LETTERS TO THE EDITOR

Radiology: an underutilized resource for undergraduate curricula

Dear Editor,

It appears quite paradoxical that although doctors encounter disease in a living human yet the familiarity of the future physicians with the human structure is grounded primarily in cadavers and artwork (Ganske et al. 2006). In the current medical curricula, time and resources to keep students abreast of an ever-increasing body of knowledge have become prized commodities (Gunderman et al. 2003). Arguably, these factors have lead to a diminutive role of anatomy in the medical curricula. The emphasis has been limited to its functional aspects only; even its raison d’etre has come under question (Ganske et al. 2006; Gunderman et al. 2003).

The ‘eye of medicine’ is a resource with the potential to fill such gaps between basic sciences and clinical medicine. It can provide the future doctors with a succinct and true-to-life view of the normal as well as the disease processes in a non-invasive manner. (Ganske et al. 2006; Gunderman et al. 2003) The scope extends beyond visualization of structures; functional and molecular imaging can afford an exceptional correlation of physiological and biochemical processes with the anatomy.

It is disconcerting that such a promising resource is yet to be utilized to an optimal extent. Although 80% of US medical schools have introduced radiological anatomy in their anatomy courses, with a large proportion of final evaluation comprising questions in radiological anatomy, the actual contribution of radiology to these teachings remains a mere 5%. Another ironical observation is that cadaveric cross-sections, not CT or MRI images, are primarily used to teach cross-sectional anatomy. More so, future projections do not indicate an alteration in the preference of teaching methods for anatomy (Ganske et al. 2006).

Regardless of the choice of specialty, almost every future doctor would utilize diagnostic imaging in patient care; be it an internist searching the reason for cough, a surgeon managing a case of acute abdomen or a pathologist seeking correlation for histopathological findings. It is high time to realize that integration of radiology into medical curricula, especially basic science courses, may not only provide medical students a practical acquaintance with the normal human processes but may also build an enduring foundation for the clinical years. We strongly urge the medical community to recognize that such endeavors can go a long way in the achievement of a well-rounded medical education.

Dr. Abdul Mueed Zafar

Research Associate

Department of Radiology

Aga Khan University

Stadium Road

Karachi, 74800

Pakistan

All health care providers must learn how to work efficiently with interpreters and respect patients’ values and preferences

Dear Sir,

We read with great interest the article by Marion et al. (2008), and we fully support introducing a ‘working effectively with interpreters’ curriculum to Physician Assistant Students (PAS). We would like to stress on few issues. Cultural awareness should be emphasized more and included in the standardized patient checklist during assessment. The Health Care Provider (HCP) should be able to respond to the cultural and religious preferences exhibited by patients as an essential part of the encounter. A patient's demand of being seen, or interpreted, by different gender personnel should be granted instead of trying to convince the patient otherwise. The student should be taught that all efforts should be done to accommodate the patients’ values and preferences and modify the clinical encounter accordingly.

While paraphrasing or omitting words during interpretation was not favoured, it might have been the ideal thing to deliver the right information to the patient, needless to say, who is the centre of the whole process. Exploring different languages may reveal that some words/phrases do not exist in other languages. Interpreters may use different phrases with similar meanings in the quest of delivering the information based on additional diversity among speakers of a common language. Ideally, students’ evaluation of such process should be done by a bilingual medical professional who is able to assess the pros and cons of such paraphrasing. We applaud the authors for pointing out that a difference in evaluation exists between a native and non-native bilingual interpreter.

Declaring our awareness of some draw backs, we would like to suggest training PAS to use an over-the-phone interpreter. By using this service, we may: (1) avoid side conversations between patients and interpreters, (2) the interpreter being an obstacle between the patient and HCP and (3) maintain direct interaction between patients and HCP.

This teaching model should be recommended to all health care students, especially medical students.

NISRIN O. ABU ELNOUR, MBBS

Language Department

Mayo Clinic

MOHAMED B. ELAMIN, MBBS

Knowledge and Encounter Research Unit

Mayo Clinic

200 1st Street SW

Rochester, MN, 55905

E-mail: [email protected]

Dissemination of student and resident research: Publication rates after poster presentation

Dear Sir

The Association of American Medical Colleges strongly recommends medical students undertake research projects (AAMC 2006) and the Accreditation Council for Graduate Medical Education requires opportunity for residents to participate in research or scholarly activities (ACGME 2008). However, neither agency provides guidelines regarding dissemination of research findings. Our Midwestern regional medical school offers an opportunity to disseminate research locally through poster presentations at an annual research Forum, however publication rate of these projects was unknown. From 1999–2006 a total of 67 posters were presented by medical students (n = 15) and residents (n = 52).

To determine project publication rates, Pub Med and Google Scholar searches were conducted using author name(s), poster title and key words. The publication rate was 34.3% overall, based on 38.5% for residents and 20.0% for medical students, which did not differ significantly (χ² = 1.133, p = 0.287). More than half (55.2%) of all poster were surgery-related, and publication for surgery-related posters (41.7%) was significantly higher than non-surgery topics (22.6%) (χ² = 4.400, p = 0.036). Posters categorized as surgery-related were by an orthopedic surgery or general surgery residents and/or on a topic pertaining to surgical procedures, technology or patients.

These rates of publication seem disturbingly low considering the posters presented information regarding completed research projects. One explanation might be that many students and residents do not complete these projects until the end of medical school or residency training, when motivation to publish may be low. Posters on surgery-related topics had more than double the publication rate of non-surgery posters, and 91.6% were conducted by residents. This may be due, in part, to the Orthopedic Research Institute which supports orthopedic surgery residents in conducting a required research project and the fact that general surgery residents are required to undertake two research projects during their training.

While our study has several limitations it still identifies a gap in the research process for medical students and residents. Failure to disseminate findings through publication in peer-reviewed journals may be a great disservice, resulting in duplication of research or failure to expand important research areas. Clearly efforts need to be made to address the low publication rates of student and resident research projects after poster presentation. Steps to undertake in this effort include: (1) assessment of individual programs, (2) determination of factors influencing publication, (3) development of interventions to address factors affecting publication rates, and (4) restructuring programs to enhance research and dissemination.

Carolyn R. Ahlers-Schmidt, PhD

KUSM-W

1010 N. Kansas

Wichita, Kansas 67214

Amy Chesser, MA

Janae Maher, MD

Seth Vernon, MD

Suicidal behavior among medical students

Dear Sir

We have conducted the following study following the suicide attempt of a student. High rates of psychological morbidity have been reported among medical students from all over the world (Dahlin et al. 2005), but information in Lebanon is lacking. Lebanon is a mediterranean country with a population of about 4 million, equally divided into Christians and Muslims. On both sides, there are strong religious and cultural sanctions against suicidal behavior and the social stigma attached to suicide is considerable. We studied all first and third-year medical students registered in 2007. We used Paykel's questionnaire measuring suicidal ideation, planning and attempts.

Out of 145 students, we obtained 141 questionnaires. One third of the students expressed suicidal thoughts, 9.9% reported suicide planning, and 4 students (2.8%) reported a suicide attempt (1 male, 3 females). There were no significant differences between years 1 and 3, or between sexes, with a slight female predominance.

These figures are comparable to similar studies elsewhere. They are underestimated due to the reluctance of medical students to express vulnerability, as this may influence their records. Medical students are be affected by several problems including worries about the future, educational constraints, social problems, classmate conflict, exam pressure, and close contact with death. However, other studies include similar powerful sources of stress, without similar rates of suicidal behavior.

We noticed a higher non significant rate of suicidal behavior in females. Female medical students are subjected to sexual discrimination by their patients or their male colleagues, both in university and hospital settings; this may influence their behavior and increase their anxiety scores; They usually seek psychological or psychiatric help, more than males. Lindeman's 40 year-review of suicide in physicians concluded that female doctors were more at risk for suicide than the general population (Lindeman et al. 1997).

For social and religious reasons, suicidal behavior is underreported in Lebanon and we think that the true extent of the problem is underestimated.

El-Rassi Issam

Haddad Fadia

Chalhoub Viviane

Dagher Christine

Saint-Joseph University

Beirut

Lebanon