Patients as teachers: an integrated approach to teaching medical students about the ambulatory care of HIV infected patients.

Our experience with medical students in a large inner city hospital left us concerned that students' fears affect their ability to learn about and care for HIV-positive people. Therefore, we decided to create an environment in which the students could feel safe exploring their own attitudes and feelings about HIV. To accomplish the goal, we developed a curriculum in the ambulatory care of HIV-positive people. We recruited and trained patients from an HIV support group at our hospital to work with students in one-on-one sessions to teach interviewing, physical exam, and patient counseling skills. As part of a 4-week ambulatory clerkship for third year students we developed a minicourse which included four sessions with didactic and experiential components. The first week consisted of an orientation and group discussion in which patients told the students about what its like to live with HIV. During each of the following three sessions, students met with a preceptor to learn about HIV in an ambulatory care setting. The didactic session was followed by one-on-one student/patient encounters in which students practised skills discussed that week and patients gave them feedback. At the close of the day, the entire group reconvened to discuss what had happened. As a result of this integrated approach, students are experiencing the relational aspects of providing medical care, often for the first and only time. In the process they are learning to take good social histories and are learning how patients with HIV relate to and sometimes reorganize their family and social support systems. Students have the opportunity to get to know, in depth, a relatively healthy person who is living with a chronic, stigmatizing illness. Both patients and students are talking to each other on a level of intimacy that is rare in the training environment. Patients express a new appreciation of their own role and power in the relationship and a new insight into the struggles of the provider. Faculty experience a renewed commitment to the importance of creating an environment where the students can discover for themselves the joy of the connection between doctor and patient. Students have an opportunity to relate to patients not as pathology, but as people with lives before and beyond the medical system. This model is practical and may be useful in teaching about other chronic diseases in the ambulatory setting.

Rapid and sensitive detection of citrinin production during fungal fermentation using high-performance liquid chromatography.

A rapid and sensitive assay was developed for the detection of the mycotoxin citrinin by reversed-phase chromatography. Citrinin was eluted from a radical-compression C18 column with a retention time of 3.86 min (flow-rate of 2.5 ml/min) with acetonitrile-water-acetic acid (40:59:1) containing tetrabutylammonium phosphate (0.0025 M) [corrected]. Comparative analysis revealed fluorescence detection to be 100 times more sensitive than detection by conventional ultraviolet absorbance. The fluorescence excitation and emission maxima of citrinin were 330 and 500 nm, respectively. The assay was linear over the concentration range between 0.01-100 micrograms/ml. Recovery experiments conducted by addition of citrinin to fermentation samples, revealed the assay quantitation efficiency to be 91-102%. Assay utility was demonstrated by using an Aspergillus niveus culture, propagated in complex liquid medium. Citrinin production was detected as early as 20 h following inoculation and increased dramatically when the culture entered the stationary phase of growth, analogous to other secondary metabolites. Unlike previously reported methods, this procedure has the advantage of enabling the direct quantitative analysis of citrinin in crude microbial fermentations without sample extraction.