Skip to main content

Sam Leinster

University of East Anglia, Norwich Medical School, Emeritus

Followers

138

Following

5

Co-author

1

Mentions

796

Public Views

I am by clinical background a surgical oncologist with interests in breast cancer, malignant melanoma and soft tissue sarcoma. My research interests include the molecular biology of breast cancer and the psychological impact of breast disease. My major contributions have been in medical education with interests in curriculum design and delivery, assessment, and the accreditation of medical schools.

less

Interests

Uploads

Papers by Sam Leinster

Is new always better? A comparison of an established teaching method with a new teaching method in a surgical course

Medical Education, Jul 1, 1982

A comparison has been made between the effectiveness of a problem-solving exercise and a formal l... more A comparison has been made between the effectiveness of a problem-solving exercise and a formal lecture on medical students' learning during their surgical attachment. The format of a clinical trial has been adapted. No difference has been shown in the knowledge conveyed by the two methods, although the students preferred the problem-solving exercise. No assessment has been made in this study of differences in the students ability to solve problems after exposure to different methods of teaching.

Effects of isoflavones on breast density in pre- and post-menopausal women: a systematic review and meta-analysis of randomized controlled trials

Human Reproduction Update, May 28, 2010

mammographic density in premenopausal women (MD 1.83%, 95% CI 0.25-3.40) without heterogeneity bu... more mammographic density in premenopausal women (MD 1.83%, 95% CI 0.25-3.40) without heterogeneity but this effect was lost in one of three sensitivity analyses. conclusions: Isoflavone intake does not alter breast density in post-menopausal women, but may cause a small increase in breast density in premenopausal women. Larger, long-term trials are required to determine if these small effects are clinically relevant.

Systematic review of studies of patients’ satisfaction with breast reconstruction after mastectomy

The Breast, Dec 1, 2007

Systematic review of studies of patients' satisfaction with breast reconstruction published in En... more Systematic review of studies of patients' satisfaction with breast reconstruction published in English (1994-2006) using Medline, Embase, Cochrane databases. Twenty-eight studies related to cosmesis and two related to pain management were identified. Study designs were mostly randomised surveys but half of samples were small. Five studies compared surgical techniques and satisfaction, twelve analysed surgical techniques; two studies looked at the effect of radiation therapy. Nine studies assessed satisfaction determinants. All studies reported good levels of satisfaction. Methodological deficiencies (small sample sizes, context and study designs, satisfaction assessment, basic statistical analysis) limit the generalisability of the findings. Overall, studies suggested that patients were satisfied with breast reconstruction whatever the technique used, whereas age or procedure timing did not affect general satisfaction. Breast symmetry, size, shape and scars were reported as influencing the patients' score. Nipple reconstruction positively influenced satisfaction; radiation before/after reconstruction achieved satisfactory cosmesis, and complications predicted dissatisfaction.

The Dundee Ready Education Environment Measure (DREEM): A review of its adoption and use

Medical Teacher, Apr 3, 2012

Background: The Dundee Ready Education Environment Measure (DREEM) was published in 1997 as a too... more Background: The Dundee Ready Education Environment Measure (DREEM) was published in 1997 as a tool to evaluate educational environments of medical schools and other health training settings and a recent review concluded that it was the most suitable such instrument. Aims: This study aimed to review the settings and purposes to which the DREEM has been applied and the approaches used to analyse and report it, with a view to guiding future users towards appropriate methodology. Method: A systematic literature review was conducted using the Web of Knowledge databases of all articles reporting DREEM data between 1997 and 4 January 2011. Results: The review found 40 publications, using data from 20 countries. DREEM is used in evaluation for diagnostic purposes, comparison between different groups and comparison with ideal/expected scores. A variety of non-parametric and parametric statistical methods have been applied, but their use is inconsistent. Conclusions: DREEM has been used internationally for different purposes and is regarded as a useful tool by users. However, reporting and analysis differs between publications. This lack of uniformity makes comparison between institutions difficult. Most users of DREEM are not statisticians and there is a need for informed guidelines on its reporting and statistical analysis.

Information needs and sources of information for women with breast cancer: a follow-up study

Journal of Advanced Nursing, Mar 1, 1996

Treatment decision making in women newly diagnosed with breast cancer

Cancer Nursing, Feb 1, 1996

The purpose of this study was to explore the hypothesis that women with breast cancer had specifi... more The purpose of this study was to explore the hypothesis that women with breast cancer had specific preferences about the degree of control they wanted over treatment decision making. One hundred fifty women, newly diagnosed with breast cancer, were interviewed and their preferences for participation in treatment decision making were established using a measurement tool designed to elicit decision-making preferences (Degner LF, Sloan JF. Decision making during serious illness: What role do patients really want to play? J Clin Epidemiol 1992;45:944-50). Two hundred women with benign breast disease served as a descriptive comparison group. Unfolding theory (Coombs CH. A theory of data. New York: John Wiley &amp; Sons, 1964) provided a means of analyzing the data so that the degree of control preferred by each woman could be established. The majority of the newly diagnosed women preferred to play a passive role in treatment decision making, leaving the decision-making responsibility to their physician, whereas the benign control group preferred a collaborative role in which joint decisions could be made between the patient and the physician. The implications of the results for patient participation are discussed.

Comparative expression of fibroblast growth factor mRNAs in benign and malignant breast disease

British Journal of Cancer, Apr 1, 1994

The messenger RNAs for the angiogenic acidic and basic fibroblast growth factors are expressed at... more The messenger RNAs for the angiogenic acidic and basic fibroblast growth factors are expressed at a significantly higher level in samples of human benign neoplastic and hyperplastic tissue than in samples from breast cancers. However, approximately one in four malignant breast cancer samples contain basic fibroblast growth factor mRNA at the same level as in the benign lesions when basic fibroblast growth factor mRNA levels are corrected with respect to levels of expression of glyceraldehyde-3-phosphate dehydrogenase mRNA. A similar proportion of human malignant breast cancer cell lines express a high level of basic fibroblast growth factor mRNA. The results suggest that some malignant breast cancers and their constitutive carcinoma cells express abundant levels of basic fibroblast growth factor mRNA. The resultant production of basic fibroblast growth factor by breast cancer cells within some tumours may contribute to their development.

Medicine in a multicultural society

BMJ, Oct 1, 2001

Learning about different cultures while at medical school may prevent you from becoming a “medica... more

Information and Support Needs Questionnaire

Setting standards

The Lancet, Feb 1, 2004

It is quite easy to decide what medical students and postgraduate trainees need to know in terms ... more

Curriculum planning

The Lancet, Aug 1, 2003

Good educational programmes have a well-planned curriculum. Several models of curriculum planning... more

Medical education and the changing face of healthcare delivery

Medical Teacher, 2002

There is an increasing and inevitable breakdown between the roles of healthcare professionals. Ef... more There is an increasing and inevitable breakdown between the roles of healthcare professionals. Effective performance as a healthcare professional is no longer predicated on memorizing a body of facts but depends on being able to assimilate, evaluate and use new information. Clinical and communication skills are not the sole domain of the medical profession but are common to a range of healthcare professionals. Developing proper attitudes is a major goal of the education of all healthcare professionals. These considerations suggest that a new approach to the education of healthcare professionals, including doctors, is needed.

Late development of incisional hernia: an unrecognised problem

BMJ, Feb 12, 1983

Cellular hyperviscosity as a cause of neurological symptoms in leukaemia.

Comparing staff and student perceptions of the student experience at a new medical school

Medical Teacher, 2009

The aim was to compare staff and student perceptions of student experience with the UEA MB/BS edu... more The aim was to compare staff and student perceptions of student experience with the UEA MB/BS educational environment. All MB/BS students were asked to complete a standard course evaluation at the end of the 2005/06 academic year, which included the Dundee Ready Education Environment Measure (DREEM). MB/BS teaching staff were asked to complete a revised version of the DREEM. Data from 403 students and 73 teaching staff were compared. The overall DREEM was 144/200 for staff and 141/200 for students. Initial analysis suggested that staff believed that students&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; were experiencing more positive learning and teaching environments than students actually were, and they viewed the students&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; social experience as more negative than it actually was. However, staff were unable to comment on number of aspects of the educational environment and scored these as &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;unsure&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;. This distorted the mean values for the subscales. When this was adjudged for, the differences disappeared. Staff did not believe that students were experiencing a perfect educational environment; in most cases their views were closely aligned. But staff &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s unfamiliarity with aspects of the educational environment suggests a continuing need to provide feedback to staff about students&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; actual experiences, to enable provision of a better environment for students.

re: The ratio of 2nd to 4th digit length and age at presentation of breast cancer: a link with prenatal oestrogen?

The Breast, Aug 1, 2001

Evaluation and assessment of social accountability in medical schools

Medical Teacher, Jul 20, 2011

Social accountability as an outcome must be measured at institutional (evaluation) and individual... more Social accountability as an outcome must be measured at institutional (evaluation) and individual (assessment) level. The definitions used in the measurement will be dependent on the social setting of the medical school being scrutinised. A formal framework is needed so that comparisons can be made and progress measured. The World Health Organisation suggests that there are four principles that delineate social accountability--relevance, quality, cost-effectiveness and equity. Medical schools are evaluated according to their planning, doing and impact in relation to these principles. Boelen and Woollard have clarified the ideas of planning, doing and impact into Conceptualisation, Production and Usability. THEnet group of medical schools use a shortened version of Boelen and Woollard&amp;amp;amp;amp;amp;amp;#39;s framework with 20 criteria to evaluate their programmes. At the individual level, there is considerable overlap between the concepts of &amp;amp;amp;amp;amp;amp;#39;social accountability&amp;amp;amp;amp;amp;amp;#39; and &amp;amp;amp;amp;amp;amp;#39;professionalism&amp;amp;amp;amp;amp;amp;#39;. Attempts are being made to define and measure professionalism, however, if the behaviour and attitudes of individual graduates is a significant component in defining social responsibility new methods of assessment need to be developed. Factors such as the available resources and the structure of the health services have a very large effect on doctors&amp;amp;amp;amp;amp;amp;#39; attitudes and behaviour. As a result, the task of evaluating and assessing the extent to which medical schools are socially accountable is complex. Judgments on how well a school is meeting the standards will have to make allowance for the local political and economic environment.

Peer review report 2 on “Efficacy of harmonic focus scalpel in seroma prevention after axillary clearance”

International Journal of Surgery, 2016

Opportunities and Options in Medical Careers

Postgraduate Medical Journal, Aug 1, 2001

Wanted: a new wound dressing

BMJ, Oct 27, 1979

Keynote Lecture From the EACE Annual Meeting 2002: An Analytical View of Cancer Education

Journal of Cancer Education, Sep 1, 2004

Page 1. ■ Special Communication Keynote Lecture From the EACE Annual Meeting 2002: An Analytical ... more

Is new always better? A comparison of an established teaching method with a new teaching method in a surgical course

Medical Education, Jul 1, 1982

A comparison has been made between the effectiveness of a problem-solving exercise and a formal l... more A comparison has been made between the effectiveness of a problem-solving exercise and a formal lecture on medical students' learning during their surgical attachment. The format of a clinical trial has been adapted. No difference has been shown in the knowledge conveyed by the two methods, although the students preferred the problem-solving exercise. No assessment has been made in this study of differences in the students ability to solve problems after exposure to different methods of teaching.

Effects of isoflavones on breast density in pre- and post-menopausal women: a systematic review and meta-analysis of randomized controlled trials

Human Reproduction Update, May 28, 2010

mammographic density in premenopausal women (MD 1.83%, 95% CI 0.25-3.40) without heterogeneity bu... more mammographic density in premenopausal women (MD 1.83%, 95% CI 0.25-3.40) without heterogeneity but this effect was lost in one of three sensitivity analyses. conclusions: Isoflavone intake does not alter breast density in post-menopausal women, but may cause a small increase in breast density in premenopausal women. Larger, long-term trials are required to determine if these small effects are clinically relevant.

Systematic review of studies of patients’ satisfaction with breast reconstruction after mastectomy

The Breast, Dec 1, 2007

Systematic review of studies of patients' satisfaction with breast reconstruction published in En... more Systematic review of studies of patients' satisfaction with breast reconstruction published in English (1994-2006) using Medline, Embase, Cochrane databases. Twenty-eight studies related to cosmesis and two related to pain management were identified. Study designs were mostly randomised surveys but half of samples were small. Five studies compared surgical techniques and satisfaction, twelve analysed surgical techniques; two studies looked at the effect of radiation therapy. Nine studies assessed satisfaction determinants. All studies reported good levels of satisfaction. Methodological deficiencies (small sample sizes, context and study designs, satisfaction assessment, basic statistical analysis) limit the generalisability of the findings. Overall, studies suggested that patients were satisfied with breast reconstruction whatever the technique used, whereas age or procedure timing did not affect general satisfaction. Breast symmetry, size, shape and scars were reported as influencing the patients' score. Nipple reconstruction positively influenced satisfaction; radiation before/after reconstruction achieved satisfactory cosmesis, and complications predicted dissatisfaction.

The Dundee Ready Education Environment Measure (DREEM): A review of its adoption and use

Medical Teacher, Apr 3, 2012

Background: The Dundee Ready Education Environment Measure (DREEM) was published in 1997 as a too... more Background: The Dundee Ready Education Environment Measure (DREEM) was published in 1997 as a tool to evaluate educational environments of medical schools and other health training settings and a recent review concluded that it was the most suitable such instrument. Aims: This study aimed to review the settings and purposes to which the DREEM has been applied and the approaches used to analyse and report it, with a view to guiding future users towards appropriate methodology. Method: A systematic literature review was conducted using the Web of Knowledge databases of all articles reporting DREEM data between 1997 and 4 January 2011. Results: The review found 40 publications, using data from 20 countries. DREEM is used in evaluation for diagnostic purposes, comparison between different groups and comparison with ideal/expected scores. A variety of non-parametric and parametric statistical methods have been applied, but their use is inconsistent. Conclusions: DREEM has been used internationally for different purposes and is regarded as a useful tool by users. However, reporting and analysis differs between publications. This lack of uniformity makes comparison between institutions difficult. Most users of DREEM are not statisticians and there is a need for informed guidelines on its reporting and statistical analysis.

Information needs and sources of information for women with breast cancer: a follow-up study

Journal of Advanced Nursing, Mar 1, 1996

Treatment decision making in women newly diagnosed with breast cancer

Cancer Nursing, Feb 1, 1996

The purpose of this study was to explore the hypothesis that women with breast cancer had specifi... more The purpose of this study was to explore the hypothesis that women with breast cancer had specific preferences about the degree of control they wanted over treatment decision making. One hundred fifty women, newly diagnosed with breast cancer, were interviewed and their preferences for participation in treatment decision making were established using a measurement tool designed to elicit decision-making preferences (Degner LF, Sloan JF. Decision making during serious illness: What role do patients really want to play? J Clin Epidemiol 1992;45:944-50). Two hundred women with benign breast disease served as a descriptive comparison group. Unfolding theory (Coombs CH. A theory of data. New York: John Wiley &amp; Sons, 1964) provided a means of analyzing the data so that the degree of control preferred by each woman could be established. The majority of the newly diagnosed women preferred to play a passive role in treatment decision making, leaving the decision-making responsibility to their physician, whereas the benign control group preferred a collaborative role in which joint decisions could be made between the patient and the physician. The implications of the results for patient participation are discussed.

Comparative expression of fibroblast growth factor mRNAs in benign and malignant breast disease

British Journal of Cancer, Apr 1, 1994

The messenger RNAs for the angiogenic acidic and basic fibroblast growth factors are expressed at... more The messenger RNAs for the angiogenic acidic and basic fibroblast growth factors are expressed at a significantly higher level in samples of human benign neoplastic and hyperplastic tissue than in samples from breast cancers. However, approximately one in four malignant breast cancer samples contain basic fibroblast growth factor mRNA at the same level as in the benign lesions when basic fibroblast growth factor mRNA levels are corrected with respect to levels of expression of glyceraldehyde-3-phosphate dehydrogenase mRNA. A similar proportion of human malignant breast cancer cell lines express a high level of basic fibroblast growth factor mRNA. The results suggest that some malignant breast cancers and their constitutive carcinoma cells express abundant levels of basic fibroblast growth factor mRNA. The resultant production of basic fibroblast growth factor by breast cancer cells within some tumours may contribute to their development.

Medicine in a multicultural society

BMJ, Oct 1, 2001

Learning about different cultures while at medical school may prevent you from becoming a “medica... more

Information and Support Needs Questionnaire

Setting standards

The Lancet, Feb 1, 2004

It is quite easy to decide what medical students and postgraduate trainees need to know in terms ... more

Curriculum planning

The Lancet, Aug 1, 2003

Good educational programmes have a well-planned curriculum. Several models of curriculum planning... more

Medical education and the changing face of healthcare delivery

Medical Teacher, 2002

There is an increasing and inevitable breakdown between the roles of healthcare professionals. Ef... more There is an increasing and inevitable breakdown between the roles of healthcare professionals. Effective performance as a healthcare professional is no longer predicated on memorizing a body of facts but depends on being able to assimilate, evaluate and use new information. Clinical and communication skills are not the sole domain of the medical profession but are common to a range of healthcare professionals. Developing proper attitudes is a major goal of the education of all healthcare professionals. These considerations suggest that a new approach to the education of healthcare professionals, including doctors, is needed.

Late development of incisional hernia: an unrecognised problem

BMJ, Feb 12, 1983

Cellular hyperviscosity as a cause of neurological symptoms in leukaemia.

Comparing staff and student perceptions of the student experience at a new medical school

Medical Teacher, 2009

The aim was to compare staff and student perceptions of student experience with the UEA MB/BS edu... more The aim was to compare staff and student perceptions of student experience with the UEA MB/BS educational environment. All MB/BS students were asked to complete a standard course evaluation at the end of the 2005/06 academic year, which included the Dundee Ready Education Environment Measure (DREEM). MB/BS teaching staff were asked to complete a revised version of the DREEM. Data from 403 students and 73 teaching staff were compared. The overall DREEM was 144/200 for staff and 141/200 for students. Initial analysis suggested that staff believed that students&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; were experiencing more positive learning and teaching environments than students actually were, and they viewed the students&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; social experience as more negative than it actually was. However, staff were unable to comment on number of aspects of the educational environment and scored these as &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;unsure&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;. This distorted the mean values for the subscales. When this was adjudged for, the differences disappeared. Staff did not believe that students were experiencing a perfect educational environment; in most cases their views were closely aligned. But staff &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s unfamiliarity with aspects of the educational environment suggests a continuing need to provide feedback to staff about students&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; actual experiences, to enable provision of a better environment for students.

re: The ratio of 2nd to 4th digit length and age at presentation of breast cancer: a link with prenatal oestrogen?

The Breast, Aug 1, 2001

Evaluation and assessment of social accountability in medical schools

Medical Teacher, Jul 20, 2011

Social accountability as an outcome must be measured at institutional (evaluation) and individual... more Social accountability as an outcome must be measured at institutional (evaluation) and individual (assessment) level. The definitions used in the measurement will be dependent on the social setting of the medical school being scrutinised. A formal framework is needed so that comparisons can be made and progress measured. The World Health Organisation suggests that there are four principles that delineate social accountability--relevance, quality, cost-effectiveness and equity. Medical schools are evaluated according to their planning, doing and impact in relation to these principles. Boelen and Woollard have clarified the ideas of planning, doing and impact into Conceptualisation, Production and Usability. THEnet group of medical schools use a shortened version of Boelen and Woollard&amp;amp;amp;amp;amp;amp;#39;s framework with 20 criteria to evaluate their programmes. At the individual level, there is considerable overlap between the concepts of &amp;amp;amp;amp;amp;amp;#39;social accountability&amp;amp;amp;amp;amp;amp;#39; and &amp;amp;amp;amp;amp;amp;#39;professionalism&amp;amp;amp;amp;amp;amp;#39;. Attempts are being made to define and measure professionalism, however, if the behaviour and attitudes of individual graduates is a significant component in defining social responsibility new methods of assessment need to be developed. Factors such as the available resources and the structure of the health services have a very large effect on doctors&amp;amp;amp;amp;amp;amp;#39; attitudes and behaviour. As a result, the task of evaluating and assessing the extent to which medical schools are socially accountable is complex. Judgments on how well a school is meeting the standards will have to make allowance for the local political and economic environment.

Peer review report 2 on “Efficacy of harmonic focus scalpel in seroma prevention after axillary clearance”

International Journal of Surgery, 2016

Opportunities and Options in Medical Careers

Postgraduate Medical Journal, Aug 1, 2001

Wanted: a new wound dressing

BMJ, Oct 27, 1979

Keynote Lecture From the EACE Annual Meeting 2002: An Analytical View of Cancer Education

Journal of Cancer Education, Sep 1, 2004

Page 1. ■ Special Communication Keynote Lecture From the EACE Annual Meeting 2002: An Analytical ... more