Mean Performance Scores Research Articles

The Efficacy of Lumbosacral Spine Phantom to Improve Resident Proficiency in Performing Ultrasound-Guided Spinal Procedure.

To evaluate the efficacy of a lumbosacral spine phantom to improve novices' proficiency in performing ultrasound-guided facet joint injection and medial branch block. Prospective study in a university hospital. In total, 30 participants with no experience of spinal ultrasonography were included and were allocated to one of two groups (control group, N = 10 and training group, N = 20). A lumbosacral spine phantom was prepared using a lumbosacral spine model embedded in a mixture of gelatin and psyllium husk. All participants were tested (test-1) following a basic education introductory program. Participants in the control group were then tested again after 1 week (test-2). Those in the training group received a further 3-h training, individually, and were tested again after 1 week (test-2). The mean performance scores on test-1 were 57.6 ± 6.0 in the control group and 57.3 ± 6.7 in the training group; and at test-2, 61.0 ± 8.6 and 91.7 ± 4.9 (P < 0.001), respectively. The median time of performance at test-1 was 158.3 ± 41.9 seconds in the control group and 185.3 ± 68.1 seconds in the training group; and at test-2, 146.9 ± 38.9 seconds and 69.9 ± 22.0 seconds (P < 0.001), respectively. In the training group, the mean self-rating level of proficiency scores were 2.2 ± 1.0 at pretraining, and 6.8 ± 0.8 at post-training, respectively (P < 0.001). Training using a gelatin-based spine phantom helped novices to acquire the skills necessary to perform ultrasound-guided lumbar facet joint injections and medial branch blocks.

Clinical teaching as part of continuing professional development: Does teaching enhance clinical performance?

Introduction: Physicians identify teaching as a factor that enhances performance, although existing data to support this relationship is limited.Purpose: To determine whether there were differences in clinical performance scores as assessed through multisource feedback (MSF) data based on clinical teaching.Methods: MSF data for 1831 family physicians, 1510 medical specialists, and 542 surgeons were collected from physicians’ medical colleagues, co-workers (e.g., nurses and pharmacists), and patients and examined in relation to information about physician teaching activities including percentage of time spent teaching during patient care and academic appointment. Multivariate analysis of variance, partial eta squared effect sizes, and Tukey’s HSD post hoc comparisons were used to determine between group differences in total MSF mean and subscale mean performance scores by teaching and academic appointment data.Results: Higher clinical performance scores were associated with holding any academic appointment and generally with any time teaching versus no teaching during patient care. This was most evident for data from medical colleagues, where these differences existed across all specialty groups.Conclusion: More involvement in teaching was associated with higher clinical performance ratings from medical colleagues and co-workers. These results may support promoting teaching as a method to enhance and maintain high-quality clinical performance.

Knowledge, Attitude and Practice of University Faculty Members and High School Teachers About Cervical Cancer Screening in Shiraz, Iran

Background: Due to the increasing rate of cervical cancer screening, and the importance of teachers and faculties in changing the perspective of population on this issue, the present study was carried out to evaluate knowledge base, attitude and performance of teachers and faculty members in relation to cervical cancer screening test. Objectives: This study attempted to evaluate the knowledge, attitude and performance of teachers and faculty members on cervical cancer screening test in Shiraz, Iran. Patients and Methods: The present cross-sectional survey was conducted on a community with high education level. The study was carried out on a sample of 417 randomly selected subjects involving 206 participants from high school teachers and 211 faculty members. Stratified random sampling method was used proportionate to the size, of the main population in each group. P value 0.05 was considered for estimating sample size. Valid and reliable questionnaires were completed via face to face interview. Data were analyzed using SPSS Software version 13. Results: Mean score of knowledge (4.78 ± 0.71) was higher in faculty members than female teachers (4.21 ± 1.16). There was no statistically significant difference in mean scores of knowledge (P value = 0.748) and attitude (P value = 0.704) between teachers of different age groups. Mean score of knowledge (P value = 0.001) and attitude (P value = 0.009) was significantly different among faculty members with different academic degrees. Although academics had higher Knowledge and attitude, the mean score of performance among teachers (18%) was higher than faculty members (16.6%). Conclusions: This study showed that in regard to screening of cervical cancer, there is no acceptable knowledge, attitude and performance level among faculty members and teachers in different zones of Shiraz.

A performance evaluation framework for technical institutions in one of the states of India

Purpose – Technical education plays an important role in the development of a country in this age of knowledge economy. Indian technical education system is facing many opportunities and challenges, one of which is how to assess the performance of technical institutions based on multiple criteria. The purpose of this paper is to describe and illustrate an application of a structured approach to determine relative efficiency and ranking of a set of private engineering colleges under multi-criteria environment. Design/methodology/approach – To cater to the increasing need of technical manpower, a very large number of private engineering colleges have been established in the state of West Bengal of eastern India within a very short period. Uniform and acceptable quality of the graduates from many of these private engineering colleges is a concern today and therefore the need for performance evaluation and ranking of these colleges is paramount. For the proposed framework a comparatively new multiple criteria decision-making tool, multiple objective optimization on the basis of simple ratio analysis (MOOSRA) is applied for performance evaluation of eight private engineering colleges taking into account some selected criteria. The subjective weights of the criteria are determined using fuzzy analytic hierarchy process (AHP). Findings – For the analysis, the required data have been provided by the management of the colleges for the academic year of 2011-2012. Based on request of the management identities of these institutes are not disclosed. The institutes are considered as anonymous institute and coded as A, B, C, D, E, F, G and H, respectively. The result of the study reveals that E is the best and the ranking the authors get is in the order of E &gt; F &gt; A &gt; H &gt; D &gt; C &gt; G &gt; B. The result shows that composite performance scores of institutions A, E and F are above the mean performance score value. Therefore these three institutions can be considered as the benchmark or peer group for the remaining five institutions which lie below the mean line of the performance score value. Originality/value – This paper provides a comprehensive yet detailed methodology for performance evaluation of academic institutions. The novelty in the approach is that fuzzy AHP and MOOSRA are being used as a benchmarking technique in a simple methodology which is generic in nature. It is one of the few studies that evaluate the performance of technical institutions in India.

The BCoS cognitive profile screen: Utility and predictive value for stroke.

We examined the utility of the Birmingham Cognitive Screen (BCoS) in discriminating cognitive profiles and recovery of function across stroke survivors. BCoS was designed for stroke-specific problems across 5 cognitive domains: (a) controlled and spatial attention, (b) language, (c) memory, (d) number processing, and (e) praxis. On the basis of specific inclusion criteria, this cross-section observational study analyzed cognitive profiles of 657 subacute stroke patients, 331 of them reassessed at 9 months. Impairments on 32 measures were evaluated by comparison with 100 matched healthy controls. Measures of affect, apathy, and activities of daily living were also taken. Between-subjects group comparisons of mean performance scores and impairment rates and within-subject examination of impairment rates over time were conducted. Logistic regressions and general linear modeling were used for multivariate analysis of domain-level effects on outcomes. Individuals with repeated stroke experienced significantly less cognitive recovery at 9 months than those with a first stroke despite similar initial level of cognitive performance. Individuals with left hemisphere lesions performed more poorly than those with right hemisphere lesions, but both groups showed similar extent of recovery at 9 months. BCoS also revealed lesion-side-specific deficits and common areas of persistent problems. Functional outcome at 9 months correlated with domain-level deficits in controlled attention, spatial attention, and praxis over and above initial dependency and concurrent levels of affect and apathy. The study demonstrates how BCoS can identify differential cognitive profiles across patient groups. This can potentially help predict outcomes and inform rehabilitation.

Effect of nutritional education through lecture and pamphlet methods on breakfast consumption behavior among primary school girls in Ahvaz

Purpose and Background: Nutrition is an important factor in the health and educational success of students. Breakfast is a main meal and skipping it would constitute a significant reason for pre- school children’s academic failure as well as pre-school children’s growth disorders. This study aims to compare the effects of lecture and pamphlet educational methods on the knowledge, attitude, and performance of the 4th and 5th grade primary school girls in Ahvaz regarding their breakfast consumption behavior. Methodology: The three group intervention method was implemented. The 165 students selected for the study were classified into three groups (55 students in each group), namely, Intervention Group 1 (lecture), Intervention Group 2 (pamphlet), and Control Group. First, the research questionnaires comprising 15 questions on knowledge domain, 12 questions on attitude, and 11 questions on performance were completed. Four educational sessions were held for the intervention groups within two weeks. After three months, the second phase questionnaires were completed. The obtained data were subsequently analyzed through SPSS 16. Findings: The mean knowledge scores obtained before and after intervention in the three groups were as follows: - Lecture Group: Before: 21; After: 27.9 - Pamphlet Group: Before: 21.7; After: 25.6 - Control Group: Before: 43.5; After: 42.9 The mean knowledge, attitude, and performance scores in the lecture and pamphlet groups were significantly greater than those in the control group (P>0.0001). Upon intervention, these scores were significantly greater in the lecture group as compared with the pamphlet group (P>0.0001).

Statistical Performance Comparisons of Computers

As a fundamental task in computer architecture research, performance comparison has been continuously hampered by the variability of computer performance. In traditional performance comparisons, the impact of performance variability is usually ignored (i.e., the means of performance observations are compared regardless of the variability), or in the few cases directly addressed with <inline-formula><tex-math>$t$</tex-math></inline-formula> -statistics without checking the number and normality of performance observations. In this paper, we formulate a performance comparison as a statistical task, and empirically illustrate why and how common practices can lead to incorrect comparisons. We propose a non-parametric hierarchical performance testing (HPT) framework for performance comparison, which is significantly more practical than standard <inline-formula><tex-math>$t$</tex-math></inline-formula> -statistics because it does not require to collect a large number of performance observations in order to achieve a normal distribution of sample mean. In particular, the proposed HPT can facilitate quantitative performance comparison, in which the performance speedup of one computer over another is statistically evaluated. Compared with the HPT, a common practice which uses geometric mean performance scores to estimate the performance speedup has errors of <inline-formula><tex-math>$8.0$ </tex-math></inline-formula> to <inline-formula><tex-math>$56.3$</tex-math></inline-formula> percent on SPEC CPU2006 or SPEC MPI2007, which demonstrates the necessity of using appropriate statistical techniques. This HPT framework has been implemented as an open-source software, and integrated in the PARSEC 3.0 benchmark suite.

Pre-interns: ready to perform?

There is an expectation that interns can perform the core procedural skill of male catheterisation; however, it is unclear if our medical graduates are competent to do so, because there is no formal practical skills exit assessment in our current programme. We sought to investigate the level of experience, the self-reported confidence, and measured competency of our pre-intern (PRINT) students to perform the procedural skill of male catheterisation. We asked 100/147 (68%) PRINT students to complete a questionnaire to elucidate their experience and confidence prior to being practically assessed on a plastic manikin, using a faculty member validated 26-item checklist. Students were also invited to attend focus groups to help identify factors that had contributed to their practical performance. Between 2010 and 2012, 100/147 (68%) PRINT students completed a questionnaire prior to being formatively assessed. The mean score for self-reported confidence was 78.3/100 (95% CI 74.8-81.8), and the mean performance score was 85.6/100 (95% CI 83.2-87.9); however, the correlation coefficient between the confidence score and performance score was weak (r = 0.18). Three focus groups were conducted, with a total of 12/100 (12%) students attending. Although students reported that they had sound knowledge of the skill, the lack of opportunity to perform the skill in the clinical setting had led to mediocre performance outcomes. We found no significant correlation among the level of experience, the self-reported ability and actual performance when students were assessed under direct observation.

Oral Health Related Quality of Life in a Group of Geriatrics.

A good quality of life in elderly population is related to different aspects of health including oral health. The aim of this study was to determine oral health-related quality of life (OHR-QoL) in elderly patients referred for dental or oro-maxillo-facial complaints to Mashhad dental school (MDS) and compare them with a group of normal population. A total of 99 patients from MDS (as case group) and 114 elderly people as control were enrolled in this cross-sectional study. Control group were chosen among the pilgrims who had come to the holy shrine of Imam Reza (Haram). Persian version of OIDP (Oral Impact of Daily Performance) index was used. Data were entered to SPSS 11.5 and Statistical analysis was performed. A total of 213 (case =99, control=114) cases were enrolled. Mean Performance score (MPS) was 6.27±10.47 (7.96±11.95 in case group, and 4.80±8.77 in control group) and the difference was significant (p=0.015). Age was conversely correlated with MPS (r=0.0125, p=0.24) although this correlation was not significant. We found, in oro-maxillofacial functions, ill-fit dentures, oral ulcers, pain and tooth mobility were major determinants of OHR-QoL. Number of impaired functions was directly and significantly correlated with MPS (r=0.92, p<0.001). Some daily functions like speaking, emotional status, cleaning teeth, physical activity were impaired in case group. Oral and maxillofacial diseases were more prevalent in case group and can be an important impairing issue in OHR-QoL.

Effects of an Education Program on Sanitation Status at Centers for Children's Food Service Management: Focusing on Jung-gu and Dong-gu regions of Daejeon Metropolitan City

Objectives: This study aimed to assess the improvement of teachers' sanitation performance and food distribution environment at Centers for children's food service management after a sanitation education program. Methods: The subjects were 119 teachers working at child care centers registered in the Daejeon Center for Children's Foodservice Management in Dongu and Jung-gu, Daejeon. The sanitation education was provided three times from March to August in 2014, and the survey questionnaires were distributed before and after the education. The sanitation status of food service environment of the centers was examined by ATP(adenosine-5'- triphosphate) bioluminescence. Results: After the sanitation education, the teachers showed higher levels of sanitation knowledge. Also, sanitation performance and recognition level of the importance of it significantly improved after the education program. The mean variation scores of importance and performance after the education were 0.14 and 0.23. According to the Importance-Performance Analysis (IPA) results of 26 sanitation attributes about the food service environment, the selection attributes with relatively low performance and importance were mostly distributed in the children's and distributer's personal hygiene management area. However, all attributes except using a personal water bottle and cup were moved to high performance and importance level. Also, the ATP examination results showed that the sanitation status of the food service environment was improved after the education program. Conclusions: The sanitation education program was effective in improving the recognition of the importance of sanitation and its performance with regard to food service management.

PTU-014 The Use Of Kinematic Analysis Of Bile Duct Cannulation As A Means Of Objectively Assessing Endoscopic Skill At Ercp

IntroductionTraining in ERCP has become more challenging due to a reduction in diagnostic cases following the introduction of MRCP. There is a need to explore options to assist with basic...

PD6-07 AUGMENTED REALITY VIDEO SIMULATION FOR ROBOTIC PARTIAL NEPHRECTOMY SURGERY TRAINING – THE NEXT GENERATION

INTRODUCTION AND OBJECTIVES: By creating a low-stakes learning environment that permits deliberate practice and timely feedback, simulation-based training (SBT) modalities have grown in popularity over recent years. The educational value of surgical simulators, however, is only as good as the curriculum in which they are utilized. We designed a simulation-based flexible ureteroscopy (fURS) training course utilizing a novel inanimate training model (Cook URS model). We set out to evaluate the new curriculum and validate the Cook URS model. METHODS: A SBT curriculum was designed for Jr level (PGY1-3) urology residents at the University of Toronto and included a didactic lecture, focusing on fundamental urolithiasis management principles and basic fURS techniques, a hands-on demonstration of the various instrumentation and skills required for fURS, and 3 independent practice sessions using the Cook URS model. Both baseline pre-test and post-course assessment of fURS skill was conducted for a standardized task; fURS with basket manipulation of lower pole stone into the upper pole. Performances were video recorded and later reviewed by 2 blinded experts using a validated assessment device. RESULTS: A total of 10 residents participated in the fURS course. There was a significant difference in mean preand post-course task completion times (15.8 vs 9.4 mins, p<0.01) and performance scores (19.20 vs 25.25, p<0.01). Eighty percent of participants rated the Cook URS model as realistic ( 4/5, mean1⁄44.20) and 5 independent endourology experts rated the model as useful as a training device ( 4/5, mean1⁄44.90), providing both face and content validity. There was also significant correlation (p<0.05) between prior fURS experience and mean overall performance scores, task completion times, passing ratings, movement efficiency, instrument handling, and flow of procedure scores (Figure 1), demonstrating construct validity for the Cook URS model. The fURS global rating scale demonstrated good reliability, (Cronbach’s alpha 1⁄4 0.848). CONCLUSIONS: Our study demonstrated that a SBT curriculum for fURS can lead to improved short-term technical skills amongst Jr level urology residents. The Cook URS model demonstrated face, content and construct validity. Further study is required. Source of Funding: none

One Week with the Experts: A Short Course Improves Musculoskeletal Undergraduate Medical Education

Musculoskeletal problems constitute a considerable workload across all medical and surgical disciplines. There is a mismatch between the burden of musculoskeletal medicine seen by non-orthopaedists clinically and the amount of time afforded it in undergraduate training. Recent initiatives to address this include the United States Bone and Joint Decade and curricular innovations that demonstrate a benefit from improved instruction. Such curricular interventions are usually situated within a wider program reform and last a short time. Gaining institutional support and securing curricular time are challenging. This article shows the positive evaluation of a brief, intense course on musculoskeletal medicine. A one-week course was offered to 154 medical students. The study took place in Ireland, where the student body comprises a mix of graduate students and undergraduate students, who enter medical school directly from second-level education. This course comprised brief didactic talks, case-based small group work, and physical examination skills demonstration. Attitudes toward musculoskeletal medicine prior to the course were elicited. The course was evaluated using pre-course and post-course standardized cognitive tests. Long-term retention was evaluated by end-of-year extended matching questions and an objective standardized clinical examination station. The test results between undergraduate and graduate students and student rating of musculoskeletal medicine as important or less important were compared. Complete data were available for 125 students (81%). Seventy-four percent of students rated musculoskeletal medicine to be of major or critical importance to their career. There was a significant difference (p &lt; 0.001, r = 0.678) in the mean score of the standardized cognitive test between the pre-course test and the post-course test; the mean performance score (and standard deviation) was 48.2% ± 14.2% (range, 17% to 79%), with a pass rate of 3.3%, for the pre-course test and 75.3% ± 15.02% (range, 32% to 100%), with a pass rate of 61%, for the post-course test. At the end of the year, 69.9% of students passed the extended matching questions and 96.7% passed an objective standardized clinical examination station. Graduate students performed better on the post-course standardized cognitive test score (p &lt; 0.001) and objective standardized clinical examination (p &lt; 0.05). Students who rated musculoskeletal medicine as important did not perform better than those who rated it as less important (p = 0.334). We report a favorable evaluation of a short, intense course on musculoskeletal medicine and suggest that the introduction of basic concepts of musculoskeletal medicine is feasible within established curricula.

Performance of Residents Serving as Clinical Teachers: A Student-Based Assessment

Little is known about the competences of residents as clinical teachers in African health care institutions. We evaluated the clinical teaching skills of internal medicine residents from the perspective of medical students in a tertiary teaching institution in Africa. We used the augmented Stanford Faculty Development Program Questionnaire, which has evidence of validity and reliability. To avoid a Hawthorne effect, students completed the questionnaire anonymously and confidentially after clinical teaching sessions by residents. A minimum score of 4 on a scale of 1 to 5 was defined a priori as possession of good clinical teaching skills. Sixty-four medical students assessed all 20 internal medicine residents in the Department of Medicine, University of Ibadan. Mean performance scores for the domains ranged from 3.07 to 3.66. Residents performed best in creating a good learning climate and worst in the promotion of understanding and retention. Sex of the resident, duration of residency, and rank had no significant impact (.09 < P < .94) on their teaching skills. Consistent with other observations in the literature, residents' clinical teaching skills were suboptimal, particularly in their ability to promote understanding and retention. To enhance these skills, we recommend the integration of appropriately tailored programs to teach pedagogic skills programs in residency training.

Neuroanatomical correlates of laparoscopic surgery training

Better understanding of the brain regions involved in performing laparoscopic surgery is likely to provide important insights for improving laparoscopic training and assessment in the future. To our knowledge, this is the first study using real Fundamentals of Laparoscopy Training (FLS)-based laparoscopic surgery training tasks in the functional magnetic resonance imaging (fMRI) environment to provide extensive characterization of the brain regions involved in this specific task execution. Nine right-handed subjects practiced five FLS-modified laparoscopic surgery-training tasks with a training box for ten sessions in a simulated fMRI environment. Following the last practice session, they underwent 3 T fMRI while performing each task. An increase in the extent of brain activation was observed as the complexity of the tasks increased. Activation in the precentral gyrus, postcentral gyrus, and premotor regions was observed in the performance of all tasks, whereas the superior parietal lobe (SPL) was activated in the more complex tasks. The mean score and brain activation for performance with the dominant hand were larger than those observed during performance with the non-dominant hand. Performing more complex tasks requires higher visual spatial ability and motor planning. Given the need for ambidextrous skills during laparoscopic tasks, the finding that lower scores and smaller brain recruitment occurred in executing tasks with the non-dominant hand than with the dominant hand suggests designing future training tasks to train the non-dominant hand more effectively. This may serve to improve overall performance in bi-manual tasks. Studies of this kind may facilitate the evidence-based development of strategies to improve the quality of laparoscopy training and assessment.

Self-Care Practices among Diabetic Patients in Anand District of Gujarat.

Background. Diabetes care requires a multipronged approach, wherein the patient has an important role to play. This study was undertaken to explore self-care practices of diabetic patients residing in Anand district of Gujarat. Methods. A cross-sectional study, involving 100 diabetic patients, was conducted in 2009-2010. Self-care practices in seven domains of physical activity, dietary practices, medication taking, monitoring of glucose, problem solving, foot care, and psychosocial adjustment were assessed using scores assigned to participants' responses. Results. The mean age was 60.9 (SD = 12.2) years and 57% were males. Majority (92%) were Hindus and were consulting private medical practitioners (71%). “Medication taking” was the domain with the best performance score (88.1%) and “problem solving” the worst (11.0%). The “psychosocial adjustment” of the participants was satisfactory (82.5%). Overall mean performance percentage score was 54.41%. Males had better performance scores as compared to females in areas of “physical activity,” “dietary practices,” and “problem solving.” Housewives had poorer performance scores. Total mean performance score was similar for patients on treatment from specialists and general practitioners. Conclusion. A self-care education program designed for this region should address the lacunae identified in various domains with a special emphasis on females.

DISIPLIN KERJA SATUAN PENGAMANAN UNIVERSITAS NEGERI PADANG

The goal of this research is to gather information about the work discipline. The population is 104 employees and the sample is 54 people taken by random sampling. The instrument of this research is questionnaire with Likert scale models that had been tested for validity and reliability. Data were analyzed by using mean score of performance. The result of this research shows that the work discipline Security Team for State Universiti of Padang is good enough. Key words : Security Team work discipline

Testing the Cross-Cultural Clinical Utility of the VMI for Palestinian, Israeli, and American Typically Developing Kindergarten Children

Purpose: To assess the cross-cultural clinical utility of the Visual Motor Integration (VMI) standardized U.S. norms for typically developing Palestinian, Israeli, and American kindergarten children. The cross-cultural comparisons tested the extent to which the VMI standardized U.S. norms for all three tests (a) are appropriate for use with the aforementioned groups without the need for cross-cultural adaptations, and (b) have adequate rates of test sensitivity and specificity such that study classification results are comparable with those obtained using the VMI U.S. norms. Methods: The sample was comprised of 134 typically developing kindergarten children. Results: The observed mean performance scores were not significantly different from the published U.S. norms on all three tests for the Palestinian group and significantly higher for the Israeli group on all three tests. For the American group, scores were higher on the Visual Motor Integration and Visual Perception tests, but lower on the Motor Coordination test. The sensitivity rates for eight of the nine calculations resulted in perfect agreement between the study classification results and the VMI standardized classification of true positive cases. The specificity rates for the Palestinian group demonstrated perfect agreement between the study classification results and the VMI standardized U.S. norms. The specificity rates obtained for the Israeli and American groups were moderate. Conclusions: These exploratory findings merit additional research to further assess the clinical utility of employing the VMI U.S. norms with or without cross-cultural adaptations for these specific or any other cultural groups.

Testing the Cross-Cultural Clinical Utility of the VMI for Palestinian, Israeli, and American Typically Developing Kindergarten Children

Purpose: To assess the cross-cultural clinical utility of the Visual Motor Integration (VMI) standardized U.S. norms for typically developing Palestinian, Israeli, and American kindergarten children. The cross-cultural comparisons tested the extent to which the VMI standardized U.S. norms for all three tests (a) are appropriate for use with the aforementioned groups without the need for cross-cultural adaptations, and (b) have adequate rates of test sensitivity and specificity such that study classification results are comparable with those obtained using the VMI U.S. norms. Methods: The sample was comprised of 134 typically developing kindergarten children. Results: The observed mean performance scores were not significantly different from the published U.S. norms on all three tests for the Palestinian group and significantly higher for the Israeli group on all three tests. For the American group, scores were higher on the Visual Motor Integration and Visual Perception tests, but lower on the Motor Coordination test. The sensitivity rates for eight of the nine calculations resulted in perfect agreement between the study classification results and the VMI standardized classification of true positive cases. The specificity rates for the Palestinian group demonstrated perfect agreement between the study classification results and the VMI standardized U.S. norms. The specificity rates obtained for the Israeli and American groups were moderate. Conclusions: These exploratory findings merit additional research to further assess the clinical utility of employing the VMI U.S. norms with or without cross-cultural adaptations for these specific or any other cultural groups.

Board 417 - Research Abstract Bedside Ultrasound in Clinical Diagnoses

Introduction/Background Ultrasound is a low cost, noninvasive, rapidly performed examination that Results in reduced test to treatment times. As a result ultrasound is becoming a ubiquitous imaging modality in many hospital systems.1-5 However, there is limited literature on ultrasound training and use in internal medicine departments. We sought to determine the current ability of internal medicine residents to image abdominal organs and whether training on the Vimedix Ultrasound Simulator influenced their accuracy immediately after and at onemonth follow-up. We also sought to determine any change in their perceived level of confidence. Methods IRB approval was obtained. Twelve third year and 13 first year medicine residents participated in the study. Residents with prior certification in ultrasound were excluded. All participants completed a questionnaire to self-rate their confidence scanning abdominal organs. Participants were then assigned to the Vimedix normal “patient” or one of five pathology programs (selected based upon their frequency on floors Renal Cyst, Cholecystitis with Cholelithiasis, Hepatic Abscess, Small and Large Ascites ). Participants were told the patient had abdominal pain and were asked to use ultrasound to make a diagnosis. Performance scores and time to diagnosis were recorded. Scan time of four minutes was alloted. Performance scores were determined by: 1) 5 points - correct diagnosis/pathology/organ; 2) 1 point - each organ scanned correctly as normal; 3) 1 point - scan-time < than 4 minutes; 4) 1 point - deducted for over diagnoses/pathology/organ. All participants were provided with a short booklet describing scanning techniques for each abdominal organ. Half of the group was randomly trained with a five minute demonstration on the simulator. The same scanning exercise was repeated at 24 hours and one month. Students ’t’ test was used for statistical analyses. Results All participant groups demonstrated statistically significant increase in their performance scores after minimal ultrasound training. All groups maintain improvement from baseline at the one month follow-up but a decrease from the 24 hour performance. Both booklet alone and booklet with simulation-based demonstration group had similar performance increases. First year resident’s baseline mean performance score was 3.4 pts and 4.5 organs scanned, vs. 24 hour follow up (booklet alone 10 pts. (P = 0.001), with booklet and demo 13.5 pts. (P=0.0001), and 8.9 organs scanned), and 1 month follow up (booklet alone 8 pts. (P=0.019), booklet and demo 7 pts. (P=0.017) with 5.3 organs scanned). Third year resident’s baseline mean performance score was 4.5 pts. with 6 organs scanned vs. 24 hour follow up (booklet alone 13 pts. (P=0.0013), booklet and demo 13.8 pts. (P=0.0001), with 8 organs scanned) and 1 month follow up (booklet alone 9 pts. (P=0.021), booklet and demo 8 pts. (P=0.094), with 6 organs scanned. The mean perceived confidence level of all participants increased from 4.1 to 5.3 with training. Conclusion The resident’s performance scores increased with minimal instruction. The training booklet alone and booklet with bedside demonstration resulted in similar levels of performance increase. After training, residents seemed more able to identify normal organs resulting in a decrease in overdiagnosis. Training also helped the residents adopt a systematic approach allowing them to scan more organs in the same time duration. Additionally the 1 year residents with training outperformed 3 year residents without training suggesting that an extremely limited but focused training session may be a more effective training modality than years of passive observation. Performance levels of all participants at the 1 month interval remained improved from the baseline assessment but showed some decay from the 24 hour interval; this may indicate a need for additional training for retention and skill maintenance. Larger studies are required for stronger demonstration of the efficacy of bedside ultrasound training.