A four-Axis-Method to Evaluate a Part of an Undergraduate Medical Students' Curriculum.

Introduction: The evaluation of programs in faculties of medicine enables them to adequately reach their mission objectives, and social responsibilities and to correct their potential lacune. Few publications have described the process of internal evaluation of a program performed by the organizational members. The authors aimed to describe a practical method called the four-axis method to assess curriculum using a practical example. Methods: The authors performed a descriptive study, highlighting the application of a particular method of evaluation of a program called the four-axis method. It consisted of the assessment of the pedagogical alignment [1], teaching techniques and evaluation tests [2], students' viewpoints and needs [3], and the teachers' opinions and needs [4]. To contextualize this method, the authors described a practical experience of the assessment of a multidisciplinary theme (theme 16), which is taught during the second year of medical education. Was performed the evaluation from January 2020 to January 2021. The population studied consisted of the tutors implicated in the teaching of the theme and the students in the second year of medical education who accepted to answer the satisfaction questionnaires. The students and tutors who did not fill out the questionnaires were excluded. No statistical tests were needed because of the descriptive nature of the study. Results: The most relevant results highlighted that 48.4% of the teachers did not systematically use bioclinical cases involving interactions between students; also, 42.4% of the students believed that the teaching sessions didn't introduce practical examples giving rise to interactions between them. Therefore, the 4-axis-based analysis indicated that weaknesses were mostly attributed to the lack of homogeneity in the teaching methods and techniques which showed the teachers' difficulties in integrating clinical data into their teaching so that they can help the students to assimilate the fundamental data. Conclusion: The authors' used a particular approach since it focused both on an objective evaluation of the teaching methods and the evaluation tests and the students' and teachers' viewpoints and needs. The major limitation of this approach was the fact that it could not integrate the educational environment that could impact the students' performances.

The diagnostic performance of micro-RNA and metabolites in lung cancer: A meta-analysis.

BACKGROUND: The diagnosis of lung cancer is based on the microscopic exam of tissue or liquid. During the recent decade, many biomarkers have been pointed to have a potential diagnostic role. These biomarkers may be assessed in blood, pleural effusion or sputum and they could avoid biopsies or other risky procedures. The authors aimed to assess the diagnostic performances of biomarkers focusing on micro-RNA and metabolites. METHODS: This meta-analysis was conducted under the PRISMA guidelines during a nine-year-period (2013-2022). the Meta-Disc software 5.4 (free version) was used. Q test and I2 statistics were carried out to explore the heterogeneity among studies. Meta-regression was performed in case of significant heterogeneity. Publication bias was assessed using the funnel plot test and the Egger's test (free version JASP). RESULTS: According to our inclusion criteria, 165 studies from 79 articles were included. The pooled SEN, SPE and dOR accounted, respectively, for 0.76, 0.79 and 13.927. The AUC was estimated to 0.859 suggesting a good diagnostic accuracy. The heterogeneity in the pooled SEN and SPE was statistically significant. The meta-regression analysis focusing on the technique used, the sample, the number of biomarkers, the biomarker subtype, the tumor stage and the ethnicity revealed the biomarker number (p = 0.009) and the tumor stage (p = 0.0241) as potential sources of heterogeneity. CONCLUSION: Even if this meta-analysis highlighted the potential diagnostic utility of biomarkers, more prospective studies should be performed, especially to assess the biomarkers' diagnostic potential in early-stage lung cancers.

Granular cell tumor of the lung and tracheobronchial tree: Two case-presentation with a review of the literature.

Pulmonary granular cells tumors (CGT) are rare tumors, that derive from Schwann cells. In the tracheobronchial and pulmonary tree, they remain a diagnostic challenge. There are no well-established criteria to differentiate between benign, atypical, and malignant GCT. Moreover, its real frequency in the respiratory tract is still unknown. Here, we represent 2 cases of bronchial and lung GCTs. We aim to highlight the frequency of all clinicopathological characteristics of this rare tumor in the tracheobronchial and pulmonary tree location based on our cases and the available literature in a large systematic review.

The Design and Validation of a Self-Assessment Questionnaire of Critical Appraisal of Medical Literature Skills in Medical Students.

Introduction: Critical appraisal of medical literature is a challenging step of the evidence-based medicine practice. Many assessment questionnaires have been published in the literature, but they have mainly focused on all the evidence-based medicine practice process. The authors aimed to develop and validate a questionnaire assessing the critical appraisal skills of medical students from the same Faculty. Methods: The questionnaire was developed by item generation through a review of the literature and an expert committee. The questionnaire was validated in terms of content validity and construct validity. Fitness of data for analysis was checked through Kaiser-Meyer-Olkin (KMO) and Bartlett's sphericity. Construct validity was carried out using a principal axis exploratory factor analysis (EFA) with 'varimax' rotation to study the internal structure of the questionnaire and to extract the test major factors. The questionnaire was administrated to a cohort of under and postgraduate medical students (n=84) to evaluate the test reliability and select the best items. The reliability of the questionnaire was assessed by Cronbach's alpha coefficient to evaluate the internal consistency. The correlations between the self-confidence and satisfaction dimension score, the critical thinking dimension score, the learning style dimension score, the Fresno-adapted test scores and the total score were assessed using the Spearman's correlation test. Results: The questionnaire consisted of 31 items. A factorial analysis grouped the items into 3 dimensions that consisted of the self-confidence and satisfaction dimension, the critical thinking dimension and the learning style dimension. Cronbach's alpha accounted for 0.95, CI95% [0.9-1] for the entire questionnaire. The factor analysis explained 79.51% of the variance. The external validity assessment based on a Spearman's correlation study highlighted a weak correlation between the total scores and the critical thinking dimension and the self-perception and satisfaction dimension. Conclusion: In spite of the limitations of this study, mainly the small number of the students recruited, the questionnaire seems to measure with adequate reliability the competences of under and postgraduate medical students.

Utility of the cytological criteria in the diagnosis of malignant pleural mesothelioma: Making the bridge between theory and practice.

INTRODUCTION: The diagnosis of malignant pleural mesothelioma (MPM) depends on microscopic examination performed on pleural biopsies taken under thoracoscopy. However, it has recently been established that cytology presents a significant diagnostic contribution enabling an earlier diagnosis with a minimally invasive procedure. AIM: To assess the diagnostic value of consensual cytological features of MPM in the differentiation between adenocarcinoma, mesothelioma and reactive mesothelial cells in pleural liquid. METHODS: All available retrospective records from the computerized pathology database system and pathology reports were searched for malignant pleural effusion cytology specimens, over a 5-year period from January 2015 to February 2020. The cytological criteria based on the international Guidelines for cytopathologic diagnosis of epithelioid and mixed type of MPM were assessed. Malignant mesothelial cells, MNML and RL were considered as the gold standard. RESULTS: 189 pleural biopsies with their corresponding cytology specimens were available for review. Among the reviewed cytologies, the diagnoses of 21/189 pleural cytologies were modified. The highest sensitivities were attributed to cytoplasmic blebbing, hypercellularity and cell ball clusters. The most specific feature was the absence of extracellular granular hyaluronic acid cores in reactive cytology and the absence of intercellular openings in NMML cell clusters. Extracellular granular hyaluronic acid cores had the highest positive predictive value and the highest negative predictive value was attributed to the cytoplasmic blebbing in both reactive cytology and NMML. CONCLUSION: These results highlight the fact that no sign is pathognomonic of the diagnosis of MPM pointing out the necessity of immunocytochemical techniques in equivocal cases.

The use of biomarkers in the diagnosis of lung cancer.

Using a simple 10 to 20 milliliters of blood sample in order to make the diagnosis of lung cancer is the dream of every patient and practitioner. In fact, even if tissue samples or bronchial liquid represent the gold standard for microscopic diagnosis, using less invasive procedures represented the aim of many researches published in the literature. The utility of biomarkers has been widely reported in screening context, mainly in association to low dose CT-scan, or in therapeutic context in order to highlight therapeutic targets or to change treatment in a context of resistance to target therapies. The use of biomarkers in a diagnostic context has been recently highlighted in the literature. The authors aimed to present a general review of different biomarkers that could be used in the diagnosis of lung cancer.

Tracheal Lobular Capillary Hemangioma: A Rare Localization.

Background: Lobular capillary hemangioma is a benign vascular tumor commonly found within the skin and upper respiratory mucosa and has rarely been reported within the trachea. The first case was reported by Irani et al. in 2003 and since then, less than 20 cases have been described. That's why the characteristics and treatments remain relatively unknown. Case Presentation: A 53-year-old woman was symptomatic of recurrent episodes of hemoptysis associated with paroxysmal dyspnea. Physical examination, routine blood investigations, and chest x-ray were normal. The flexible bronchoscopy showed a polypoid bleeding lesion arising from the right lateral wall of the middle third of the trachea. Tumor biopsy was not performed considering an eventual bleeding risk. Computed tomography scanning showed a vascular, endotracheal budding tissue process without peritracheal or distant extension. A rigid bronchoscopy was performed for diagnostic and therapeutic purposes. A 10-millimeter bronchoscope was used. A rigid coring technique was performed to remove the tumor. A minimal bleeding was completely controlled after diode laser treatment. There were no complications during or after the procedure. Pathology revealed no malignancy and the diagnosis of lobular capillary hemangioma was confirmed. At a 6-month follow-up, the patient was asymptomatic and the endoscopic control did not show any tumor recurrence. Conclusion: The lobular capillary hemangioma is a benign tumor rarely observed in the trachea. Clinical features are not specific and the short-term prognosis depends on tumor size. Considering its benign nature, tumor removal by interventional bronchoscopy should be proposed as the first-line treatment.

Is critical thinking potential correlated to critical appraisal skills of medical literature?

INTRODUCTION: Critical appraisal of medical literature is a mandatory skill to practice evidence-based medicine. The relation between the critical appraisal skills and the critical thinking potential has been rarely assessed in the literature. AIM: To assess the relation of critical thinking potential to critical appraisal of medical literature competencies. Besides, they tried to highlight the variation of the critical thinking potential according to the students' level. METHODS: The authors conducted a mixed study associating a quantitative and a qualitative approach. The study included second year (SYME), third year (TYME) and postgraduate medical students (CME) and family doctors (FD) from the same faculty of medicine. All the students received the same active training focused on critical appraisal of medical literature. They were asked to fulfil a pre-requisite test and a self-assessment questionnaire before the training session and a final test after the training. The self-assessment questionnaire was conceived by an expert committee and assessed the main characteristics of critical thinking consisting of sensitivity to context, self-correction and search for criteria. Three months after the training, the students were interviewed using a semi-structured interview. The SPSS software 16.0 was used. RESULTS: In our study, 58.9% of the students presented a high critical thinking potential profile. Their scores varied according to their levels with better scores in SYME and FD and intermediate scores in TYME and CME. The pre-requisite test scores varied according to the critical thinking profile and the level. On the other hand, final test scores didn't differ according to the critical thinking profile or the level. CONCLUSION: Our results put emphasis on the variation of the critical thinking potential according to the students' levels. The better results of the SYME students in comparison to those in the TYME put emphasis on the necessity of changing curriculum in order to enhance the sensitivity and the inclination of the students.

A qualitative study about critical appraisal of medical literature learning among medical students.

INTRODUCTION: Skills in critical appraisal of medical literature are compulsory to achieve in medical practice. This step is the third step of the evidence-based medicine process whose main role is to bridge a gap between scientific evidence and practice. Acquiring skills in critical appraisal of the literature has been reported to be challenging for the trainees with different limits according to their levels, backgrounds or specialties. AIM: To assess the limits and factors influencing the practice of appraising literature of different students from the same faculty. This faculty included training of biostatistics and preventive medicine in the curriculum during the first 2 years of medical education without linking this learning to the evidence-based medicine practice. METHODS: The authors performed a qualitative study including volunteers who attended voluntarily the same training about critical appraisal of medical literature. The study was based on a satisfaction questionnaire fulfilled by all the participants at the end of the training and on an individual semi-structured interviews programmed 3 months after the training. The satisfaction questionnaire was rated by the authors. The authors proceeded also to a content analysis of the interviews following 3 steps: pre-analysis, treatment of the results, and interpretation. RESULTS: All the participants (95) fulfilled the questionnaire. The satisfaction's mean score revealed a general moderate satisfaction. Eleven students agreed to be interviewed: Five students from the third year of medical education, 2 students from the second year of medical education, 2 postgraduate students and 2 family doctors. The main themes discussed by the interviewees consisted of training organization, the assessment, the impact on research and the impact on the care process. CONCLUSION: To promote EBM learning, medical students first need to actively participate to interactive learning, introduced early and gradually into the curriculum and integrating all specialties including postgraduate students.

About the efficacy of a serious game in critical appraisal learning: a cluster randomized controlled trial.

INTRODUCTION: Serious games have been reported to be a valuable method of learning for over a decade. AIM: The authors assessed the efficacy of using a serious games to teach critical appraisal practice to medical students in comparison to face-to-face learning methods. METHODS: This was a cluster randomised controlled trial including 3rd year medical students. The control group had to perform a critical appraisal of two articles guided by a checklist, while the intervention group performed a critical appraisal using a home-made serious game. Judgment criteria consisted of the students' scores attributed to their appraisal of a same article after the training period. RESULTS: Twenty-four students in the control and intervention group were enrolled in the study. There was no significant difference in scores between both groups. The satisfaction questionnaire highlighted more motivation and self-accomplishment feeling in the intervention group. CONCLUSION: This study didn't show a significant difference between the scores of both groups but the motivation of the students included in the intervention group was improved and encourages the use of both methods in critical appraisal teaching.

The impact of tutor expertise on the students' scores in active learning methods: a meta-analysis.

Introduction: The tutor's role has been changing in the active learning methods in comparison to the traditional ones. Tutors are encouraged to become facilitators and to guide the students to construct a new knowledge by making bridges with the old one. Tutor's expertise in the active methods has been discussed with different results. The aim of this study was to assess the impact of tutor expertise on the students' scores in active learning methods. Methods: The authors conducted this meta-analysis under the guidelines of a critical tool for systematic reviews (AMSTAR2). PubMed, Embase, Cochrane library, Scopus and Science Direct were the databases used for searching. The articles included compared students' learning scores according to tutor expertise between 2 groups of students with an active method of learning. The Review Manager software 5.3 was used to conduct this meta-analysis. We considered the mean difference as the effect size. Results: 3169 students and 222 learning groups of 5 to 10 students were included in this study. The combined mean difference reached 0.84 with 95% CI [0.22, 1.46]. A significant difference between the two groups was observed in favour of the non-expert group (p=0.008). The heterogeneity I-square was evaluated to 98%. The Funnel plot reflected no publication bias (p=0.21). A sub-group analysis was performed taking into account the studies dealing with medical curriculum and the assessment methods used. It showed a significant difference between the two groups in favour of non-expert tutors (p<0.05). Conclusion: Even if the results of this meta-analysis couldn't be conclusive and can't induce recommendations, they highlighted the tendency of non-expert tutors to be more student-centred. The heterogeneity observed can be decreased by establishing consensual definitions of expertise and assessment tools in further research studies in order to reflect the validity and efficiency of different tutoring styles in active learning methods.

Spindle cell hemangioma of the lung: An unusual presentation.

Spindle cell hemangioma (SCH) is a benign vascular tumour, first identified by Weiss and Enzinger in 1986. Habitually, the SCH affects almost exclusively the dermis and subcutaneous tissues of distal extremities. So far, only 2 cases have been described in the lung. We describe herein the third case of SCH occurring in the lung in a 47 year-old woman. The patient was successfully treated by right lower lobectomy. The histopathological and immunohistochemistry examination of the excised tumour leads to the definitive diagnosis. Our case is instructive by its different clinical and radiological presentation compared to the previous two cases.

Collision lung tumor associating typical carcinoid tumor to sclerosing hemangioma.

Collision tumors associating carcinoid tumor and sclerosing pneumocytoma have rarely been reported in the literature. The clinical presentation may be challenging especially in cases showing multiple and bilateral nodules. This case illustrates the association of both tumors diagnosed incidentally and illustrates a full spectrum of neuroendocrine lesions and sclerosing pneumocytoma. The authors present the case of a 52-year-old patient presenting an abdominal pain revealing a vesicular lithiasis and multiple pulmonary nodules. Radiologic follow-up of the asymptomatic lung lesions revealed the stabilization of a left lobe lesion with a disappearance of the other lesions. A lobectomy with a mediastinal lymph node curettage was performed. The microscopic examination revealed both tumor components associating a typical carcinoid tumor to a sclerosing pneumocytoma in association to lesions of diffuse neuroendocrine hyperplasia present in the peri-tumoral parenchyma. This case illustrates radiologic, gross, and microscopic features of a rare pulmonary tumor.

Mediastinal cysts : a 52-case retrospective study.

INTRODUCTION: mediastinal cysts are rare lesions developed from mediastinal structures. They may be acquired like thoracic duct cysts or lymphangiomas or congenital like the bronchogenic cysts, enteric cysts or celomic cysts. These cysts are rare and may cause diagnostic challenges. AIM: To assess the major characteristics of these cysts based on a single institution experience. METHODS: the authors performed a descriptive, retrospective study from January 2009 to March 2020 in a single institution. Cystic lesions taking birth from the mediastinum for which gross features, microscopic features were available were included. RESULTS: this study contained 52 mediastinal cysts that were completely resected and no patient presented complications after the surgical resection. The bronchogenic cysts were the most frequent and represented 57.69% of all lesions. Thymic cysts and pericardial cysts represented respectively 40.38% and 1.92% of the cases. The positive diagnosis was based on the microscopic exam. The final diagnosis was concordant with the radiologic findings in 15 cases reaching a rate of 28%. CONCLUSION: the diagnosis of mediastinal cysts is based on the microscopic analysis of the cystic wall. Pericardial cysts may be suspected based on their characteristic location in the cardiophrenic angle, thymic cyst may be evoked based on their location in the thymic region and bronchogenic cysts are mainly located in the middle mediastinum. Inspite of these most frequent locations, the cysts may be located in any part of the mediastinum and may be difficult to diagnose when the key diagnostic features are absent.

Prognostic impact of tumor-infiltrating lymphocytes in non-small cell lung carcinomas.

INTRODUCTION: Tumor-infiltrating lymphocytes represent a pivotal component of the host anti-tumor response. Thus, they considerably influence the evolution of cancers including non-small cell lung carcinomas. Even if, this important role is consensual, many discordant results are published in the literature about the prognostic role of the different populations of tumor-infiltrating lymphocytes. The aim of our work was to evaluate the prognostic impact of CD8+, CD4+, and forkhead box protein P3+ lymphocytes in the tumor microenvironment of non-small cell lung carcinomas. METHODS: We conducted a retrospective descriptive study, which included non-small cell lung carcinomas diagnosed in the department of pathology and followed in the medical oncology department of the same hospital between 2011 and 2015. Tumor-infiltrating lymphocytes were analyzed by the immunohistochemical method for forkhead box protein P3, CD4, and CD8. Intratumoral and stromal-labeled lymphocytes were quantified by manual counting at high magnification (×400). Forkhead box protein P3+/CD8+, forkhead box protein P3+/CD4+, and CD8+/CD4+ ratios were subsequently calculated. The prognostic value of tumor-infiltrating lymphocytes was assessed in respect of overall survival, recurrence-free survival, and relapse-free survival. RESULTS: Thirty-nine patients were included. The mean age of patients was 59.6 years. A complete surgical resection (p = 0.009), and a CD8/CD4 ratio (p = 0.008) were prognostic factors for overall survival. Complete surgical resection (p = 0.003), the forkhead box protein P3/CD8 (p = 0.005), and forkhead box protein P3/CD4 (p = 0.037) ratios were prognostic factors for recurrence-free survival. The CD8+ tumor-infiltrating lymphocytes rate (p = 0.037) was a prognostic factor for relapse-free survival with a threshold of 67.8/high power field. Microscopic subtype (p = 0.037) was a prognostic factor for relapse-free survival when only adenocarcinoma and squamous cell carcinoma were considered. In multivariate analysis, age (p = 0.004) and a CD8/CD4 ratio (p = 0.016) were independent predictors of overall survival. CONCLUSION: Despite the limitations of our study, our results confirm the prognostic value of tumor-infiltrating lymphocytes in non-small cell lung carcinomas and the importance of the combined quantification of their different subpopulations.

[Thymic hyperplasia: A study of 46 cases]. / Les hyperplasies thymiques.

BACKGROUND: Thymic hyperplasia presents as an anterior mediastinal mass and poses important diagnostic and therapeutic challenge. Two types of thymic hyperplasia are described: true hyperplasia and follicular hyperplasie. Literature data are peculiar concerning both entities. We aimed to describe the clinical and microscopic characteristics of thymic hyperplasia through a single institution experience during an 11-year-period. METHODS: Thymic hyperplasia diagnosed during the period between 2009 and 2020 were included. RESULTS: In all, 46 thymic hyperplasias were diagnosed. The 46 patients consisted in 33 women and 13 men with a mean age of 30 years. Microscopic diagnosis concluded to a follicular hyperplasia in 12 cases and a true thymic hyperplasia in 34 cases. The diagnosis of true thymic hyperplasia posed a diagnostic challenge with an involuted thymus in 1 case and a thymolipoma in 1 case. The confrontation with the clinical data allowed retaining the diagnosis. CONCLUSION: The diagnosis of thymic hyperplasia is based on microscopic features. The confrontation with clinical data and the measurements of the thymus according to the age allow to retain the diagnosis in most challenging cases.

An unusual clinical manifestation of a relapsed typical pulmonary carcinoϊd tumor.

Typical carcinoid tumors of the lungs carry an excellent prognosis after complete surgical excision. However, recurrence of these cancers remains poorly described in the literature and may occur many years after surgery. We report a case of carcinoid tumor of the lung. Clinical presentation and follow-up were uneventful. The 55 years old patient had got a surgical removal of a huge typical carcinoid tumor of the left lung. A left pneumonectomy with a mediastinal lymph node resection were performed. Thirteen years later, paraneoplastic acromegaly revealed a pulmonary and extrapulmonary recurrence of the tumor. We prescribed a chemotherapy regimen including Cisplatin and Etoposide. Endocrine paraneoplastic syndromes are related to mutations in specifically known genes. Several mutations may become a promising therapeutic target in the future. In the case of neuro-endocrine pulmonary tumors, authors described BCOR gene mutation as an oncogenic development inducer and an eventual generator of ectopic tumoral secretions. The more we get familiar with carcinoid tumor mutations, the closer we get to targeted therapy for non-resectable tumors.

Amenorrhea and elevated ßhuman chorionic gonadotropin of unknown origin: An unexpected location of choriocarcinoma.

Choriocarcinoma is a rare malignancy originating from trophoblastic cells that is known to arise from the placenta. In this report, we describe the case of a 28-year-old female who consulted for amenorrhea and elevated ßhCG mimicking a pregnancy of an unknown location, which ultimately turned out to be primary choriocarcinoma of the lung.

Improving the communicational skills in medicine using role play: a study about 28 students in the second cycle of medical studies.

BACKGROUND: Medical teaching is usually centred on an objective-based approach and influenced by a flexnerian approach inducing an emphasis on abilities and skills more than the know-how. The know-how is usually under taught and assessed. AIM: To assess the competencies in announcing bad news of students in medicine in addition to their satisfaction about the methods used which were serious games. METHODS: Students in the third-pregraduate year of medicine who performed their externship in a Department of Pathology of a university Hopsital were included during the year 2018-2019. Seven groups including 4 externs performing a 3-week-period were included. The training started with a pre-test, which consisted in an Objective-Structured-Clinical situation with a simulated patient and a evaluator with a checklist. The students were asked to perform a serious game, then they assisted to a lecture-based learning about the rules of announce of bad news. The serious game was screened then watched by all the students. After a debriefing session, the students were asked to fulfill a post test and a questionnaire-test. RESULTS: Twenty-eight students were included. The mean score accounted for 6,76 +/- 2,78 over 20 for the pre-test and 13,17 +/- 1,99 over 20 for the post-test. A significant difference was observed between the pre and post test (p<0.0001). All the students expressed their satisfaction. 27 students wished to repeat the experience. All the students put emphasis on the importance of the peer and auto-evaluation phase using videos. 14 students suggested to integrate this teaching method to the curriculum of the Faculty before their internship. CONCLUSION: Inspite of some limits, this study highlighted the improvement of the students' relational competences in addition to their satisfaction related to the use of role play in the acquisition of relational competences related to particular situation such as the announce of bad news.