"Should I prioritize medical problem solving or attentive listening?": the dilemmas and challenges that medical students experience when learning to conduct consultations

Objective: Communication skills can be trained alongside clinical reasoning, history taking or clinical examination skills. This is advocated as a solution to the low transfer of communication skills. Still, students have to integrate the knowledge/skills acquired during different curriculum parts in patient consultations at some point. How do medical students experience these integrated consultations within a simulated environment and in real practice when dealing with responsibility?

Methods: Six focus groups were conducted with (pre-)/clerkship students.

Results: Students were motivated to practice integrated consultations with simulated patients and felt like 'real physicians'. However, their focus on medical problem solving drew attention away from improving their communication skills. Responsibility for real patients triggered students' identity development. This identity formation guided the development of an own consultation style, a process that was hampered by conflicting demands of role models.

Conclusion: Practicing complete consultations results in the dilemma of prioritizing medical problem solving above attention for patient communication. Integrated consultation training advances this dilemma to the pre-clerkship period. During clerkships this dilemma is heightened because real patients trigger empathy and responsibility, which invites students to define their role as doctor.

Practice Implications: When training integrated consultations, educators should pay attention to students' learning priorities and support the development of students' professional identity.

How high (and far) can you go? On setting fines in cartel cases involving vertically-integrated undertakings and foreign sales

Occupy Differently: Space, Community and Urban Counter-Conduct

This article demonstrates how the concept of counter-conducts helps us understand Occupy by directing attention to the correlation between the way advanced liberalism works to control urban spaces and the way that control is countered through Occupy’s tactics. The first section outlines the term counter-conducts by looking to Foucault’s short and undeveloped theorisation. The second examines how advanced liberalism conducts conduct through the use of urban space, concentrating on London which comes to form a space of and for the mobility and circulation of goods, people and ideas. Occupy’s tactics directly confront and counter such movement while engaging in its own forms of counter-circulation and (im)mobility. The third section examines how advanced liberal techniques have increasingly come to use a particular, heavily instrumentalised understanding of community in order to divide and control urban populations. Occupy’s tactics embody versions of community which confront and oppose such instrumentalisation, ultimately both engaging with that control and partially reproducing it. Through these counter-conducts we can come to a view of Occupy as inevitably succeeding in its failure as a movement and failing in its success, while opening to an (im)possible
futurity of occupying urban space differently.

Re-Reading the Riots: Counter-Conduct in London 2011

The riots that took place in England in August 2011 have widely been described as destructive, senseless and without purpose. This article, taking inspiration from Michel Foucault’s later work on revolt as counter-conduct, argues for a new understanding of how to read political expression and thereby calls for the riots to be thought differently, as a form of counter-conduct. This demands a new appreciation for the possibilities of revolt where spontaneous, impulsive, mundane and non-spectacular events like riots can be construed as political rather than purely criminal. It also opens up possibilities for how we might understand the ethos of the ‘revolting subject’.

Quality control and conduct of genome-wide association meta-analyses.

Rigorous organization and quality control (QC) are necessary to facilitate successful genome-wide association meta-analyses (GWAMAs) of statistics aggregated across multiple genome-wide association studies. This protocol provides guidelines for (i) organizational aspects of GWAMAs, and for (ii) QC at the study file level, the meta-level across studies and the meta-analysis output level. Real-world examples highlight issues experienced and solutions developed by the GIANT Consortium that has conducted meta-analyses including data from 125 studies comprising more than 330,000 individuals. We provide a general protocol for conducting GWAMAs and carrying out QC to minimize errors and to guarantee maximum use of the data. We also include details for the use of a powerful and flexible software package called EasyQC. Precise timings will be greatly influenced by consortium size. For consortia of comparable size to the GIANT Consortium, this protocol takes a minimum of about 10 months to complete.

Training medical students to conduct motivational interviewing: a randomized controlled trial.

OBJECTIVE: To examine the effectiveness of motivational interviewing (MI) training among medical students. METHODS: All students (n=131) (year 5) at Lausanne Medical School, Switzerland were randomized into an experimental or a control group. After a training in basic communication skills (control condition), an 8-h MI training was completed by 84.8% students in the exprimental group. One week later, students in both groups were invited to meet with two standardized patients. MI skills were coded by blinded research assistants using the Motivational Interviewing Treatment Integrity 3.0. RESULTS: Superior MI performance was shown for trained versus control students, as demonstrated by higher scores for "Empathy" [p<0.001] and "MI Spirit" [p<0.001]. Scores were similar between groups for "Direction", indicating that students in both groups invited the patient to talk about behavior change. Behavior counts assessment demonstrated better performance in MI in trained versus untrained students regarding occurences of MI-adherent behavior [p<0.001], MI non-adherent behavior [p<0.001], Closed questions [p<0.001], Open questions [p=0.001], simple reflections [p=0.03], and Complex reflections [p<0.001]. Occurrences were similar between groups regarding "Giving information". CONCLUSION: An 8-h training workshop was associated with improved MI performance. PRACTICE IMPLICATIONS: These findings lend support for the implementation of MI training in medical schools.

Substance use and suicidal conduct: a study of adolescents hospitalized for suicide attempt and ideation.

AIM: To study the prevalence of psychoactive substance use disorder (PSUD) among suicidal adolescents, psychoactive substance intoxication at the moment of the attempt, and the association between PSUD at baseline and either occurrence of suicide or repetition of suicide attempt(s). METHODS: 186 adolescents aged 16 to 21 y hospitalized for suicide attempt or overwhelming suicidal ideation were included (T0); 148 of them were traced again for evaluations after 6 mo (T1) and/or 18 mo (T2). DSM-IV diagnoses were assessed each time using the Mini International Neuropsychiatric Interview. RESULTS: At T0, 39.2% of the subjects were found to have a PSUD. Among them, a significantly higher proportion was intoxicated at the time of the attempt than those without PSUD (44.3% vs 25.4%). Among the 148 adolescents who could be traced at either T1 or T2, two died from suicide and 30 repeated suicide attempts once or more times. A marginally significant association was found between death by suicide/repetition of suicide attempt and alcohol abuse/dependence at baseline (OR=3.3, 95% CI 0.7-15.0; OR=2.6, 95% CI 0.7-9.3). More than one suicide attempt before admission to hospital at T0 (OR=3.2, 95% CI 1.1-10.0) and age over 19 y at T0 (OR=3.2, 95% CI 1.1-9.2) were independently associated with the likelihood of death by suicide or repetition of suicide attempt. CONCLUSION: Among adolescents hospitalized for suicide attempt or overwhelming suicidal ideation, the risk of death or repetition of attempt is high and is associated with previous suicide attempts--especially among older adolescents--and also marginally associated with PSUD; these adolescents should be carefully evaluated for such risks and followed up once discharged from the hospital.

Le Cartel burlesque entre deux amis, envoyé de Paris à Ruel, et refusé pendant la conférance

[Mazarinade. 1649]

Resolutions reported by the Military Committee, expressive of the thanks of Congress to Major General Jackson, and the troops under his command, for their gallantry and good conduct, in the defence of New Orleans.--

February 13, 1815. Printed by order of the Senate of the United States.

Resolutions reported by the Military Committee, expressive of the thanks of Congress to Major General Jackson, and the troops under his command, for their gallantry and good conduct, in the defence of New Orleans

February 13, 1815. Printed by order of the Senate of the United States. Printed by Roger C. Weightman

Thoughts upon the conduct of our administration in relation both to Great Britain and France, more especially in reference to the late negotiation, concerning the attack on the Chesapeake

Printed at the Repertory Office