Quality Assurance of Undergraduate Medical Education in Israel by Continuous Monitoring and Prioritization of the Accreditation Standards.

External accreditation reviews of undergraduate medical curricula play an important role in their quality assurance. However, these reviews occur only at 4-10-year intervals and are not optimal for the immediate identification of problems related to teaching. Therefore, the Standards of Medical Education in Israel require medical schools to engage in continuous, ongoing monitoring of their teaching programs for compliance with accreditation standards.

Reflections on the current and future roles of clinician-scientists.

"Clinician-scientists" is an all-inclusive term for board-certified specialists who engage in patient care and laboratory-based (biomedical) research, patient-based (clinical) research, or population-based (epidemiological) research. In recent years, the number of medical graduates who choose to combine patient care and research has declined, generating concerns about the future of medical research. This paper reviews: a) the various current categories of clinician-scientists, b) the reasons proposed for the declining number of medical graduates who opt for a career as clinician-scientists, c) the various interventions aimed at reversing this trend, and d) the projections for the future role of clinician-scientists.

Expected benefits of streamlining undergraduate medical education by early commitment to specific medical specialties.

Undergraduate medical education is too long; it does not meet the needs for physicians' workforce; and its content is inconsistent with the job characteristics of some of its graduates. In this paper we attempt to respond to these problems by streamlining medical education along the following three reforms. First, high school graduates would be eligible for undergraduate medical education programs of 4 years duration.

Sources of distress during medical training and clinical practice: Suggestions for reducing their impact.

Background: Medical students and doctors experience several types of professional distress. Their causes ("stressors") are commonly classified as exogenous (adapting to medical school or clinical practice) and endogenous (due to personality traits). Attempts to reduce distress have consisted of providing students with support and counseling, and improving doctors' management of work time and workload.

Narrative review: should teaching of the respiratory physical examination be restricted only to signs with proven reliability and validity?

Objective: To review the reported reliability (reproducibility, inter-examiner agreement) and validity (sensitivity, specificity and likelihood ratios) of respiratory physical examination (PE) signs, and suggest an approach to teaching these signs to medical students.

Methods: Review of the literature. We searched Paper Chase between 1966 and June 2009 to identify and evaluate published studies on the diagnostic accuracy of respiratory PE signs.

Current trends in the educational approach for teaching interviewing skills to medical students.

Research in the acquisition of patient interviewing skills by medical students has dealt mostly with the evaluation of the effectiveness of various teaching programs and techniques. The educational approaches (i.e.

Variability in duration of follow up may bias the conclusions of cohort studies of patients with patent foramen ovale.

Closure of patent foramen ovale (PFO) is expected to prevent paradoxical emboli. In the absence of randomized trials, its efficacy has been assessed by comparing uncontrolled cohort studies of medically treated patients with those treated by PFO closure. The objective of this study was to highlight a confounder of such studies, namely, the variability in the duration of follow-up.

A proposal for overcoming problems in teaching interviewing skills to medical students.

The objective of this paper is to draw attention to four features that distinguish the pedagogy of patient interviewing from the teaching of other clinical skills: (a) students are not naïve to the skill to be learned, (b) they encounter role models with a wide variability in interviewing styles, (c) clinical teachers are not usually specialists in the behavioral sciences, including patient interviewing, and (d) the validity of the methods used for assessment of interviewing skills is uncertain. We propose to adjust the teaching of patient interviewing to these features by (a) gaining an insight into the students' views and using these views as a point of departure for discussions of patient interviewing; (b) helping students to understand why different clinicians use different communication styles; (c) providing the clinical tutors with additional training that will help them function as both specialists who share their expertise with the students and facilitators of small-group learning; and (d) using assessment methods that encourage joint deliberation by the learner and the examiner, rather than a judgmental right-wrong dualism by the examiner alone. The teaching approach that we suggest is consistent with current theories of adult learning, and it occurs in an egalitarian rather than a hierarchical environment.

Uncertainties in the selection of applicants for medical school.

Decisions about admissions to medical school are based on assessments of the applicants' cognitive achievements and non-cognitive traits. Admission criteria are expected to be fair, transparent, evidence-based and legally defensible. However, unlike cognitive criteria, which are highly reliable and moderately valid, the reliability and validity of the non-cognitive criteria are low or uncertain.

The time horizons of formal decision analyses.

Clinical decision analyses use time horizons that vary from hours to the patient's entire life. Analyses of decisions with a lifetime horizon commonly use Markov models, which simulate the patient's lifespan by dividing it into equal periods (cycles). At each cycle, the model exposes a hypothetical cohort to the competing hazards of normal aging and of the disease in question (disease-specific hazards), and the results are presented as years of life expectancy.

A proposal for teaching basic clinical skills for mastery: the case against vertical integration.

The authors argue that medical school faculty should (1) make a distinction among competencies that they feel need to be taught for mastery (i.e., at a level of proficiency expected from a practicing physician) and those that should be taught at lower levels of proficiency, and (2) impart the former competencies in single teaching units.

Viewpoint: suggestions for a shift in teaching clinical skills to medical students: the reflective clinical examination.

How medical students are taught physical examination (PE) skills appears to have changed little since the 1950s. Textbooks are organized according to organ systems and describe methods of eliciting and recording history and PE data using a routine format. In many medical schools, the preclinical teaching programs for clinical examination skills similarly emphasize an orderly collection of data.

Enhancing self-awareness in medical students: an overview of teaching approaches.

Self-awareness is an individual's tendency to pay attention to his or her own emotions, attitudes, and behavior in response to specific situations. In the case of physicians, self-awareness is their insight into how their emotional makeup influences patient care. Conceivably, such insight may improve doctors' professional performance.

What is empathy, and how can it be promoted during clinical clerkships?

The ability of medical students to empathize often declines as they progress through the curriculum. This suggests that there is a need to promote empathy toward patients during the clinical clerkships. In this article, the authors attempt to identify the patient interviewing style that facilitates empathy and some practice habits that interfere with it.

Overcoming barriers to teaching the behavioral and social sciences to medical students.

Most U.S. medical schools offer courses in the behavioral and social sciences (BSS), but their implementation is frequently impeded by problems.

A step-wise role playing approach for teaching patient counseling skills to medical students.

We describe a step-wise role playing approach to bedside teaching during the clinical training of medical students. The objective of this approach is to teach them the skills which are required to practice patient-centered medicine. "Patient-centered medicine" refers to a style of practice which relates to patients' needs rather than to the doctor's own plan, and which moves from professional control to patient empowerment.

Teaching doctor-patient interviewing skills using an integrated learner and teacher-centered approach.

Background And Objective: We describe an approach for the resolution of difficulties that some preclinical medical students appeared to have when acquiring patient interviewing skills.

Setting: Two medical schools in Israel.

Type Of Study: Descriptive.

The 'dark nucleus' and disruptions of follicular architecture: possible new histological aids for the diagnosis of the follicular variant of papillary carcinoma of the thyroid.

Aims: In order to facilitate the diagnosis of malignancy in solitary thyroid nodules which are non-invasive low-grade tumours, i.e. follicular variant of papillary carcinoma (FVPC) for which few histological discriminators exist, a search was made for additional diagnostically useful histological features.

Characterization and distribution of an oncofetal antigen (M2A antigen) expressed on testicular germ cell tumours.

M2A antigen is an oncofetal antigen associated with germ cell neoplasia, present in testis on fetal gonocytes and re-expressed on carcinoma in situ (CIS) and germ cell tumours. We developed a panel of monoclonal antibodies (mAb), M2A (IgG2a), D1-26 (IgG2b) and D2-40 (IgG1), to this antigen in order to characterize its structure and study its distribution among germ cell tumours. M2A antigen was purified by sequential lectin and antibody affinity chromatography and characterized as a monomeric M, 40 000 surface sialoglycoprotein, extensively glycosylated with O-linked carbohydrate structures, but devoid of N-linked sugars.

Treatment of X-linked hereditary nephritis in Samoyed dogs with angiotensin converting enzyme (ACE) inhibitor.

X-linked hereditary nephritis (HN) in Samoyed dogs is a model for human HN (Alport's syndrome). Angiotensin converting enzyme (ACE) inhibitors have been shown to slow the progression of renal disease in animal models and human patients. To determine the effect of ACE inhibitor treatment on X-linked HN in Samoyed dogs, a group of affected and a group of normal males were each randomly divided into two subgroups, which were either treated with an ACE inhibitor or left untreated.

A novel anti-seminoma monoclonal antibody (M2A) labelled with technetium-99m: potential application for radioimmunoscintigraphy.

Objective: To study the potential usefulness of monoclonal antibody (mAb) M2A specific for seminoma to image tumour nodules in a preclinical nude mouse model.

Materials And Methods: MAb M2A was labelled with technetium-99m (99mTc) following reduction and was administered intraperitoneally to nude mice bearing subcutaneous HEY cell xenografts against which the antibody was originally raised. Biodistribution and gamma scintigraphy studies were performed 24 h after administration of 99mTc-M2A.

Canine X chromosome-linked hereditary nephritis: a genetic model for human X-linked hereditary nephritis resulting from a single base mutation in the gene encoding the alpha 5 chain of collagen type IV.

Many families with X-chromosome linked hereditary nephritis (HN) have mutations in the gene on the X chromosome that codes for the alpha 5 chain of collagen type IV. Canine X-linked HN is an animal model for human X-linked HN. To study the alpha 5(IV) gene in this model, we used the nucleotide sequence published for the human alpha 5(IV) cDNA to construct sets of primers covering approximately 95% of the complete cDNA.

Targeting of [111In]biocytin to cultured ovarian adenocarcinoma cells using covalent monoclonal antibody-streptavidin conjugates.

Three monoclonal antibodies (mAb) directed against the human ovarian adenocarcinoma cell line HEY, were substituted with maleimide and covalently bonded to thiolated streptavidin. The conjugates were separated from unreacted reagents by successive affinity chromatography on protein A-Sepharose and iminobiotin columns. Purified conjugates consisted of an immunoglobulin (Ig) monomer bound to a streptavidin tetramer through a covalent bond between the Ig molecule and one of the streptavidin subunits.