with relevance to the case. Paper copies of the caseswere distributed to faculty for checking of content.These were then edited by elective students, whosubsequently posted them on Dalmedix. Studentswere asked to complete questionnaires regardingtheir learning experience, with 9 items to beanswered on a Likert scale of 1–5 (1 ¼ stronglydisagree, 5 ¼ strongly agree) and 2 open-endedquestions. Currently, more questionnaire data arebeing collected. A total of 65 PowerPoint� casepresentations have been posted on the Dalhousieintranet, available to medical students for learning.Evaluation of results and impact Over the past 3years, 328 students have participated. One clerk wasunable to obtain consent to make a presentationfrom the patient and family. Case-based PowerPoint�presentations shared using Bridgit� conferencingsoftware have been an invaluable learning tool formedical students. Pilot questionnaires administeredin 2004)05 and 2005)06 have indicated that 87% ofclerks found creating and presenting a case presen-tation a useful learning experience. In addition, 85%of students thought cases available on the university’sintranet would be a useful learning tool and 83% ofclerks found it useful to watch other groups present(mean Likert score 4Æ2 ± 0Æ6). The clerks identified 3main strengths in the case presentation learningprocess: learning about specific cases; practisingpresentations, and patient contact. Students foundwriting a multiple-choice question the most challen-ging aspect of the presentation (mean Likert score3Æ9 ± 0Æ8).

Due to the success of the case-based presentationlearning component in paediatrics, a similar formathas been launched in obstetrics and gynaecology.Discussion about involving an overseas medicalschool is underway and the cases are to be imple-mented as a distributed education component in anew medical school.

Correspondence: Kim Blake, IWK Health Centre, Dalhousie University,5850 ⁄ 5980 University Avenue, Halifax, Nova Scotia B3K 6R8, Canada.Tel: 00 1 902 470 6499; Fax: 00 1 902 470 6913; E-mail: kblake@dal.ca

doi: 10.1111/j.1365-2929.2007.02738.x

Early introduction to critical care medicine:a student curriculum

Paula Carvalho

Context and setting An 8-week programme in criticalcare medicine for Year 3 and 4 medical students atthe University of Washington, Seattle was implemen-ted to review concepts in physiology and critical caremedicine. Although many of these topics had

previously been covered in the first 2 years of medicalschool, they were re-introduced and applied in acritical care setting, where a clear understanding isimperative for patient management.Why the idea was necessary Patients are admitted tointensive care units (ICUs) with increasing frequencydue to the technological advances available tomanage a higher severity of illness. Students aretaught the fundamental concepts of acid-base bal-ance, respiratory physiology, cardiovascular haemo-dynamics and mechanical ventilation during Years 1and 2 of medical school, but may lack a clearunderstanding of these concepts by the time theyenter clinical clerkships. For this reason, topics inpulmonary and critical care medicine ordinarilytaught at fellowship level were presented muchearlier, to Year 3 and 4 medical students, to evaluatewhether a firm grasp of this information would be ofbenefit earlier in their careers.What was done A course syllabus and objectives wereprovided, and the following topics were reviewed:

• acid-base balance: acid-base disorders and theconcept of the anion gap;

• gas exchange: the alveolar gas equation, oxygencontent, oxygen delivery, the respiratory quotientand shunt fraction;

• airway management: airway anatomy and man-agement techniques with various airway adjuncts;

• mechanical ventilation: a review of standard andnewer ventilator modes, and a simulatedventilator experience;

• arrhythmia review: arrhythmia recognition andtreatment;

• chest tubes: indications, function and trouble-shooting, and

• critical care cases and �pearls�: including massivepulmonary embolism, septic shock, meningococ-caemia, hypothermia, venous air embolism, flailchest, fat embolism syndrome, pericardialtamponade, and drug overdose.

Evaluation of results and impact The students weregiven a pre-course test with problems derived fromthe course objectives and a number of patientspreviously followed in a medical ⁄ surgical ICU, and aself-assessment of their knowledge. On completion ofthe course, students were given a test on topics fromthe course objectives, as well as a questionnaire abouttheir subjective level of knowledge using values of 0(low) to 10 (high). During their internship year(1–2 years after the course), the same students weregiven another survey using values of 0 (low) to 10(high), regarding the utility of the course and their

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perceptions of the benefits of early critical caretraining.

A total of 57 students completed the course. Eachstudent had followed 2 ± 1 patients in a med-ical ⁄ surgical ICU before the course, and 10 ± 3patients after the course. Test scores in ICU physiol-ogy, acid-base diagnosis, arrhythmia recognition,airway management, and mechanical ventilationimproved from 22 ± 10% to 86 ± 14%, and subjectivescores increased from 2 ± 2 to 8 ± 1. The students feltthat the information presented in these sessionshelped them with their medical and surgicalclerkships, as well as with Year 4 sub-internships. Theinterns’ overall mean score was 9 ± 1, suggesting asubjective benefit from early training in critical caremedicine.

Correspondence: Paula Carvalho, Veterans Affairs Medical Center, 500West Fort Street, Boise, Idaho 83702, USA. Tel: 00 1 208 422 1325;Fax: 00 1 208 422 1319; E-mail: Paula.Carvalho@med.va.gov

doi: 10.1111/j.1365-2929.2007.02739.x

Innovative orientation: a treasure hunt inFoundation Year one

Tom W M Walker, Suzanne V McMahon & Matthew Walters

Context and setting There are advantages to beingable to find your way around the hospital you areabout to start work in. Traditionally, pre-registrationhouse officers would attend the day before theystarted for an induction. Orientation is vital toimprove the transition from student to doctor;however, it can be time-consuming, repetitive andboring. The following occurred in the WesternInfirmary, Glasgow.Why the idea was necessary The UK General MedicalCouncil’s report Tomorrow’s Doctors and the Depart-ment of Health’s �Modernising Medical Careers�initiative have thrown more emphasis onto practicaltraining and education. Consequently, a period oftime spent shadowing the post in which the medicalstudent will be working has been in place for anumber of years. Most hospitals have parts that newdoctors never need to visit until there is anemergency. There are also various departments andareas that a new doctor needs to visit regularly, suchas the radiology department and the canteen.What was done A 10-station treasure hunt was set upfor Foundation Year 1 shadows. Stations weredesigned with 3 issues in mind: where the shadowshave to go during the day; what they need to thinkabout on the way, and, lastly, what they have to dowhen they arrive. Tasks involved the types of clinical

vignette or jobs regularly encountered by foundationdoctors. Answers were given in the next numberedenvelope. Tasks were supplied in 10 �goldenenvelopes�. Examples of the contents of the enve-lopes are:

• Cardiac arrest Level 9 CCU. You are on the crashteam. Think about the reversible causes of acardiac arrest. What information do you need toexclude these?

• You are told by the on-call biochemist that apatient on Level 10 has a potassium level of 6.1.Go and see the patient. Take another sample anddeliver it to the emergency biochemistry lab onLevel 7. Think about the causes of a highpotassium level. Also think what initial treatmentyou will start. Take a piece of blank paper andwrite down your assessment as if you were writingthe patient’s medical notes.

• It is quiet and you have time for a sandwich. Go tothe canteen. Go to the mess on Level 11. Explorethe mess area and see what facilities are there.After lunch, open the next Golden Envelope.

Evaluation of results and impact The 2 foundationshadows who completed the treasure hunt enjoyed itand found it useful. They learned their way aroundthe hospital, visiting sites frequently and were rarelyvisited by a foundation doctor. Furthermore, theywere able to work in a team and develop a friendship.They made their way around the hospital without thetime constraints imposed by the urgency of an actualacute clinical situation, but with those of a simulatedscenario. They felt that this was better than a passivetour. We feel that the treasure hunt will become avaluable learning tool and a useful adjunct to hospitalorientation programmes.

Correspondence: T W M Walker, c/o Dr M Walters, Department ofMedicine and Therapeutics, Western Infirmary, Dumbarton Road,Glasgow G11 6NT, UK. Tel: 00 44 (0)141 211 2320;Fax: 00 44 (0)141 211 2895; E-mail: tomwmw@hotmail.com

doi: 10.1111/j.1365-2929.2007.02740.x

A novel, clinically based curriculum for Year onemedical students

Michelle Lin & Alan M Gelb

Context and setting Medical schools in the USAtraditionally focus on basic sciences and textbooklearning in the first half and patient-oriented, clinicalclerkships in the second half of training. Thisdichotomous learning environment hinders the

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� Blackwell Publishing Ltd 2007. MEDICAL EDUCATION 2007; 41: 505–526