Teaching Czech to the international medical students: teamwork approach.

Some aspects of team teaching Medical Czech to international medical students as a part of the mandatory curricular subject the Czech language are discussed on the basis of ten years of experience with the applied pedagogical method. As the patient is involved in the team, principles of medical ethics are to be strictly observed by both the teachers and the students. In the teaching situation, the roles of the linguist and medical specialist are not interchangeable. The examination results show the normal distribution curve, but the process of language skills acquisition may be so far measured only by usual pedagogical methods without deeper knowledge of the inborn language capabilities, brain potential and psychological differences of individual students.

Clinical informatics in medical education: yesterday, today, tomorrow. Experiences at the first Faculty of Medicine, Charles University.

The subject known as clinical informatics started to develop in the 60's in medical education of clinical disciplines and was mainly concerned with structuring information for instruction and examinations. This application contributed substantially to the development of the discipline of medical education that started to be considered as a legitimate new field that could become a clinical sub-specialty in its own right. Due to uneven access to computer hardware the area developed differently in the West and East. We elaborated our projects for application of didactic games in internal medicine for the paper and pencil system. On turn of the 90's the use of PCs brought new possibilities for the application of computer programme support in the analysis of the effectiveness of the system of instruction in internal medicine we were concerned with. We carried out two longitudinal studies in clinical memory of the 4th and 6th year students of the same study cycle. In a non-anonymous questionnaire, more than 1000 respondents described their experience in observation/examination of 70 recommended disorders important for internal practice. We offer some unpublished results showing how the clinical memory of the students is formed during the four-year study and how few possibilities there are for some students to see some manifestations of various clinical disorders. Thinking about the future we are preparing a series of integrated medical and language programmes for the use of the multi-medial approach.

[Research fraud]. / Podvod ve výzkumu--"research fraud".

In this article problems of research fraud are discussed. Academic courses of teaching scientific integrity and the impact of clinical trial fraud on good clinical research practice are mentioned.

Multiprofessional education in social medicine and clinical ethics.

This contribution describes a project of multiprofessional education in social medicine and clinical ethics based on educational experience of 3rd Department of Internal Medicine, First Medical Faculty, Charles University in conjunction with the Centre of Gerontology Prague. This undergraduate program will be offered to medics, stomatologists and health science students including the English course and will invite to participate students from non-medical faculties such as social science, pedagogy, theology, interested in ethics of health care providing. Basic principles of the new project are: education in clinical setting, early student-patient contact, multiprofessional education in common seminars of problem based learning small groups and developing various forms of communication.

Business ethics as a novel issue in health care economics.

The problems of health care providing and solutions suggested to solve them should be discussed publicly at all appropriate levels in all developed countries. In this contribution, new approaches to understanding the problems of business ethics in health care are mentioned and recommended for discussion. An application of such principles of business ethics as trust, accountability, solidarity, transparency and social responsibility is considered in the four following areas. First, it is the allocation of limited resources in health care. This is the world-wide problem of the end of 20th century, as the development of medical technologies offers a wide range of new diagnostic and therapeutic procedures. In our country this coincides with the on-going, and still incompleted reform of health care. Second, the other area is that of connecting health-care and social problems, important namely for vulnerable groups such as children, the elderly and chronically ill. The third area is concerned with the privatization of health care, the newly emanating structure and function of the health care system and the role of health care provides in society. The last group contains issues concerning attempts to facilitate communication between health care specialists and general public, as well as attempts to support those institutions of the civic democratic society that are oriented toward health, sickness and health care providing.

The Ethics Committee of the General Faculty Hospital and First Medical Faculty, Charles University.

The purpose of this contribution is to inform about the activities of the local ethics commission established at one of our largest teaching (University) hospitals. In 1995 the following priorities were recognized: studying international ethical standards of research involving human subjects and strictly adhering to them; bilingual administrative agenda in Czech and English; enforcing the patients' rights in health care and emphasizing them in education of medics and other students of health related disciplines; stimulating effective communication between doctors, other health care workers and lay persons in the commission as well as between the members of the commission and authors of research projects applying for ethical evaluation. Since 1993 the commission has been revising and storing in the archives more than 600 research projects. In 1996, 181 new research projects were reviewed, which is 35% more than in 1995. Approval was granted in 154 cases (85.08%), 3 cases (1.66%) were rejected, 15 cases (8.29%) approved on condition of complying with the recommendations of the commission, 6 cases (3.31%) recommended for another commission, and in 3 cases reviewing the project was postponed for lack of necessary data. The members of the commission agree that the future activities should lead to forming a broader group of consultants of the commission and other professional and lay people interested in clinical ethics. According to their meaning, legislation concerning ethical commissions in the Czech Republic, including material and financial support and administrative help, is urgently needed.

[Educational innovations at the 3rd Internal Medicine Clinic]. / Inovace výuky na III. interní klinice.

Professor Joseph Charvát, head of the IIIrd Medical Department in 1945-1970, was interested in medical education very broadly and initiated research work in this field. Later in the seventies and eighties his disciples realized a number of educational programmes concerning improving the effectiveness of clinical teaching by the use the method of self-directed learning, assessing students' clinical competence, students' undergraduate education for primary care and computer-aided analysis of undergraduate education results in internal medicine. Recently attention was focused on problems of ethics and physician-patient and health team communication and in this respect a new educational programme of students' early clinical contact in internal medicine for students of preclinical years was established.

[Analysis of the literary legacy of Professor Josef Charvát]. / Analýza literární pozustalosti profesora Josefa Charváta.

The literary inheritance of Professor Joseph Charvát (1897-1984) consists of 10 monographs and 545 other titles, some of which have not appeared in the public press. The author himself arranged his original papers written in Czech as well as other European languages, reviews, essays on health education, publicistic discourses and Varia chronologically from 1922 till 1981. His literary inheritance reflects the history of the Czech internal medicine, the Czech medical faculty of Charles University in Prague and the Czech society and illustrates the broad field of interests of the author. As a disciple of Joseph Pelnár, he was a broadly oriented internist and a classic of the Czech academic medicine. He is recognized as the founder of Czechoslovak endocrinology and one of the founders of behavioural medicine (21). He was interested in medical education (12) and promotion of clinical science and research. He predicted the significance of biocybernetics, clinical genetics and social medicine and public health for the further development of health sciences. His literary inheritance reflects his civic responsibility, courage and authority he enjoyed in the Czech society during the Thirties, the Forties and the Sixties. His work gives evidence of his activities in the World Health Organization and on Economic and Social Council of the Advisory Committee of United Nations, concerning the application of science and technology to the general world development (13, 14, 15, 16). Professor Joseph Charvát's inheritance has not only historical relevance as it contains specific entities, such as holistic approach to medicine, science, men and human society, which should be rediscovered in the present time. Important is also his warning that the progress of humanistic subjects in medicine lags behind the advances in natural science and technology. Professor Charvát offers an interesting concept of creativity. His mastery of communication and his ethical reflexion on scientific knowledge in natural sciences are of lasting value. The dominant principle of his attitude toward problem solving, in medicine and in the society as well, is a positive feedback concept.

Chemoprophylaxis against malaria in Papua New Guinea: a trial of amodiaquine and a combination of dapsone and pyrimethamine.

A placebo-controlled chemoprophylaxis trial was carried out in 1980 in 318 semi-immune school children in the Madang area of Papua New Guinea, where there was a high prevalence of strains of Plasmodium falciparum resistant to 4-aminoquinolines. Since prophylaxis with amodiaquine at 5 mg/kg weekly had failed, amodiaquine at a dose of 10mg/kg weekly and Maloprim (half a tablet or one tablet depending on body weight, which gave ranges of dapsone of 1.7-3.3mg/kg and pyrimethamine 0.2-0.4 mg/kg) weekly were tried. Neither regimen was completely successful in preventing parasitaemia, though after 13 weeks of prophylaxis the slide positivity rate was 16% for the amodiaquine group and 2% for the Maloprim group, which was in each case significantly lower than the normal baseline rate in the controls of 42%. Amodiaquine was completely successful in suppressing Plasmodium vivax infections. Breakthrough parasitaemia occurred, with either P. falciparum or P. vivax, in 5% of subjects on Maloprim at some time during the 13-week period of prophylaxis. Significantly more children in both the amodiaquine and Maloprim groups than in the placebo group showed a reduction in spleen size. All groups showed an unexplained fall in haemoglobin level over the study period but the fall was significantly less in both the prophylaxis groups. There was no adverse effect on white cell counts by either drug regimen. Chemoprophylaxis as a component of an integrated malaria control program should not be overlooked, provided that compliance can be maintained. However, in this particular case the principal purpose of the study had been to evaluate the proposed chemoprophylactic regimens in school children before embarking on an intervention study in young children. As a result of this study it was decided not to go ahead with the chemoprophylactic intervention in young children but to adopt an approach based on early presumptive treatment.

[Computer-assisted analysis of the results of training in internal medicine]. / Analýza výsledku výuky vnitrního lékarství s vyuzitím výpocetní techniky.

Analysis of the results of teaching of clinical disciplines has in the long run an impact on the standard and value of medical care. It requires processing of quantitative and qualitative data. The selection of indicators which will be followed up and procedures used for their processing are of fundamental importance. The submitted investigation is an example how to use possibilities to process results of effectiveness analysis in teaching internal medicine by means of computer technique. As an indicator of effectiveness the authors selected the percentage of students who had an opportunity during the given period of their studies to observe a certain pathological condition, and as method of data collection a survey by means of questionnaires was used. The task permits to differentiate the students' experience (whether the student examined the patient himself or whether the patient was only demonstrated) and it makes it possible to differentiate the place of observation (at the university teaching hospital or regional non-teaching hospital attachment). The task permits also to form sub-groups of respondents to combine them as desired and to compare their results. The described computer programme support comprises primary processing of the output of the questionnaire survey. The questionnaires are transformed and stored by groups of respondents in data files of suitable format (programme SDFORM); the processing of results is described as well as their presentation as output listing or on the display in the interactive way (SDRESULT programme). Using the above programmes, the authors processed the results of a survey made among students during and after completion of the studies in a series of 70 recommended pathological conditions. As an example the authors compare results of observations in 20 selected pathological conditions important for the diagnosis and therapy in primary care in the final stage of the medical course in 1981 and 1985.

[The effect of corticoids on bone tissue in myasthenia gravis]. / Vliv kortikoidu na kostní tkán u myasthenia gravis.

Myasthenia gravis is an autoimmune disease where corticoids are the basis of therapy. They are taken for short periods in large amounts, as well as for prolonged periods in medium or small doses. The authors investigated in the described groups the effect of corticoids on bone tissue. They provided evidence of a significant effect on the diffraction pattern, geometrical arrangement of the apatite grid and ion changes in relation to the period of corticoid administration without significant clinical manifestations of osteoporosis, when respecting therapeutic principles.

[Primary emergency care in undergraduate education]. / Primární neodkladná péce v pregraduální výuce.

The paper deals with the contemporary state of undergraduate training in emergency care and in primary emergency care at medical faculties in the CSSR. The discipline of emergency care is a new interdisciplinary entity which is becoming part of basic medical education. In undergraduate training it forms a problem oriented interdisciplinary complex with the central role of the teacher--specialist in anaesthesiology and resuscitation. The author discusses the concept of teaching at the Faculty of General Medicine, Charles University, Prague which foresees two stages of training in emergency care, the basic stage in the 3rd 5th year and the stage of practical training in the 6th year devoted mainly to problems of primary emergency care. She submits the proposal of a graduate course for extending basic skills of primary emergency care during the early postgraduate period and wants to take advantage of the increasing interest of students in the training of emergency care within the framework of methodical innovations.

[Testing student knowledge of emergency care at the Charles University School of General Medicine and the processing of certain conditions in primary emergency care into computerized educational training models]. / Testování znalostí studentu FVL UK Praha z neodkladné péce a zpracování vybraných stavu z primární neodkladné péce do modelových výukových situací na pocítaci.

The objective expression of the state of knowledge of 6th year students of the Faculty of General Medicine in the field of emergency care is an important factor in the evaluation of their preparation for the medical profession, regardless of the specialty they choose. Knowledge of these data is essential for improvement of undergraduate teaching of emergency care. Suitable application of computer technique can supplement the possibilities how to achieve this. The application of so-called model situations on personal computers makes it possible to extend training of decision taking to all spheres of medical training.

[Desmoid fibromatosis in absorption infrared spectroscopy, emission spectral analysis and roentgen diffraction recording]. / Desmoidní fibromatóza v absorpcní infracervené spektroskopii, emisní spektrální analýze a v rentgenovém difrakcním záznamu.

The authors present results of serial quality and quantity microanalyses of bone patterns and dental tissue patterns in patient with desmoid fibromatosis. Methods of absorption spectroscopy, emission spectral analysis and X-ray diffraction analysis with follow-up to x-ray examination are tested. The above mentioned methods function in a on-line system by means of specially adjusted monitor unit which is controlled centrally by the computer processor system. The whole process of measurement is fully automated and the data obtained are recorded processed in the unit data structure classified into index sequence blocks of data. Serial microanalyses offer exact data for the study of structural changes of dental and bone tissues which manifest themselves in order of crystal grid shifts. They prove the fact that microanalyses give new possibilities in detection and interpretation of chemical and structural changes of apatite cell.

Use of the concept of subjective probability in undergraduate training in differential diagnosing.

In teaching clinical problem solving the probabilistic component should be emphasized. In the domain of empirical medical knowledge to be utilized in diagnostic strategies the prediction according to clinicians' subjective probabilities is used in medical decision making concerning patient problem definition and diagnosis. Two approaches in teaching differential diagnosing by decision models using short case studies are compared. The first is traditional one with the concept of one "true" diagnosis selected from proposed diagnoses group in a MCQ-test. The second approach reflects more the medical practice reality: the students have to predict quantified subjective probabilities of each diagnosis in a suggested diagnoses group considering all the diagnoses probable and not excluding each other. The advantages of the second procedure are evaluated.