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BackgroundTo assess the student perspective on acceptability, realism, and perceived effect of communication training with peer role play (RP) and standardised patients (SP).Methods69 prefinal year students from a large German medical faculty were randomly assigned to one of two groups receiving communication training with RP (N = 34) or SP (N = 35) in the course of their paediatric rotation. In both groups, training addressed major medical and communication problems encountered in the exploration and counselling of parents of sick children. Acceptability and realism of the training as well as perceived effects and applicability for future parent-physician encounters were assessed using six-point Likert scales.ResultsBoth forms of training were highly accepted (RP 5.32 ± .41, SP 5.51 ± .44, n.s.; 6 = very good, 1 = very poor) and perceived to be highly realistic (RP 5.60 ± .38, SP 5.53 ± .36, n.s.; 6 = highly realistic, 1 = unrealistic). Regarding perceived effects, participation was seen to be significantly more worthwhile in the SP group (RP 5.17 ± .37, SP 5.50 ± .43; p < .003; 6 = totally agree, 1 = don't agree at all). Both training methods were perceived as useful for training communication skills (RP 5.01 ± .68, SP 5.34 ± .47; 6 = totally agree; 1 = don't agree at all) and were considered to be moderately applicable for future parent-physician encounters (RP 4.29 ± 1.08, SP 5.00 ± .89; 6 = well prepared, 1 = unprepared), with usefulness and applicability both being rated higher in the SP group (p < .032 and p < .009).ConclusionsRP and SP represent comparably valuable tools for the training of specific communication skills from the student perspective. Both provide highly realistic training scenarios and warrant inclusion in medical curricula. Given the expense of SP, deciding which method to employ should be carefully weighed up. From the perspective of the students in our study, SP were seen as a more useful and more applicable tool than RP. We discuss the potential of RP to foster a greater empathic appreciation of the patient perspective.

Students perceived the design principles identified as being conducive to their learning. Many of these principles are supported by the results of other published studies. Future studies should address the effects of these principles using quantitative controlled designs.

Numerous investigations have shown that in primary breast adenocarcinomas DNA aneuploidy in contrast to DNA diploidy indicates high malignancy potential. On the basis of the study of 104 breast carcinomas, we describe a subtype of aneuploidy, which demonstrates a low degree of malignancy. In image cytometric DNA histograms, this subtype possessed a low percentage (< or = 8.8%) of nonmodal DNA values as measured by the stemline scatter index (SSI), which is defined as sum of the percentage of cells in the S-phase region, the G(2) exceeding rate and the coefficient of variation of the tumor stemline. The cut point of SSI = 8.8% (P = 0.03) enabled us to also subdivide diploid and tetraploid tumors into clinically low and high malignant variants. One possible reason for aneuploidy is impaired distribution of chromosomes at mitosis caused by numerical or structural centrosome aberrations. Cyclins A and E seem to be involved in centrosome duplication. Real-time quantitative PCR measurements of cyclin A and E transcript levels and immunohistochemical determination of cyclin A protein expression showed statistically significantly increased values in the tumors with a high SSI (>8.8%), compared with those with a low SSI. A pilot study demonstrated centrosomal aberrations in an average of 9.6% of the measured cells in four aneuploid carcinomas with high SSI values and in an average of 2.5% of the cells in three aneuploid and three diploid tumors with low SSI. Our data indicate that the SSI, most likely reflecting the degree of genomic instability, allows additional classifying of the known aneuploid, diploid, and tetraploid categories of primary breast adenocarcinomas into low and high malignant subtypes.

PerspectiveMuch has been written about the challenges facing the current medical education system in the United States. Medical knowledge is expanding rapidly, which demands not only more efficient teaching methods but also the teaching of knowledge management, yet lectures and book learning remain primary means of instruction in many medical schools. Much evidence shows the negative impact of the current educational model on student mental health, 2 and indirect evidence indicates that improving mental health and capturing intrinsic motivation will have a positive impact on learning.3 Additionally, although clinical reasoning is a cornerstone of medical practice, the continued problem of diagnostic error 4 suggests that medical education should focus more on the application of foundational knowledge in diverse contexts to foster both the development of diagnostic expertise and the acknowledgment of one's own limits. Further, legitimate concerns about medical error 5 call into question not only the quality of the health care system but also whether the contemporary U.S. system of medical education needs to better assess the competence of its graduates. The medical education community is working-across disciplines and across the continuum-to identify and implement strategies to improve educational outcomes 6 ; however, the current challenges will remain difficult to solve without a better understanding of the effectiveness of these new educational strategies.Just as a modern health care system is compelled to translate advances in the basic and clinical sciences into medical practice, a modern medical education system must translate advances in fields such as cognitive and educational psychology, education, the learning sciences, and educational technology into educational practice. The incorporation of technology into education offers the promise of addressing educational challenges in new ways. 7,8 Often, modern technologies offer more hope than actual solutions, and there is the potential for this to occur in the use of educational technology in medical education. Our aim with this Perspective is to suggest roles for a specific form of technologyenhanced education-virtual patients (VPs)-in addressing specific challenges facing medical education. We will do this by, first, describing what VPs are and their current roles in medical education and, then, proposing specific educational strategies for the use of VPs and the educational outcomes we believe VPs can facilitate. What Are VPs?Medical educators and others have defined "virtual patient" as "an interactive computer simulation of real-life clinical scenarios for the purpose of healthcare and medical training, education, or assessment" 9 or "a specific type of computer program that simulates reallife clinical scenarios [through which] learners emulate the roles of health care providers to obtain a history, conduct a physical exam, and make diagnostic and therapeutic decisions." 10 AbstractThe medical education community is working-across disciplines and ...

BackgroundE-learning and blended learning approaches gain more and more popularity in emergency medicine curricula. So far, little data is available on the impact of such approaches on procedural learning and skill acquisition and their comparison with traditional approaches.ObjectiveThis study investigated the impact of a blended learning approach, including Web-based virtual patients (VPs) and standard pediatric basic life support (PBLS) training, on procedural knowledge, objective performance, and self-assessment.MethodsA total of 57 medical students were randomly assigned to an intervention group (n=30) and a control group (n=27). Both groups received paper handouts in preparation of simulation-based PBLS training. The intervention group additionally completed two Web-based VPs with embedded video clips. Measurements were taken at randomization (t0), after the preparation period (t1), and after hands-on training (t2). Clinical decision-making skills and procedural knowledge were assessed at t0 and t1. PBLS performance was scored regarding adherence to the correct algorithm, conformance to temporal demands, and the quality of procedural steps at t1 and t2. Participants’ self-assessments were recorded in all three measurements.ResultsProcedural knowledge of the intervention group was significantly superior to that of the control group at t1. At t2, the intervention group showed significantly better adherence to the algorithm and temporal demands, and better procedural quality of PBLS in objective measures than did the control group. These aspects differed between the groups even at t1 (after VPs, prior to practical training). Self-assessments differed significantly only at t1 in favor of the intervention group.ConclusionsTraining with VPs combined with hands-on training improves PBLS performance as judged by objective measures.

The literature is packed with "one-size-fits-all" advice on how to develop intentionally formed virtual communities of practice (VCoPs). However, a closer look at the literature shows that VCoPs often have unique "personalities." Based on an extensive review of the literature and a study of 18 VCoPs, we built a typology containing 21 structuring characteristics. We then used this typology and three of the studied VCoPs to show how different their basic natures are. Researchers and practitioners alike must not only recognize the diversity of VCoPs, but also identify challenges, strategies and practices that are contingent upon their specific characteristics.

IntroductionMini Clinical Evaluation Exercise (Mini-CEX) and Direct Observation of Procedural Skills (DOPS) are used as formative assessments worldwide. Since an up-to-date comprehensive synthesis of the educational impact of Mini-CEX and DOPS is lacking, we performed a systematic review. Moreover, as the educational impact might be influenced by characteristics of the setting in which Mini-CEX and DOPS take place or their implementation status, we additionally investigated these potential influences.MethodsWe searched Scopus, Web of Science, and Ovid, including All Ovid Journals, Embase, ERIC, Ovid MEDLINE(R), and PsycINFO, for original research articles investigating the educational impact of Mini-CEX and DOPS on undergraduate and postgraduate trainees from all health professions, published in English or German from 1995 to 2016. Educational impact was operationalized and classified using Barr’s adaptation of Kirkpatrick’s four-level model. Where applicable, outcomes were pooled in meta-analyses, separately for Mini-CEX and DOPS. To examine potential influences, we used Fisher’s exact test for count data.ResultsWe identified 26 articles demonstrating heterogeneous effects of Mini-CEX and DOPS on learners’ reactions (Kirkpatrick Level 1) and positive effects of Mini-CEX and DOPS on trainees’ performance (Kirkpatrick Level 2b; Mini-CEX: standardized mean difference (SMD) = 0.26, p = 0.014; DOPS: SMD = 3.33, p<0.001). No studies were found on higher Kirkpatrick levels. Regarding potential influences, we found two implementation characteristics, “quality” and “participant responsiveness”, to be associated with the educational impact.ConclusionsDespite the limited evidence, the meta-analyses demonstrated positive effects of Mini-CEX and DOPS on trainee performance. Additionally, we revealed implementation characteristics to be associated with the educational impact. Hence, we assume that considering implementation characteristics could increase the educational impact of Mini-CEX and DOPS.