Clin Med
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Graduates entering medicine need to achieve the same learning outcomes as school leaver medical students in less time. Time is not the only consideration, and rather than just compress five-year courses into a four-year time-frame, curriculum planners have often taken the opportunity to introduce innovations for small cohorts as schools begin these new programmes. This article considers how the particular needs of graduate entrants can be met by UK medical curricula and reviews accumulating evidence around the design considerations, especially that of problem-based learning. Graduate entry courses have been at the forefront of curriculum planning for new professionalism in doctors.
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If the first two or three antiepileptic drugs used do not control epilepsy, there is little chance that subsequent medications will be effective. In individuals with refractory focal epilepsy, neurosurgery can have a 60-70% chance of bringing long-term remission and these cases should be referred to a specialised centre for evaluation. The standard evaluation includes clinical review, brain imaging with magnetic resonance imaging, recording of seizures with prolonged scalp electroencephalography (EEG) and video, neuropsychological and psychiatric assessments. ⋯ In some individuals further evaluation with functional imaging and intracranial EEG recordings may be necessary. The most commonly performed resective operation is an anterior temporal lobe resection to remove a sclerotic hippocampus, followed by lesionectomies and neocortical resections. Palliative manoeuvres, to reduce seizure frequency and severity include corpus callosotomy, subpial transection and vagal nerve stimulation.