SUMMARYA 70-year-old man was diagnosed with a massive bleeding duodenal ulcer which was refractory to emergency endoscopic management. Angiogram of the coeliac and superior mesenteric arteries revealed bleeding from the superior and inferior pancreaticoduodenal arteries. Transcatheter arterial embolisation of superior and inferior pancreaticoduodenal arteries along with the gastroduodenal artery was performed. Two weeks later he developed severe necrotising pancreatitis of the pancreatic head probably due to ischaemia, which was managed conservatively. Three months later the patient experienced another episode of pancreatitis which progressed into multiorgan dysfunction and the patient passed away.
BACKGROUND
Why the idea was necessary Organising and implementing an OSCE is a time-intensive and costly endeavour. Student course evaluation data consistently indicated that adjustments in the IPE course and its corresponding OSCE were needed to ensure the course effectively introduced Year 1 medical students to clinical skills and that resources were well spent. What was done A 2-step modification process ensued. First, course faculty addressed the problems associated with the OSCE: limited faculty involvement; ambiguous goals and objectives, and limited, delayed and impersonal feedback. Restructuring began with the addition of OSCE review sessions, where groups of 12 students met with the course director some days prior to their OSCE to clarify the goals and objectives, discuss the format of the OSCE and review clinical skills. Next, the OSCE was trimmed down to 4 clinical cases to create time for grand rounds. During grand rounds, the course director met with the 12 students and 6 SPs involved in that afternoon's OSCE. The SPs provided immediate verbal feedback on the students' interpersonal skills. The course director then dismissed the SPs and reviewed pertinent aspects of each clinical encounter, focusing on key examination components and how to effectively document findings. Evaluation of results and impact A comparison of pre-and post-intervention course evaluation data revealed a marked divergence from previous academic years. Previously, the OSCE was cited as a component of the course that required improvement. After our intervention, it was frequently identified as a well organised, beneficial highlight of the IPE course. Improving student satisfaction and comfort levels in this introductory Year 1 clinical skills course sets the stage for enhanced student education along the entire clinical skills continuum. Student evaluations of the Year 1 OSCE have consistently revealed apprehension and criticism of the practice. Specifically, the students felt unprepared and too anxious to benefit from the experience. A cohort of motivated Year 2 medical students reflected on their OSCE experiences, identified concerns, and decided to take action to improve the experience. They developed a practice OSCE for Year 1 students to assist them in practising their interviewing and physical examination techniques and examination writing skills in an atmosphere that was comfortable and would familiarise them with the OSCE format. Why the idea was necessary Upper-level student involvement in education reinforces how critical the OSCE is to the curriculum and provides priceless role modelling and practice in clinical skills. Although faculty-led individual practice sessions with students are certainly desirable, they are often too time-intensive and costly to justify. Medical student participation in education also fosters an environment that promotes lifelong learning and may attract talented students to a career in academic medicine. What was done Four Year 2 medical students developed learning objectives and organised a practice O...
Impairment of color vision is known as “Achromatopsia.” This condition is multifactorial with a myriad of causes, from local at the retinal level to central at the occipital cortex level. The most common causes are inherited conditions. However, acquired achromatopsia has been acknowledged in numerous case reports and studies. Achromatopsia secondary to posterior cerebral artery (PCA) stroke is an extremely rare phenomenon and had been reported in a few case reports. In this case, we report a patient presenting with achromatopsia as the only complaint due to an infarction of the left occipital cortex.
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