Competence by Design: The Role of High-Stakes Examinations in a Competence Based Medical Education System.

Competency based medical education is developed utilizing a program of assessment that ideally supports learners to reflect on their knowledge and skills, allows them to exercise a growth mindset that prepares them for coaching and eventual lifelong learning, and can support important progression and certification decisions. Examinations can serve as an important anchor to that program of assessment, particularly when considering their strength as an independent, third-party assessment with evidence that they can predict future physician performance and patient outcomes. This paper describes the aims of the ("the Royal College") certification examinations, their future role, and how they relate to the Competence by Design model, particularly as the culture of workplace assessment and the evidence for validity evolves.

Moving away from medicines: an overview of chronic pain management.

Chronic pain can be debilitating and affects an increasing number of people in the UK due to an ageing population and the rising prevalence of comorbidities. Chronic pain can be primary, where it is not accounted for by another condition, or secondary, where it results from an underlying condition or injury. The National Institute for Health and Care Excellence has published updated guidance on the assessment and management of chronic pain in adults.

What will radiation oncology look like in 2050? A look at a changing professional landscape in Europe and beyond.

The number of newly diagnosed cancers per year is predicted to almost double in the next two decades worldwide, and it remains unclear if and when this alarming trend will level off or even reverse. As such, cancer is very likely to continue to pose a major threat to human health. Radiation oncology is an indispensable pillar of cancer treatment and a well-developed discipline.

A single HIV-1 cluster and a skewed immune homeostasis drive the early spread of HIV among resting CD4+ cell subsets within one month post-infection.

Optimizing therapeutic strategies for an HIV cure requires better understanding the characteristics of early HIV-1 spread among resting CD4+ cells within the first month of primary HIV-1 infection (PHI). We studied the immune distribution, diversity, and inducibility of total HIV-DNA among the following cell subsets: monocytes, peripheral blood activated and resting CD4 T cells, long-lived (naive [TN] and central-memory [TCM]) and short-lived (transitional-memory [TTM] and effector-memory cells [TEM]) resting CD4+T cells from 12 acutely-infected individuals recruited at a median 36 days from infection. Cells were sorted for total HIV-DNA quantification, phylogenetic analysis and inducibility, all studied in relation to activation status and cell signaling.

Post-treatment HIV-1 controllers with a long-term virological remission after the interruption of early initiated antiretroviral therapy ANRS VISCONTI Study.

Combination antiretroviral therapy (cART) reduces HIV-associated morbidities and mortalities but cannot cure the infection. Given the difficulty of eradicating HIV-1, a functional cure for HIV-infected patients appears to be a more reachable short-term goal. We identified 14 HIV patients (post-treatment controllers [PTCs]) whose viremia remained controlled for several years after the interruption of prolonged cART initiated during the primary infection.

Immune control of HIV-1 reservoirs.

Purpose Of Review: To discuss the recent major advances in the understanding of how host immune defenses contribute to HIV reservoir control.

Recent Findings: Immune control of HIV-1 reservoirs is a two-step process: viral replication activation from latent reservoirs followed by elimination of virus-expressing cells by the host. Environmental factors, such as pro-inflammatory type-I interferon, chemokines or cytokines, can facilitate HIV-1 replication, confer dormancy in CD4 cells or confer resistance to cytopathogenic effects of cytotoxic CD8 T cells.

Direct quantification of cell-associated HIV DNA in isolated rectal and blood memory CD4 T cells revealed their similar and low infection levels in long-term treated HIV-infected patients.

To evaluate the contribution of CD4 T cells from blood and gut compartments to the HIV-1 reservoir, we directly quantified cell-associated HIV DNA in isolated rectal (R-) and peripheral blood (PB-) memory CD4 T cells from 11 successfully long-term treated patients. Proportion of activated (CD25(+); CD69(+); and HLA-DR(+)) and CCR5 expressing CD4 T cells were markedly higher in rectal tissue compared with blood. However, HIV-1 infection levels of R- and PB-memory CD4 T cells did not significantly differ (medians: 4000 and 2100 copies per million cells) after effective long-term viral control, suggesting that each of these 2 compartments does not contribute in a similar fashion to the total HIV reservoir.

Modification of an OSCE format to enhance patient continuity in a high-stakes assessment of clinical performance.

Background: Traditional Objective Structured Clinical Examinations (OSCEs) are psychometrically sound but have the limitation of fragmenting complex clinical cases into brief stations. We describe a pilot study of a modified OSCE that attempts to balance a typical OSCE format with a semblance of a continuous, complex, patient case.

Methods: Two OSCE scenarios were developed.

Assessing cardiac physical examination skills using simulation technology and real patients: a comparison study.

Objective: High-stakes assessments of doctors' physical examination skills often employ standardised patients (SPs) who lack physical abnormalities. Simulation technology provides additional opportunities to assess these skills by mimicking physical abnormalities. The current study examined the relationship between internists' cardiac physical examination competence as assessed with simulation technology compared with that assessed with real patients (RPs).

Assessing the relationship between cardiac physical examination technique and accurate bedside diagnosis during an objective structured clinical examination (OSCE).

Background: Many standardized patient (SP) encounters employ SPs without physical findings and, thus, assess physical examination technique. The relationship between technique, accurate bedside diagnosis, and global competence in physical examination remains unclear.

Method: Twenty-eight internists undertook a cardiac physical examination objective structured clinical examination, using three modalities: real cardiac patients (RP), "normal" SPs combined with related cardiac audio-video simulations, and a cardiology patient simulator (CPS).

Does physical examination competence correlate with bedside diagnostic acumen? An observational study.

Aim: To examine the relationship between a physician's ability to examine a standardized patient (SP) and their ability to correctly identify related clinical findings created with simulation technology.

Method: The authors conducted an observational study of 347 candidates during a Canadian national specialty examination at the end of post-graduate internal medicine training. Stations were created that combined physical examination of an SP with evaluation of a related audio-video simulation of a patient abnormality, in the domains of cardiology and neurology.

Child abuse registration, fetal growth, and preterm birth: a population based study.

Objectives: To study the relation of intra-uterine growth and gestational age with child protection registration in a 20 year whole population birth cohort.

Setting: West Sussex area of England.

Study Design: Retrospective whole population birth cohort.

Disabling conditions and registration for child abuse and neglect: a population-based study.

Objective: To study the relationship between disabling conditions and registration for child abuse and neglect in a 19-year whole-population birth cohort.

Setting: West Sussex area of the United Kingdom.

Study Design: Retrospective whole-population cohort.

Symmetric and asymmetric two-handed pull-push strength of young adults.

Forty normal young adults volunteered for an experiment in which they were required to perform two-handed maximal pull-push in isometric and isokinetic modes (50 cm/s linear velocity of the handle) at 50-, 100-, and 150-cm heights of handle in sagittal, 30-deg lateral, and 60-deg lateral planes. Subjects were stabilized on a circular platform that rotated on its axis and allowed fixation in any position to achieve asymmetric settings. The pull-push strengths were applied to a 53-cm wide handle and were measured through the load cell assembly of the Static Dynamic Strength Tester.

A randomized crossover trial of Quick Medical Reference (QMR) as a teaching tool for medical interns.

Objective: To determine whether the addition of Quick Medical Reference (QMR) to usual educational tools improves an intern's performance in managing clinical cases that test diagnostic and investigative skills.

Design: Randomized, controlled, single-blinded crossover study.

Setting: Tertiary care teaching hospital.