Moira Maley

Rapid death of injected myoblasts in myoblast transfer therapy

Myoblast transplantation has been proposed as a potential therapy for Duchenne muscular dystrophy (DMD). A Y‐chromosome‐specific probe was used to track the fate of donor male myoblasts injected into dystrophic muscles of female mdx mice (which are an animal model for DMD). In situ analysis with the Y‐probe showed extremely poor survival of isolated normal male (C57B1/10Sn) donor myoblasts after injection into injured or uninjured muscles of dystrophic (mdx) and normal (C57B1/10Sn) female host mice. A decrease in the numbers of donor (male) myoblasts was seen from 2 days and was marked by 7 days after injection: few or no donor myoblasts were detected in host muscles examined at 3–12 months. There was limited movement of the injected donor myoblasts and fusion into host myofibers was rare. The results of this study strongly suggest that the failure of clinical trials of myoblast transplantation therapy in boys with DMD may have been due to rapid and massive death of the donor myoblasts soon after myoblast injection.

Development and clinical assessment of an artificial cornea

Keratoprosthesis research has been a gradual, rather fragmentary process with advances being made by isolated groups of researchers. This has arisen partly because of poor funding in the area; research groups which have achieved commercial support have often had constraints upon the full disclosure of their findings. Despite these difficulties there has been real progress over the last decade by several independent groups. This article concentrates upon our own development of a hydrogel core-and-skirt keratoprosthesis, the Chirila KPro, in order to illustrate the scientific and clinical problems common to keratoprosthesis research. Pilot data from a clinical trial is presented and the priorities for future research are discussed.

Using rural and remote settings in the undergraduate medical curriculum: AMEE Guide No. 47

The goal of global equity in health care requires that the training of health-care professionals be better tuned to meet the needs of the communities they serve. In fact medical education is being driven into isolated communities by factors including workforce undersupply, education pedagogy, medical practice and research needs. Rural and remote medical education (RRME) happens in rural hospitals and rural general practices, singly or in combination, generally for periods of 4 to 40 weeks. An effective RRME programme matches the context of the local health service and community. Its implementation reflects the local capacity for providing learning opportunities, facilitates collaboration of all participants and capitalises on local creativity in teaching. Implementation barriers stem from change management, professional culture and resource allocation. Blending learning approaches as much as technology and local culture allow is central to achieving student learning outcomes and professional development of local medical teachers. RRME harnesses the rich learning environment of communities such that students rapidly achieve competence and confidence in a primary care/generalist setting. Longer programmes with an integrated (generalist) approach based in the immersion learning paradigm appear successful in returning graduates to rural practice and a career track with a quality lifestyle.

Technology-enabled assessment of health professions education: Consensus statement and recommendations from the Ottawa 2010 conference

The uptake of information and communication technologies (ICTs) in health professions education can have far-reaching consequences on assessment. The medical education community still needs to develop a deeper understanding of how technology can underpin and extend assessment practices. This article was developed by the 2010 Ottawa Conference Consensus Group on technology-enabled assessment to guide practitioners and researchers working in this area. This article highlights the changing nature of ICTs in assessment, the importance of aligning technology-enabled assessment with local context and needs, the need for better evidence to support use of technologies in health profession education assessment, and a number of challenges, particularly validity threats, that need to be addressed while incorporating technology in assessment. Our recommendations are intended for all practitioners across health professional education. Recommendations include adhering to principles of good assessment, the need for developing coherent institutional policy, using technologies to broaden the competencies to be assessed, linking patient-outcome data to assessment of practitioner performance, and capitalizing on technologies for the management of the entire life-cycle of assessment.

Synthesis, physical characterization, and biological performance of sequential homointerpenetrating polymer network sponges based on poly (2-hydroxyethyl methacrylate)

A limitation in the use of hydrophilic poly(2-hydroxyethyl methacrylate) (PHEMA) sponges as implantable devices is their inherently poor mechanical strength. This precludes proper surgical manipulation, especially in the eye where the size of the implant is usually small. In this study a new method was developed to produce mechanically stronger PHEMA sponges. Sequential homointerpenetrating polymer network (homo-IPN) sponges were made by using HEMA as the precursor for generating both the first network and the successive interpenetrated networks. Following the formation of network I, the sponge was squeezed to remove the interstitial water, soaked in the second monomer (also HEMA), and squeezed again to remove the excess monomer from the pores before being subjected to the second polymerization leading to the formation of network II. Two two-component IPN sponges (K2 and K4) with increasing HEMA content in the network II and a three-component IPN sponge (K3) were produced, and their properties were compared to those of a homopolymer PHEMA sponge (control). Apart from elongation, the tensile properties were all significantly enhanced in the IPN sponges; the water content was the same as in the control sponge, except for sponge K4, which was lower. Light microscopy revealed similar pore morphologies of the control and IPN sponges K2 and K3, and the majority of the pores were around 25 microm. Sponge K4 displayed smaller pores of around 10 microm. Cellular invasion into the sponges was examined in vitro (incubation with 3T3 fibroblasts) and in vivo (implantation in rabbit corneas). Although the in vitro assay detected a change in the cell behavior in the early stage of invasion, which was probably due to the formation of IPNs, such changes were not reflected in the longer term in vivo experiment. There was a proper integration of sponges K2 and K3 with the corneal stroma, but much less cellular invasion and no neovascularization in sponge K4. We concluded that IPN formation is a valid method to enhance the strength of PHEMA sponges, provided that the content of HEMA in the successive networks is not too high.

Tuning medical education for rural-ready practice: designing and resourcing optimally

In an effort to bring doctors back to the bush the Australian government has resourced a number of rural clinical schools (RCS). At the RCS in the University of Western Australia students were allocated in small groups to rural sites for the entire fifth year of a six-year course, sitting the same final examinations as city students. Key factors guiding the successful outcome were the resourcing and implementation of the infrastructure and teaching and learning pedagogy. In designing support, the disconnection of students from their city colleagues was anticipated as an issue, as was the pedagogical indoctrination of the teachers. The curriculum implementation was adapted in this light. The role of the Web in teaching and learning, and their status as ‘student colleagues’ and independent learners were pivotal aspects. As students settled at their site, their confidence grew and their anxiety over urban disconnection dissipated. By benchmarking themselves using Web-based formative assessments and in formative ‘objective structured clinical examinations’ staged for them by the RCS, the students received ongoing feedback on their progress. This model of embedding students in rural centres for an extended period with rural practitioners as teachers was successfully implemented at multiple sites geographically vastly separate.

Addressing current problems in teaching pathology to medical students: blended learning

Background: Forces influencing the remodelling of medical curricula have clouded the visibility of pathology teaching yet its mastery is central to the study of medicine. The shortage in the workforce available for routine clinical diagnosis, research and teaching, and increasing student numbers have driven the development of innovative teaching methods. Aims: To develop teaching methods which improved student satisfaction and engagement in their learning of pathology, and which also accommodated larger classes. Methods: An iterative development cycle adopting effective use of the web and sound instructional design pedagogies was followed. Two face-to-face formats, i.e. small group and large group, and a self-directed web-based (online) format were implemented on a cohort of 220 third year medical students. Outcomes were evaluated by analysis of a student preceptions questionnaire and of students’ web footprints in the online resource. Results: Themes relating to teaching techniques, learning preferences and accessibility issues emerged as significant in the students’ perceptions. Measures of user “online avidity”, “case breadth compliance” and “formative assessment compliance/diligence” were determined by comparing historical behaviour in the web resource with patterns of use within these modules. Students who were proven avid online users entered the resource more frequently than less avid users. However less avid online users did not necessarily access a narrower breadth of cases than avid online users. Students who made maximal use of the web formative assessments tended to have better summative outcomes. Conclusions: The students adopted the online resource as a learning tool. The optimal combination of small group face-to-face tutorials and the self-directed web-based (online) format improved pathology teaching, partly because it satisfied a broader range of learning styles in students. The cycle used of develop, implement, evaluate was successful as it engaged the students, was evidence based and driven by discipline experts who were commited teachers.

Longitudinal assessment in an undergraduate longitudinal integrated clerkship: The mini Clinical Evaluation Exercise (mCEX) profile

Aim: Student and assessor performance were examined over three academic years using the mini Clinical Evaluation Exercise (mCEX) as a continuous feedback tool across all disciplines, in all learning contexts, for an entire integrated undergraduate year. Methods: Students could complete any number of mCEX, but had to submit a minimum number per discipline. Students were free to choose assessors. Assessors were not trained. Data were collected in a customised database, and analysed in SPSS ver 18.0.0. Results: 5686 mCEX were submitted during 2008–2010 (Cronbachs α = 0.80). Marks were affected by doctor grade (F = 146.6, p < 0.000), difficulty of clinical encounter (F = 33.3, p < 0.000) and clinical discipline (F = 13.8, p < 0.000). Students most frequently sought harder markers (experienced general practitioner/hospital specialists). Increases in mCEX marks were greatest during the early, formative months (F = 42.7, p < 0.000). More mCEX were submitted than required, without differentiation between weak or strong students (rxy = 0.22, p = 0.78). Conclusions: Undergraduate students in longitudinal clerkships acquire most skills during ‘formative’ learning. They seek ‘hard’ assessors, consistent with year-long mentoring relationships and educational/feedback value. Assessors mark consistent with a framework of encouraging student performance. Over an entire longitudinal clerkship, students complete mCEX in excess of course requirements. This study confirms the impact of the longitudinal context on assessor and student behaviour.

Single chromosome defect, partial trisomy 1q, in a colon cancer cell line☆

The characterization of a single chromosome defect previously reported in a case of inherited nonpolyposis colorectal cancer is the essence of this communication. The defect, originally described as 13p+, is now being defined and the karyotype designated as 46,XY,-13,+der(13)t(1;13)(q32.1;p11).

Growing rural doctors as teachers: a rural community of medical education practice.

This reflective work considered the journey of rural doctors from diverse backgrounds as teachers and academics during the establishment and rapid expansion of an Australian rural clinical school. The observed social and academic processes are analysed in the context of social learning theory. The extent to which the theoretical social processes match observations during a period of transformational change indicates how social learning processes contributed to the outcome. Ten areas of thematic teacher concerns were identified during teachers’ professional development and the strategies used to address these declared. Despite the concurrent evolution of both the overall organisation (teacher environment) and teachers’ task (curriculum approach), a community of rural educational practice (CREP) formed and thrived. It adopted a culture of sharing experiences which enabled ongoing knowledge brokering, engaged experts and transformed members. Critical reflection resulting from engagement in mutual activity and a supporting culture of enablement driven by senior leadership was central to success. A generic framework for building a successful CREP includes, leadership that ‘enables’ its members to flourish, a rural academic identity with a ‘Community of Practice’ governance, internal benchmarking by members to measure and refine practice, critical reflection ‘in’ and ‘on’ academic practice, vertical and horizontal mentoring.