P Pu ur rp po os se e: : This study was designed to assess the effect of preoperative medical consults on both perioperative management and surgical outcome.M Me et th ho od ds s: : The charts of 387 consecutive patients over the age of 50 undergoing non-cardiac, elective surgery during a six-week period were retrospectively examined. Patient factors including age, ASA status, gender, type of surgery, outcome (death, unexpected intensive care unit admission or uncomplicated discharge), presence of medical consult, and, in those cases where a medical consult was present, stated reason for the consult, the ordering physician, and recommendations of the consultant, were recorded. R Re es su ul lt ts s: : 138 patients receiving medical consults (35.7%) were identified (a total of 146 consults). The most common stated purpose of the consults examined was "preoperative evaluation." In only five consults (3.4%) did the consultant identify a new finding. Sixty-two consults (42.5%) contained no recommendations. There was no statistically significant difference in outcome between those patients who received a medical consult and those who did not.C Co on nc cl lu us si io on n: : A review of 146 medical consults suggests that the majority of such consults give little advice that truly impacts either perioperative management or outcome of surgery. NESTHESIOLOGISTS and surgeons frequently request preoperative consultation from internists and family practitioners for patients with pre-existing or suspected disease. There can be considerable confusion, however, amongst physicians regarding both the reasons for which a consult was requested 1 and the ultimate purposes that the consult serves. Objectif : Évaluer l'effet des consultations médicales préopératoires2 Such confusion often results in consultants' recommendations being ignored.3 Kleinmann found that very few anesthesiologists or surgeons specify what is being requested when asking for a cardiology consult.4 Lee 1 documented that in 14% of cases, requesting physicians and medical consultants actually disagreed on the reasons for the consult. Rudd, 5 in a study on preoperative

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Purpose: As Emergency Medical Technician educators develop curricula to meet new national educational standards, effective teaching strategies validated for course content and unique student demographics are warranted. Three methods for answering multiple choice questions presented during lectures were compared: a) Audience Response System (ARS, clickers), b) hand-raising-with-eyes-closed (no-cost option), and c) passive response (no-cost option). The purpose was to determine if using the ARS resulted in improved exam scores. Method: 113 Emergency Medical Technician (EMT) students participated in this cross-over, block randomized, controlled trial, which was incorporated into their Cardiac Emergencies and Pulmonary Emergencies course lectures. Students took pretests, immediate post-tests, and delayed post-tests composed of multiple choice questions that targeted either lower or higher order thinking. Results: For both lectures, there were significant improvements on all immediate post-test scores compared to all pretest scores (p Conclusions: In this cohort, incorporation of no-cost question-driven teaching strategies into lectures was as effective as an ARS at encouraging significant, immediate and sustained improvements in answering multiple choice questions.

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