Student observation and participation in unprofessional behaviors increased during clerkships. Participation in unprofessional behaviors is associated with perceiving these behaviors as acceptable.
We present the medical students' perspective on the hotly contested topic of professionalism in medical education and explore why students are often hostile to education in professionalism. We then suggest ways to improve professionalism education in the medical curriculum.
Early repolarization is not associated with cardiac death and has patterns that help distinguish it from STE associated with cardiac conditions, such as myocardial ischemia or injury, pericarditis, and the Brugada syndrome.
Background:Simulation-based training has been used in medical training environments to facilitate the learning of surgical and minimally invasive techniques. We hypothesized that integration of a procedural simulation curriculum into a cardiology fellowship program may be educationally beneficial.Methods:We conducted an 18-month prospective study of cardiology trainees at Vanderbilt University Medical Center. Two consecutive classes of first-year fellows (n = 17) underwent a teaching protocol facilitated by simulated cases and equipment. We performed knowledge and skills evaluations for 3 procedures (transvenous pacing [TVP] wire, intra-aortic balloon pump [IABP], and pericardiocentesis [PC]). The index class of fellows was reevaluated at 18 months postintervention to measure retention. Using nonparametric statistical tests, we compared assessments of the intervention group, at the time of intervention and 18 months, with those of third-year fellows (n = 7) who did not receive simulator-based training.Results:Compared with controls, the intervention cohort had higher scores on the postsimulator written assessment, TVP skills assessment, and IABP skills assessment (P = .04, .007, and .02, respectively). However, there was no statistically significant difference in scores on the PC skills assessment between intervention and control groups (P = .08). Skills assessment scores for the intervention group remained higher than the controls at 18 months (P = .01, .004, and .002 for TVP, IABP, and PC, respectively). Participation rate was 100% (24/24).Conclusions:Procedural simulation training may be an effective tool to enhance the acquisition of knowledge and technical skills for cardiology trainees. Future studies may address methods to improve performance retention over time.
Four patients withi acute rheumatic carditis of iio(leraite to severe degree were treated witli cortisone. After a latent period of 5 to 15 days, there was fairly rapid subsidence in teml)erature, ev-tlhrocv-te se(limentatioll rate and some othelr signs of inflanmmation. After cessation of the course of cortisone therapy, there was evidence of recrudescence of rheumatic activity in all four patients. In three of these the tlherapy was resune(l, with quite unusually rapid decline in the fever tand sedimentation rate. The cardiologic sigis shlowedl no improvement tlhroughout the entire period of observation.F OLLOWING the dramatic results reported for cortisone therapy in rheumatoid arthritis by Hench, Kendall and coworkers,' these authors applied this hormone to the treatment of 3 patients with acute rheumatic fever and reported a rapid subsidence of fever, tachycardia, polyarthritis, elevated sedimentation rates, and abnormal electrocardiographic changes.2 A later report by the group, which included studies on 8 additional patients (4 given cortisone and 4 given adrenocorticotropic hormone, confirmed the earlier findings.3 In addition, however, it was noticed that 2 of the patients treated with cortisone suffered recurrences of rheumatic activity when the administration of cortisone was discontinued. Resumption of the use of cortisone abolished the evidence of activity in both cases. Massell4 has reported favorable results in the treatment of a series of 14 cases of acute rheumatic fever with ACTH.The obvious importance of these findings led us to institute the experimental treatment with cortisone of patients with acute rheumatic carditis who were under close clinical observation. seemed to be the case in the patients studied by Hench and his associates. Although thus far only 4 patients have been included in this study, certain observations which were ma(le seemed to warrant the reporting of these preliminary data. METHODS AND MATERIALSThe 4 patients included in this study all had definite carditis of moderate or severe degree. They were hospitalized in the two institutions from which this study is reported. They ranged in age from 4 to 22 years.The patients were examined physically at least every two days by two or three of the authors. Laboratory examinations included the erythrocyte sedimentation rate (ESR), white blood cell count, and hemoglobin concentration. Electrocardiograms were taken as required. The sedimentation rate was determined by a method described elsewhere. ture fell gradually, reaching a plateau in 17 days.When cortisone was readministered to 3 patients the temperatures, which had risen on cessation of cortisone therapy, fell even more sharply, reaching normal in 1, 3, and 6 days respectively.2. Effect on Polyarthritis. When cortisone was first administered to the 2 patients complaining of joint pains, both were free of pain within 4 days.Three patients complained of joint pains on cessation of cortisone therapy. These patients were free of pain again within 4 days after resumption of the h...
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