Abstract. Background: Ultrasound is increasingly used in clinical practice as a bedside tool. As medical graduates first encounter the technique in early residency, ultrasound training needs to be integrated into the undergraduate curriculum. In Switzerland, abdominal ultrasound skills have been taught by a faculty-led, 21-hour course. However, this course does not have sufficient capacity to meet the increasing demand, and there have been doubts about its effectiveness as a teaching method. We therefore developed a 21-hour blended-learning course, comprising five hours of e-learning and 16 hours of near-peer tutoring. This study investigates whether this new teaching format is as good as, or superior to, the faculty-led method. Methods: The SIGNATURE study is an investigator-initiated, two-arm, randomised controlled trial, enrolling 152 medical students at the Universities of Bern, Fribourg and Zurich. Stratified by study site, students are 1:1 randomised to either the blended-learning course or the faculty-led 2.5-day ultrasound course. Students undergo a six-station objective structured clinical examination (OSCE) and complete an online questionnaire immediately after the course and 6 months later. Discussion: If demonstrated to be effective, the blended-learning course would allow an increase in the number of undergraduate medical students that can acquire ultrasound skills before starting their residencies.

BackgroundWe describe a runner who completed a self-paced marathon (42.195 km) in a climate chamber with a temperature difference of 100°C, starting at an ambient temperature (Tambient) of −45°C and finishing at an Tambient of +55°C.MethodsTambient was set at −45°C at the start, and was steadily increased at a rate of 1°C at 4.5-minute intervals to +55°C. Before the start, after every 10.5 km, and at the end of the marathon, body mass, urine, and sweat production were measured and samples of venous blood and urine were collected. The runner’s temperature was recorded every 10 seconds at four sites, ie, the rectum for body core temperature (Tcore), and at the forehead, right wrist, and right ankle for surface temperatures (Tskin).ResultsThe subject took 6.5 hours to complete the marathon, during which Tcore varied by 0.9°C (start 37.5°C, peak 38.4°C). The largest difference (∆) of Tskin was recorded at the ankle (∆16°C). The calculated amount of sweat produced increased by 888% from baseline. In the blood samples, myoglobin (+250%) showed the highest change. Of the pituitary hormones, somatotropic hormone (+391%) and prolactin (+221%) increased the most. Regarding fluid regulation hormones, renin (+1145%) and aldosterone (+313%) showed the greatest increase.ConclusionThese results show that running a marathon in a climate chamber with a total ∆Tambient of 100°C is possible, and that the Tambient to Tcore relationship is maintained. These results may offer insight into regulatory mechanisms to avoid hypothermia and hyperthermia. The same study is to be performed using more subjects with the same characteristics to validate the present findings.

A 20-year-old Swiss male presented at the emergency department with acute onset of febrile temperatures and hemoptysis and a 3-month history of productive cough. An X-ray and CT scan of the chest, sputum samples for acid-fast bacilli, polymerase chain reaction(PCR), and cultures for Mycobacteria revealed pulmonary infection with Mycobacterium tuberculosis. None of the classical risk factors for tuberculosis were present, but the patient reported regularly smoking a water pipe. Water-pipe smoking poses a serious risk of M. tuberculosis transmission.

Purpose Medical schools increasingly rely on near-peer tutors for ultrasound teaching. We set out to compare the efficacy of a blended near-peer ultrasound teaching program to that of a standard faculty course in a randomized controlled non-inferiority trial. Methods 152 medical students were randomly assigned to receive 21 hours of ultrasound teaching either by near-peer teachers or medical doctors. The near-peer course consisted of a blended learning that included spaced repetition; the faculty-led course was the European common course for abdominal sonography. Primary outcome measurement was students’ ultrasound knowledge at Month 6, assessed by structured examination (score 0 to 50). Secondary outcomes included scores at Month 0 and changes in scores after the course. Results Students in the near-peer group scored 37 points; students in the faculty group scored 31 points six months after course completion. The difference of 5.99 points (95% CI 4.48;7.49) in favor of the near-peer group was significant (p<0.001); scores immediately after the course were 3.8 points higher in the near-peer group (2.35;5.25, p<0.001). Ultrasound skills decreased significantly in the six months after course completion in the faculty group (- 2.41 points, [-3.39;-1.42], p<0.001]) but barely decreased in the near-peer group (-0.22 points, [-1.19;0.75, p=0.66]). Conclusions The near-peer course that combined blended learning and spaced repetition outperformed standard faculty teaching in basic ultrasound education. This study encourages medical schools to use peer teaching combined with e-learning and spaced repetition as an effective means to meet the increasing demand for ultrasound training. Ziel Um die wachsende Nachfrage für Ultraschalllehre zu decken, werden Near-Peer Tutoren zunehmend in die Kurse eingebunden. Wir verglichen die Effektivität von Near-Peer Lehre in einem blended learning Programm mit ärztlich-geführter Lehre in einer kontrolliert-randomisierten Nicht-Unterlegenheitsstudie. Methodik 152 Medizinstudierende wurden zu jeweils 21 Stunden Ultraschalllehre, entweder durch near-peer Tutoren oder ärztliche Tutoren randomisiert. Der Near-Peer Kurs beinhaltete Spaced Repetition, der ärztliche Kurs war der europäische Basiskurs für Abdomenultraschall. Hauptergebnis waren die Ultraschallfähigkeiten nach sechs Monaten (0-50 Punkte). Nebenergebnisse waren die Fähigkeiten direkt nach dem Kurs und die Veränderung der Fähigkeiten über sechs Monate. Ergebnisse Studierende in der Near-Peer Gruppe erreichten 37 Punkte, Studierende in der ärztlichen Gruppe 31 Punkte sechs Monate nach Kursabschluss. Der Unterschied von 5.99 Punkten (95% CI 4.48;7.49) zu Gunsten der Near-Peer Gruppe war signifikant (p<0.001). Die Punktzahlen direkt nach dem Kurs waren in der Near-Peer Gruppe 3.8 Punkte besser (2.35;5.25, p<0.001). In der ärztlichen Gruppe nahmen die Fähigkeiten über sechs Monate signifikant ab (- 2.41 Punkte, [-3.39;-1.42, p<0.001]), im Gegensatz zur Near-Peer Gruppe (-0.22 Punkte, [-1.19;0.75], p=0.66]). Schlussfolgerungen Der Near-Peer Kurs, welcher blended learning und spaced repetition kombinierte, zeigte bessere Lernergebnisse als der ärztlich-geführte Kurs. Diese Studie ermutigt medizinische Fakultäten, Near-Peer Lehre in Kombination mit spaced repetition und e-Learning anzubieten um dem steigenden Bedarf für Ultraschalltraining zu entsprechen.