Objective: Small-cell lung carcinoma (SCLC) and limbic encephalitis are recognized g-aminobutyric acid-B receptor (GABA B R) autoantibody accompaniments. We sought to determine in a diagnostic serology laboratory the frequency and accompaniments (neurologic, oncologic, and serologic) of GABA B R-immunoglobulin G (IgG). Methods:We tested stored serum and CSF specimens from 3 patient groups for GABA B R-IgG by indirect immunofluorescence on mouse brain tissue and transfected HEK293 cells. Group 1 included 3,989 patients tested for GABA B R-IgG in service evaluation for suspected autoimmune encephalopathy. Group 2 included 49 patients with an unclassified CNS synaptic IgG detected (antedating descriptions of GABA B R autoantibody). Group 3 included 384 patients in whom $1 SCLC-predictive autoantibodies had been detected.Results: GABA B R-specific IgG was detected in 17 patients (serum, 14; CSF, 11). N-type calcium channel antibody coexisted with GABA B R-IgG in all seropositive patients of groups 1 and 2. In group 1, 7 of 3,989 patients were positive (0.2%). All had limbic encephalitis; 5 had SCLC. Four patients received immunotherapy and improved neurologically. In group 2, 5 of 49 patients were positive (10%). Three had limbic encephalitis, 1 had rapidly progressive encephalomyelopathy, and 1 had cerebellar ataxia. Two patients had SCLC and 1 had multiple myeloma. In group 3, 5 of 384 patients were positive (1.3%); titers were low (detected only by transfected cell assay). The neurologic presentations were diverse and attributable to coexisting T-cell-mediated autoimmunity (indicated by CRMP-5 IgG [2], ANNA-1 [2], and ANNA-3 [2]), rather than to GABA B R-IgG.Conclusion: GABA B R autoantibody is a marker of an uncommon but treatable paraneoplastic neurologic disorder, usually occurring in the setting of limbic encephalitis and SCLC. Autoantibodies specific for the CNS inhibitory g-aminobutyric acid-B receptor (GABA B R, B1 and B2 subunits) have been reported in patients with paraneoplastic limbic encephalitis (LE). Small-cell lung carcinoma (SCLC) and other neuroendocrine neoplasms 1,2 have been reported as oncologic accompaniments. The neuronal N-type voltage-gated calcium channel antibody, another paraneoplastic autoantibody SCLC marker, is commonly reported as a serologic accompaniment.1 Paraneoplastic neurologic disorders associated with autoantibodies targeting neural plasma membrane antigens (e.g., GABA B R) tend to improve with early cancer treatment and immunotherapy.1 In contrast, disorders associated with autoantibodies specific for neural intracellular antigens (i.e., nuclear and cytoplasmic) are less responsive to these treatments.To date, most patients reported with GABA B R antibody have been ascertained through evaluation of patients with LE.1,2 Autoimmune serologic evaluation in a clinical service laboratory, involving patients with diverse neurologic presentations, allows broader ascertainment of clinical associations. Here, we report the detection frequency of GABA B R antibody and associ...

Medical schools revise their curricula in order to develop physicians best skilled to serve the public's needs. To ensure a smooth transition to residency programs, undergraduate medical education is often driven by the six core competencies endorsed by the Accreditation Council for Graduate Medical Education (ACGME): patient care, medical knowledge, practice-based learning, interpersonal skills, professionalism, and systems-based practice. Recent curricular redesign at Mayo Medical School provided an opportunity to restructure anatomy education and integrate radiology with first-year gross and developmental anatomy. The resulting 6-week (120-contact-hour) human structure block provides students with opportunities to learn gross anatomy through dissection, radiologic imaging, and embryologic correlation. We report more than 20 educational interventions from the human structure block that may serve as a model for incorporating the ACGME core competencies into basic science and early medical education. The block emphasizes clinically-oriented anatomy, invites self- and peer-evaluation, provides daily formative feedback through an audience response system, and employs team-based learning. The course includes didactic briefing sessions and roles for students as teachers, leaders, and collaborators. Third-year medical students serve as teaching assistants. With its clinical focus and competency-based design, the human structure block connects basic science with best-practice clinical medicine.

Professionalism is a core competency of medical training that requires students to develop the skills of providing and receiving feedback. Our study evaluated the effectiveness of delivering feedback in a group setting compared with an individual setting. The first-year class of Mayo medical students (n = 49) enrolled in gross anatomy (in dissection teams), completed weekly anonymous evaluations of themselves and their teammates regarding seven aspects of professionalism (altruism, compassion, respect, honesty/integrity, responsibility, commitment to excellence, and self-reflection). Professionalism scores from these surveys were calculated using a six-point Likert scale. Students were also asked to comment on strengths and possible areas for improvement on each peer. At the midpoint of the course, peer comments and professionalism scores were shared with students in debriefing sessions either individually or with their team. Analysis of preintervention and postintervention professionalism scores indicated that the students receiving feedback in a one-on-one setting (student and instructor) were more likely to demonstrate higher scores on subsequent evaluations as compared with those students receiving feedback in a group setting (all team members and one instructor). Our findings suggest that providing feedback to first-year medical students on an individual basis is the best way to improve professional attitudes and behaviors.

A medical student's ability to present a case history is a critical skill that is difficult to teach. Case histories presented without theatrical engagement may fail to catch the attention of their intended recipients. More engaging presentations incorporate 'stage presence', eye contact, vocal inflection, interesting detail and succinct, well organised performances. They convey stories effectively without wasting time. To address the didactic challenge for instructing future doctors in how to 'act', the Mayo Medical School and The Mayo Clinic Center for Humanities in Medicine partnered with the Guthrie Theater to pilot the programme 'Telling the Patient's Story'. Guthrie teaching artists taught storytelling skills to medical students through improvisation, writing, movement and acting exercises. Mayo Clinic doctors participated and provided students with feedback on presentations and stories from their own experiences in patient care. The course's primary objective was to build students' confidence and expertise in storytelling. These skills were then applied to presenting cases and communicating with patients in a fresher, more engaging way. This paper outlines the instructional activities as aligned with course objectives. Progress was tracked by comparing pre-course and post-course surveys from the seven participating students. All agreed that the theatrical techniques were effective teaching methods. Moreover, this project can serve as an innovative model for how arts and humanities professionals can be incorporated for teaching and professional development initiatives at all levels of medical education.