Exploring simulation in the internal medicine clerkship.

BACKGROUND: Simulation-based medical education has been shown to produce substantial educational benefits; however, the integration and effectiveness of high-fidelity simulation within the internal medicine (IM) clerkship remains largely unexplored. Investigators sought to determine the effectiveness of simulation in improving student confidence in acute coronary syndrome (ACS) and the Advanced Cardiac Life Support (ACLS) curriculum. Secondary goals included examining student perceptions of the role of simulation in medical education. METHODS: Investigators implemented a formative high-fidelity simulation curriculum in the IM clerkship at a large teaching institution. Third-year medical students enrolled in the IM clerkship between January and June 2014 attended a simulation course during their ambulatory block. Following a 2-hour session, participants completed a 17-item questionnaire. Descriptive statistical analyses and a thematic qualitative analysis were performed. Integration of high-fidelity simulation within the internal medicine clerkship remains largely unexplored RESULTS: The response rate was 100 per cent (n = 43). Students reported improvements in their ability to identify and manage ACS and ACLS before and after the simulation course: 93 per cent felt that simulation boosted their self-confidence in performing these tasks on a real patient; 86 per cent reported receiving useful feedback during the training sessions; 98 per cent agreed that their experience was enjoyable; and 95 per cent would recommend this course to other students. CONCLUSIONS: Internal medicine (IM) clerkship students participating in our pilot course demonstrated increased confidence in identifying and managing pathologies associated with ACS and arrhythmias. Students viewed simulation as an engaging and useful activity, desiring additional training sessions.

Decreased hypothalamic and adrenal angiotensin II receptor expression and adrenomedullary catecholamines in transgenic mice with impaired glucocorticoid receptor function.

In transgenic mice expressing an antisense mRNA against the glucocorticoid receptor (GR), which partially blocks GR expression, impaired glucocorticoid feedback efficacy is accompanied by reduced hypothalamic corticotropin-releasing hormone (CRH) and vasopressin (AVP) activity and reduced peripheral sympathetic tone, indications of a shift in the balance of hypothalamic CRH and sympathetic regulation. As angiotensin II (Ang II) regulates CRH, AVP and sympathetic activity, we studied the expression of Ang II receptors in the hypothalamus and adrenal gland of GR transgenic and wild-type mice, adrenal catecholamines and mRNA for their rate-limiting enzyme, tyrosine hydroxylase (TH). We found that transgenic mice expressed significantly less numbers of Ang II AT(1) receptors in the hypothalamic paraventricular nucleus and median eminence, lower numbers of AT(2) receptors in supraoptic and paraventricular nuclei and lower numbers of AT(2) receptors in the adrenal medulla when compared with wild-type controls. The expression of TH mRNA and the concentration of adrenomedullary epinephrine and norepinephrine were also lower in transgenic mice when compared with wild-type controls. Decreased hypothalamic and adrenal Ang II receptor stimulation as a result of decreased GR expression may explain the decreased hypothalamic CRH and AVP and decreased adrenomedullary and sympathetic activities in this model.