PBL 2.0: enhancing problem-based learning through increased student participation.

PURPOSE: The purpose of this study was to test a new problem-based learning (PBL) method to see if it reinvigorated the learning experience. METHOD: A new PBL format called PBL 2.0, which met for 90 min two times per week, was introduced in 2009 into an 11-week integrated neuroscience course. One hundred second-year medical students, divided into 10 groups of 10, who had completed their first year of medical school using a traditional PBL format, participated in PBL 2.0. Students were prohibited from using computers during the first session. Learning objectives were distributed at the end of the first day to the small groups, and students were assigned to pairs/trios responsible for leading an interactive discussion on specific learning objectives the following day. Student-led 'lectures' were prohibited. All students were responsible for learning all of the learning objectives so that they could participate in their discussions. RESULTS: One hundred and six students were surveyed and 98 submitted answers (92% response). The majority of groups adhered to the new PBL method. Students invested more time preparing the learning objectives. Students indicated that the level of interaction among students increased. The majority of students preferred the new PBL format. CONCLUSIONS: PBL 2.0 was effective in increasing student interaction and promoting increased learning.

Suicidal overdoses of psychotropic drugs by elderly in New York City: comparison with younger adults.

We compared New York City suicide victims aged 18-59 with those 60+ according to rates by which psychotropic/analgesic drugs and ethanol contributed to death. Barbiturates were more frequent in the elderly, while antidepressants were more frequent in younger adults. Addressing the potential for overdose with barbiturates may aid suicide prevention in the elderly.

Flexner redux.

Medical education in the 20th century has been vastly influenced by the Carnegie Foundation Flexner Report. The basic tenets of the modern four-year medical curriculum and the dominant role of the associated university teaching hospital were cemented into place and have remained the paradigm of the present-day medical educational process. The Flexner Report contributed importantly to the development of the modern health-care system. Despite enormous success, a number of current problems have been identified in today's medical educational curricula and have catalyzed the generation of a new Carnegie Foundation report that emphasizes the building of strong bridges across the artificial divide that separates the basic science and clinical years and lays the foundation for the growth and development of translational medicine. In addition, the report raises crucial issues regarding a national medical workforce policy.

Standardized patient outcomes trial (SPOT) in neurology.

BACKGROUND: The neurologic examination is a challenging component of the physical examination for medical students. In response, primarily based on expert consensus, medical schools have supplemented their curricula with standardized patient (SP) sessions that are focused on the neurologic examination. Hypothesis-driven quantitative data are needed to justify the further use of this resource-intensive educational modality, specifically regarding whether using SPs to teach the neurological examination effects a long-term benefit on the application of neurological examination skills. METHODS: This study is a cross-sectional analysis of prospectively collected data from medical students at Weill Cornell Medical College. The control group (n=129) received the standard curriculum. The intervention group (n=58) received the standard curriculum and an additional SP session focused on the neurologic examination during the second year of medical school. Student performance on the neurologic examination was assessed in the control and intervention groups via an OSCE administered during the fourth year of medical school. A Neurologic Physical Exam (NPE) score of 0.0 to 6.0 was calculated for each student based on a neurologic examination checklist completed by the SPs during the OSCE. Composite NPE scores in the control and intervention groups were compared with the unpaired t-test. RESULTS: In the fourth year OSCE, composite NPE scores in the intervention group (3.5±1.1) were statistically significantly greater than those in the control group (2.2±1.1) (p<0.0001). CONCLUSIONS: SP sessions are an effective tool for teaching the neurologic examination. We determined that a single, structured SP session conducted as an adjunct to our traditional lectures and small groups is associated with a statistically significant improvement in student performance measured 2 years after the session.

Antidepressant use in elderly suicide victims in New York city: an analysis of 255 cases.

OBJECTIVE: We examined postmortem evidence of antidepressant, analgesic, and anxiolytic-hypnotic drugs in suicide victims aged 65 years and older. METHOD: We assessed data on Medical Examiner-certified suicide victims aged 65 years or older from 2001 through 2004 who had resided and died in New York City and who underwent toxicologic investigation for antidepressant, analgesic, and anxiolytic-hypnotic drugs. We calculated annual population-based suicide rates and rates of positive toxicologic findings for each of the 3 classes of medications across 3 age strata: 65 to 74, 75 to 84, and 85 years and older. RESULTS: There were 255 certified suicide victims among New York City residents aged 65 years or older from 2001 through 2004. Results of toxicologic testing were available for 63.5% (162) of suicide victims. Antidepressants were detected in 22.0% of suicide victims aged 65 to 74 years, 26.8% of those aged 75 to 84 years, and 16.7% of those aged 85 years and older. The oldest age stratum had both the highest suicide rates in the over-65-years population at 10.7 per 100,000 and the lowest percentage of antidepressant use among all geriatric suicide victims. CONCLUSION: Rates of detection of antidepressant medication were low for all geriatric suicide victims, especially the oldest. Analgesics and anxiolytic-hypnotics may have been taken in lieu of antidepressants by suicide victims aged 85 years and older. Assuming that many of the suicide victims had clinically treatable depression, these findings implicate problems in the delivery of specific antidepressant pharmacologic treatment to the "old-old."

Antidepressants in adult suicides in New York City: 2001-2004.

BACKGROUND: The U.S. Food and Drug Administration recently extended the Black Box warning on anti-depressants regarding pediatric suicidality to include young adults. The decision was guided by results from meta-analyses of 372 randomized controlled clinical trials of antidepressants for adults. Nearly all suicidality in those trials was nonfatal suicide attempts and ideation. Here, we consider whether antidepressants are linked with adult suicide deaths. METHOD: Subjects in this medical examiner surveillance study included all suicides, 18 years and older, in New York City from 2001-2004. Postmortem blood was analyzed for the presence of antidepressants. RESULTS: There were 1419 adult suicides in New York City during the study period. Antidepressants were detected at autopsy in 23.1% of the suicides who met criteria for toxicology analyses. Antidepressants were least prevalent in suicides aged 18-24 years (13.9%). CONCLUSIONS: Antidepressants were detected in less than one-quarter of adult suicides in New York City from 2001-2004. The majority of the suicides were not attributable to antidepressant use, and perhaps many could have been prevented with appropriate treatment. Although this study does not provide evidence for a link between antidepressant use and subsequent suicide, careful monitoring of patients receiving antidepressants remains critically important.