On-call shifts for doctors are associated with higher levels of perceived and biological stress, medical error and sharps injury. Medical students feel underprepared for their first year of clinical practice, particularly in the management of acutely unwell patients, task prioritisation and workload, prescribing medication, and decision making. However, the educational interventions developed to teach medical students about on-call shifts are limited and there is no national education approach to simulate on-call scenarios currently. 1 | WHAT WA S TRIED?An educational intervention consisting of a six-station, high-fidelity simulated 'virtual on-call' was created to assess the effectiveness of such a simulation on preparedness for becoming a doctor in 20 finalyear medical students. The stations were based on the competencies expected of a first-year doctor by a focus group of doctors. The stations covered: an emergency situation with an unconscious patient; warfarin prescribing in a patient with a metallic heart valve; interpretation of a chest X-ray in a patient with pneumonia; fluid prescription; requests for investigations, and prescribing. The scenarios were distributed around the hospital and students were called by pager to direct them to each station. The students were also called about lowpriority scenarios in addition to the six core stations, such as a station that involved writing a discharge letter for a patient being discharged the following week, to allow the students to prioritise their workload.A paper questionnaire assessing 10 domains (confidence, knowledge, technical skills, situational awareness, decision making, communication, teamwork, leadership, stress management, and coping with fatigue) using a Likert scale was distributed pre-and post-simulation. The Likert scale ranged from 1 (strongly disagree) to 5 (strongly agree). A two-tailed paired t-test and Cronbach's alpha were used to analyse the questionnaire responses. | WHAT LE SSON S WERE LE ARNED?The virtual on-call significantly improved students' overall confidence about entering the Foundation Years. There was a significant increase in mean Likert scores after completion of the virtual on-call (mean ± standard deviation [SD] score 3.51 ± 0.44) compared with prior to its completion (mean ± SD score 3.05 ± 0.47) (P = .0001). There was significant improvement in eight of the 10 domains assessed (confidence, knowledge, situational awareness, decision making, communication, leadership, stress management, and coping with fatigue; P < .05). No significant improvements were seen in the domains of technical skills and teamwork (P = .43 and P = .72, respectively). Cronbach's alpha demonstrated that the questionnaire was reliable (α = 0.83 and α = 0.80 for the pre-and post-intervention questionnaires, respectively). There were no missing data for any of the 10 domains. The main areas for improvement refer to the provision of stations for technical skills and teamwork. This could be addressed by inserting a station based on a simulated venepunctur...
Congenital toxoplasmosis is an uncommon infection. Hypothalamic/pituitary involvement leading to isolated central diabetes insipidus is extremely rare. Making a correct diagnosis of this condition, albeit challenging, is crucial for adequate management. We present a 54-year-old female who developed central diabetes insipidus as a complication of congenital toxoplasmosis. She had polydipsia and hypernatraemia on presentation and responded to intranasal desmopressin with normalization of above-mentioned findings. Magnetic resonance imaging and cranial X-ray’s showed pronounced intracranial calcifications in both choroid plexuses. Thyroid function tests, serum cortisol level and anterior pituitary function were all normal. To the best of our knowledge, this is the first reported case of isolated diabetes insipidus due to congenital toxoplasmosis in literature diagnosed late in adulthood and gives an insight into the challenges of diagnosing central diabetes insipidus and the hypothalamic/pituitary involvement in cases of congenital toxoplasmosis.
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