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Learning Points (learning + point)
Kinds of Learning Points Selected AbstractsToothache referred from auriculotemporal neuralgia: case reportINTERNATIONAL ENDODONTIC JOURNAL, Issue 9 2009R. A. Murayama Abstract Aim, To present a 52-year-old male patient who complained of intense pain of short duration in the region of the left external ear and in the ipsilateral maxillary second molar that was relieved by blockade of the auriculotemporal nerve in the infratemporal fossa. Summary, Extra- and intraoral physical examination revealed a trigger point that reproduced the symptoms upon finger pressure in the ipsilateral auriculotemporal nerve and in the outer auricular pavilion. The patient's medical history was unremarkable. The maxillary left second molar tooth was not responsive to pulp sensitivity testing and there was no pain upon percussion or palpation of the buccal sulcus. Periapical radiographs revealed a satisfactory root filling in the maxillary left second molar. On the basis of the clinical signs and symptoms, the auriculotemporal was blocked with 0.5 mL 2% lidocaine and 0.5 mL of a suspension containing dexamethasone acetate (8 mg mL,1) and dexamethasone disodium sulfate (2 mg mL,1), with full remission of pain 6 months later. The diagnosis was auriculotemporal neuralgia. Key learning point ,,Auriculotemporal neuralgia should be considered as a possible cause of nonodontogenic toothache and thus included in the differential diagnoses. ,,The blockade of the auriculotemporal nerve in the infratemporal fossa is diagnostic and therapeutic. It can be achieved with a solution of lidocaine and dexamethasone. [source] Culturally appropriate health education for Type 2 diabetes in ethnic minority groups: a systematic and narrative review of randomized controlled trialsDIABETIC MEDICINE, Issue 6 2010K. Hawthorne Diabet. Med. 27, 613,623 (2010) Abstract To determine if culturally appropriate health education is more effective than ,usual' health education for people with diabetes from ethnic minority groups living in high- and upper-middle-income countries. A systematic review with meta-analysis, following the methodology of the Cochrane Collaboration. Electronic literature searches of nine databases were made, with hand searching of three journals and 16 author contacts. The criteria for inclusion into the analysis were randomized controlled trials of a specified diabetes health education intervention, and a named ethnic minority group with Type 2 diabetes. Data were collected on HbA1c, blood pressure, and quality-of-life measures. A narrative review was also performed. Few studies fitted the selection criteria, and were heterogeneous in methodologies and outcome measures, making meta-analysis difficult. HbA1c showed an improvement at 3 months [weighted mean difference (WMD) ,0.32%, 95% confidence interval (CI) ,0.63, ,0.01] and 6 months post intervention (WMD ,0.60%, 95% CI ,0.85, ,0.35). Knowledge scores also improved in the intervention groups at 6 months (standardized mean difference 0.46, 95% CI 0.27, 0.65). There was only one longer-term follow-up study, and one formal cost-effectiveness analysis. Culturally appropriate health education was more effective than ,usual' health education in improving HbA1c and knowledge in the short to medium term. Due to poor standardization between studies, the data did not allow determination of the key elements of interventions across countries, ethnic groups and health systems, or a broad view of their cost-effectiveness. The narrative review identifies learning points to direct future research. [source] Consequences of misdiagnosis of lymphomatoid papulosisEUROPEAN JOURNAL OF CANCER CARE, Issue 2 2006S. LAUBE mrcp We report two patients with lymphomatoid papulosis (LyP), who were initially diagnosed as systemic T-cell lymphoma. The patients presented with recurrent self-healing cutaneous lesions and skin biopsies showed a lymphocytic infiltrate with malignant features. Clinico-pathological correlation of findings was not performed and results of staging investigations were misinterpreted. Consequently, both patients were unnecessarily treated with multi-agent chemotherapy, radiotherapy and stem cell/bone marrow transplants and sustained long-term adverse effects. The clinical and histological features of LyP are described and appropriate management discussed in detail. Factors leading to the unnecessary treatment of both patients are examined and several learning points highlighted such as the importance of a multidisciplinary approach. [source] Apical surgery of a maxillary molar creating a maxillary sinus window using ultrasonics: a clinical caseINTERNATIONAL ENDODONTIC JOURNAL, Issue 11 2010B. García García B, Peñarrocha M, Peñarrocha MA, von Arx T. Apical surgery of a maxillary molar creating a maxillary sinus window using ultrasonics: a clinical case. International Endodontic Journal, 43, 1054,1061, 2010. Abstract Aim, To describe a method of carrying out apical surgery of a maxillary molar using ultrasonics to create a lateral sinus window into the maxillary sinus and an endoscope to enhance visibility during surgery. Summary, A 37-year-old female patient presented with tenderness to percussion of the maxillary second right molar. Root canal treatment had been undertaken, and the tooth restored with a metal-ceramic crown. Radiological examination revealed an apical radiolucency in close proximity to the maxillary sinus. Apical surgery of the molar was performed through the maxillary sinus, using ultrasonics for the osteotomy, creating a window in the lateral wall of the maxillary sinus. During surgery, the lining of the sinus was exposed and elevated without perforation. The root-end was resected using a round tungsten carbide drill, and the root-end cavity was prepared with ultrasonic retrotips. Root-end filling was accomplished with MTA®. An endoscope was used to examine the cut root face, the prepared cavity and the root-end filling. No intraoperative or postoperative complications were observed. At the 12-month follow-up, the tooth had no clinical signs or symptoms, and the radiograph demonstrated progressing resolution of the radiolucency. Key learning points ,,When conventional root canal retreatment cannot be performed or has failed, apical surgery may be considered, even in maxillary molars with roots in close proximity to the maxillary sinus. ,,Ultrasonic sinus window preparation allows more control and can minimize perforation of the sinus membrane when compared with conventional rotary drilling techniques. ,,The endoscope enhances visibility during endodontic surgery, thus improving the quality of the case. [source] Apexogenesis after initial root canal treatment of an immature maxillary incisor , a case reportINTERNATIONAL ENDODONTIC JOURNAL, Issue 1 2010S. R. Kvinnsland Abstract Aim, To present a case where a traumatized, immature tooth still showed capacity for continued root development and apexogenesis after root canal treatment was initiated based on an inaccurate pulpal diagnosis. Summary, Traumatic dental injuries may result in endodontic complications. Treatment strategies for traumatized, immature teeth should aim at preserving pulp vitality to ensure further root development and tooth maturation. A 9-year-old boy, who had suffered a concussion injury to the maxillary anterior teeth, was referred after endodontic treatment was initiated in tooth 21 one week earlier. The tooth had incomplete root length, thin dentinal walls and a wide open apex. The pulp chamber had been accessed, and the pulp canal instrumented to size 100. According to the referral, bleeding from the root made it difficult to fill the root canal with calcium hydroxide. No radiographic signs of apical breakdown were recorded. Based on radiographic and clinical findings, a conservative treatment approach was followed to allow continued root development. Follow-up with radiographic examination every 3rd month was performed for 15 months. Continued root formation with apical closure was recorded. In the cervical area, a hard tissue barrier developed, which was sealed with white mineral trioxide aggregate (MTA). Bonded composite was used to seal the access cavity. At the final 2 years follow-up, the tooth showed further root development and was free from symptoms. Key learning points, ,,Endodontic treatment of immature teeth may result in a poor long-term prognosis. ,,The pulp of immature teeth has a significant repair potential as long as infection is prevented. ,,Treatment strategies of traumatized, immature permanent teeth should aim at preserving pulp vitality to secure further root development and tooth maturation. ,,Radiographic interpretation of the periapical area of immature teeth may be confused by the un-mineralized radiolucent zone surrounding the dental papilla. [source] A novel technique for the removal of fractured instruments in the apical third of curved root canalsINTERNATIONAL ENDODONTIC JOURNAL, Issue 3 2009M. Rahimi Abstract Aim, To report on a conservative approach for removal of a fractured file in the severely curved apical portion of the distobuccal canal of a mandibular molar. Summary, With the assistance of stainless steel hand files and a chloroform-dipped gutta-percha cone, a fractured rotary NiTi instrument was successfully removed. The use of this technique may assist in removal of loose instrument fragments that are not easily accessible to other removal techniques. Key learning points, ,,Instrument fractures do not always lead to an unfavourable prognosis and their removal from the apical third of curved canals should not be routinely attempted. ,,The case highlights that it is possible to conservatively remove loosely bound objects from the hard-to-reach areas of the root canal system. [source] Diagnosis and treatment of odontogenic cutaneous sinus tracts of endodontic origin: three case studiesINTERNATIONAL ENDODONTIC JOURNAL, Issue 3 2009B. Pasternak-Júnior Abstract Aim, To describe three cases of extraoral sinus tracts, related to infected teeth, which were initially misdiagnosed as skin lesions and inappropriately treated. Summary, The extraoral sinus tracts were initially misdiagnosed as skin lesions. Dermatological surgery was performed and antibiotics prescribed but the lesions did not resolve. Then, a dental cause was sought, and identified. Endodontic intervention resulted in resolution of the problem, confirming the initial misdiagnosis. Key learning points ,,Dermatologists and other medical practitioners should be aware that dental extraoral sinus tracts can be confused with skin lesions. ,,A dental aetiology, as part of a differential diagnosis, should be kept in mind with oro-facial skin lesions. ,,If an extraoral sinus tract is of endodontic origin, then elimination of infection through effective endodontic treatment will lead to resolution of the sinus tract. ,,Early correct diagnosis can prevent unnecessary and ineffective antibiotic therapy and/or surgical intervention. [source] Pulp revascularization of necrotic bilateral bicuspids using a modified novel technique to eliminate potential coronal discolouration: a case reportINTERNATIONAL ENDODONTIC JOURNAL, Issue 1 2009K. Reynolds Abstract Aim, To present a case report in which the pulp of two bilateral mandibular premolars with dens evaginatus were revascularized using a modified novel technique to avoid undesired crown discolouration. Summary, Recently, regeneration of necrotic pulps has become an alternative conservative treatment option for young permanent teeth with immature roots and is a subject of great interest in the field of endodontics. This novel procedure exploits the full potential of the pulp for dentine deposition and produces a stronger mature root that is better able to withstand the forces than can result in fracture. However, the current protocol has potential clinical and biological complications. Amongst them, crown discolouration, development of resistant bacterial strains and allergic reaction to the intracanal medication. In the case presented, a modified technique to avoid undesired crown discolouration was applied sealing the dentinal tubules of the chamber, thus avoiding any contact between the tri-antibiotic paste and the dentinal walls. Key learning points, ,,Sealing the dentinal tubules of the chamber prevents the undesirable crown discolouration produced by tri-antibiotic medication whilst maintaining the revascularization potential of the pulp. ,,Further research is warranted to seek an alternative infection control protocol capable of preventing possible allergic reactions and development of resistant strains of bacteria, as well as a biological material capable of inducing angiogenesis and allow a more predictable scaffold and tissue regeneration. [source] Anomalous mandibular premolars: a mandibular first premolar with three roots and a mandibular second premolar with a C-shaped canal systemINTERNATIONAL ENDODONTIC JOURNAL, Issue 11 2008B. M. Cleghorn Abstract Aim, To describe unusual variations in the root morphology and root canal systems of mandibular first and second premolar teeth extracted for orthodontic reasons. Summary, Normally mandibular first and second premolar teeth have single roots with single canals. A 15-year-old patient presented for orthodontic treatment and two mandibular premolar teeth were examined post-extraction. The mandibular first premolar exhibited three distinct, separate roots and the mandibular second premolar exhibited a C-shaped root canal system. The coronal morphology of each of the mandibular premolars revealed dimensions and anatomy within normal limits. The incidence of a three-rooted mandibular first premolar is approximately 0.2%. Key learning points ,,Thorough clinical and radiographic interpretation is important in recognizing anomalous root and root canal systems. ,,The most common forms of root and canal systems and its aberrations must be understood to realize variations from normal do occur. ,,Successful root canal treatment requires an accurate diagnosis of the root canal system using all available aids. ,,Value of microcomputed tomography in the study of anatomy ex vivo and cone-beam tomography in clinical endodontics of complex premolar cases is increasing. [source] Step-wise treatment of two periodontal-endodontic lesions in a heavy smokerINTERNATIONAL ENDODONTIC JOURNAL, Issue 11 2008C. Walter Abstract Aim, To report a clinical case of two advanced periodontal-endodontic lesions with a focus on treatment issues related to tobacco use. Summary, A 53-year-old Caucasian male was referred to the School of Dentistry, Basel, Switzerland, for periodontal treatment. The major diagnoses were chronic (smoker) periodontitis and advanced combined periodontal-endodontic lesions on the mandibular left lateral incisor and right incisor. Conventional root canal treatment was performed, and subsequently led to reduced radiolucencies around the affected roots after 14 months. The remaining osseous defect was augmented by guided tissue regeneration using bovine bone substitute and resorbable membrane. The follow-up revealed a stable situation from clinical (probing depth 2,4 mm) and radiological points of view 32 months after initiation of treatment. Treatment considerations related to tobacco use are discussed. Key learning points, ,,After conventional root canal treatment, osseous healing should occur before further complementary therapy is taken into account. ,,Issues related to tobacco use have to be considered before treatment is initiated. [source] Complex endodontic treatment of an immature type III dens invaginatus.INTERNATIONAL ENDODONTIC JOURNAL, Issue 10 2008A case report Abstract Aim, To report the endodontic treatment of an immature maxillary central incisor with dens invaginatus. Summary, Dens invaginatus is a rare malformation of teeth, probably resulting from an infolding of the dental papilla during tooth development. The present case describes the complex endodontic treatment of a type III dens invaginatus in an immature maxillary central incisor with a necrotic pulp and abscess formation. The initial treatment goal was to achieve apexification of the pseudocanal root and conservative root canal treatment in the main canal. Following 1-year of treatment with calcium hydroxide dressings, radiography revealed a healing response, but no sign of a hard tissue barrier at the apex. Periapical surgery with the placement of a zinc oxide cement (IRM) root-end filling was considered successful at the 4-year follow-up. Key learning points ,,The complexity of the canal system and open apex in dens invaginatus present a challenge to endodontic treatment. ,,Correct diagnosis and treatment planning are fundamental to treatment of dens invaginatus. ,,Periapical surgery is indicated in cases of unsuccessful apexification in immature teeth with dens invaginatus and nonvital pulp. [source] Foreign body in the apical portion of a root canal in a tooth with an immature apex: a case reportINTERNATIONAL ENDODONTIC JOURNAL, Issue 10 2008A. R. Prabhakar Abstract Aim, To describe the successful retrieval of a foreign object located in the apical portion of an immature root canal by simple orthograde techniques, avoiding the need for surgery or intentional reimplantation. Summary, A radio-opaque foreign object lodged in the apical portion of an immature root canal was discovered on radiographic examination of a patient with a complicated crown fracture. Attempts to retrieve it resulted in displacement into the periapical area. Eventually, the object was retrieved by a simple technique, followed by successful apexification, root canal filling and jacket crown placement. Key learning points ,,Foreign bodies in root canals should be carefully evaluated to determine their nature, position, size and the degree of difficulty that may be encountered during retrieval. ,,Patience, care and appropriate techniques may be helpful in retrieving foreign bodies and avoiding periapical surgery. ,,Complicated crown fractures should be managed promptly, and prolonged open drainage avoided in children if the risks of foreign body impaction are to be minimized. [source] A preliminary study on the technical feasibility and outcome of retrograde root canal treatmentINTERNATIONAL ENDODONTIC JOURNAL, Issue 9 2008P. Jonasson Abstract Aim, To investigate the technical feasibility and outcome of retrograde root canal treatment. Summary, Endodontic access cavity preparation in abutment teeth may jeopardize the retention of the coronal restoration leading to prosthodontic failure. In such cases leaving the crown intact and performing retrograde root canal treatment might be an alternative approach. The potential to promote healing with retrograde endodontic treatment, and the technical feasibility to shape, clean and fill the canal was evaluated retrospectively. The study consisted of 21 incisors, canines and premolar teeth followed-up clinically and radiographically from 6 to 48 months. In 14 teeth the canals were completely negotiated. These cases were all judged as completely healed. In five cases no canal could be explored by files and a conventional ultrasonic root-end preparation and filling was performed. Two of these were classified as completely healed and three as ,uncertain'. In 2 two-rooted premolars a combination was performed with complete instrumentation of the buccal canal and the ultrasonic root-end preparation of the palatal root. One case was judged as a failure and the other was classified as completely healed. The results from this preliminary evaluation of retrograde root canal treatment are promising and merit a randomized clinical trial. Key learning points ,,Abutment teeth with vital pulps may develop pulp necrosis and apical periodontitis in 10% of cases. ,,Endodontic access preparation through an artificial crown may weaken its retention and jeopardize the longevity of a bridgework. ,,Retrograde root canal treatment is often feasible in maxillary teeth. ,,Results from this preliminary study suggest that treatment outcome for retrograde and orthograde root canal treatment is similar. [source] Intraosseous schwannoma mimicking a periapical lesion on the adjacent tooth: case reportINTERNATIONAL ENDODONTIC JOURNAL, Issue 1 2007M. D. Martins Abstract Aim, To present an additional case of intraosseous schawannoma involving the apical area in the mandibular alveolar bone mimicking an inflammatory periapical lesion. Summary, This article describes a case of schwannoma periapically located mimicking an inflammatory periapical lesion in the mandible of a 34-year-old female. Diagnostic and therapeutic problems can occur when this lesion is misinterpreted as being endodontic in origin. The diagnosis, radiograph, immunohistochemical aspects and treatment are also discussed. Key learning points, ,Intraosseous schwannoma is a rare unilocular radiolucency that when located periapically could be misdiagnosed as an endodontic lesion and result in unnecessary root canal treatment. ,The vitality of the pulp is an important test to exclude lesions of inflammatory origin. ,Histological examination is important to establish the diagnosis of lesions in the periradicular region. [source] Cemental tear: a case reportINTERNATIONAL ENDODONTIC JOURNAL, Issue 1 2006M. L. Stewart Abstract Aim, To report a case of a cemental tear. Summary, A case is reported of a patient with a history of trauma, root canal treatment and retreatment procedures to eliminate recurring sinus tracts. An exploratory surgery, extraction, and biopsy resulted in a diagnosis of cemental tear. Key learning points, ,,The detachment of a fragment of cementum is described as a cemental tear. ,,Cemental tears have been reported in the periodontal literature associated with localized, rapid periodontal breakdown. Common causative factors are aging and traumatic occlusion but the exact aetiology is unknown. ,,Trauma may be considered as a potential aetiologic factor for cemental tears in addition to occlusal traumatism and aging. [source] Anatomic Endodontic Technology (AET) , a crown-down root canal preparation technique: basic concepts, operative procedure and instrumentsINTERNATIONAL ENDODONTIC JOURNAL, Issue 8 2005F. Riitano Abstract Aim, To illustrate the conceptual basis and the operative procedure of the Anatomic Endodontic TechnologyTM (AET) technique and to illustrate the specific instruments used in each phase. Summary, The basic characteristics of the AETTM technique are reported. The instruments and procedure are described in three phases: coronal access, coronal-middle preparation and apical preparation. In the first phase, correct cavity design is described. In the coronal-middle phase, the use of four stainless steel shaping instruments, powered by a reciprocating handpiece is described, incorporating a brushing-milling action against canal walls. During the apical phase, dedicated apical stainless steel and NiTi hand instruments are used to complete the preparation. The stainless steel apical files are used with a 1/4 turn and withdrawal movement whilst the NiTi are used in 360° rotary motion. Key learning points ,,Most current canal shaping techniques do not prepare all the canal walls and can result in over-enlargement in some areas. ,,AETTM defines three regions of the canal: coronal (from the cavo-surface of the access cavity), coronal-middle, and apical. ,,Coronal-middle instrumentation is undertaken with four mechanically driven stainless steel shaping instrument used in brushing-milling action against canal walls. ,,Apical preparation is completed by hand and with the formation of a stop. [source] Use of a molar clamp to isolate two adjacent single-rooted teeth: a clinical aidINTERNATIONAL ENDODONTIC JOURNAL, Issue 7 2004K. L. Chen Abstract Aim, To emphasize the importance of rubber dam isolation in root canal treatment and to present a technique to simultaneously isolate two single-rooted teeth using a molar clamp. Summary, Isolation of two adjacent teeth with inadequate tooth structure is a challenge. The split-dam technique or using two clamps have drawbacks. This report presents a technique to simultaneously isolate two adjacent single-rooted teeth that are difficult to isolate by conventional methods. Its advantages are efficiency, reduction of radiation exposure, better access, good visibility and isolation. Key learning points, ,,The basis of this technique is to isolate two teeth as two roots of a molar tooth. ,,The indications for this technique are two adjacent prepared crowns and crownless roots. ,,The appropriate molar clamp can be selected on the basis of the mesial,distal clamp jaw distance being equal to the mesial,distal spacing of the two roots. The buccal,lingual jaw distance of the clamp should be smaller than the dimension of the roots to provide adequate retention. [source] Resolution of persistent periapical infection by endodontic surgeryINTERNATIONAL ENDODONTIC JOURNAL, Issue 1 2004F. B. A. Ferreira Abstract Aim, To examine the surfaces of a root tip removed during surgical endodontic treatment for the presence of microorganisms. Summary, The present clinical case illustrates an endodontic retreatment of a maxillary premolar tooth with a fistula and periapical reaction. The case was under treatment for 1 year, during which an intracanal medicament was replaced several times. As the lesion did not decrease and exudate was persistent through the fistula and root canal, root end resection with root end filling was performed. Microbiological samples were collected from the fistula, where Propionibacterium acnes, a species associated with endodontic failures, was detected by appropriate anaerobic technique. The resected root apex was observed by scanning electron microscopy (SEM), which revealed cocci and fungal forms surrounding one of the foramina. After 12 months, the periapical lesion had reduced. Key learning points ,,Persistent extraradicular infections are not affected by the action of antimicrobial agents such as irrigants and medicaments used during root canal treatment. ,,Apical surgery is a suitable alternative for definitive removal of an established refractory infection, promoting repair of difficult cases. [source] Endodontic and periodontal treatments of a geminated mandibular first premolarINTERNATIONAL ENDODONTIC JOURNAL, Issue 2 2002S. Aryanpour Abstract Aim, To describe a rare case of gemination involving a mandibular first premolar. Summary The complex morphology of geminated teeth renders their endodontic and periodontal management difficult. Root canal and periodontal treatments were performed on a geminated mandibular first premolar with three canals. Clinical examination showed two separated crowns with united roots. Radiographically, two distinct pulp chambers with two joined and a third independent canal were seen. Conventional root canal treatment resulted in complete healing of the apical lesion. However, the occurrence of a vertical fracture led to the extraction of the mesial segment. At the follow-up visit, the distal segment was clinically healthy and continued to satisfy functional demands. Key learning points ,Failure to diagnose the initial crack along a gemination groove resulted in further propagation and finally complete vertical fracture. ,Owing to the abnormal morphology of the crown and the complexity of the root canal system in geminated teeth, treatment protocols require special attention. ,For asymptomatic cases without aesthetic or orthodontic problems and without associated pathosis, routine review and careful maintenance are required. [source] The standardized-taper root canal preparation , Part 6.INTERNATIONAL ENDODONTIC JOURNAL, Issue 3 2001GT file technique in abruptly curved canals Abstract Aim, To describe the application of GT files in roots with abrupt curvatures. Summary Most dentists interpret obstructions to instrument progress as calcification, rather than abrupt curvature. Basically, there are not any apically calcified canals, only clinicians who are not clever enough or patient enough to sneak to patency. Dentists should be on their guard and sensitive to the ,rubber band' sensation of residual pulp tissue, and the ,loose resistance' sensation of the curved or ledged canal. Residual pulp tissue should be removed and the canal lubricated. The ledged or curved canal will only be helped by file bending. The size 10 file test is the key to identify canals requiring pre-bent instruments. The canal should first be flared short of the obstruction, before shaping the canal after it with regular, pre-bent K-files. Pre-bent GT hand-files can then be used with care to blend the apical and more coronal regions for final shape. Cone-fit may then require chilling and pre-bending GP cones (pre-bend more than one), before packing the canal. Key learning points ,Root canals do not calcify apically. ,File progress is prevented by pulp tissue, abrupt curvatures or ledging. ,Loose resistance to the passage of a size 10 file shows the canals that require instrument pre-bending. This test should be repeated at intervals during the preparation. ,Even NiTi GT files can be pre-bent for use in abrupt curves. ,Gutta percha cones can be pre-bent after chilling. [source] Design principles for virtual patients: a focus group study among studentsMEDICAL EDUCATION, Issue 6 2009Sören Huwendiek Objectives, This study aimed to examine what students perceive as the ideal features of virtual patient (VP) design in order to foster learning with a special focus on clinical reasoning. Methods, A total of 104 Year 5 medical students worked through at least eight VPs representing four different designs during their paediatric clerkship. The VPs were presented in two modes and differed in terms of the authenticity of the user interface (with or without graphics support), predominant question type (long- versus short-menu questions) and freedom of navigation (relatively free versus predetermined). Each mode was presented in a rich and a poor version with regard to the use of different media and questions and explanations explicitly directed at clinical reasoning. Five groups of between four and nine randomly selected students (n = 27) participated in focus group interviews facilitated by a moderator using a questioning route. The interviews were videotaped, transcribed and analysed. Summary reports were approved by the students. Results, Ten principles of VP design emerged from the analysis. A VP should be relevant, of an appropriate level of difficulty, highly interactive, offer specific feedback, make optimal use of media, help students focus on relevant learning points, offer recapitulation of key learning points, provide an authentic web-based interface and student tasks, and contain questions and explanations tailored to the clinical reasoning process. Conclusions, 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. [source] How can we prepare medical students for theatre-based learning?MEDICAL EDUCATION, Issue 10 2007Nishan Fernando Context, The quality of medical undergraduate operating theatre-based teaching is variable. Preparation prior to attending theatre may support student learning. Identifying and agreeing key skills, competences and objectives for theatre-based teaching may contribute to this process of preparation. Methods, We carried out a cross-sectional survey of consultant surgeons and students using a forced choice questionnaire containing 16 skills and competences classified as ,essential', ,desirable' or ,not appropriate', and a choice of 6 different teaching methods, scored for perceived effectiveness on a 5-point Likert scale. Questionnaire content was based on the findings from an earlier qualitative study. Results, Comparative data analyses (Mann, Whitney and Kruskal,Wallis tests) were carried out using spss Version 14. A total of 42 consultant surgeons and 46 students completed the questionnaire (46% and 100% response rates, respectively). Knowledge of standard theatre etiquette and protocols, ability to scrub up adequately, ability to adhere to sterile procedures, awareness of risks to self, staff and patients, and appreciation of the need for careful peri-operative monitoring were considered ,essential' by the majority. Student and consultant responses differed significantly on 5 items, with students generally considering more practical skills and competences to be essential. Differences between students on medical and surgical attachments were also identified. Conclusions, Consultant surgeons and medical students agree on many aspects of the important learning points for theatre-based teaching. Compared with their teachers, students, particularly those on attachment to surgical specialties, are more ambitious , perhaps overly so , in the level of practical skills and risk awareness they expect to gain in theatre. [source] Child disability case studies: an interprofessional learning opportunity for medical students and paediatric nursing studentsMEDICAL EDUCATION, Issue 8 2007Karen N Street Context, We describe an interprofessional learning (IPL) opportunity for pre-qualification medical and paediatric nursing students using community-based case studies of disabled children and their families. Methods, A total of 160 students were randomly allocated into interprofessional and uniprofessional pairs. Each pair visited a disabled child at home and school and presented their experience to the rest of the group. Quantitative and qualitative evaluation methods were used to explore the learning experience. Data collection tools included a scale measuring attitudes towards IPL, which was completed by all students before and after their visits and focus groups. Results, The value of the community setting and independent working of the case study was appreciated by the students. The intimacy involved in working in IP pairs demonstrated both positive and negative features. Nursing students showed more open and positive attitudes towards IPL than medical students. Nursing students in IP pairs appear to have benefited most from the exercise, notably in terms of confidence and self-esteem. Professional differences in communication skills and approach were identified as particular learning points for all students. Conclusions, The added value of combining quantitative and qualitative research methods is well demonstrated by this study. Learning opportunities from the case study were greater as a result of working interprofessionally. Student attitudes towards IPL and professional stereotyping changed as a result of this IPL exercise. The importance of the social context of learning and the contact hypothesis are supported by our findings. [source] Simulation in undergraduate medical education: bridging the gap between theory and practiceMEDICAL EDUCATION, Issue 1 2004Jennifer M Weller Objective, To evaluate the use of simulation-based teaching in the medical undergraduate curriculum in the context of management of medical emergencies, using a medium fidelity simulator. Design, Small groups of medical students attended a simulation workshop on management of medical emergencies. The workshop was evaluated in a postcourse questionnaire. Subjects, All Year 4 medical students allocated to the resuscitation rotation during the first half of 2002. Main outcome measures, Student perceptions of learning outcomes, the value of the simulation in the undergraduate curriculum and their self-assessed improved mastery of workshop material. Results, A total of 33 students attended the workshop and all completed questionnaires. Students rated the workshop highly and found it a valuable learning experience. In all, 21 (64%) students identified teamwork skills as key learning points; 11 (33%) felt they had learnt how to approach a problem better, particularly in terms of using a systematic approach, and 12 (36%) felt they had learnt how to apply their theoretical knowledge in a clinical setting better. All 33 students were positive about the use of simulation in their training; 14 students wrote that simulation should be used more or should be mandatory in training; 5 students commented positively on the realism of the learning experience and a further 5 said they valued the opportunity to learn new skills in a safe environment. Conclusion, This study demonstrates that medical students value simulation-based learning highly. In particular, they value the opportunity to apply their theoretical knowledge in a safe and realistic setting, to develop teamwork skills and to develop a systematic approach to a problem. A medium fidelity simulator is a valuable educational tool in medical undergraduate education. [source] Innovations in parenting support: an evaluation of the YMCA's ,Parenting Teenagers' initiativeCHILDREN & SOCIETY, Issue 3 2002Debi Roker This paper describes the evaluation of a three year Initiative run by the YMCA. The aim of the Initiative was to set up 30 different projects in YMCA centres in England, to provide help and support to the parents of teenagers. The Initiative was evaluated by the Trust for the Study of Adolescence. Funding was agreed for 29 projects, which included group-based courses, ,Dads and Lads' projects, mediation schemes, transition evenings, and families and computing courses. A variety of outcomes from these projects are identified, both for parents, young people, project workers, and the YMCA as an organisation. Key issues and learning points from the Initiative are also identified. Finally, some general comments are made about strategies to provide support to the parents of teenagers. Copyright © 2002 John Wiley & Sons, Ltd. [source] | ||||||||||