The computerised tutorial more effectively imparted knowledge immediately post-teaching. However, facilitated case discussion is the preferred modality in terms of participant enjoyment and perceived usefulness.

Measurement of endogenous thrombin potential (ETP) detects hypercoagulability and can be used to identify activated protein C resistance due to factor V Leiden (FVL). However, not all carriers of FVL suffer thrombosis and therefore we sought to determine if the test for ETP could be modified in such a way as to enable detection of FVL patients who were at increased risk of venous thromboembolism. Protac, an activator of both protein C and factor V, was incorporated into the traditional thrombin generation reaction and ratios (reaction with Protac:reaction without Protac) were calculated. Plasma samples from 42 FVL heterozygotes (12 with a history of thrombosis and 30 with no prior thrombosis) and 38 controls (non-FVL with no history of thrombosis) were analysed. The mean ETP ratio was significantly higher in FVL heterozygotes (0.90 ± 0.06) compared to normal controls (0.41 ± 0.10; p = 0.00004). Multivariate analysis indicated that the average ETP ratio was significantly and inversely correlated with factor V levels in FVL heterozygotes (p = 0.002) but not controls. Within the FVL group, patients with a history of thrombosis had higher ETP ratios (0.92 ± 0.06) compared to those without (0.89 ± 0.05), however, this did not reach statistical significance (p = 0.09). Further investigation into the use of ETP for detecting risk of thrombosis in people who are genetically predisposed is warranted. The recent introduction of diagnostic ETP measurements in the form of the calibrated automated thrombin generation from Thrombinoscope and the TechnoThrombin from Baxter should facilitate such studies.

This is the first randomised crossover trial evaluating the teaching of clinical reasoning in comparative medical education research. Interactive lecturing and computerised tutorial were both effective in teaching observational skills and clinical reasoning. Interactive lecture is the preferred method, and may influence initial engagement in learning.

Aims The study aimed to create and evaluate the educational effectiveness of a digital resource instructing paediatric trainees in a systematic approach to critical and quality observation of normal child development. Methods A digital educational resource was developed utilising the skills of an expert developmental paediatrician who was videoed assessing normal early child development at a series of critical stages. Videos illustrated aspects of language, sophistication of play and socialisation, cognition, and motor progress. Expert commentary, teaching text and summaries were used. A randomised controlled trial evaluated the resource. Paediatric trainees were recruited from The Sydney Children's Hospitals Network. Outcome measures were repeated at three time points (pre‐teaching, immediate‐post and 1 month) and included self‐rated attitudes, knowledge of markers of development and observational expertise. Qualitative data on teaching usefulness were obtained through open‐ended questions. Results Fifty‐six paediatric trainees (registrar 79%, women 82%; mean age 31 years) completed the pre‐assessment, 46 the immediate‐post and 45 the 1‐month follow‐up (20% attrition). Compared with the Control group, the Teaching group scored higher over time on markers of development (P = 0.006), observational expertise (P < 0.0001), confidence (P = 0.035) and satisfaction (P < 0.0001). Teaching participants valued the video and expert commentary and reported improvement in confidence and understanding and acquiring a more structured approach. Conclusions The ‘Beyond Milestones’ free online resource for medical professionals improves knowledge, increases confidence and is useful, providing a structured approach to developmental assessment. The techniques taught can be applied to every paediatric consultation.

Seventy per cent of participants rated the lecture on the highest scale for usefulness and interest. There was a significant post-lecture increase in clinical confidence in seizure identification (p < 0.0005). Open-ended questions showed that videos were most useful (81/149) and interesting (109/149), and that the presentation of the syndromal classification provided a useful approach (114/149). Focus group discussion, lecturer and peer observation cross-validated these findings and highlighted the importance of expert commentary to the videos and the clinical relevance of material.