Defining Goals and Learning Objectives for a Longitudinal Clerkship in the Complex Context of Health Care

In autumn 2007 the Swiss Medical School of Berne (Switzerland) implemented mandatory short-term clerkships in primary health care for all undergraduate medical students. Students studying for a Bachelor degree complete 8 half-days per year in the office of a general practitioner, while students studying for a Masters complete a three-week clerkship. Every student completes his clerkships in the same GP office during his four years of study. The purpose of this paper is to show how the goals and learning objectives were developed and evaluated. Method:A working group of general practitioners and faculty had the task of defining goals and learning objectives for a specific training program within the complex context of primary health care. The group based its work on various national and international publications. An evaluation of the program, a list of minimum requirements for the clerkships, an oral exam in the first year and an OSCE assignment in the third year assessed achievement of the learning objectives. Results: The findings present the goals and principal learning objectives for these clerkships, the results of the evaluation and the achievement of minimum requirements. Most of the defined learning objectives were taught and duly learned by students. Some learning objectives proved to be incompatible in the context of ambulatory primary care and had to be adjusted accordingly. Discussion: The learning objectives were evaluated and adapted to address students’ and teachers’ needs and the requirements of the medical school. The achievement of minimum requirements (and hence of the learning objectives) for clerkships has been mandatory since 2008. Further evaluations will show whether additional learning objectives need to be adopte

In vitro precision of fit of computer-aided designed and computer-aided manufactured titanium screw-retained fixed dental prostheses before and after ceramic veneering

OBJECTIVE To compare the precision of fit of full-arch implant-supported screw-retained computer-aided designed and computer-aided manufactured (CAD/CAM) titanium-fixed dental prostheses (FDP) before and after veneering. The null-hypothesis was that there is no difference in vertical microgap values between pure titanium frameworks and FDPs after porcelain firing. MATERIALS AND METHODS Five CAD/CAM titanium grade IV frameworks for a screw-retained 10-unit implant-supported reconstruction on six implants (FDI tooth positions 15, 13, 11, 21, 23, 25) were fabricated after digitizing the implant platforms and the cuspid-supporting framework resin pattern with a laser scanner (CARES(®) Scan CS2; Institut Straumann AG, Basel, Switzerland). A bonder, an opaquer, three layers of porcelain, and one layer of glaze were applied (Vita Titankeramik) and fired according to the manufacturer's preheating and fire cycle instructions at 400-800°C. The one-screw test (implant 25 screw-retained) was applied before and after veneering of the FDPs to assess the vertical microgap between implant and framework platform with a scanning electron microscope. The mean microgap was calculated from interproximal and buccal values. Statistical comparison was performed with non-parametric tests. RESULTS All vertical microgaps were clinically acceptable with values <90 μm. No statistically significant pairwise difference (P = 0.98) was observed between the relative effects of vertical microgap of unveneered (median 19 μm; 95% CI 13-35 μm) and veneered FDPs (20 μm; 13-31 μm), providing support for the null-hypothesis. Analysis within the groups showed significantly different values between the five implants of the FDPs before (P = 0.044) and after veneering (P = 0.020), while a monotonous trend of increasing values from implant 23 (closest position to screw-retained implant 25) to 15 (most distant implant) could not be observed (P = 0.169, P = 0.270). CONCLUSIONS Full-arch CAD/CAM titanium screw-retained frameworks have a high accuracy. Porcelain firing procedure had no impact on the precision of fit of the final FDPs. All implant microgap measurements of each FDP showed clinically acceptable vertical misfit values before and after veneering. Thus, the results do not only show accurate performance of the milling and firing but show also a reproducible scanning and designing process.

Validation of a paradigm to measure instrumental aggression (iap) on a sample of male adolescents with adjustment problems

Aggressive behavior can be classified in hostile and instrumental aggressions (anderson & bushman, 2002). this classification is mostly synonymously used with reactive and proactive aggression, whereas the differences between hostile and instrumental aggression lie on three dimensions, the primary goal, amount of anger and planning and calculation(bushman & anderson, 2001). although there are rating instruments and experimental paradigms to measure hostile aggression, there is no instrument to measure instrumental aggression. the following study will present an account to measure instrumental aggression with an experimental laboratory paradigm. the instrument was firstly tested on two samples of normal young adolescents (n1 = 100; amage. = 19.14; n2 = 60; amage. = 21.46). the first study revealed a strong correlation with a laboratory aggression paradigm measuring hostile aggression, but no correlations with self-reported aggression in the buss and perry questionnaire. these results were replicated in a second study, revealing an additional correlation with aggressive but not adaptive assertiveness. secondly the instrument was part of the evaluation of the reasoning and rehabilitation program r&r2 (ross, hilborn & lidell, 1984) in an institution for male adolescents with adjustment problems in switzerland. the r&r2 is a cognitive behavioral group therapy to reduce antisocial and promote prosocial cognitions and behavior. the treatment group (n= 16; rangeage = 15-17) is compared to a no treatment control group (n=24; rangeage = 17-19) preand post- treatment. further aggressive behavior was surveyed and experimentally measured. hostile rumination, aggressive and adaptive assertiveness, emotional and social competence were included in the measurement to estimate construct validity.

Who’s to blame? How narcissists and ex-partners of narcissists make sense of romantic breakup

Objective: past research has shown relationship problems associated with narcissists’ excessive self-centeredness and lacking concern for others. Using romantic relationships as opportunities to self-enhance rather than caring about intimacy, narcissists are sensitive to shortcomings in their partners and quick to withdraw investment once relationships turn out to be less than perfect. Our research aimed to reveal whether narcissists are aware of their destructive relationship behavior or tend to put the blame for a failed relationship on their ex-partners. Conversely, do ex-partners of narcissists take the blame and feel responsible for the breakup or walk away convinced their narcissistic ex-partners’ behavior was just too unbearable? Method: 120 participants (19-59 yrs) who reported a recent romantic breakup completed a battery of questionnaires online, including measures of narcissism and self-esteem, as well as newly created scales assessing attributions for breakup. In addition to self-reports, participants retrospectively rated their ex-partners on adapted versions of the same measures. Results: narcissists made attributions to lacking relationship investment mostly in themselves and to a lesser extent in their partners. However, this pattern was reversed when self-esteem was controlled, with attributions to partner shortcomings outnumbering aspects of own destructive behavior. Narcissism perceived in the ex-partner was related to reports of lacking investment in oneself as well as the ex-partner, but controlling for self-esteem reduced the number of attributions to own shortcomings. Conclusion: our analyses revealed that narcissists do show some awareness of their contribution to a failed relationship, although controlling for self-esteem increased their blame of the ex-partner. In contrast, associations between perceived partner-narcissism and aspects of own lacking relationship investment became fewer when self-esteem was controlled for.

A view through gloomy glasses: accuracy and bias in relationships of narcissists

Narcissists’ perception of others is marked by a negative bias in the service of their own self-enhancement. The aim of this study was to determine whether narcissists’ negative bias extends to the perception of romantic partners too. In addition, we explored whether partners of narcissists succumb to specific perception biases as well. During 14 days, 86 couples completed measures of support given to and received from their partners. The results indicated that both male and female narcissists were more accurate in detecting negative support (e.g., blaming the partner for his or her problems) received from their partners, while female narcissists only were less accurate in perceiving altruistic support motives (e.g., truly enjoying to help the partner) of their male partner. Moreover, narcissists as well as their partners displayed a negative bias by underestimating the amount of altruistic support motives reported by each of them. On the other hand, partners of narcissists were positively biased as well and underestimated the negative support given by the narcissists. Results are discussed in relation to the self-regulatory goals of narcissists and of their partners and with respect to the possible impact of their accuracy and biases on the couple wellbeing.

Impact of a stress coping strategy on perceived stress levels and performance during a simulated cardiopulmonary resuscitation: a randomized controlled trial

Background Cardiopulmonary resuscitation (CPR) causes significant stress, which may cause deficiencies in attention and increase distractibility. This may lead to misjudgements of priorities and delays in CPR performance, which may further increase mental stress (vicious cycle). This study assessed the impact of a task-focusing strategy on perceived stress levels and performance during a simulated CPR scenario. Methods This prospective, randomized-controlled trial was conducted at the simulator-center of the University Hospital Basel, Switzerland. A total of 124 volunteer medical students were randomized to receive a 10 minute instruction to cope with stress by loudly posing two taskfocusing questions (“what is the patient’s condition?”, “what immediate action is needed?”) when feeling overwhelmed by stress (intervention group) or a control group. The primary outcome was the perceived levels of stress and feeling overwhelmed (stress/overload); secondary outcomes were hands-on time, time to start CPR and number of leadership statements. Results Participants in the intervention group reported significantly less stress/overload levels compared to the control group (mean difference: -0.6 (95%CI −1.3, -0.1), p=0.04). Higher stress/overload was associated with less hands-on time. Leadership statements did not differ between groups, but the number of leadership statements did relate to performance. Hands-on time was longer in the intervention- group, but the difference was not statistically different (difference 5.5 (95%CI −3.1, 14.2), p=0.2); there were no differences in time to start CPR (difference −1.4 (95%CI −8.4, 5.7), p=0.71). Conclusions A brief stress-coping strategy moderately decreased perceived stress without significantly affecting performance in a simulated CPR. Further studies should investigate more intense interventions for reducing stress.

Success rate of paramedian palatal implants in adolescent and adult orthodontic patients: a retrospective cohort study.

The purpose of this study was to examine the success rate of paramedian palatal Orthosystem first- and second-generation implants used for anchorage in orthodontic treatment in patients treated by one experienced orthodontist. The records of 143 patients (90 female, 53 male, median age: 15.7 years, range: 10.2-50.9) receiving 145 palatal implants of the first or second generation (Orthosystem, Straumann AG, Basel, Switzerland) were examined. All the palatal implants were placed in a paramedian palatal location by three experienced surgeons. Stable implants were orthodontically loaded after a healing period of 3 months. Out of the 145 inserted paramedian palatal implants only seven implants (4.8%) were not considered stable after insertion. All the successfully osseointegrated implants remained stable during orthodontic treatment. Paramedian palatal implants are highly reliable and effective devices to obtain skeletal anchorage for orthodontic treatment. This study has shown that the paramedian location is a good alternative to the median location.

The diffusion of /l/ -vocalization in Swiss German

Several western Swiss German dialects roughly grouped around the nation's capital Bern show /l/ > [u] vocalization in various contexts. The spatial boundaries of /l/-vocalization in Swiss German are suspected to have been expanding since being described in the Linguistic Atlas of German-Speaking Switzerland in the middle of the 20th century. The present study assesses the overall expansion of /l/-vocalization by means of a rapid anonymous survey in 20 urban regional centers situated just beyond the traditional boundaries of /l/-vocalization highlighted by the Atlas. Results show that the expansion of /l/-vocalization mainly progresses in southeasterly, southerly, and westerly directions, but with much less success to the north and northwest, where the equally influential dialectal areas of Basel and Zürich seem to exert opposing influences. Further analysis of the data indicates that somewhat differing constraint hierarchies are at work in the different places to which vocalization has diffused.