This research provides a case study of how an empirical research approach can be used to identify and validate priorities for changes in medical education at a national level. This approach may be of interest in other countries.

Authors' abstractAs a preliminary step to beginning to assess the usefulness ofclinical vignettes to measure ethical sensitivity in undergraduate medical students, five clinical vignettes with seven to nine ethical issues each were created. The ethical issues in the vignettes were discussed and outlined by an expert panel. One randomly selected vignette was presented to first, second and thirdyear students at the University ofToronto aspart ofanother examination. The students were asked to list the issues presented by thepatient problem. Responses from 281 students were obtained.These students identified an average of2.72 ethical issues per vignette. Each response was classified under the domains ofautonomy, beneficence andjustice. Comparisons were made between classes and between vignettes. There was considerable vaniation between classes and the responses to different vignettes seem to indicate that different vignettes measure the various domains in different ways. It does appear that the use of vignettes is one way to measure aspects ofethical sensitivity in medical students but more study is required to clarfy exactly what is being measured.

A 79-year-old woman had a 10-year history of dementia, initially presenting as non-fluent aphasia. Magnetic resonance imaging showed frontal atrophy (left greater than right) and hyperintense foci within white matter. Neuropathologically, there was severe frontal atrophy due to cortical neuronal loss with spongy change and to an even greater loss of white matter that contained prominent eosinophilic deposits. The deposits were immunoreactive for phosphorylated tau, non-reactive for Abeta and alpha-synuclein and equivocally or weakly reactive for ubiquitin. They stained with the Gallyas, Bielschowsky, and Bodian techniques. Ultrastructural examination revealed the deposits to be composed of straight filaments with a diameter of approximately 10 nm, primarily in white matter glia. Moderate loss of neurons in substantia nigra and numerous argyrophilic threads in gray and particularly white matter were noted. The precise relationship between this disorder and other frontotemporal degenerations/tauopathies, as well as the pathogenetic basis of the leukoencephalopathy, remains to be determined.

Strokes have been rarely associated with immunoglobulin G (IVIg) therapy. A 70-year-old woman with stable polycythemia vera developed Guillain-Barré syndrome and received IVIg, 8 days following which she became comatose due to bilaterally symmetric cerebral infarcts. Autopsy showed intravascular aggregates of fibrin-IgG but also platelets and a necrotizing microangiopathy in the infarcts.

For the same amount of curricular time, an integrated spiral curriculum for teaching public health appears to be more effective than traditional approaches.

Cervical dystonia patients had a history, prior to symptom onset, of significantly more frequent episodes of surgery and of car accidents with hospital attendance than their age-matched unaffected siblings. Soft tissue trauma appears to increase risk of development of cervical dystonia in genetically predetermined individuals.

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The authors describe the Ptolemy Project, a recently developed model of electronic access to medical literature for surgeons in developing countries.