Defining performance levels in undergraduate otolaryngology education.

Objectives: This study seeks the opinions of qualified doctors on what they feel medical students should learn about otolaryngology. It aims to identify both the content deemed relevant and the performance levels for medical students in otolaryngology.

Methods: A national survey developed from a content analysis of undergraduate otolaryngology curricula from the UK was undertaken, accompanied by a review of the literature and input from an expert group.

Toward interprofessional learning and education: Mapping common outcomes for prequalifying healthcare professional programs in the United Kingdom.

Introduction: Interprofessional education (IPE) continues to be a key component in prequalifying health professional education, with calls for regulators to publish a joint statement regarding IPE outcomes. To date, the regulatory documents for healthcare education in the United Kingdom have not been examined for common learning outcomes; information that could be used to inform such a statement and to identify opportunities for interprofessional learning.

Methods: A mapping of the outcomes/standards required by five, UK, health profession regulatory bodies was undertaken.

An undergraduate Otolaryngology curriculum comparison in the United Kingdom using a curriculum evaluation framework.

Objective: To compare undergraduate otolaryngology curricula in the United Kingdom. To develop a tool which would allow undergraduate specialty curricula to be compared.

Design: Development of a curriculum evaluation framework (CEF) and survey.

Insightful Practice: a robust measure of medical students' professional response to feedback on their performance.

Background: Healthcare professionals need to show accountability, responsibility and appropriate response to audit feedback. Assessment of Insightful Practice (engagement, insight and appropriate action for improvement) has been shown to offer a robust system, in general practice, to identify concerns in doctors' response to independent feedback. This study researched the system's utility in medical undergraduates.

Constructing and evaluating a validity argument for the final-year ward simulation exercise.

The authors report final-year ward simulation data from the University of Dundee Medical School. Faculty who designed this assessment intend for the final score to represent an individual senior medical student's level of clinical performance. The results are included in each student's portfolio as one source of evidence of the student's capability as a practitioner, professional, and scholar.

Impact of student choice on academic performance: cross-sectional and longitudinal observations of a student cohort.

Background: Student choice plays a prominent role in the undergraduate curriculum in many contemporary medical schools. A key unanswered question relates to its impact on academic performance.

Methods: We studied 301 students who were in years 2 and 3 of their medical studies in 2005/06.

Direct observed procedural skills assessment in the undergraduate setting.

Background: Medical students are required to undertake procedural clinical skills training before they qualify as doctors, and an assessment of these skills is a critical element of their fitness to practice.

Context: Challenges facing educators include the logistics of observing: i.e.

Thyroid testing in pregnant women with thyroid dysfunction in Tayside, Scotland: the thyroid epidemiology, audit and research study (TEARS).

Objective: To investigate the rate of thyroid testing during pregnancy.

Design: Population-based, retrospective record-linkage study.

Setting: Health care data on pregnant women in Tayside, Scotland.

Uptake of folic acid supplements before and during pregnancy: focus group analysis of women's views and experiences.

Background:   To reduce risk of neural tube defects, current guidance recommends that all women who could become pregnant should take a daily 400 μg folic acid supplement before conception and until the 12th week of pregnancy. It is recognised that compliance with this guidance is sub-optimal, although little is known about the reasons why. The present study aims to explore the rationale behind women's decision-making on folic acid supplement use to inform health communications.

Relationship between maternal arterial wave reflection, microvascular function and fetal growth in normal pregnancy.

Objective: In 50 normotensive pregnancies, we examined the relationship between fetal growth, arterial wave reflection, and microvascular function at 22, 34 weeks gestation, and six weeks postpartum.

Methods: Arterial wave reflection was determined by measuring augmentation index (AIx). Changes in skin microcirculation to acetylcholine (ACh) and sodium nitroprusside (SNP) were assessed using laser Doppler imaging.

The E-learning revolution in obstetrics and gynaecology.

The explosion of information technology has created new opportunities and tools to assist the trainee in the process of learning. This chapter describes how the Royal College of Obstetricians and Gynaecologists (RCOG) is embracing the opportunities provided by this technology to create interactive and engaging learning programmes designed to support trainees in achieving the knowledge, skills and attitudes required to practise. It considers how the RCOG has developed a number of online initiatives to support training, the drivers for doing so and presents some ideas for future developments.

A randomised, double-blinded, placebo-controlled study of the phosphodiesterase type 5 inhibitor sildenafil for the treatment of preeclampsia.

Objective: To determine if the phosphodiesterase type 5 inhibitor sildenafil prolongs pregnancy in women with preeclampsia.

Methods: Women with preeclampsia at gestational ages 24-34 weeks were recruited from nine hospitals in the UK, and randomly assigned to sildenafil citrate or placebo. Medication was increased every 3 days from 20 mg three times daily (tid), to 40 mg, and 80 mg tid.

The role of modifiable pre-pregnancy risk factors in preventing adverse fetal outcomes among women with type 1 and type 2 diabetes.

We investigated the fetal outcomes of pregnancy in women with pre-existing diabetes in relation to pre-pregnancy risk factors using a community-based cohort of women in Tayside, Scotland. There were 211 pregnancies in 132 women with insulin-requiring type 1 and 2 diabetes between January 1993 and December 2005. Adverse fetal outcome was classified as spontaneous miscarriage, termination for medical reasons, stillbirth, neonatal death, or congenital malformation and occurred in 61 (29%) pregnancies.

Progesterone for the prevention of preterm birth in twin pregnancy (STOPPIT): a randomised, double-blind, placebo-controlled study and meta-analysis.

Background: Women with twin pregnancy are at high risk for spontaneous preterm delivery. Progesterone seems to be effective in reducing preterm birth in selected high-risk singleton pregnancies, albeit with no significant reduction in perinatal mortality and little evidence of neonatal benefit. We investigated the use of progesterone for prevention of preterm birth in twin pregnancy.

Sources of variation in performance on a shared OSCE station across four UK medical schools.

Context: High-stakes undergraduate clinical assessments should be based on transparent standards comparable between different medical schools. However, simply sharing questions and pass marks may not ensure comparable standards and judgements. We hypothesised that in multicentre examinations, teaching institutions contribute to systematic variations in students' marks between different medical schools through the behaviour of their markers, standard-setters and simulated patients.

Cross-referencing the Scottish Doctor and Tomorrow's Doctors learning outcome frameworks.

Learning outcomes, organised into systems or frameworks which describe and define the output of an educational programme, are being created and used in healthcare education with increasing frequency (Harden 2001, 2002). Medical schools may be required to conform to more than one such outcome framework. For example, both the UK General Medical Council (GMC) and the Scottish Deans' Medical Curriculum Group (SDMCG) have created and published a systematic learning outcome framework for medical graduates.

Evidence for multiple circulating factors in preeclampsia.

Objective: The purpose of this study was to enrich vasoactive factors that are present in the plasma of women with preeclampsia by the application of sequential fractionation and determination of the activity of each fraction in a bioassay.

Study Design: Pooled plasma from women with preeclampsia (n = 23) and matched control subjects (n = 23) was subjected to fractionation with ultrafiltration, targeted immunodepletion, or size exclusion chromatography. Myometrial arteries that were isolated from healthy cesarean section biopsy specimens (n = 28) were incubated with plasma fractions (2%, volume/volume), and their endothelial function was assessed by wire myography.

Poor glycated haemoglobin control and adverse pregnancy outcomes in type 1 and type 2 diabetes mellitus: systematic review of observational studies.

Background: Glycaemic control in women with diabetes is critical to satisfactory pregnancy outcome. A systematic review of two randomised trials concluded that there was no clear evidence of benefit from very tight versus tight glycaemic control for pregnant women with diabetes.

Methods: A systematic review of observational studies addressing miscarriage, congenital malformations and perinatal mortality among pregnant women with type 1 and type 2 diabetes was carried out.

Changes in endothelial function precede the clinical disease in women in whom preeclampsia develops.

Endothelial dysfunction is important in the pathophysiology of preeclampsia. No study has examined endothelial function sequentially at different gestations before development of the clinical syndrome and after delivery (to compare maternal from placental influences). We sought to determine whether endothelial function changes before the clinical development of preeclampsia.

Use of proteomic patterns as a novel screening tool in pre-eclampsia.

This pilot study aimed to use Ciphergen ProteinChip technology to determine differences in protein profiles in plasma, taken at 26 weeks, from women at risk of developing pre-eclampsia. Five proteins were found to be significantly up-regulated in samples from women who subsequently developed pre-eclampsia compared with women who remained normotensive.

MMP-2 levels are elevated in the plasma of women who subsequently develop preeclampsia.

Objective: To determine levels of matrix metalloproteinase (MMP)-2 and MMP-9, and the tissue inhibitors of metalloproteinases (TIMP)-1 and TIMP-2 in the plasma of women destined to develop preeclampsia prior to the onset of clinical disease.

Study Design: Plasma samples were taken from women whose pregnancies were subsequently complicated by preeclampsia and from normal pregnant women at 22 and 26 weeks and at delivery or diagnosis. Following equal protein loading, MMP-2 and 9 and TIMP-1 and 2 were quantified using zymography and Western blot analysis, respectively.