Learning Activities and Third-Year Medical Student Ratings of High Quality Teaching Across Different Clerkships.

OBJECTIVE: To identify and compare learning activities that students associate with high quality teaching across clerkships. METHODS: For six months, 110 third year medical students recorded data on learning activities and teaching quality using personal digital assistants (PDAs) during five different required clinical clerkships. Univariate and multivariate analyses were performed to assess the association between learning activities and student ratings of high teaching quality. RESULTS: 11,450 teaching interactions were recorded. Univariate analysis revealed that feedback was associated with perceptions of high quality teaching in all clerkships. Proposing a plan, formulating an assessment and giving an oral case presentation were associated with high quality teaching in 80% of the clerkships (p < 0.01). Multivariate analysis demonstrated that receiving high quality feedback was an independent predictor of student ratings of high quality teaching for all clerkships. CONCLUSION: Receiving high quality feedback is the learning activity most strongly associated with students' ratings of high quality teaching across four different clerkships.

Beneficial effects of flexible insulin therapy in children and adolescents with type 1 diabetes mellitus.

The purpose of this study was to determine the feasibility of a flexible multiple daily insulin (FMDI) regimen in routine pediatric diabetes care by comparing HbA(1c), body mass index (BMI), and episodes of severe hypoglycemia (SH) before and after initiation of FMDI therapy. Data from 44 patients (2-16 years old), on a conventional insulin (CI) regimen, were collected during quarterly diabetes clinic visits. These patients were transitioned from CI to FMDI regimen: pre-meal lispro (bolus) and once or twice daily Humulin Ultralente with or without bedtime Humulin NPH as the basal insulin. There was a significant improvement in HbA(1c) in prepubertal (9.3%+/-1.3% vs. 8.0%+/-1.1%, p<0.002) and pubertal subjects (9.2%+/-1.0% vs. 8.2%+/-0.9%, p<0.001). Pubertal subgroup demonstrated an increase in BMI (21.3+/-3.1 vs. 22.7+/-3.2 kg/m(2), p<0.0001) after one year. The rate of SH was decreased in both prepubertal ( p<0.01) and pubertal ( p<0.05) groups of patients on FMDI therapy. The use of FMDI in a general pediatric diabetic population is a feasible therapeutic option for maintenance and possible improvement of glycemic control. It may effectively decrease the HbA(1c), and reduce hypoglycemic episodes, without producing an abnormal increase in BMI.