OBJECTIVE: To determine whether medical students using the Normal Pregnancy Virtual Patient program (Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts) have better knowledge and skills in obstetric counseling than traditional clerkship students. STUDY DESIGN: We performed a randomized, controlled trial of 23 students at Harvard Medical School to determine whether participation in a virtual patient program improves medical student knowledge and skills in obstetric counseling. Students were randomized to the obstetrics/gynecology clerkship (n = 11) or the clerkship plus Normal Pregnancy Virtual Patient (n = 12) in 2006-2008. Students interviewed a standardized patient at the end of the clerkship. Two blinded physicians reviewed the videotaped interview and used a standardized checklist to assess knowledge and counseling skills in preconception, breastfeeding, genetics, postpartum counseling, and overall performance. RESULTS: Stratified analyses indicated the virtual patient group provided significantly better preconception counseling than controls (p = 0.002). Overall, students who completed the Virtual Patient program scored higher than those in traditional clerkship alone, though not significantly (26.0 vs. 22.0, p = 0.25). The study may not have had sufficient numbers of students enrolled to detect a significant difference. CONCLUSION: The use of a virtual patient program in obstetrics improves medical students' preconception counseling skills.

OBJECTIVE: The aim of this study was to determine the effect of DRIs on hot flash symptoms in menopausal women. DESIGN: This was a randomized, double-blind, placebo-controlled trial of menopausal women, aged 38 to 60 years, who experienced 4 to 14 hot flashes per day. After a 1-week run-in period, a total of 190 menopausal women were randomized to receive a placebo or 40 or 60 mg/day of a DRI for 12 weeks. The primary outcome was the mean changes from baseline to week 12 in the frequency of hot flashes recorded in the participant diary. The secondary outcomes included changes in quality of life and hormonal profiles. RESULTS: A total of 147 women (77%) completed the study. It was found that 40 and 60 mg of DRI improved hot flash frequency and severity equally. At 8 weeks hot flash frequency was reduced by 43% in the 40-mg DRI group and by 41% in the 60-mg DRI group, compared with 32% in the placebo group (P = not significant vs placebo). The corresponding numbers for 12 weeks were 52%, 51%, and 39%, respectively (P = 0.07 and 0.09 vs placebo). When comparing the two treatment groups with the placebo group, there were significant reductions in mean daily hot flash frequency. The supplement (either 40 or 60 mg) reduced hot flash frequency by 43% at 8 weeks (P = 0.1) and 52% at 12 weeks (P = 0.048) but did not cause any significant changes in endogenous sex hormones or thyroid hormones. Menopausal quality of life improved in all three groups, although there were no statistically significant differences between groups. CONCLUSIONS: DRI supplementation may be an effective and acceptable alternative to hormone treatment for menopausal hot flashes.