Spaced education improves the retention of clinical knowledge by medical students: a randomised controlled trial.

PURPOSE: Medical knowledge learned by trainees is often quickly forgotten. How can the educational process be tailored to shift learning into longer-term memory? We investigated whether 'spaced education', consisting of weekly e-mailed case scenarios and clinical questions, could improve the retention of students' learning. METHODS: During the 2004-5 surgery clerkships, 3rd-year students completed a mandatory 1-week clinical rotation in urology and validated web-based teaching programme on 4 core urology topics. Spaced educational e-mails were constructed on all 4 topics based on a validated urology curriculum. Each consisted of a short clinically relevant question or clinical case scenario in multiple-choice question format, followed by the answer, teaching point summary and explanations of the answers. Students were randomised to receive weekly e-mailed case scenarios in only 2 of the 4 urology topics upon completion of their urology rotation. Students completed a validated 28-item test (Cronbach's alpha = 0.76) on all 4 topics prior to and after the rotation and at the end of the academic year. RESULTS: A total of 95 of 133 students (71%) completed the end-of-year test. There were no significant differences in baseline characteristics between randomised cohorts. Spaced education significantly improved composite end-of-year test scores (P < 0.001, paired t-test). The impact of the spaced educational e-mails was largest for those students who completed their urology education 6-8 and 9-11 months previously (Cohen's effect sizes of 1.01 and 0.73, respectively). CONCLUSION: Spaced education consisting of clinical scenarios and questions distributed weekly via e-mail can significantly improve students' retention of medical knowledge.

Development and initial evaluation of a novel urology curriculum for medical students.

PURPOSE: After the development and implementation of a novel urology curriculum for medical students we evaluated urological learning by medical students using a validated measure of learning in the 4 clinical areas of benign prostatic hyperplasia, erectile dysfunction, prostate cancer and prostate specific antigen screening. MATERIALS AND METHODS: Third year medical students completed an online validated pre-test and post-test immediately before and after the mandatory 1-week clinical rotation in urology. Online pre-surveys and post-surveys were also administered. Overall student participation was 90% (37 of 41) with 63% of students (26 of 41) completing all 4 tests and surveys. RESULTS: Student overall test scores improved significantly upon completion of the 1-week clinical rotation in urology (p <0.001). A trend toward increased learning by male students was identified (p = 0.07). Significant variation in exposure to outpatient clinics and in the performance of physical examination skills was observed among the different teaching sites. CONCLUSIONS: This study demonstrates significant learning by medical students during their 1-week clinical rotation in urology. Further data are needed to confirm the trend toward increased learning by males and elucidate its etiology. Scheduling changes have been implemented to address the inconsistencies across clinical sites.

Development of validated instrument to measure medical student learning in clinical urology: a step toward evidence based education.

PURPOSE: To date published efforts to assess and improve medical student learning in urology have been limited due to the lack of an assessment tool with which to measure student learning. We report the development of a validated measure of medical student learning in urology. MATERIALS AND METHODS: Four core topics in clinical urology were selected as the focus of the test development, namely prostate cancer, screening with prostate specific antigen, benign prostatic hyperplasia and erectile dysfunction. Detailed curricula and multiple choice questions were created for each topic. Content validity of the curriculum and 28 item examination was established by a panel of 2 urologists and 2 medical physicians. Instrument reliability was determined by administering the test on line to third-year surgery students. Test construct validity was established through its administration to 19 urology residents and attending physicians. RESULTS: Reliability of the 28-item test instrument was measured by Cronbach's alpha at 0.76 and its 1-week test-retest reliability was 0.72. All urology experts performed well on the test. Mean urological expert scores were significantly higher than mean student post-test scores (24.9 +/- 2.1 vs 17.8 +/- 3.8, 2-tailed t test p <0.001). Urological experts with greater urological training had higher scores than those with less residency training. CONCLUSIONS: This study documents the development of a validated measure of medical student learning in urology. This validated instrument has the potential to improve educational quality control at medical schools and facilitate the development of effective, evidence based teaching methods.

Multiple presynaptic and postsynaptic sites of inhibitory modulation by myomodulin at ARC neuromuscular junctions of Aplysia.

The functional activity of even simple cellular ensembles is often controlled by surprisingly complex networks of neuromodulators. One such network has been extensively studied in the accessory radula closer (ARC) neuromuscular system of Aplysia. The ARC muscle is innervated by two motor neurons, B15 and B16, which release modulatory peptide cotransmitters to shape ACh-mediated contractions of the muscle. Previous analysis has shown that key to the combinatorial ability of B15 and B16 to control multiple parameters of the contraction is an asymmetry in their peptide modulatory actions. B16, but not B15, releases myomodulin, which, among other actions, inhibits the contraction. Work in single ARC muscle fibers has identified a distinctive myomodulin-activated K current as a candidate postsynaptic mechanism of the inhibition. However, definitive evidence for this mechanism has been lacking. Here, working with the single fibers and then motor neuron-elicited excitatory junction potentials (EJPs) and contractions of the intact ARC muscle, we have confirmed two central predictions of the K-current hypothesis: the myomodulin inhibition of contraction is associated with a correspondingly large inhibition of the underlying depolarization, and the inhibition of both contraction and depolarization is blocked by 4-aminopyridine (4-AP), a potent and selective blocker of the myomodulin-activated K current. However, in the intact muscle, the experiments revealed a second, 4-AP-resistant component of myomodulin inhibition of both B15- and B16-elicited EJPs. This component resembles, and mutually occludes with, inhibition of the EJPs by another peptide modulator released from both B15 and B16, buccalin, which acts by a presynaptic mechanism, inhibition of ACh release from the motor neuron terminals. Direct measurements of peptide release showed that myomodulin also inhibits buccalin release from B15 terminals. At the level of contractions, nevertheless, the postsynaptic K-current mechanism is responsible for much of the myomodulin inhibition of peak contraction amplitude. The presynaptic mechanism, which is most evident during the initial build-up of the EJP waveform, underlies instead an increase of contraction latency.

Seminal plasma induces programmed cell death in cultured peripheral blood mononuclear cells.

Immunosuppressive properties of seminal plasma inhibit the recovery of infectious HIV from semen, and led to the view early in the pandemic that semen HIV was transmitted principally by infected semen cells. More recent studies have revealed significant titers of HIV RNA in seminal plasma, however, even from men receiving successful antiviral therapy. Thus, studies of infectious HIV in seminal plasma are important to understanding sexual transmission and response to therapy. The present studies were undertaken to determine whether seminal plasma immunosuppression is mediated by the induction of programmed cell death (PCD). Peripheral blood mononuclear cells (PBMCs) were cultured without or with phytohemagglutinin and seminal plasma from normal donors, or men postvasectomy, or seminal vesicle protein collected at surgery. PBMC survival was measured at 3, 6, and 18 hr of culture; cells were examined for evidence of PCD by uptake of the fluorescent dye YO-PRO, and for fragmented nuclear DNA by the TUNEL assay. Approximately 90% of PBMCs cultured with seminal plasma from intact or vasectomized men were lost during 18 hr of culture; seminal vesicle protein did not induce cell loss. PCD assays were positive for PBMCs exposed to the seminal plasma, and negative for PBMCs cultured with seminal vesicle protein. Serum was not required for PCD induction. A 3-hr pulse with seminal plasma was sufficient to initiate PCD. These findings indicate that PCD induction accounts for the cytotoxic properties of semen, that the PCD is not the result of semen amine oxidases, and either that substances produced by seminal vesicles only at ejaculation, or by the prostate, are responsible for PCD induction.

Real time MRI-ultrasound image guided stereotactic prostate biopsy.

To report a technique for target directed transperineal ultrasound guided biopsy using high resolution endorectal MRI images Ultrasound fusion. Two patients presented after external beam irradiation for prostate cancer with a rising PSA. An Endorectal MRI using a 1.5 Tesla scanner was obtained. Subsequently a Transrectal Ultrasound guided biopsy was performed. The Ultrasound probe was fixed to a stepper-stabilizer to provide a reference coordinate system for stereotaxic needle biopsy needle placement. The MRI image set was fused to the Ultrasound images in real time. Abnormal areas determined in the MR images were targeted for biopsy. Recurrent prostate carcinoma was detected pathologically in 3 of 4 stereotactic biopsies. Abnormal areas suspicious for cancer detected on T1 weighted images obtained in a strong field Endorectal MRI scan can be targeted for stereotactic biopsy using Transrectal Ultrasound. This image guide technique may be very useful in directing biopsies.