Evaluation à l'aide d'un livre de bord des compétences cliniques acquises par des stagiaires en médecine. [Evaluation using a logbook of mastering of clinical skills by medical students]

La maîtrise des compétences cliniques est extrêmement importante pour le médecin. Leur enseignement est aujourd'hui facilité grâce à la disponibilité du «Swiss Catalogue of Learning Objectives for Undergraduate Medical Training» où sont décrits les niveaux de compétence à atteindre au terme des études de médecine. Un carnet de bord a été préparé à la Faculté de biologie et de médecine de Lausanne à partir de ce document. Il a permis de mettre en évidence chez les étudiants une très nette amélioration de la maîtrise des compétences cliniques entre le début et la fin des stages en médecine interne, chirurgie/orthopédie, pédiatrie, gynécologie/obstétrique et psychiatrie. Un tel outil devrait permettre dans l'avenir de mieux guider l'apprentissage des étudiants et de suivre leurs progrès à chaque étape du curriculum. [Abstract] The mastering of the clinical skills is of utmost importance for the physician. The teaching of the skills is nowadays made easier with the <<Swiss Catalogue of Learning Objectives for Undergraduate Medical Training>> which lists all the skills and their respective level of expected mastering at graduation. In order to do a survey on how good the students are at those skills, a logbook based on this document has been setup at the Faculty of biology and medicine of the University of Lausanne. This has shown that students went through a clear progression of the mastering of the skills during their elective year in internal medicine, surgery/orthopaedics, paediatric, obstetric and gynaecology as well as psychiatry. Such an instrument should in the future help to better guide the learning process of the clinical skills and to do a better follow-up of their progress.

Wolves in sheep's clothing: SDO asymmetrically predicts perceived ethnic victimization among White and Latino students across three years

Dominant groups have claimed to be the targets of discrimination on several historical occasions during violent intergroup conflict and genocide.The authors argue that perceptions of ethnic victimization among members of dominant groups express social dominance motives and thus may be recruited for the enforcement of group hierarchy. They examine the antecedents of perceived ethnic victimization among dominants, following 561 college students over 3 years from freshman year to graduation year. Using longitudinal, cross-lagged structural equation modeling, the authors show that social dominance orientation (SDO) positively predicts perceived ethnic victimization among Whites but not among Latinos, whereas victimization does not predict SDO over time. In contrast, ethnic identity and victimization reciprocally predicted each other longitudinally with equal strength among White and Latino students. SDO is not merely a reflection of contextualized social identity concerns but a psychological, relational motivation that undergirds intergroup attitudes across extended periods of time and interacts with the context of group dominance.

Aider les étudiants en médecine à approcher la mort [Helping medical students to approach death].

A project recently launched by the Faculty of biology and medicine of Lausanne introduces the approach of facing death during both the dissection and the course of clinical activities. Existential questions relating to mortality are bound to arise sooner or later during the course of the study. For the sake of humanized clinical practice, these questions must be confronted. In response to a request by a student association, an accompanying curriculum with active student's contribution through encounters with death in anatomy and clinical situations was created in Lausanne. Students will benefit from this new program throughout their curriculum. This program is the first of its kind in Switzerland.

Music performance anxiety among full-time music students

Introduction Music performance anxiety (MPA, often referred to as "stage fright") is one of the leading severe medical problems among musicians. For about 15-25% of musicians MPA is a serious problem. Particularly high levels of MPA are observed among music students. Musical performance can induce negative emotions, including anxiety, which in some individuals can approach extreme levels of terror and take the form of panic attack, impair the quality of the performance, lead to avoidance of performance situations, and consequently have debilitating effects on the career. Coping efforts used by musicians in their attempts to manage MPA, such as sedatives, alcohol, and β-blockers can have deleterious health side-effects. Music ranks high in the cultural and economic life of Switzerland. In ten university music schools, students from all around the world are educated to become professional musicians. Despite the importance of musical education in Switzerland, data concerning the phenomenon of MPA are largely lacking. Goal and Methods The main goal of this research was to survey the occurrence, experience, and management of MPA among full-time music students in French Swiss conservatories. A questionnaire was developed based on the literature and interviews with music students and teachers and distributed to all the students of the conservatories of Fribourg, Geneva, Lausanne, and Neuchâtel in the spring 2007. 194 students (61% women) returned the questionnaire. Results The size of the problem: MPA is a major problem for 1/3 of the students (ranks 3 and 4). The consequences of MPA: 22% and 35% of the students think that they have failed exams and auditions, respectively, because of MPA. Further, 25% of the students have already avoided performing and 11% have interrupted public performances because of MPA. Coping with MPA: 90% of the students have never used alcohol prior to performing, whereas 97% and 81%, respectively, have never used recreation drugs and medication. The majority of students use relaxation exercises, respiratory exercises, and meditation techniques to prepare themselves. About ¾ of the students think that the use of alcohol and recreational drugs to manage MPA is never justified. 53% of the students think that the use of medication is justified on some occasions. Need for information and support: 66% of the students would like to receive more support and help to cope with music performance situations. This support should mainly come from their teachers and specialists. 53% of the students know nothing or little about possible means for the management of MPA. About 50% consider themselves not at all or little informed about the possible risks associated with the consumption of alcohol, recreational drugs, and medication for the management of performance situations. 89% would like to know more about MPA and 94% think that this topic should be discussed much more in their musical education at the conservatory. Conclusions The results of this survey indicate that MPA is a major problem for 1/3 of the students with serious consequences on their career. There is a huge need for more information and support on how to manage the stress due to performance situations. The use of alcohol, recreational drugs, and medication is modest but the students are poorly informed about possible side-effects of these coping strategies. It seems clear that more should be done in the French Swiss conservatories about music performance anxiety to inform, educate, and prepare the students for their future professional career.

Evolutionary impact assessment: accounting for evolutionary consequences of fishing in an ecosystem approach to fisheries management

Managing fisheries resources to maintain healthy ecosystems is one of the main goals of the ecosystem approach to fisheries (EAF). While a number of international treaties call for the implementation of EAF, there are still gaps in the underlying methodology. One aspect that has received substantial scientific attention recently is fisheries-induced evolution (FIE). Increasing evidence indicates that intensive fishing has the potential to exert strong directional selection on life-history traits, behaviour, physiology, and morphology of exploited fish. Of particular concern is that reversing evolutionary responses to fishing can be much more difficult than reversing demographic or phenotypically plastic responses. Furthermore, like climate change, multiple agents cause FIE, with effects accumulating over time. Consequently, FIE may alter the utility derived from fish stocks, which in turn can modify the monetary value living aquatic resources provide to society. Quantifying and predicting the evolutionary effects of fishing is therefore important for both ecological and economic reasons. An important reason this is not happening is the lack of an appropriate assessment framework. We therefore describe the evolutionary impact assessment (EvoIA) as a structured approach for assessing the evolutionary consequences of fishing and evaluating the predicted evolutionary outcomes of alternative management options. EvoIA can contribute to EAF by clarifying how evolution may alter stock properties and ecological relations, support the precautionary approach to fisheries management by addressing a previously overlooked source of uncertainty and risk, and thus contribute to sustainable fisheries.

Sequencing and characterizing the genome of Estrella lausannensis as an undergraduate project: training students and biological insights.

With the widespread availability of high-throughput sequencing technologies, sequencing projects have become pervasive in the molecular life sciences. The huge bulk of data generated daily must be analyzed further by biologists with skills in bioinformatics and by "embedded bioinformaticians," i.e., bioinformaticians integrated in wet lab research groups. Thus, students interested in molecular life sciences must be trained in the main steps of genomics: sequencing, assembly, annotation and analysis. To reach that goal, a practical course has been set up for master students at the University of Lausanne: the "Sequence a genome" class. At the beginning of the academic year, a few bacterial species whose genome is unknown are provided to the students, who sequence and assemble the genome(s) and perform manual annotation. Here, we report the progress of the first class from September 2010 to June 2011 and the results obtained by seven master students who specifically assembled and annotated the genome of Estrella lausannensis, an obligate intracellular bacterium related to Chlamydia. The draft genome of Estrella is composed of 29 scaffolds encompassing 2,819,825 bp that encode for 2233 putative proteins. Estrella also possesses a 9136 bp plasmid that encodes for 14 genes, among which we found an integrase and a toxin/antitoxin module. Like all other members of the Chlamydiales order, Estrella possesses a highly conserved type III secretion system, considered as a key virulence factor. The annotation of the Estrella genome also allowed the characterization of the metabolic abilities of this strictly intracellular bacterium. Altogether, the students provided the scientific community with the Estrella genome sequence and a preliminary understanding of the biology of this recently-discovered bacterial genus, while learning to use cutting-edge technologies for sequencing and to perform bioinformatics analyses.

Teaching motivational interviewing to medical students : a pre-post test pilot study

Objective: To test the efficacy of teaching motivational interviewing (MI) to medical students. Methods: Thirteen 4th year medical students volunteered to participate. Seven days before and 7 days after an 8-hour interactive training MI workshop, each student performed a videorecorded interview with two standardized patients: a 60 year old alcohol dependent woman and a 50 year old cigarette smoking man. Students' counseling skills were coded by two blinded clinicians using the Motivational Interviewing Treatment Integrity 3.0 (MITI). Inter-rater reliability was calculated for all interviews and a test-retest was completed in a sub-sample of 10 consecutive interviews three days apart. Difference between MITI scores before and after training were calculated and tested using non-parametric tests. Effect size was approximated by calculating the probability that posttest scores are greater than pretest scores (P*=P(Pre<Post)+1/2P(Pre=Post)), P*>1/2 indicating greater scores in posttest, P*=1/2 no effect, and P*<1/2 smaller scores in posttest. Results: Median differences between MITI scores before and after MI training indicated a general progression in MI skills: MI spirit global score (median difference=1.5, Inter quartile range=1.5, p<0.001, P*=0.90); Empathy global score (med diff=1, IQR=0.5, p<0.001, P*=0.85); Percentage of MI adherent skills (med diff=36.6, IQR=50.5, p<0.001, P*=0.85); Percentage of open questions (med diff=18.6, IQR=21.6, p<0.001, P*=0.96); reflections/ questions ratio (med diff=0.2, IQR=0.4, p<0.001, P*=0.81). Only Direction global score and the percentage of complex reflections were not significantly improved (med diff=0, IQR=1, p=0.53, P*=0.44, and med diff=4.3, IQR=24.8, p=0.48, P*=0.62, respectively). Inter-rater reliability indicated weighted kappa ranged between 0.14 for Direction to 0.51 for Collaboration and ICC ranged between 0.28 for Simple reflection to 0.95 for Closed question. Test-retests indicated weighted kappa ranged between 0.27 for Direction to 0.80 for Empathy and ICC ranged between 0.87 for Complex reflection to 0.98 for Closed question. Conclusion: This pilot study indicated that an 8-hour training in MI for voluntary 4th year medical students resulted in significant improvement of MI skills. Larger sample of unselected medical students should be studied to generalize the benefit of MI training to medical students. Interrater reliability and test-retests suggested that coders' training should be intensified.

Hyperventilation complaints in music performance anxiety among classical music students.

Objective: Despite the importance of respiration and hyperventilation in anxiety disorders, research on breathing disturbances associated with hyperventilation is rare in the field of music performance anxiety (MPA, also known as stage fright). The only comparable study in this area reported a positive correlation between negative feelings of MPA and hyperventilation complaints during performance. The goals of this study were (a) to extend these previous findings to the period before performance, (b) to test whether a positive correlation also exists between hyperventilation complaints and the experience of stage fright as a problem, (c) to investigate instrument-specific symptom reporting, and (d) to confirm gender differences in negative feelings of MPA and hyperventilation complaints reported in other studies. Methods: We assessed 169 university students of classical music with a questionnaire comprising: the State-Trait Anxiety Inventory for negative feelings of MPA, the Nijmegen Questionnaire for hyperventilation complaints, and a single item for the experience of stage fright as a problem. Results: We found a significant positive correlation between hyperventilation complaints and negative feelings of MPA before performance and a significant positive correlation between hyperventilation complaints and the experience of stage fright as a problem. Wind musicians/singers reported a significantly higher frequency of respiratory symptoms than other musicians. Furthermore, women scored significantly higher on hyperventilation complaints and negative feelings of MPA. Conclusion: These results further the findings of previous reports by suggesting that breathing disturbances associated with hyperventilation may play a role in MPA prior to going on stage. Experimental studies are needed to confirm whether hyperventilation complaints associated with negative feelings of MPA manifest themselves at the physiological level. (C) 2010 Elsevier Inc. All rights reserved.

Testing new identity models and processes in French-speaking adolescents and emerging adults students

Developing a sense of identity is a crucial psychosocial task for young people. The purpose of this study was to evaluate identity development in French-speaking adolescents and emerging adults (in France and Switzerland) using a process-oriented model of identity formation including five dimensions (i.e., exploration in breadth, commitment making, exploration in depth, identification with commitment, and ruminative exploration). The study included participants from three different samples (total N = 2239, 66.7% women): two samples of emerging adult student and one sample of adolescents. Results confirmed the hypothesized five-factor dimensional model of identity in our three samples and provided evidence for convergent validity of the model. The results also indicated that exploration in depth might be subdivided in two aspects: a first form of exploration in depth leading to a better understanding and to an increase of the strength of current commitments and a second form of exploration in depth leading to a re-evaluation and a reconsideration of current commitments. Further, the identity status cluster solution that emerged is globally in line with previous literature (i.e., achievement, foreclosure, moratorium, carefree diffusion, diffused diffusion, undifferentiated). However, despite a structural similarity, we found variations in identity profiles because identity development is shaped by cultural context. These specific variations are discussed in light of social, educational and economic differences between France and the French-speaking part of Switzerland. Implications and suggestions for future research are offered.

A genome-wide approach accounting for body mass index identifies genetic variants influencing fasting glycemic traits and insulin resistance.

Recent genome-wide association studies have described many loci implicated in type 2 diabetes (T2D) pathophysiology and β-cell dysfunction but have contributed little to the understanding of the genetic basis of insulin resistance. We hypothesized that genes implicated in insulin resistance pathways might be uncovered by accounting for differences in body mass index (BMI) and potential interactions between BMI and genetic variants. We applied a joint meta-analysis approach to test associations with fasting insulin and glucose on a genome-wide scale. We present six previously unknown loci associated with fasting insulin at P < 5 × 10(-8) in combined discovery and follow-up analyses of 52 studies comprising up to 96,496 non-diabetic individuals. Risk variants were associated with higher triglyceride and lower high-density lipoprotein (HDL) cholesterol levels, suggesting a role for these loci in insulin resistance pathways. The discovery of these loci will aid further characterization of the role of insulin resistance in T2D pathophysiology.

Cardio respiratory activity in high-anxious vs. low-anxious professional music students before and during performance

Questionnaire studies indicate that high-anxious musicians may suffer from hyperventilation symptoms before and/or during performance. Reported symptoms include amongst others shortness of breath, fast or deep breathing, dizziness and thumping heart. However, no study has yet tested if these self-reported symptoms reflect actual cardio respiratory changes. Disturbances in breathing patterns and hyperventilation may contribute to the often observed poorer performance of anxious musicians under stressful performance situations. The main goal of this study is to determine if music performance anxiety is manifest physiologically in specific correlates of cardio respiratory activity. We studied 74 professional music students divided into two groups (i.e. high-anxious and lowanxious) based on their self-reported performance anxiety in three distinct situations: baseline, private performance (without audience), public performance (with audience). We measured a) breathing patterns, end-tidal carbon dioxide (EtCO2, a good non-invasive estimator for hyperventilation), ECG and b) self-perceived emotions and self-perceived physiological activation. The poster will concentrate on the preliminary results of this study. The focus will be a) on differences between high-anxious and low-anxious musicians regarding breaths per minute and heart rate and b) on the response coherence between self-perceived palpitations and actual heart rate.

Habitudes alimentaires et image corporelle chez des étudiants de deuxième année de gymnase à Lausanne [Food habits and body image of students in Lausanne]

During adolescence, nutrition needs are high; however the literature shows that few adolescents are following standardized nutritional requirements. A few weeks before an intervention about nutrition to high school adolescents in Lausanne, they were invited to fill in a self-reported questionnaire about their nutrition modes and habits, and their self-image satisfaction (N = 198). Results show that only 5% of youth are eating 5 fruits and vegetables per day and only 29% 3 to 5 dairy products. 21% of female and 6% of boys are not satisfied about their self-image, and those exhibiting a poor self-image tend to adopt health compromising eating patterns in a higher proportion. During adolescence it is important not only to investigate the nutritional habits but also one's self image.