The Quality Of Evidence In Preclinical Medical Education Literature: A Systematic Review.

INTRODUCTION: To practice effective evidence-based teaching, the need for well-designed studies that describe outcomes related to educational interventions is critical. The quality of the literate in basic science disciplines is unknown. The study objective was to conduct a systematic review of the literature to assess study design in articles describing innovations in preclinical medical education. METHOD: The authors searched PubMed for all articles published in English between 2000 and 2017 describing interventions in preclinical medical education related to anatomy, physiology, and biochemistry. Articles were scored using a modification of the Medical Education Research Study Quality Instrument. RESULTS: Of the 817 articles identified, 177 met final inclusion criteria (75 anatomy, 86 physiology, and 16 biochemistry). Laboratory, student-driven, and online activities were the most frequently reported. The average score for all papers was 15.7 (27 points possible). More than 80% reported experiences with one cohort of students and >97% involved only one institution. Only 25-49% of reports utilized a comparison (control) group. Proper statistical models for analysis of results were used in only 44-62% of papers. CONCLUSION: Manuscripts had a strong tendency toward single institutional studies that involved one cohort of students. The use of a control/comparison group when assessing effectiveness was seen in <50% and nearly all reported outcomes solely in the form of student satisfaction or factual recall/skill performance.

Clinical comparison of ocular and systemic findings in diagnosed cases of abusive and non-abusive head trauma.

PURPOSE: Child abuse is a leading cause of death in infants, which is often associated with abusive head trauma (AHT). The purpose of this retrospective analysis was to identify ocular and systemic findings in confirmed cases of AHT and compare them to a group of non-abusive head trauma (NAHT) patients. PATIENTS AND METHODS: A retrospective chart review of 165 patients with accidental and non-accidental trauma admitted between 2013 and 2015 to Children's Hospital and Medical Center in Omaha, NE, USA, was performed. Diagnosis of AHT was made after the analysis of ocular and systemic findings by various subspecialists. The NAHT group consisted of accidental trauma, abusive trauma without significant apparent head involvement on initial evaluation and unconfirmed AHT cases. RESULTS: Of the 165 presenting cases, 30 patients were diagnosed with AHT and 127 were diagnosed with NAHT. Ocular findings in AHT patients were significant for retinal hemorrhages (63%) and vitreous hemorrhages (37%), while NAHT patients had no ocular findings (p<0.001). Neuroimaging revealed subdural hemorrhages (SDHs) in 29 out of 30 AHT patients (97%) and in 27 out of 127 NAHT patients (21%). Seizures were present in 43% of AHT patients (n=13) and only in 8% of NAHT patients (n=10). CONCLUSION: AHT has statistically significant findings of retinal and vitreous hemorrhages. The absence of diffuse retinal hemorrhages, however, does not preclude the AHT diagnosis as more than one-third of AHT patients lacked retinal hemorrhages. SDHs, loss of consciousness and history of seizures also have high correlation with a diagnosis of AHT.