SummaryWork-based assessments (WBAs) were only recently introduced into medicine. However, since their introduction, they have rapidly grown in popularity. WBAs are now a routine part of medical training. As WBAs are being implemented, the practical difficulties with their use have come to light. A major problem is failure of the trainees, trainers and training programmes to adequately engage with them. In this review, the reasons for this and how these can be overcome are discussed.

Autosomal recessive distal renal tubular acidosis is usually a severe disease of childhood, often presenting as failure to thrive in infancy. It is often, but not always, accompanied by sensorineural hearing loss, the clinical severity and age of onset of which may be different from the other clinical features. Mutations in either ATP6V1B1 or ATP6V0A4 are the chief causes of primary distal renal tubular acidosis with or without hearing loss, although the loss is often milder in the latter. We describe a kindred with compound heterozygous alterations in ATP6V0A4, where hearing loss was formally diagnosed late in both siblings such that they missed early opportunities for hearing support. This kindred highlights the importance of routine audiologic assessments of all children with distal renal tubular acidosis, irrespective either of age at diagnosis or of which gene is mutated. In addition, when diagnostic genetic testing is undertaken, both genes should be screened irrespective of current hearing status. A strategy for this is outlined.

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Clinical Audit Dovepress submit your manuscript | www.dovepress.com Dovepress 1 S h o rt r e p o rt open access to scientific and medical research open Access Full text Article Background: The purpose of this study was to assess the effectiveness of a single focused teaching session in improving junior doctors' knowledge of intravenous fluid therapy. Methods: A questionnaire was developed from the current national guidelines on perioperative intravenous fluid therapy, ie, the 2008 British Consensus Guidelines on Intravenous Fluid Therapy for Adult Surgical Patients. The questionnaire was administered to foundation year 1 doctors atbaseline. Subsequently a teaching session on intravenous fluid therapy was organized. The participants completed the questionnaire immediately after and again 2-5 weeks after the teaching session. The main outcome measure was the change in mean score after the intervention. Results:The mean pre-education score was 4.3 (36%). The mean post-education scores immediately and an average of 22 days after the teaching session were 10.3 (85%) and 9.5 (79%), respectively. Conclusion: A single focused teaching session is a simple and effective way of improving junior doctors' knowledge of intravenous fluid therapy. We recommend that a teaching session on intravenous fluids be integrated into the teaching program for all junior doctors.

H. influenzae is a rare, but treatable cause of discitis.