Introducing first-year medical students to clinical practice by having them "shadow" third-year clerks.

BACKGROUND: A new clinical experience was developed in which 1st-year medical students (MS1s) shadowed 3rd-year medical students (MS3s) as they performed their usual clerkship duties for 6 half-days, 1 in each clerkship. Researchers wanted to determine whether this was a worthwhile experience for MS1s and what they learned. DESCRIPTION: MS1s documented their experiences shadowing MS3s in confidential responses to open-ended questions on a course Web site. Researchers conducted a qualitative analysis of student comments. EVALUATION: The analysis showed the students to be perceptive, thoughtful observers and yielded 5 broad categories of learning. Students learned about the practice of medicine, the process of becoming a doctor, providers of health care, the nature of real patients, and the procedures of medicine. Students rated the experience as "excellent." CONCLUSION: Shadowing an MS3 in clinical settings is a beneficial and valued learning experience for beginning medical students.

The challenge of teaching rehabilitative care in medical school.

Rehabilitative care has gained importance because the population is aging, and improved acute and chronic medical care saves and prolongs lives but leaves some patients with temporary or permanent physical impairments. However, despite its importance, the teaching and learning of rehabilitative care in medical school lag behind medical education relating to acute and chronic care. The authors analyze the broad scope of rehabilitative care and the need to include it in the medical school curriculum. They also discuss advantages for students and their patients of learning rehabilitative care in the undergraduate curriculum and suggest methods to improve teaching it.

Topical treatment of sclerodermoid chronic graft vs. host disease.

Sclerodermoid chronic graft vs. host disease is a severe adverse immunologic reaction following allogeneic bone marrow transplantation, with deposition of collagen in the skin and possibly other soft tissues, resulting in loss of range of motion and functional capabilities. We present a case of a 14-yr-old girl who received a matched, unrelated donor bone marrow transplant for myelodysplastic syndrome complicated by sclerodermoid chronic graft vs. host disease, causing severe contractures of the shoulders, elbows, wrists, fingers, hips and knees. This case report and review of the literature regarding chronic graft vs. host disease suggest that a controlled trial of a multimodality therapeutic approach, including topical treatment, is warranted to determine whether this approach improves function in these patients.

Antegrade continence enema for adult neurogenic patients.

Urologists often care for adult patients with neurogenic bladder. Adult patients with neurogenic bladder may have concommitant neurogenic bowel. Neurogenic bowel may be refractory to conservative management. The Malone antegrade continence enema (ACE) has been successful in pediatric neurogenic bowel. Little experience has been described among adult neurogenic bowel patients. We describe the technique of the ACE and review our results for adult neurogenic bowel.