In their statement of principles, the Council of Heads of Medical Schools indicate that the purpose of a medical education is to graduate individuals well fitted to meet the present and future needs of society for medical care.[1] They go on to state that this can be achieved, at least in part, if the social, cultural, and ethnic backgrounds of graduates reflect broadly the diversity of the patient population. It seems that this principle is not currently met by medical schools in the United Kingdom. In a study commissioned by the Council of Heads of Medical Schools in 1998, McManus found that certain groups (students from ethnic minorities, sixth form colleges or further education institutions, and lower socioeconomic groups) were disadvantaged when seeking admission to medical school.[2] As a result, the council devised an action plan in which medical schools were required to draw up policies relating to equal opportunities as a matter of urgency.

In general, the groups of people that are underrepresented in the medical profession tend to be overrepresented in the patient population as a result of many factors, including poverty, poor diet and housing, poor educational standards, and occupational factors. Pupils from lower socioeconomic groups are disadvantaged in many ways when applying for entry to medical education. Their secondary schools are not usually those with a record of high academic achievement, and progression to further or higher education is not a tradition. Similarly, the pupils come from backgrounds where participation in higher education is rare. They often do not have the opportunity to undertake suitable work experience and thus have difficulty demonstrating through their application that they are suitable for a career in a caring profession. As a result, their application forms do not often contain the type of features usually looked for by admissions tutors and may therefore not be considered further.

Schemes aimed at widening access Should be designed to attract this previously untapped pool of potential doctors into medicine, thus providing the NHS with a clinical workforce which more accurately reflects the socioeconomic base of society. Such schemes need to raise awareness of higher education in general and to show pupils that a career in medicine, which might at first seem outside their wildest aspirations, is in fact possible. The schemes should attempt to provide some sort of compensation for pupils’ relatively poor academic base and in particular should provide the type of generic, transferable skills to which such pupils may have had limited exposure. Communication skills are particularly important in this regard. Finally, the schemes should make appropriate work experience and exposure to the profession in general available to the pupils.

A new recruitment programme

The University of Sheffield as a whole has shown a longstanding commitment to widening access to higher education, particularly in the local area, and already attracts high numbers of students from lower socioeconomic groups, as evidenced by the substantial Widening Participation premium additional funding allocated by the Higher Education Funding Council for England to the University for 1999-2000. The medical school already participates in some of these activities and will shortly begin a new recruitment programme aimed specifically at students from non-traditional and underrepresented backgrounds. This early outreach programme is described in detail below, but the medical school has already shown its commitment to widening access by welcoming applications from applicants with nontraditional backgrounds. We already have a relatively high proportion of mature students (25% of entrants to the six year foundation course and 14% of entrants to the five year course). Students with a background in nursing are particularly welcome, and we have a relatively high proportion of students with nontraditional educational backgrounds, including BTEC and GNVQ courses.

The Compact Scheme

The Compact Scheme began in medicine in 1994. It provides individual support by trained admissions staff, and the formal academic entry requirements are relaxed where appropriate. Year 12 pupils whose personal, domestic, or financial circumstances may prevent them from displaying their full academic potential are helped in the application and admission process. Pupils are first identified in their schools and, if thought to be suitable, are referred by the school to the university and then to the scheme’s liaison officer for the school of medicine. In an informal interview, students are assessed in general terms and are given advice and support about their application. The majority then proceed to the formal interview stage, along with the standard applicants.

We feel it is important that such students should not be made to feel “different” from their fellow applicants and thus, although the interviewers are made aware of the pupil’s special circumstances, the other applicants being interviewed at the same time are not. Similarly, once admitted, these students are not identifiable in any way to their fellow students or to teaching staff, unless the students themselves decide to inform them. They receive no special treatment and in particular are not identifiable during assessment episodes. They are, however, followed closely during their studies and are made aware that they may seek advice and guidance from the liaison officer at any time.

Feb. 2-4: Certificate in business administration physicians program. Auburn University, Auburn. (15 hrs: P) Sponsor: Southern Medical Association. Contact Joyce Lane: 800-423-4992.

Alaska

Dec. 1-2: Child and adolescent psychiatry. Providence Alaska Medical Center, Anchorage. (7 1/2 hrs: E) Sponsor: Providence Health System Alaska. Contact Mark Agnew, M.D.: 907-261-3011.

Arizona

Dec. 6-7: Dermatologic procedures. Holiday Inn Sunspree Resort, Scottsdale. (16 hrs: P) Sponsor: National Procedures Institute. Contact Chantee DuFort: 517-631-4664.

Dec. 6-7: Sclerotherapy. Holiday Inn Sunspree Resort, Scottsdale. (11 1/4 hrs: P) Sponsor: National Procedures Institute. Contact Chantee DuFort: 517-631-4664.

Dec. 8: Flexible sigmoidoscopy. Holiday Inn Sunspree Resort, Scottsdale. (6 3/4 hrs: P) Sponsor: National Procedures Institute. Contact Chantee DuFort: 517-631-4664.

Dec. 8-9: Orthopedics for the office practice. Holiday Inn Sunspree Resort, Scottsdale. (12 hrs: P) Sponsor: National Procedures Institute. Contact Chantee DuFort: 517-631-4664.

Dec. 14-17: Intensive conversational medical Spanish/culture workshop. Manicopa Medical Center, Phoenix. (36 3/4 hrs: P) Sponsor: Rios Associates. Contact Joanna Rios: 520-907-3318;

Reduced funding, rising student numbers, geographical dispersal, and increased competition in a complex global market have put medical schools under pressure to embrace computer assisted learning

New technologies may have important educational advantages, but without support and training for staff and students they could prove an expensive disaster

Expansion of computer assisted learning requires cultural change as well as careful strategic planning, resource sharing, staff incentives, active promotion of multidisciplinary working, and effective quality control

It is becoming “a truth universally acknowledged” that the education of undergraduate medical students will be enhanced through the use of computer assisted learning. Access to the wide range of online options illustrated in the figure must surely make learning more exciting, effective, and likely to be retained. This assumption is potentially but by no means inevitably correct.

Deans of medical faculties often receive requests for development funding for computer assisted learning projects. Decisions to introduce these projects into the undergraduate curriculum are generally justified by one or more of the arguments listed in box 1.

Box 1: Why fund computer assisted learning?

Computer assisted learning is inevitable–Individual lecturers and departments are already beginning to introduce a wide range of computer based applications, sometimes in a haphazard way. Planned and coordinated development is better than indiscriminate expansion

It is convenient and flexible–Courses supported by computer assisted learning applications may require fewer face to face lectures and seminars and place fewer geographical and temporal constraints on staff and students. Students at peripheral hospitals or primary care centres may benefit in particular

Unique presentational benefits–Computer presentation is particularly suited to subjects that are visually intensive, detail oriented, and difficult to conceptualise, such as complex biochemical processes or microscopic images.[1] Furthermore, “virtual” cases may reduce the need to use animal or human tissue in learning

Personalised learning–Each learner can progress at his or her preferred pace. They can repeat, interrupt, and resume at will, which may have particular advantages for weaker students

Economies of scale–Once an application has been set up, the incremental cost of offering it to additional students is relatively small

Competitive advantage–Potential applicants may use the quality of information technology to discriminate between medical schools. A “leading edge” virtual campus is likely to attract good students

Achieves the ultimate goal of higher education–The goal is to link people into learning communities. Computer applications, especially the internet and world wide web, are an extremely efficient way of doing this[2]

Expands pedagogical horizons–The most controversial argument for using computer assisted learning in higher education is the alleged ability of the virtual campus to alter fundamentally the relation between people and knowledge[3]

Developing applications

Computer assisted learning applications generally require the student to follow the content without immediate or direct supervision from the tutor. But the computer can be a temperamental and unforgiving beast, and computer assisted learning applications must therefore embody the quality features described in box 2. For all these reasons, computer assisted learning materials are initially much more labour intensive and time consuming to prepare than most face to face courses, and they often require input from fairly senior members of staff. Once the basic format is agreed and the initial materials have been written, however, materials can be maintained and updated relatively easily and by more junior members. Off the shelf templates that allow someone with no specific training to produce materials of professional quality are increasingly available. Introducing computer assisted learning technologies into a traditional course will generally occur in stages, as described in box 3. Adapting pre-existing materials designed as handouts or revision notes can sometimes save considerable time.

Box 2: Quality features of applications

Open learning (self study) materials–Applications must be prepared in advance, cover explicit course aims and learning objectives, and include a high degree of “signposting,” explanatory text, and trouble shooting information

Website design–Websites should have a logical structure and sequence, utilise features such as hypertext and graphics, and include links to public access, web based materials such as electronic journals where appropriate

Technical design–Applications must be user friendly and operate effectively within the hardware and software constraints of the end user

University culture–Applications must present an academic ethos in the untidy, commercial, and laissez-faire culture of web based publishing and protect the student from the distractions of the internet

Dale[R] Tracheostomy Tube Holders from Dale Medical Products replace twill ties and provide comfortable, controlled support of tracheostomy tubes. Dale’s exclusive use of a section of stretch material accommodates a resident’s cough reflex or edema, and ensures precise tube positioning. The product employs quick-fastening closure tabs for fast, easy, secure application to any tracheostomy tube. The tube holders have a soft cotton-lined neckband to prevent excoriation of the neck.

Dale[R] Foley Catheter Holders are designed to minimize the risk of infection caused by meatal irritation or accidental catheter pull-through. Two-inch wide surgical stretch material provides a comfortable, secure fit to patients of all sizes without the danger of blood-flow restriction. The catheter holder is easily secured without the time and cost associated with traditional tape application.

An important initiative at the U.S. Navy Medical Information Management Center (NMIMC) in Bethesda, MD, has been to empower its healthcare community by pioneering the virtual organization. This entails securely sharing a substantial amount of medical information, such as medical benefits, newsletters and e-mails, with more than 100,000 users worldwide, across every, conceivable technological environment.

Due to the size, cost and complexity involved in this project, NMIMC had to look beyond traditional VPN and secure extranet solutions. “Security was an absolute priority and every solution we looked at was reliable in this aspect,” says Lt. Rick Nickerson, head of security at NMIMC. “The real difficulty was to find a secure remote-access solution that could effectively work for this many remote users with unpredictable PC configurations. These users are generally not very technical and have minimal or no technical support.”

NMIMC manages a large volume of medical information–used to plan, coordinate and provide cost-effective information management throughout the world for Navy personnel and their families. Information is accessed through a variety of means, including e-mail, files, Web applications, terminal applications and traditional client-server applications. Recent efforts have been made to centralize, standardize and simplify access to more of this data using standalone or centralized Web servers.

The scale and nature of this secure remote-access problem demanded unique features beyond just high security to protect sensitive military and medical data. The widely dispersed, unpredictable and often unsupported PC configuration of remote users meant the solution could not assume anything about the client beyond the existence of an Internet connection and a browser. In addition, the sum of all direct, hidden and on-going costs had to remain reasonable, while scaling with tens of thousands of users.

NMIMC briefly considered traditional VPNs, with proprietary clients often using IPSec to securely communicate over insecure networks like the Internet. “We didn’t need or want all the functionality of traditional VPNs, and the cost and complexity involved made them unworkable,” says Nickerson.

A traditional extranet was NMIMC’s next choice. A basic Web portal-based extranet could eliminate most of the technical barriers of the traditional VPN client.

“Extranets can be complex, costly and time-consuming to build and maintain,” suggests Nickerson. “We already had the data and applications we wanted to share on our existing network and didn’t have the time or the resources to build another extranet network. All these additional systems, servers and clients just add more cost, failure points and management headaches for us.”

NMIMC eventually chose the Secure Extranet Appliance (SEA) solution from SafeWeb of Emeryville, CA. The solution integrates traditionally disparate standalone extranet technologies within a simple plug-in network appliance. By reducing the entire “extranet” to an appliance, there is no significant network reconfiguration, nor additional hardware and software required.

A secure extranet is built with the SEA in four broad steps. First, it is connected to the network and configured like any other network device, with information like the IP address and network gateway. Second, either internal or external authentication directories are defined to determine user and group access.

Third, internal resources like e-mail, file and Web servers are defined with granular access rules. Finally, the administrator determines which user has access to which resources via a customizable dynamic portal.

The SEA enables companies to set up a complete, secure extranet within a day, instead of months or years. The solution was implemented at NMIMC at a onetime cost of $90,000, with no annual license or other additional fees required.

“Our old system proved far too difficult to implement, manage and use. It didn’t provide us with centralized auditing capabilities or allow us to easily control user access,” says Nickerson. “The SEA has greater functionality and allows us to extend our service to all Navy medicine personnel without compromising security.”

NMIMC’s SEA currently gives secure remote access to more than 55,000 naval reservists in a high-availability, fail-over configuration, in conjunction with RadWare, a SafeWeb partner. This project is being extended to more than 100,000 active and reservist Navy personnel to provide them access to additional medical benefits and related information.

MERIDIAN Medical Technologies Inc., a developer of drug-delivery technology and innovative cardiopulmonary diagnostics, said that the Army has received approval from the Food and Drug Administration for Meridian’s automated assembly and filling production line for the Antidote Treatment Nerve Agent Auto-injector, or ATNAA. The company began manufacturing the ATNAA in January.

A joint research effort between the U.S. Army Medical Research and Materiel Command and Meridian resulted in FDA approval of the assembly and production line, company officials said.

The ATNAA offers significant advantages to the Army over currently used auto-injectors, they said. It’s easier to use, less bulky and reduces antidote administration time.

The ATNAA uses multichambered auto-injector technology to deliver two antidotes in a single injection while keeping the two drugs separate in the injector. The auto-injectors are prefilled, spring-loaded, pen-like devices that, when activated and pressed against the body, deliver precise dosages of medication quickly, safely and easily.–Meridian Medical Technologies

Automation is a critical component in the progress and evolution of any medical laboratory. But automating a laboratory and all of its processes is not simply a matter of plugging in a few machines and watching samples line up for testing. Managers need to know what automation entails and how it fits in with their own circumstances. Because of the complexities inherent in the automation process, an explanation of those and a “how-to list” for the preparation of, transition to, and implementation of an automation line follows.

Automation can help alleviate the pending labor shortage due to fewer students. The shortage of medical technologists (MTs) is becoming more significant every year as fewer students enter the field. Annually, only 4,000 people nationwide are graduating in the field. Schools are graduating 30% fewer MT students than 10 years ago and 56% fewer MT students than 20 years ago. The shortage is so severe that it has caught the attention of the U.S. Congress: Rep. John Shimkus recently re-introduced the Medical Laboratory Personnel Shortage Act–a bill intended to encourage more students to pursue medical laboratory careers by providing financial assistance.

Automation can help alleviate the pending labor shortage due to retirement. Current professionals are reaching retirement age in disproportionate numbers. Forty percent of medical laboratory employees are between the ages of 46 and 66 according to the American Society for Clinical Pathology, and nearly half of the current workforce will be ready for retirement by 2010. The U.S. Department of Labor’s Bureau of Labor Statistics estimates that 13,800 medical laboratory professionals will be needed each year through 2012 to fill vacant positions.

Automation can help respond to the increased demands that will accompany an aging population. The aging baby boomer population will soon create increased demand for medical testing. By 2040, 26% of the U.S. population will be at least 60 years old, up from 16.3% in 2000, according to the Center for Strategic and International Studies.

Automation optimizes the functioning, effectiveness, and accuracy of a laboratory. Laboratory automation allows for more testing in a shorter amount of time. It optimizes workflow processes to provide rapid, accurate, and cost-effective test results. Workstation consolidation, which reduces the amount of manual testing that is necessary, typically results from automation.

Automation can produce a more dynamic and robust laboratory. Automation typically frees up medical technologists to spend more time on the difficult cases that require careful analysis and assessment. Automation can also help a laboratory move from being viewed as an expense into being viewed as a revenue-generating resource. With an increased capacity for testing, a laboratory can expand its client base by serving outside healthcare facilities in addition to accommodating in-house needs.

Considering the possibilities

The need for automation is growing, and the benefits are compelling. Still, automating a laboratory is a significant undertaking and one that requires dedication and preparation. Labmanagers should fully understand what they need as they begin the process.

The first step is to make sure that the staff will energetically champion the effort, because the desire for automation must be strong. As with any significant change, the decision to automate may be met with reluctance and hesitation–whether from management wavering over costs or from veteran technologists wary of change.

Even the most enthusiastic advocates for automation should ensure that taking such a momentous step is justifiable. Consequently, the lab manager must assess future needs as well as current requirements. The medical laboratory should already be conducting a sufficient number of tests to justify the initial expense, although future demand may be near enough and strong enough to offset current shortfalls. Today’s medical laboratory that performs 400 hematology tests a day may soon be called to perform 1,000 a day. Will the new automation system be able to handle the increased workload? Also, if a laboratory is located in a geographic area with seasonal demands, these requirements should be built into the initial assessment. For example, laboratories in Florida and Arizona experience enormous surges in capacity demands during the winter months.

The impact of transitioning

Experience has shown that the transition to automation impacts the laboratory in profound ways. Perhaps most importantly, an automated system reduces the amount of manual testing required and produces a corresponding improvement in test-result accuracy. If stringent rules and algorithms are put in place, fewer slide reviews or manual differentials may be necessary, and there will be less need for further manipulation of samples. Less sample manipulation means fewer opportunities for error.

Ultracell Medical Technologies manufactures a complete line of nasal and sinus packing products, including an 8.0-cm anatomic pack available both with and without an airway. Ultracell material has a continuous open pore structure, giving it both strength and softness.

The 8.0 cm is the size most commonly used after septal, turbinate, and rhinoplastic surgery, as well as other intranasal procedures. The specially designed anatomic shape follows the contours of the nasal cavity and allows for equal pressure while absorbing postoperative fluids. PVA sponge packing is superior to other fibrous packing materials, such as cotton and gauze. Contact the company for free samples or more information.

Lone Star Medical Products, Inc., offers a line of new lightweight, reusable Aluminum Retractor Rings, Model 1104 and Model 1107, suitable for use in a wide variety of surgical procedures.

The new Aluminum Retractor Rings feature the same positive-locking-hinge design as the company’s single-use retractor rings and can be used with any of the Lone Star Retractor Hooks. The ring design features significant weight reduction in a reusable retractor ring, along with improved ergonomic design for easier stay attachment and readjustment.

The Aluminum Retractor Rings weigh only ounces more than Lone Star’s single-use Noryl[R] Retractor Rings. They are constructed of anodized aluminum with surgical-grade stainless steel hinge screws and threads.

Model 1104 measures 12.7″ (32.2 cm) by 7.2″ (18.4 cm) and is packaged singly, nonsterile. Model 1107 measures 14.2″ (36 cm) square. These products can be resterilized using any generally accepted procedure.

Another acquisition involves the Roche health care group and medical device supplier Disetronic, the world’s second-largest maker of insulin pumps. Roche offered Disetronic shareholders two Roche non-voting equity securities and $489 for each Disetronic share. Based on mid-February exchange rates, the deal was worth some $1.2 billion.

Roche will be able to offer comprehensive diabetes management solutions, from blood glucose meters for self-monitoring to programmable insulin pumps that allow patients to administer insulin doses continuously according to their individual needs. However, Roche reported it would resell Disetronic Injection Systems to Disetronic’s founder and chairman Willy Michel for $306.6 million.