Teaching in the new NHS: the specialised ward based teacher

OBJECTIVES

To evaluate the effects of introducing specialised ward based teachers (WBTs) who had a broad remit to improve third year medical undergraduates' clinical experience.

DESIGN

Quantitative and qualitative methods including interviews with WBTs, participating consultants and SIFT co-ordinator; student questionnaire and evaluations; analysis of Objective Structured Clinical Examination (OSCE) scores to ascertain if exposure to WBTs affected OSCE scores.

SETTING

Two university teaching hospitals.

PARTICIPANTS

Third year undergraduate medical students from one school of medicine; four WBTs; 25 consultants; SIFT co-ordinator.

MAIN OUTCOME MEASURES

Student evaluations. Student questionnaires. Student OSCE scores. Interview data.

RESULTS

WBTs had a demonstrable effect on student performance in OSCE examinations. 94% of students either agreed or strongly agreed that WBTs had helped them develop their examination skills and 87% either agreed or strongly agreed that WBTs had helped them develop their history taking skills. Interview data indicated that the consultants and SIFT co-ordinator considered that WBTs made an important contribution to clinical teaching.

CONCLUSIONS

This study suggests that specialised WBTs are one way to manage clinical experience and enhance learning of undergraduate medical students. As clinical teaching moves into earlier parts of the undergraduate curriculum and into the community there is potential for this role to be developed.

The mechanical power output and hydromechanical efficiency of northern pike (Esox lucius) fast-starts

The mechanical power output and hydrodynamic efficiency of northern pike, Esox lucius, during acceleration from rest (fast-start) are calculated from hydrodynamic theory for two kinematic patterns, C-starts (used in escape) and S-starts (used in prey capture). The Weihs model is employed and modified to calculate the mechanical power produced by a fish during a fast-start. A term is included for the power required to accelerate body sections laterally. Lateral deceleration of fish body sections and their associated added mass are expressed as an active process requiring energy expenditure or as a passive process requiring no energy expenditure. In addition, two methods of calculating useful power (the power used to accelerate the virtual mass of the fish, i.e. fish body mass + longitudinal added mass, in the direction of motion), one derived from the Weihs model and the second by summing the changes in kinetic energy of the virtual mass of the fish during a fast-start, are compared and found to give similar estimates of useful power (not significantly different; differences average 22 %). Comparisons of the kinematics and performance of C- and S-starts reveal that C-starts are consistently terminated after two tail flips (stages 1 and 2) whereas S-starts continue for 3­6 tail flips (stages 3­6). In addition, acceleration during C-starts is more rapid and velocities are higher (2.3­2.8 m s-1) than during S-starts (0.8­1.8 m s-1) over the first 100 ms. However, the peak velocities achieved during S-starts and C-starts are similar over the duration of a fast-start. The superior acceleration rates achieved during the initial stages of a C-start can be explained, in part, by the use of greater maximum angles of attack, higher lateral and perpendicular velocities and larger maximum forces by the caudal fin. Hydrodynamic efficiencies for fast-starts range from 0.16 to 0.39, values that are lower than those observed during either burst-and-coast or steady swimming. Efficiencies are lower for S-starts than for C-starts during the first two tail beats. S-start efficiencies increase with each subsequent tail flip and the maximum efficiencies realised are similar to those achieved during C-starts. Power output during C- and S-starts (449.0 and 394.9 W kg-1 muscle fibre, respectively) approaches the theoretical maximum for vertebrate striated muscle (500 W kg-1). Also, the inferred muscle stress is close to the predicted optimum for maximum power output, at 30 % of the maximum isometric stress recorded for isolated fast muscle fibres. These measurements suggest that fast-start performance is near a physiological limit and is probably constrained by muscle function. The superior acceleration rates achieved by C-starts over S-starts are explained in part by differences in hydrodynamic efficiency, whereas power outputs are similar.