the nephron, metabolic studies (de novo protein synthesis as assessed by amino acid incorporation and fatty acid oxidation) were performed in freshly isolated rat glomeruli and proximal tubular fragments (PTF) in the presence of increasing concentrations of mercury (Hg), chromium (Cr), and cadmium (Cd) salts. Glomerular protein synthesis was very sensitive to Hg (concentration to reduce protein synthesis by 50%: 3.4 microM) and Cr (15 microM), while in PTF amino acid incorporation was similarly affected by Cd and Hg (32 and 34 microM). Glomerular fatty acid synthesis was also more sensitive to Hg than that in PTF (3.2 vs 55 microM, p less than 0.005). In experiments to study the effects of reduced glutathione (0.5 and 1 mM) on the metal toxicity, preincubation of the fragments with reduced glutathione failed to protect glomeruli against subsequent exposure to the metals, but partially protected PTF (greater than 100 microM for Hg and Cd). These data show that isolated glomeruli are more susceptible to those metals with the potential to cause ARF in vivo, with Hg being the most potent toxin. The results suggest that the glomerular sensitivity to Hg may indicate an important target region of the nephron in the development of ARF which has previously not been recognized.

Nephrotoxicity: a rational approach to target cell injury in vitro in the kidney.

1. The kidney is a complex organ in which there is cellular heterogeneity. Many nephrotoxic chemicals target preferentially for discrete cell types, but adjacent, morphologically different cells are unaffected. This selectivity has made the assessment of nephrotoxicity in vivo (and the study of underlying mechanisms) difficult. Discrete renal injury can, however, be exploited in vitro, to study the interactions between the toxic compound and the target cell. 2. Several in vitro models have been used to study the potential interaction between the target cells and chemicals, including perfusion of the isolated kidney, renal slices, freshly isolated fragments, primary cultures and continuous cell lines. Where appropriate, isolated organelles and purified enzymes can also be used. 3. The target cell toxicity in vivo of adriamycin, 2-bromoethanamine and hexachlorobutadiene N-acetyl cysteine conjugate is selectively maintained towards glomerular epithelial, medullary interstitial and proximal tubular cells, respectively, in vitro, showing that the "in vivo-in vitro gap" can be bridged. Characteristics unique to each of these renal cell types, such as the selective uptake of a toxin, enzyme systems for generating biologically reactive intermediates, and the presence of lipid droplets (rich in polyunsaturated fatty acid) and peroxidase activity have been identified, and one or more of these may explain the mechanisms of selective injury in discrete regions of the kidney.