A case study of the implementation of a competency-based curriculum in a Caribbean teaching hospital.

OBJECTIVE: Several teaching hospitals are currently modifying their curriculum to comply with the changing demands in medical education. As a result, we decided to evaluate whether a competency-based curriculum implemented in a Caribbean teaching hospital fulfilled the requirements as defined by the CanMEDS framework. METHODS: We made use of a triangulation method in the survey to obtain information on the educational process. Two separate methods were used consisting of site visits by visiting professors and a medical educator. The focus was on the structure, content and assessments of the educational activities. RESULTS: Major recommendations included increased involvement of medical specialists in the educational activities in the clinical workplace. There was need for improvement of communication between medical specialists, patients, nurses, trainees and residents. Overall, improvements were observed in the structure of clinical rotations and content of the training programme. CONCLUSION: The implemented assessment programme provided necessary information for effective evaluation of the competency-based curriculum. We were able to identify new and feasible methods for improving the curriculum in our educational setting.

Urinary tract infection in male general practice patients: uropathogens and antibiotic susceptibility.

OBJECTIVES: To evaluate uropathogens and their antibiotic susceptibility in male general practitioner (GP) patients presenting with an uncomplicated urinary tract infection (UTI). MATERIAL AND METHODS: A population-based study was conducted among males, 18 years and older, general practice patients, who had symptoms indicative of an uncomplicated UTI. A UTI was defined as >/=10(3) colony-forming units/mL (CFU/mL). The etiology of the infection, antimicrobial susceptibility, and treatment strategies used by the GP were determined. RESULTS: Escherichia coli was most frequently isolated (48%), followed by other enterobacteriaceae (24%) and enterococci (9%). The etiology of infection was age-dependent; E. coli was more frequently isolated in younger patients and Pseudomonas aeruginosa in the elderly. The overall susceptibility rates were low for amoxicillin (63%) and trimethoprim (70%), and high for fluoroquinolones (91%) and amoxicillin-clavulanic acid (90%), which is similar to susceptibility rates in females with UTIs from the same population. Antibiotics were prescribed to 59% of the males with symptoms of UTI. Fluoroquinolones were given to 33% of the patients and trimethoprim-sulfamethoxazole to 24%. No difference in antibiotic prescription, nor in duration of therapy, was found between the different age groups. CONCLUSIONS: In the male presenting with complaints of an acute uncomplicated UTI at the GP, E. coli, followed by other Gram-negative bacteria were the most frequently isolated uropathogens. Susceptibility rates in uncomplicated male and female UTIs were similar, indicating that data from UTI susceptibility studies in females from the same geographic region can be useful in the choice of empirical therapy in males.

[A spontaneous haemarthros in a postpartal woman: a case of acquired haemophilia A]. / Een spontane gewrichtsbloeding bij een vrouw post partum: een geval van verworven hemofilie A.

A woman aged 35 years presented with a haemarthros of the left elbow 6 months after her first parturition due to acquired haemophilia A. The bleeding episodes were mild and treated with recombinant activated factor VII. Because of the mild bleeding tendency and the chance of spontaneous remission it was decided to withhold immunosuppressive treatment. During the course of one year, the factor VIII level and the activated partial thromboplastin time (APTT) normalized and the autoantibodies disappeared. Four years after her first parturition, she had an uncomplicated pregnancy and the postpartum period was uneventful. Up to fourteen months postpartum, there are no signs of recurrence of the acquired haemophilia A. Acquired haemophilia A post partum usually presents in the first 3 months post partum. Frequently presenting symptoms are haemorrhages post partum, menorrhagia, soft-tissue haemorrhages and haemorrhages during surgical procedures. As a rule, the haemorrhages are slight. The titers of blocking antibodies are low in comparison with the titers in congenital haemophilia A.