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Background: This study focuses on a skills test based clinical assessment where 118 fourth-year medical students at the four teaching hospitals of Karolinska Institutet participated in the same 12-module OSCE. The goal of one of the twelve examination modules was to assess the students' skills and ability to solve a virtual patient (VP) case (the ISP system), which included medical history taking, lab tests, physical examinations and suggestion of a preliminary diagnosis. Aims: The primary aim of this study was to evaluate the potential of a VP as a possible tool for assessment of clinical reasoning and problem solving ability among medical students. The feeling of realism of the VP and its possible affective impact on the student's confidence were also investigated. Method: We observed and analysed students' reactions, engagement and performance (activity log files) during their interactive sessions with the simulation. An individual human assistant was provided along with the computer simulation and the videotaped interaction student/assistant was then analysed in detail and related to the students' outcomes. Results:The results indicate possible advantages of using ISP-like systems for assessment. The VP was for instance able to reliably differentiate between students' performances but some weaknesses were also identified, like a confounding influence on students' outcomes by the assistants used. Significant differences, affecting the results, were found between the students in their degree of affective response towards the system as well as the perceived usefulness of assistance. Conclusion: Students need to be trained beforehand in mastering the assessment tool. Rating compliance needs to be targeted before VP-based systems like ISP can be used in exams and if such systems would be used in high-stake exams, the use of human assistants should be limited and scoring rubrics validated (and preferably automated).

The isomorphous crystals of the hydrochloride and the hydrobromide of dopamine, CsH~IO2N, are orthorhombic, space group Pbc21 with four formula units in cells having the dimensions a= 10.52, b = 11 "13, c = 7"94 A and a = 10"69, b = 11"47, c = 7.97 A respectively. The structure of the hydrochloride was determined three-dimensionally and refined by least-squares methods to a final R= 0.084. The structure is stabilized by a network of hydrogen bonds with the chloride ions as acceptors.

Until recently there has been very limited information concerning the molecular geometry and conformation of biogenic monoamines and this lack of knowledge has seriously hampered efforts to unravel the structure—function relationships at the molecular level. Nevertheless, several theories have been proposed regarding interaction between the monoamines and their receptor sites. This is especially true for the neurohumoral transmitters dopamine, noradrenaline (norepinephrine) and serotonin (5-hydroxytryptamine), the target areas of which seem to be specific not only in the sense of chemical structure but also from the steric point of view. The well-known differences in biological activity due to chiralty illustrate the importance of the three-dimensional architecture of the molecules and indicate also the presence of stereospecific receptor sites. A detailed knowledge of the conformation of the biogenic monoamines would not only elucidate the requirements upon a natural or synthetic monoamine for proper function but also give indirect information about the geometry of the receptor sites.

Interactive Simulated Patient (ISP) is a computer-based simulation tool designed to provide medical students with the opportunity to practice their clinical problem solving skills. The ISP system allows students to perform most clinical decision-making procedures in a simulated environment, including history taking in natural language, many hundreds of laboratory tests (e.g., images and endoscopy), and physical examination procedures. The system has been evaluated in a number of courses at three universities, Karolinska Institutet and Uppsala University in Sweden, and Stanford University in the United States. This article describes a study conducted in 2002, with an emphasis on results that pertain to collaboration between students. Results indicate that ISP is engaging and stimulates more active student involvement than traditional paper-based case presentation methods and that students seem to collaborate more easily when using ISP compared to traditional paper-based methods. *This project has been supported by the Swedish LearningLab and the Wallenberg Global Learning Network with grants from the Knut and Alice Wallenberg Foundation. 387