Incorporating Older Adults as "Trained Patients" to Teach Advance Care Planning to Third-Year Medical Students.

BACKGROUND: Advance care planning (ACP) is a critical component of end-of-life (EoL) care, yet infrequently taught in medical training. OBJECTIVE: We designed a novel curriculum that affords third-year medical students (MS3s) the opportunity to practice EoL care discussions with a trained older adult in the patient's home. DESIGN: Volunteers were instructed as trained patients (TPs) to evaluate MS3s interviewing and communication skills. The MS3s received a didactic lecture and supplemental material about ACP. Pairs of MS3s conducted ACP interviews with TPs who gave verbal and written feedback to students. Student evaluations included reflective essays and pre/postsurveys in ACP skills. SETTINGS AND PARTICIPANTS: A total of 223 US MS3s participated in the curriculum. RESULTS: Qualitative analysis of reflective essays revealed 4 themes: (1) students' personal feelings, attitudes, and observations about conducting ACP interviews; (2) observations about the process of relationship building; (3) learning about and respecting patients' values and choices; and (4) the importance of practicing the ACP skills in medical school. Students' confidence in skills significantly improved in all 7 domains ( P < .001): (1) introduce subject of EoL; (2) define advance directives; (3) assess values, goals, and priorities; (4) discuss prior experience with death; (5) assess expectations about treatment and hospitalization; (6) explain cardiopulmonary resuscitation and outcomes; and (7) deal with own feelings about EoL and providers' limitations. CONCLUSIONS: The use of older adults as TPs in an ACP curriculum provides students an opportunity to practice skills and receive feedback in the nonmedical setting, thereby improving comfort and confidence in approaching these conversations for future patients.

Medical Student Interest in Flexible Residency Training Options.

BACKGROUND AND OBJECTIVES: Medical residents continue to experience high rates of burnout during residency training even after implementation of the 2003 Accreditation Council for Graduate Medical Education duty-hour restrictions. The purpose of this study is to determine medical student interest in flexible residency training options. METHODS: Researchers developed an 11-question survey for second through fourth-year medical students. The populations surveyed included medical students who were: (1) attending the 2015 American Academy of Family Physicians National Conference, the 2015 Family Medicine Midwest Conference, and (2) enrolled at University of Chicago Pritzker School of Medicine, University of Illinois College of Medicine at Chicago, Drexel University College of Medicine, and Case Western Reserve University School of Medicine. RESULTS: The survey was completed by 789 medical students. Over half of medical students surveyed indicated that they would be interested in working part-time during some portion of their residency training (51%), and that access to part-time training options would increase their likelihood of applying to a particular residency program (52%). When given the option of three residency training schedules of varying lengths, 41% of male students and 60% of female students chose a 60-hour workweek, even when that meant extending the residency length by 33% and reducing their yearly salary to $39,000. CONCLUSIONS: There is considerable interest among medical students in access to part-time residency training options and reduced-hour residency programs. This level of interest indicates that offering flexible training options could be an effective recruitment tool for residency programs and could improve students' perception of their work-life balance during residency.

An obesity remedy for diabetes.

For obese patients with type 2 diabetes, surgery may be the best bet.

PURLs: statins for patients with nonalcoholic fatty liver?

Although physicians often avoid prescribing statins for patients with nonalcoholic fatty liver, their use has been found to reduce cardiovascular morbidity and mortality- and to lower liver enzymes.

Does ultrasound training boost Year 1 medical student competence and confidence when learning abdominal examination?

OBJECTIVES: Learning to perform physical examination of the abdomen is a challenge for medical students. Medical educators need to find engaging, effective tools to help students acquire competence and confidence in abdominal examination techniques. This study evaluates the added value of ultrasound training when Year 1 medical students learn abdominal examination. METHODS: The study used a randomised trial with a wait-list control condition. Year 1 medical students were randomised into 2 groups: those who were given immediate ultrasound training, and those for whom ultrasound training was delayed while they received standard instruction on abdominal examination. Standardised patients (SPs) used a clinical skills assessment (CSA) checklist to assess student abdominal examination competence on 2 occasions - CSA-1 and CSA-2 - separated by 8 weeks. Students also estimated SP liver size for comparison with gold-standard ultrasound measurements. Students completed skills confidence surveys. RESULTS: Proficiency in abdominal examination technique acquired from traditional instruction boosted with ultrasound training showed no advantage at CSA-1. However, at CSA-2 the delayed ultrasound training group showed significant improvement. Students uniformly underestimated SP liver sizes and the estimates were not affected by ultrasound training. Student confidence in both groups improved from baseline to CSA-1 and CSA-2. CONCLUSIONS: Ultrasound training as an adjunct to traditional means of teaching abdominal examination improves students' physical examination technique after students have acquired skills with basic examination manoeuvres.

Vaginitis: case reports and brief review.

Vaginitis is the most frequently gynecologic diagnosis encountered by physicians who provide primary care to women. Accurate diagnosis can be elusive, complicating treatment. Most experts believe that up to 90% of vaginitis cases are secondary to bacterial vaginosis, vulvo-vaginal candidiasis, and trichomoniasis. The diagnosis of vaginitis is based on the patient's symptoms, the physical examination, the findings of microscopic examination of the wetmount and potassium hydroxide (KOH) preparations, and the results of the pH litmus test. Additional cultures and testing may be needed for difficult-to-diagnose cases.