Causes and characteristics of medical student referrals to a professional behaviour board.

OBJECTIVES: To describe the nature of unprofessional behaviour displayed by medical students, as well as the characteristics of students referred to the professional behaviour board. METHODS: A descriptive mixed methods approach was taken, in which qualitative data on unprofessional behaviour, as well as quantitative data on the demographics of referred students were collected during the study period between June 1, 2009 and January 1, 2014. In order to compare the referred students with the total student population, data on gender, nationality and phase in the curriculum of the total student population, collected from the student administration desk, were also used. RESULTS: In the study period, a total of 107 referrals were reported, concerning 93 different students (3% of the total student population). Sixty-five of the 107 referrals (61%) concerned male students. Thirty referrals (28%) concerned non-Dutch students. Most referrals (71%) occurred during clinical rotations. The referrals were equally distributed over three professional behaviour domains: dealing with oneself, dealing with others, and dealing with tasks/work. 'Withdrawn behaviour' was reported 17 times, 'insufficient Dutch language proficiency' 14 times, 'impertinent emails' 9 times and 'placing privacy-sensitive photos on the internet' 3 times. CONCLUSIONS: Although only a minority of students are referred to a professional behaviour board, this study shows that student characteristics such as gender and nationality may correlate to a higher incidence of unprofessional behaviour. Further explanatory and exploratory research is needed to unravel this relationship, and to study the influence of curriculum reforms on these relationships, respectively.

[Medical Officer Ellerman, lecturer in pharmacology and editor of the Nederlandsch Lancet]. / Officier van Gezondheid Ellerman. Docent geneesmiddelleer en redacteur van het Nederlandsch Lancet.

George Lievin Henri Ellerman (1817-1849) followed his medical-military training at the Military Medical Training College (RKMG) in Utrecht, the Netherlands, from 1835 to 1839, and gained his PhD from Leiden University in 1841. From 1843 to 1849 he was a lecturer in pharmacology at the RKMG. He was one of the first editors of the Nederlandsch Lancet. Together with his fellow board members Donders and Jansen he set this journal on a new course. Due to the new mix of scientific and practice-oriented articles the journal developed into the most important medical scientific journal in the Netherlands; it was however not among the journals that merged to become the Nederlands Tijdschrift voor Geneeskunde [Dutch Journal of Medicine]. In 1846 Ellerman published a Dutch translation of Friedrich Oesterlen's textbook of pharmacology 'Handbuch der Heilmittellehre'. This book was considered to be a complete and lucid survey of pharmacology and a major step towards a more scientific pharmacology. After his death at the age of 32, he was remembered as a good scientist and dedicated, hardworking lecturer.

Obstructive jaundice and hematemesis: two cases with unusual presentations of intra-abdominal tuberculosis.

Extrapulmonary tuberculosis (TB) is notorious for its many manifestations, which can lead to delayed diagnosis and treatment. In particular, abdominal tuberculosis is easily overlooked because the incidence is low and because it can mimic common noninfectious abdominal syndromes. We describe here a 37-year-old Moroccan man presenting with obstructive jaundice and a 42-year-old man originating from the Philippines who presented with recurrent hematemesis due to portal hypertension. In both patients, a retroperitoneal mass was found and tuberculosis was first diagnosed after a diagnostic laparotomy. Tuberculosis should be included in the differential diagnosis of intra-abdominal mass lesions, especially in persons originating from regions where tuberculosis is endemic. Invasive procedures are often required to obtain adequate diagnostic samples.

Alexithymia does not predict the persistence of medically unexplained physical symptoms.

BACKGROUND: Alexithymia is thought to be associated with the development of medically unexplained physical symptoms (UPS). So far little research has been published on alexithymia as a risk factor for the persistence of UPS. OBJECTIVE: To determine the clinical outcome in UPS patients and to study the relative importance of alexithymia in predicting that outcome. METHODS: A follow-up study was conducted among general medical outpatients with UPS. Patients underwent extensive examinations at baseline and were reassessed after a mean 61-week interval. Outcome of the UPS and general health perception at follow-up were used as major outcome variables. RESULTS: Outcome of the UPS and general health perception at follow-up were not strongly associated with each other. More than half (63%) of the patients reported improvement of their initial symptoms, but only 38% of the patients considered themselves at follow-up to be in good health. UPS outcome was predominantly predicted by the duration of the UPS and the number of additional physical symptoms at baseline. General health perception at follow-up was predominantly predicted by the general health perception at baseline and the number of additional physical symptoms and pain experience at baseline. The explained variance of the general health perception was three times as high as the explained variance for the UPS outcome. Alexithymia was not associated with any of the two outcome variables. CONCLUSIONS: Outcome of the UPS and general health perception at follow-up are not strongly associated and are predicted by different variables. Alexithymia, however, is not an important predictor for the outcome in the majority of UPS patients.

Causes of hyponatremia in the Departments of Internal Medicine and Neurosurgery.

BACKGROUND: Hyponatremia is a common electrolyte disorder in hospitalised patients. The distribution of the various causes of hyponatremia has been studied in hospitalised patients in general, but little is known about the distribution in specific departments. We performed a prevalence study on the aetiology of hyponatremia in two departments in our hospital, namely, the Department of Internal Medicine and the Department of Neurosurgery. METHODS: Consecutive adult patients with hyponatremia (serum sodium concentration