2006 - UZ Leuven

internship. These components represent dynamics in the clinicalenvironment that constantly require students to (re-)define and (re-)position themselves: the agenda of the internship (working versuslearning); the attitude of the supervisor (evaluator versus coach); theculture of the training setting (work-orientated versus trainingorientated);the intern's learning attitude (passive versus proactive),and the nature of the learning process (informal versus formal). Themodel of components and tensions offers a conceptual framework toanalyse and understand students' learning during internship. It notonly contributes to a grounded theoretical conceptualisation of clinicallearning, but may also be used in efforts to improve the quality oflearning during internship, as well as the level of support andsupervision.DE LEYN P., STROOBANTS S., DE WEVER W., LERUT T., COOSEMANSW., DECKER G., NAFTEUX P., VAN RAEMDONCK D., MORTELMANS L.,NACKAERTS K., VANSTEENKISTE J.: Prospective comparative study ofintegrated positron emission tomography-computed tomography scancompared with remediastinoscopy in the assessment of residualmediastinal lymph node disease after induction chemotherapy formediastinoscopy-proven stage IIIA-N2 non-small-cell lung cancer: aLeuven cancer group study. J. Clin. Oncol., 2006; 24(1): 3333-3339.Purpose: Mediastinal restaging after induction therapy for non-smallcelllung cancer remains a difficult and controversial issue. The goal ofthis prospective study was to compare the performance of integratedpositron emission tomography (PET)-computed tomography (CT) andremediastinoscopy in the evaluation of mediastinal lymph nodemetastasis after induction chemotherapy.Patients and methods: Thirty consecutive stage IIIA-N2 non-small-celllung cancer patients surgically treated at our institution were enteredonto this prospective study. N2 disease was proven by cervicalmediastinoscopy, at which a mean number of 3.8 lymph node levelswere biopsied. After completion of induction chemotherapy, themediastinum was reassessed by integrated PET-CT andremediastinoscopy. All patients underwent thoracotomy withattempted complete resection and systematic nodal dissection.Results PET-CT showed no evidence of nodal disease (N0) in 13patients, Hilar nodal disease (N1) disease in three patients, andresidual mediastinal disease (N2) in 14 patients. Remediastinoscopywas positive in only five patients. The preinduction involved lymphnode level could be accurately re-evaluated in 18 patients. This wasnot the case in the other 12 because of extensive fibrosis andadhesions. In 17 patients, persistent N2 disease was found atthoracotomy. The sensitivity, specificity, and accuracy of PET-CT95