DREEM and beyond; studies of the educational environment as a means for its enhancement.

CONTEXT: Educational environment makes an important contribution to student learning. The DREEM (Dundee Ready Educational Environment Measure) questionnaire is a validated instrument for assessing educational environment, but used alone it has little value for identifying means of remediation of poor aspects of environment. AIMS: This study used qualitative analysis, in association with the DREEM questionnaire, to evaluate the educational environment across all five years of a large undergraduate medical school, and identify areas for change to enhance student experience. METHOD: The DREEM questionnaire was administered to 968 undergraduate students, together with an open question asking for suggested changes to current medical school practices. Items of concern highlighted by this study were further defined through qualitative analysis, using focus groups, email questionnaires and introduction of Stressful Incident reporting. RESULTS: Through responses to the open question, two items with low scores on the DREEM questionnaire were identified as requiring remediation. Focus groups and email questionnaires were used to define the underlying causes of poor scores, which varied by student year group. Stress resulting from experiences on clinical placement was highlighted by some students, but on closer investigation found to be rare. Remedial steps to improve student support are described. CONCLUSIONS: The qualitative data have substantially enhanced questionnaire interpretation, and allowed actions to address common causes for student dissatisfaction to be undertaken. This combined methodology is recommended to other institutions wishing to improve the educational environment, and thus the overall quality of educational provision.

Attitudes towards transferable skills in medical undergraduates.

CONTEXT: Changes to the style of medical teaching will place a greater responsibility on individual medical students to manage their own learning, highlighting the need for students to develop good so-called 'transferable' skills at an early stage in their undergraduate career. OBJECTIVES: To assess the attitudes of first year undergraduates towards transferable skills, and investigate the gender difference in these attitudes. To assess the contribution of their first year course to skills development. SUBJECTS: First year students, enrolled on a traditional-style course. METHOD: A questionnaire asking the students to consider: (a) the importance of named transferable skills for medicine; (b) their own ability in these areas; and (c) the influence of their first year course. RESULTS: All students, irrespective of gender, regarded transferable skills as very important to medicine, rating organizational skills and self-learning skills as most important. Overall, students have a high level of confidence in their own skills. Male students rated their overall level of skills more highly than women. In particular they rated their information handling, managing self-learning and technical skills more highly. Students feel that their first year course has enhanced their skills in most areas. CONCLUSIONS: Our results suggest that students will feel equipped to succeed in a learning system which places the onus on them to take responsibility for their own learning. They clearly believe that they have the necessary skills for independent learning. The study highlights the need to enhance students' self-evaluation skills.

Topiramate for drug-resistant epilepsies.

Topiramate is a new anti-epileptic drug with proven efficacy against partial seizures in adults. A retrospective assessment of the use of topiramate in drug-resistant childhood epilepsy was undertaken. Thirty-four children (median age of 10 years; range 2-18 years) were treated for a median of 9 months (range 6-18 months). The starting dose was 0.25-2.0 mg/kg/day increasing to a maximum of 13 mg/kg/day. Generalized seizures occurred in 27 patients, partial seizures in 15 and infantile spasms in two. Epilepsies were localization-related in 15 patients and generalized in 18. One patient had severe myoclonic epilepsy in infancy. Two patients had Lennox-Gastaut syndrome, five (two currently and three previously) had West syndrome and one had epilepsy with myoclonic absences. Twenty patients had a substantial (> 50%) reduction in seizure frequency; two of whom became seizure-free. Two-patients had an increase in seizures. Efficacy was seen against simple and complex partial seizures, generalized tonic-clonic seizures (primarily generalized), atonic and tonic seizures, myoclonic seizures and infantile spasms. There was no response in the one patient with myoclonic absence seizures. Adverse effects were reported in nine patients; appetite suppression occurred in five patients, behaviour disturbances in three, somnolence in two and poor concentration in one patient. Topiramate is efficacious in a wide spectrum of childhood epilepsies and is well tolerated.

Student feedback: influencing the quality of teaching in a paediatric module.

The aim of this study was to assess the impact of feedback on the quality of tutorials. Students completed structured feedback questionnaires on the perceived usefulness of teaching sessions. They perceived significant differences in the quality of tutorials delivered by experienced and inexperienced teachers (P < 0.01), although the differences tended to become less throughout the year. In the second year, teachers had advice from an experienced tutor in planning the sessions, in addition to receiving feedback from the students. During the second year, the students did not perceive any difference in the usefulness of these tutorials to them. The study showed that the quality of tutorials can be improved by passing structured feedback to the teacher, but that some skills training was also required to completely eliminate perceived differences.

A prospective comparison of central and peripheral vein access for parenteral nutrition in the newborn.

Central venous parenteral nutrition (PN) is frequently used in preterm infants. Although central venous catheters (CVC) permit reliable delivery of hypertonic solution, they may be associated with more serious complications than when a peripheral venous infusion is used. The aim of this randomised prospective study was to compare complications of central versus peripheral venous access using Silastic catheters identical expect for intravascular length. Eighty such devices were inserted, 38 central (CVC), 42 peripheral (PVC). Catheter life was not significantly different between groups: median (range) CVC 10d (2-25); PVC 7d (1-22) with no difference in overall complication rate. Although peripherally sited catheters tended not to function for as long as CVCs, they offer a useful alternative to central venous catheterisation.

Infusion techniques for perinatal home care.

Perinatal home infusion therapy is one service component of a comprehensive maternity care program. Physicians can prescribe perinatal home infusion therapies for various conditions, as an alternative to treatment in acute care settings. Maternal and fetal assessment is an integral part of the management of these therapies.

Comparison of two types of paediatric curricula.

Paediatrics is taught in the fourth year at two different hospitals in Leeds with a common examination at the end of the courses. Apparent discrepancies in the results obtained between students attached to the hospitals prompted a comparison of the results over a 2-year period. The paediatric curriculum in hospital A is taught in an integrated design with obstetrics/gynaecology whereas hospital B follows a more conventional discipline-based module. Significant differences were found with consistently lower results achieved from the integrated course. Further analysis of the students' abilities by assessment of two examinations in pathology where all students are taught in the same course revealed that students subsequently assigned to hospital A were significantly less able. This study highlighted the importance of further evaluation before assuming that the curriculum design is solely to blame for differences in final assessments. However, continued dissatisfaction with the integrated course design by both students and teachers still necessitates review of the curriculum design.

Perinatal home care: one entrepreneur's experience.

Nurses have responded to the entrepreneurial movement by entering into various nontraditional roles and starting their own businesses. This article describes the author's experience in establishing a perinatal home-care business. The characteristics of women and nurse entrepreneurs are discussed, as are the components of a business plan and how to manage a business.

Reversible changes in cerebral activity associated with acidosis in preterm neonates.

Computerized online EEG monitoring in ventilated preterm infants less than 32 weeks' gestation enabled evaluation of the effect of acidosis on cerebral function. All episodes of acidosis were found to be associated with changes in the levels of cerebral activity. In 21 of the 32 episodes, EEG activity returned to pre-acidosis levels after therapeutic intervention. The duration of EEG abnormality was related to the severity of acidosis. However, the time to recovery of the EEG after therapeutic procedures was not related to duration of the EEG change.

Renal function in hyperparathyroidism with complicating nephrocalcinosis.

Primary hyperparathyroidism in childhood is rare. Long-standing hypercalcaemia is reported to result in severe and irreversible renal damage. However, renal complications of hyperparathyroidism, particularly nephrocalcinosis are uncommon. We report a 12-year-old girl presenting after three years with extensive nephrocalcinosis and with rapid recovery of renal function.

The effect of pethidine on the neonatal EEG.

Thirty-two preterm infants were monitored with an on-line cotside EEG system for periods of up to nine days. Changes in the normal pattern of discontinuity of the EEG were seen in association with pethidine administration. The duration of the EEG suppression after pethidine administration was greatest after the first dose and progressively less with subsequent doses. It was not related to the gestational maturity or postnatal age at which the dose was given. This system of EEG analysis allowed recognition of this previously undescribed effect of pethidine on the neonatal EEG, and should have application to monitoring the effects of brain function of other drugs in routine neonatal practice.

A new system for cotside display and analysis of the preterm neonatal electroencephalogram.

Continuous EEG monitoring is considered to be a sensitive indicator of changes in cerebral function. This paper describes a system for cotside display and analysis of EEG discontinuity and amplitude in one-minute epochs, with provision for simultaneous recording of the EEG. It has been successfully used to monitor continuously the EEGs of more than 30 babies in a neonatal intensive care unit for periods of up to nine days. This system rapidly provides indications of changes in cerebral function, which can allow early intervention and possible prevention of morbidity.

The Bachelor of Medical Science research degree as a start for clinician-scientists.

A retrospective case-control study of Bachelor of Medical Science (BMedSc) graduates of the University of Queensland found that 20% were in full-time academic or research positions compared with only 0.9% in controls (P less than 0.001). A larger percentage graduated from the medical course with honours degrees compared with controls (47.8% vs 10.8%, P less than 0.001). At the time of the survey, a higher percentage held higher research degrees (17.3% vs 3.0%) or were working towards such degrees (12.0% vs 0%). As a group they had published more articles in refereed scientific journals and more books or chapters in books (P less than 0.001). The majority of BMedSc graduates (75%) stated that the programme was 'a worthwhile endeavour' and 73.8% said they would do the degree again if given the time over as a medical student. These results indicate that the BMedSc programme, if properly promoted, can be a valuable means of reversing the decline in clinician-scientist manpower.