Should sports and exercise medicine be taught in the Swiss undergraduate medical curricula? A survey among 1764 Swiss medical students

Objectives The global lack of sports and exercise medicine (SEM) teaching at medical schools contrasts with evidence that physical activity (PA) plays a major role in preventing and treating non-communicable diseases (NCDs). The aims of this study were to (a) examine whether Swiss medical students are expected to acquire SEM-related skills and knowledge, (b) systematically reviewed SEM teaching in the Swiss undergraduate medical curricula, (c) assess if Swiss medical students are aware of SEM and (d) whether they would like SEM to be included in their curricula. Methods Two authors independently screened the 'Principal Relevant Objectives and Framework for Integrative Learning and Education in Switzerland' (PROFILES) for SEM-related learning objectives and reviewed the curricula. 7708 Swiss medical students were invited to participate in an online survey. Results 32 SEM-related learning objectives were identified in PROFILES with 20 of them linked to PA. Four of eight Swiss medical schools display limited mandatory SEM teachings. 1764 students participated in the survey (482.0% of the necessary sample size, 22.9% of all Swiss medical students). One in two students knew that SEM includes preventing and treating NCDs. Almost 95% of the participants would like SEM to be included in the curricula. Conclusion Despite its inclusion in PROFILES and comprehensive evidence that SEM should be taught at medical schools, this is scarcely the case in Switzerland. Swiss medical students have limited understanding of SEM, but are keen to have it included in the curricula. This study highlights the need for more comprehensive SEM teaching at Swiss medical schools

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Inflammation and cardiovascular status impact midazolam pharmacokinetics in critically Ill children: an observational, prospective, controlled study

Aims: Altered physiology caused by critical illness may change midazolam pharmacokinetics (PK) and thereby result in adverse reactions and outcomes in this vulnerable patient population. This study set out to determine which critical illness related factors impact on midazolam pharmacokinetics in children using population PK modelling. Methods: An observational, prospective, controlled study of children admitted to University Hospitals Leicester NHS Trust receiving IV midazolam as part of routine care. Children recruited into the study were either critically-ill receiving continuous infusions of midazolam or otherwise well, admitted for elective day-case surgery (control) who received a single IV bolus dose of midazolam. Blood midazolam and 1-OH-midazolam concentration and patient clinical data were used to develop a population PK model and to determine covariates which affect midazolam disposition during critical illness. Results: 35 patients were recruited into the critically ill arm of the study, 54 children into the control arm. Modelling demonstrated a significant change in midazolam clearance with acute inflammation (measured using C-Reactive Protein, CRP), cardio-vascular status and weight. Simulations predict that elevated CRP and compromised cardiovascular function in critically ill children result in midazolam concentrations up to 10-fold higher than healthy children. Conclusions: Raised CRP and compromised cardiovascular function significantly reduce midazolam clearance. The extremely high levels of midazolam observed in some critically-ill children indicate that the current therapeutic dosing regimen for midazolam can lead to over-dosing. Clinicians should be aware of this risk and intensify monitoring of such patients.</jats:p

Optimising undergraduate medico-legal and professionalism teaching through a student-selected component

PurposeWe sought to understand how best to teach medico-ethics, law and professionalism to undergraduate medical students using a student selected component.Materials and methodsStudents received small-group, seminar-based teaching from the module organiser and external representatives from organisations such as the General Medical Council and Medical Protection Society. Experiential learning was also facilitated through attendance at fitness to practice tribunals and Coroner’s court, followed by structured debrief sessions. Two cohorts of medical students(n=40) from Manchester University were surveyed before and after undergoing the placement, with qualitative interviews and thematic analysis for a subset of this group(n=16) and course leaders(n=4).ResultsThere were significant (p&lt;0.05) improvements in students’ self-reported understanding of key medicolegal organisations and accessing guidance on professionalism. Thematic analysis uncovered increasing confidence in the role of the medicolegal system, barriers to challenging unprofessional behaviour, and a desire for this to be placed in the curricula.ConclusionsThis placement was well received and demonstrates an importance for this content to be taught effectively in the medical curricula. Having protected time to attend sessions while an undergraduate may reduce anxiety felt by doctors fearing medicolegal proceedings and help challenge unprofessional behaviours. Further work could explore mechanisms into how best to incorporate this into the medical curricula.</jats:sec