Mind the gap: Learners' perspectives on what they learn in communication compared to how they and others behave in the real world.

OBJECTIVE: To explore the lack of the learners' voice at previous international conferences on communication in healthcare. METHODS: A group of medical students and recently qualified junior doctors were invited to give the learner's perspective on how communication skills are taught and how they are implemented in 'real life', at a 90min symposium at the EACH International Conference on Communication in Healthcare, 4th September 2008, Oslo. RESULTS: We attempt to bridge the gap between learning communication skills formally in the medical classroom and actually implementing these in the real world between doctors and patients from a learners' perspective. In making this transition we highlight obvious weaknesses and potential pitfalls, whilst also drawing attention to the successful strategies used in our respective medical schools. Four key areas are discussed: (1) using simulated patients, (2) learning in the clinical setting, (3) barriers to utilizing communication skills, (4) future directions. We have drawn upon the learning experiences from both undergraduate and postgraduate environments in the UK, the USA and Norway. CONCLUSION: Our experiences differed between universities from the same country, which widened across continents. The differences between how we behave in the classroom and how we are with real patients when unobserved have been highlighted; and we have attempted to explain why trainees sometimes modify their behavior in medical assessments with standardized patients for examinations as opposed to how we would perform on wards or in general practice. The teaching of communication skills will continue to develop over the forthcoming years. PRACTICE IMPLICATIONS: Integrating communication skills into medical school curricula is essential. Identifying enthusiastic doctors who are effective communicators and have the initiative to help develop this is vital. It may be beneficial to train simulated patients to react to students in a variety of different ways to reflect the diversity of true patient responses. In addition, having a better understanding of the multidisciplinary roles and rapidly developing technology would facilitate not only communication between health professionals but would also help optimize patient care.

Serum 1,25-dihydroxy vitamin D is inversely associated with body mass index.

BACKGROUND: Based on in vitro studies, it has been hypothesized that 1,25-dihydroxy vitamin D (1,25-vit D) may promote weight gain in humans, but previous studies have demonstrated conflicting results regarding the association between serum 1,25-vit D and body mass index (BMI). AIM OF THE STUDY: To evaluate the relation between serum 1,25-vit D and BMI. METHODS: Two thousand one hundred and eighty-seven subjects, recruited from a metabolic and medical lifestyle management clinic, were included in a cross-sectional study. BMI, 25-hydroxy vitamin D (25-OH-vit D) and 1,25-vit D were measured. The cohort was divided according to BMI in five groups (<25, 25-29.9, 30-34.9, 35-39.9 and >39.9 kg/m(2)). Statistical analyses were performed with multiple linear regression models. Age and gender were used as explanatory covariates. RESULTS: With increasing BMI group, there was a significant decrease in both serum 25-OH-vit D and 1,25-vit D (P<0.001). Those with BMI >39.9 kg/m(2) had 24% lower serum 25-OH-vit D levels and 18% lower 1,25-vit D levels than those with BMI <25 kg/m(2). CONCLUSIONS: There is an inverse association between BMI and the serum levels of 25-OH-vit D and 1,25-vit D. This makes it highly unlikely that high levels of circulating 1,25-vit D contribute to the development of obesity.