Medicine Exam Research Articles

Electrodiagnostic Medicine Skills Competency in Physical Medicine and Rehabilitation Residents

This project sought to create an educational module including evaluation methodology to instruct physical medicine and rehabilitation (PM&R) residents in electrodiagnostic evaluation of patients with neuromuscular problems, and to verify acquired competencies in those electrodiagnostic skills through objective evaluation methodology. Sixteen residents were trained by board-certified neuromuscular and electrodiagnostic medicine physicians through technical training, lectures, and review of self-assessment examination (SAE) concepts from the American Academy of Physical Medicine & Rehabilitation syllabus provided in the Archives of Physical Medicine and Rehabilitation. After delivery of the educational module, knowledge acquisition and skill attainment were measured in (1) clinical skill in diagnostic procedures via a procedure checklist, (2) diagnosis and ability to design a patient-care management plan via chart simulated recall (CSR) exams, (3) physician/patient interaction via patient surveys, (4) physician/staff interaction via 360-degree global ratings, and (5) ability to write a comprehensive patient-care report and to document a patient-care management plan in accordance with Medicare guidelines via written patient reports. Assessment tools developed for this program address the basic competencies outlined by the Accreditation Council for Graduate Medical Education (ACGME). To test the success of the standardized educational module, data were collected on an ongoing basis. Objective measures compared resident SAE scores in electrodiagnostics (EDX) before and after institution of the comprehensive EDX competency module in a PM&R residency program. Fifteen of 16 residents (94%) successfully demonstrated proficiency in every segment of the evaluation element of the educational module by the end of their PGY-4 electrodiagnostic rotation. The resident who did not initially pass underwent remedial coursework and passed on the second attempt. Furthermore, the residents' proficiency as demonstrated by the evaluation after implementation of the standardized educational module positively correlated to an increase in resident SAE scores in EDX compared with resident scores before implementation of the educational module. Resident proficiency in EDX medicine skills and knowledge was objectively verified after completion of the standardized educational module. Validation of the assessment tools is evidenced by collected data correlating with significantly improved SAE scores and American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM) exam scores, as outlined in the result section. In addition, the clinical development tool (procedure checklist) was validated by residents being individually observed performing skills and deemed competent by an AANEM-certified physician. The standardized educational module and evaluation methodology provide a potential framework for the definition of baseline competency in the clinical skill area of EDX.

“If I were AASM President I would…”

“If I were AASM President I would…”

59. General medicine residents' perception of the mini-CEXs

The mini-CEX is a 30 minute observed clinical encounter. It can be done in the outpatient, inpatient or emergency room setting. It strives to look at several parameters including a clinical history, physical, professionalism and overall clinical competence. Trainees are rated using a 9-point scoring system: 1-3 unsatisfactory, 4-6 satisfactory and 7-9 superior. 
 Eight months after the introduction of the mini-CEX to the core University of British Columbia Internal Medicine Residents, a one hour semi-structured focus group for residents in each of the three years took place. The focus groups were conducted by an independent moderator, audio-recorded and transcribed. 
 Using a phenomenological approach the comments made by the focus groups participants were read independently by three authors, organized into major themes. In doing so, several intriguing common patterns were revealed on how General Medicine Residents perceive their experience in completing a mini-CEX. 
 The themes include Education, Assessment and Preparation for the Royal College of Physicians and Surgeons Internal Medicine exam. Resident learners perceived that the mini-CEX process provided insight into their clinical strengths and weaknesses. Focus group participants favored that the mini-CEX experience will benefit them in preparation, and successful completion of their licensing exam. 
 Daelmans HE, Overmeer RM, van der Hem-Stockroos HH, Scherpbier AJ, Stehouwer CD, van der Vleuten CP. In-training assessment: qualitative study of effects on supervision and feedback in an undergraduate clinical rotation. Medical Education 2006; 40(1):51-8.
 De Lima AA, Henquin R, Thierer J, Paulin J, Lamari S, Belcastro F, Van der Vleuten CPM. A qualitative study of the impact on learning of the mini clinical evaluation exercise in postgraduate training. Medical Teacher January 2005; 27(1):46-52.
 DiCicco-Bloom B, Crabtree BF. The Qualitative Research Interview. Medical Education 2006; 40:314-32.

Fallopian Tube Occlusion, An Alternative to Tubal Ligation

Diagnosis of fallopian tube pathology has been performed with X-rays, ultrasound, magnetic resonance imaging, and even nuclear medicine exams. However, fallopian tube interventions are almost exclusively the domain of fluoroscopy. Fallopian tube interventions can be divided into two categories: embolization and recanalization. The former has only recently been described using imaging guidance while the latter has been accepted as a safe and effective procedure since the early 1990s. This article will highlight the technique and results associated with fallopian tube embolization.

Preparing for the written board exam in emergency medicine, fourth editionBy Carol S. Rivers and Todd Dorfman. Milford, OH: Emergency Medicine Educational Enterprises, Inc., 2003, 1,222 pages, $225 ($170 resident price) (softcover)

Preparing for the written board exam in emergency medicine, fourth editionBy Carol S. Rivers and Todd Dorfman. Milford, OH: Emergency Medicine Educational Enterprises, Inc., 2003, 1,222 pages, $225 ($170 resident price) (softcover)

Un sistema de digitalización de gamma cámaras analógicas

Digitalization of analogue gamma cameras systems, using special acquisition boards in microcomputers and appropriate software for acquisition and processing of nuclear medicine images is described in detail. Microcomputer integrated systems interconnected by means of a Local Area Network (LAN) and connected to several gamma cameras have been implemented using specialized acquisition boards. The PIP software (Portable Image Processing) was installed on each microcomputer to acquire and preprocess the nuclear medicine images. A specialized image processing software has been designed and developed for these purposes. This software allows processing of each nuclear medicine exam, in a semiautomatic procedure, and recording of the results on radiological films. . A stable, flexible and inexpensive system which makes it possible to digitize, visualize, process, and print nuclear medicine images obtained from analogue gamma cameras was implemented in the Nuclear Medicine Division. Such a system yields higher quality images than those obtained with analogue cameras while keeping operating costs considerably lower (filming: 24.6%, fixing 48.2% and developing 26%.) Analogue gamma camera systems can be digitalized economically. This system makes it possible to obtain optimal clinical quality nuclear medicine images, to increase the acquisition and processing efficiency, and to reduce the steps involved in each exam.

United States: Overview of Cancer Pain and Palliative Care

The growth of the palliative care movement in the United States will have enormous impact on pain specialty in terms of the increasing need for the skills of its professional work force and demand for improved symptom management from our sickest and most vulnerable patients. In this paper, we review the need for palliative care, recent developments in this new field and implications for specialists in pain management.

Ambulatory morning report: can it prepare residents for the American Board of Internal Medicine Examination?

We assessed the ability of a novel ambulatory morning report format to expose internal medicine residents to the breadth of topics covered by the American Board of Internal Medicine (ABIM) exam. Cases were selected by the Ambulatory Assistant Chief Residents and recorded in a logbook to limit duplication. We conducted a retrospective review of 406 cases discussed from July 1998 to July 2000 and cataloged each according to the primary content area. The percentage of cases in each area accurately reflected that covered by the ABIM exam, with little redundancy or over-selection of esoteric diseases. Our data suggest that a general medicine clinic is capable of exposing house staff to the wide breadth of internal medicine topics previously thought to be unique to subspecialty clinics.

Update on patient radiation doses at a large tertiary care medical center.

Radiation procedures in diagnostic radiology and nuclear medicine examinations, especially at referral centers, contribute a significant proportion to population dose; hence, there is a presumed detriment. Knowledge of the magnitude of dose from each type of exam is helpful in determining where to implement dose reduction efforts. Additionally, new records of dose data facilitate comparisons with past measurements. In this paper, updated patient exam dose data (frequency and effective dose equivalent) are provided for a large, comprehensive, tertiary care medical center that served more than 340,000 patients in 1997. Patient billing code data were used to study 31 different types of diagnostic exams encompassed in five major categories (angiography, fluoroscopy, radiography, nuclear medicine, and computerized tomography). Organ doses for each radiographic and nuclear medicine exam were estimated using published Monte Carlo conversion factors and appropriate exposure values. Estimates of organ doses were utilized to compute effective dose equivalent (EDE) per ICRP 26 and collective effective dose equivalent. Mean effective dose equivalent was also calculated for each exam category. Total collective effective dose equivalent had decreased from 1988 (2,030 person-Sv) to 1997 (1,817 person-Sv). The largest contributors to collective effective dose equivalent were angiography (768 person-Sv), computerized tomography (447 person-Sv), and nuclear medicine (355 person-Sv). Radiography (150 person-Sv) and fluoroscopy (97 person-Sv) contributed the least to collective effective dose equivalent. Mean effective dose equivalent contributions remained the same, with angiography accounting for the highest component, followed by nuclear medicine, computerized tomography, fluoroscopy, and radiography, respectively. Effective dose equivalent, collective effective dose equivalent, and mean effective dose equivalent values were calculated and tabulated in five major categories. These data provide updated information as to trends in exam and; collective dose from 31 common types of radiologic exams performed at a large medical center, which can be used as an up to date baseline for analyses of trends in U.S. radiation doses due to medical imaging procedures. Although minor changes were observed in comparing the mean effective dose equivalent data to those of a previous study, substantial differences were evident in the collective effective dose equivalent data. This was due primarily to variations in the number of patients examined and changes in technology and practice.

Date Set for 2002 Sports Medicine Exam

Date Set for 2002 Sports Medicine Exam

Six-year Documentation of the Association between Excellent Clinical Teaching and Improved Studentsʼ Examination Performances

Six-year Documentation of the Association between Excellent Clinical Teaching and Improved Studentsʼ Examination Performances

Abraham Jacobi, MD, Respectable Rebel

Abraham Jacobi was an outspoken rebel who was a vigorous advocate for better health care of children, but he was a responsible one who worked through professional organizations, using data and analysis to achieve his goals. His life is a model well worth emulating today when children's services are under attack (Table1). Born in a small town in precentralized Germany, his parents, who lived a very modest existence, were advised not to spend much money on him because he was so sickly. He probably had rickets, and his adult small stature was attributed to early malnutrition. His head, large in comparison to his body, was often described as leonine (Figure). His mother gave him the best education she could, however, and after attending several medical schools, as was the peripatetic custom then in Germany, he graduated in 1851 from the University of Bonn. Immediately he joined the Democratic revolution sweeping Germany and was jailed for “high treason” for 2 years. Clearly the rebel in him was dominant at this stage of his life. In discussing his role in the revolution of 1848 in Germany that led to his arrest, he said that as students they were galvanized to action by reading the forbidden literature of Schiller's William Tell , the story of a patriot willing to die for freedom. His actual imprisonment was not so romantic. He had befriended Carl Schurtz, who enlisted Jacobi to be a go-between for an illicit revolutionary activity. Schurtz's mission was to rescue a professor Kinkel from the prison fortress Spandau outside of Berlin. When Jacobi went to Berlin to take his Doctor of Medicine (MD) exams, he was recognized as a friend of Schurtz and arrested. His 2 years in jail were often spent in chains or in solitary confinement, but here he …

Chest Medicine: Essentials of Pulmonary and Critical Care Medicine.

A favorite among residents and pulmonary fellows, this text provides all the information needed to evaluate and manage respiratory diseases and critically ill patients and to pass the American Board of Internal Medicine's subspecialty exam in pulmonary medicine. The Fifth Edition includes new information on ARDS, sedation of critically ill patients, rehabilitation for COPD, care of elderly patients, genetic testing for asthma, CTA and other diagnostic techniques for pulmonary thromboembolism, new antifungal drugs without renal toxicity, new treatment guidelines for pneumothorax, and ventilators and noninvasive ventilation for respiratory failure. This edition also includes more algorithms and differential diagnosis tables.