Assessing professionalism in early medical education: experience with peer evaluation and self-evaluation in the gross anatomy course.

INTRODUCTION: As today's healthcare model moves toward more streamlined and corporate industrialism, it is our responsibility, as doctors, to ensure the integrity of medicine's foundation in professionalism. The erosion of professional values not only creates a climate of animosity, but reverberates negatively to impact the development of students, who model their behaviour after those they most respect. This hazard has spurred an evaluation of medical school curricula, with a new emphasis on professionalism in the philosophy of medical education. Courses such as Gross Anatomy that, in the past, offered "pure content," are now being used to teach and evaluate professionalism. The goal of this study was to determine if peer evaluation and self-evaluation used in conjunction and implemented early in the medical curriculum, can serve as useful tools to assess and provide feedback regarding professional behaviour in first-year medical students. MATERIALS AND METHODS: From 1999 to 2003, students at Mayo Clinic College of Medicine evaluated themselves and their peers during the Gross and Developmental Anatomy Course. Numerical evaluations and written comments were statistically analysed within established categories of professionalism and correlated with academic performance, gender, and peer rating and self-rating. RESULTS: The majority of written comments pertained to inter-professional respect, responsibility, and excellence. Students who gave higher peer evaluation and self-evaluation scores provided more positive comments, and students performing well in the course provided more positive comments about their peers and themselves than did those struggling academically. Students consistently rated their peers higher than themselves, and male students rated themselves higher than did female students. CONCLUSIONS: Implementing peer evaluation and self-evaluation early in the medical curriculum is a valuable exercise in teaching first-year medical students assessment skills when evaluating their behaviour, as well as the behaviour of their colleagues.

Animated PowerPoint as a tool to teach anatomy.

Anatomy is a visual science. For centuries, anatomic information has been conveyed through drawings that have been presented to students through every available medium. The projection of animated images from a computer is a medium that offers great promise in effecting improved communication of anatomic information. Using Microsoft PowerPoint software, we have developed animated presentations for all of our lectures in Gross and Developmental Anatomy. As a starting point, we scan pen-and-ink drawings to create a digital image. The image may be edited and manipulated in an image processing program. Next, the image is imported into a PowerPoint slide where it is labeled and otherwise enhanced (arteries overlaid with red color, veins in blue, etc.) and the enhancements are animated, as we describe here step by step. For the lecture, the file is loaded on a server that is accessible through a network from a computer in the lecture hall. The output is directed to a video projector and the PowerPoint presentation is projected in the "Slide Show" mode. We use a wireless mouse that allows us to control the presentation from anywhere in the room. Before the lecture, students are provided with the same unlabeled drawings as handouts, and during the lecture the students are actively engaged in labeling the drawings and making related notes. After the lecture, the file is saved in HTML format and posted on our course web site where students can access the slides. Evaluation by the students at the end of the course demonstrated that this style of presentation was very favorably received.

[Accuracy of pretherapeutic diagnosis of early invasive cervical carcinoma]. / Trafnosc rozpoznania przedterapeutycznego raka wczesnoinwazyjnego szyjki macicy.

In 114 women treated at the First Department of Gynecology Medical Academy in Cracow, between the years 1967-1985 there was compared the agreement of the histological examination of a colposcopy directed biopsy specimen with the histological examination of the operative specimen in cervical carcinoma with early invasion. In 103 cases (90.4%) histological examination of a guided biopsy specimen of early invasive carcinoma confirmed the results of the operative specimen. In 1 case the operative specimen confirmed severe dysplasia as in the guided biopsy specimen early invasive carcinoma. In 10 cases the guided biopsy specimen confirmed CIN 3 (6 cases severe dysplasia and 4 cases ca in situ), the results of operative specimen confirmed early invasive carcinoma. In 5 out the above 10 cases, the results were altered due to a 3-8 mouth delay of surgery. The divergence regards to the remaining 5 cases (4.4%). This high agreement of histological examination of a colposcopy guided biopsy specimen and operative specimen shows a significant accurate meaning of colposcopy in confirming early lesions of cervical carcinoma.

Steroid-induced proteins secreted by the uterus of the guinea pig.

This study was conducted to identify proteins synthesized and secreted de novo by the guinea pig uterus. Uterine samples were obtained from cycling, late-pregnant as well as ovariectomized and steroid-treated guinea pigs and cultured with either L-[3H]leucine or L-[35S]methionine. Two-dimensional SDS-PAGE of culture medium followed by fluorography was used to determine proteins synthesized and secreted de novo during a 24-h incubation period. Two complexes of estradiol-stimulated proteins (ESP) were detected. Each complex was composed of 5-7 unique proteins with slightly different isoelectric points. The higher molecular-weight complex had a molecular weight of 65,000-60,000 and an isoelectric point range of 5.2-6.1. The lower molecular-weight complex had a molecular weight of 60,000-55,000 and a similar range of isoelectric points. The two complexes of ESP were not observed in medium of explants from animals that received placebos, were late-pregnant, or were treated with progesterone only. Progesterone administered in combination with estradiol enhanced production of both complexes of ESP to similar degrees. Neither complex of ESP was secreted by the explant culture in the presence of tunicamycin, suggesting that the proteins are glycosylated. These findings demonstrate that the uterus of the guinea pig produces two unique complexes of proteins in response to estradiol stimulation, and all results are consistent with the hypothesis that ESP are contained in the carbohydrate-rich secretory granules of endometrial gland cells.

Human relaxin inhibits division but not differentiation of 3T3-L1 cells.

For the first time, we demonstrate here the ability of human relaxin to block cell division. During the induction of differentiation of 3T3-L1 fibroblasts to adipocytes, the cells typically undergo two rounds of cell division followed by accumulation of lipid droplets and expression of insulin-stimulated glucose transport as the cells attain the adipocyte phenotype. Human relaxin added during induction had no effect on the development of the adipocyte phenotype or insulin-stimulated glucose transport. However, it blocked cell division at a half-maximal concentration of 1.25 nM, well within physiological range. This could be reversed by the addition of antibodies specific for human relaxin. Thus relaxin joins a select number of hormones with growth inhibitory properties such as transforming growth factor-beta (TGF beta) and mammastatin. Potentially, this is an important but until now unidentified function of relaxin. Unlike other inhibitory polypeptides, like TGF beta, relaxin does not prevent differentiation but rather uncouples it from cell division.

Effect of relaxin on differentiation of 3T3-L1 preadipocytes.

Relaxin is a member of the insulin-like growth factor family that functions primarily during pregnancy and parturition. Because previous studies have shown that rat adipocytes respond to relaxin, we undertook this study to investigate the effect of relaxin on the differentiation of 3T3-L1 fibroblasts in cell culture. First, relaxin prevented the normal course of cell division during the induction phase, but did not interfere with expression of the adipocyte phenotype, as indicated by lipid accumulation and insulin-sensitive glucose transport. Relaxin-treated cells were 2-3 times larger than cells induced by the normal procedure, as determined by both computer-assisted size analysis and intracellular water volume. These effects on cell division and cell size could be reversed by removal of relaxin during early induction. The concentration of relaxin required to elicit the half-maximal effect was 75 ng/ml (12.5 nM). These studies demonstrate that relaxin affects the proliferative response during the inductive phase of differentiation of the 3T3-L1 cell line without affecting differentiation directly. This effect of relaxin on proliferation is unique and is discussed in relation to the cell cycle. It is our hope that these cells will serve as a model system for investigating the mechanisms by which relaxin functions and allow further studies on receptor structure and function.

[Adnexal actinomycosis in a woman using an intrauterine contraceptive device (IUD)]. / Promienica przydatków u kobiety z wkladka wewnatrzmaciczna (IUD).

PIP: The case-study of genital actinomycosis in a 33-year old woman wearing a "Copper T200" IUD is presented. She was hospitalized and treated for lower abdominal pain and non-characteristic signs of adnexitis twice. Adnexectomy on the left side was performed to remove an orange-size cyst. Histo-pathological examination of a prepared tissue sample revealed a colony of Actinomyces. Following the operation the patient was treated with 3 x 500 mg Flagyl (metronidazole) 3 x 80 mg of Gentamicin im. The wound healed in 19 days after operation. This woman had worn the IUD continuously for more than 3 years, thus there was an increased risk of uterine lesions. The most frequent consequences of wearing IUDs for a long time are dysmenorrhea and endometritis and therapeutic approaches are detailed. Since its first description in the literature in 1857 actinomycosis has not been mentioned frequently. However, with the spread of IUDs, the number of actinomycosis-like cases has increased and this justifies the need for improved diagnosis. The frequency of actinomycosis occurring in women wearing IUDs ranges between 1.6% and 19.7%^ieng