Structured Clinical Evaluation Research Articles

No trauma-related diagnosis in emergency trauma room whole-body computer tomography of patients with inconspicuous primary survey.

Whole-body computer tomographic examinations (WBCT) are essential in diagnosing the severely injured. The structured clinical evaluation in the emergency trauma room, according to ATLS® and guidelines, helps to indicate the correct radiological imaging to avoid overtriage and undertriage. This retrospective, single-center study aimed to evaluate the value of WBCT in patients with an inconspicuous primary survey and whether there is any evidence for this investigation in this group of patients. This retrospective, single-center study was conducted with patients admitted to a maximum-care hospital and supraregional trauma center in Germany and part of the TraumaNetwork DGU® in southwest Germany between January 2012 and November 2017. Hospital files were used for evaluation, and WBCT was carried out using a 32-row MSCT device from Siemens Healthineers, Volume Zoom, Erlangen, Germany. For evaluation, non-parametric procedures such as the chi-square test, U test, Fisher test, and Wilcoxon rank sum test were used to test for significance (p < 0.05). From 3976 patients treated with WBCT, 120 patients (3.02%) showed an inconspicuous primary survey. This examination did not reveal any trauma sequelae in any of this group. Additionally, 198 patients (4.98%) showed minor clinical symptoms in the primary survey, but no morphological trauma sequence could be diagnosed in WBCT diagnostics. Three hundred forty-two patients were not admitted as inpatients after WBCT and discharged to further outpatient treatment because there were no objectifiable reasons for inpatient treatment. Four hundred fifteen patients did not receive WBCT for, e.g., isolated extremity trauma, child, pregnancy, or death. Not one of the clinically asymptomatic patients had an imageable injury after WBCT diagnostics in this study. WBCT should only be performed in severely injured patients after clinical assessment regardless of "trauma mechanism." According to guidelines and ATLS®, the clinical examination seems to be a safe and reliable method for reasonable and responsible decision-making regarding the realization of WBCT with all well-known risk factors.

Compare the Effectiveness of Objective Structured Clinical Evaluation (OSCE) versus Checklist in Demonstration of Antenatal Abdominal Examination among Final Year G.N.M. students.

The OSCE is an approach to the assessment of clinical competence in which the components of competence are assessed in a planned or structured way with attention being paid to the objectivity of the evaluation” Harden, 1988 .The Objective Structured Clinical Exam (OSCE) is a performance- based exam. During the exam, trainees are observed and evaluated as theygo through a series of stations where they interview, examine and treat standardized patients presenting with some type of problem. An OSCE is: • Objectivity, because examiners use a checklist for evaluating the trainees. • Structured, because every trainee sees the same problem and performs same tasks in the same time frame. • Clinical based, because the tasks are representative of those faced in real clinical situations • An evaluation method II – Materials and Methods Comparative research design was used with group I &amp; group II to assess the effectiveness of objective structured clinical evaluation (OSCE) versus checklist in demonstration of antenatal abdominal examination among final year G.N.M students. The study conducted on 30 samples in each group. Data was collected using Objective Structured Clinical Evaluation and checklist for assessing performance of G.N.M final year students on abdominal examination. III – Results The overall mean and S.D. of OSCE was 11.03 with a percentage mean of 91.39% and 16.59 whereas the overall mean and S.D. of Checklist was 55.73 with a percentage mean of 79.62% and 11.24. The calculated ‘t’ value was higher than the table value (t58 = , P&lt; 0.01). Hence, the null hypothesis was rejected and research hypothesis was accepted and it was inferred that in the present study there was significant difference between the effectiveness of demonstration on antenatal abdominal examination during pregnancy assessed by Objective Structured Clinical Evaluation (OSCE) &amp; checklist among G.N.M final year students. Comparing the mean percentage of OSCE and Checklist 91.39% and 79.62%, it is inferred that the mean percentage of OSCE i.e. 91.39% is higher than the mean percentage of Checklist i.e. 79.62%. Therefore, it can be concluded that the OSCE is more effective than the checklist for evaluating the demonstration of abdominal examination during pregnancy. IV – Conclusion This study concluded that in comparison to, OSCE was found to be a more effective assessment tool than traditional method checklist. Use of OSCE as formative tool will help in modifying teaching- learning strategies so that both, the teachers as well as the students can derive maximum benefit

Beyond lectures and practical courses: Teaching pharmacology using imaginative pedagogical tools

Pharmacology has broadened its scope considerably in recent decades. Initially, it was of interest to chemists, doctors and pharmacists. In recent years, however, it has been incorporated into the teaching of biologists, molecular biologists, biotechnologists, chemical engineers and many health professionals, among others. Traditional teaching methods, such as lectures or laboratory work, have been superseded by the use of new pedagogical approaches to enable a better conceptualization and understanding of the discipline. In this article, we present several new methods that have been used in Spanish universities. Firstly, we describe a teaching network that has allowed the sharing of pedagogical innovations in Spanish universities. A European experience to improve prescribing safety is described in detail. The use of popular films and medical TV series in biomedical students shows how these audiovisual resources can be helpful in teaching pharmacology. The use of virtual worlds is detailed to introduce this new approach to teaching. The increasingly important area of the social aspects of pharmacology is also considered in two sections, one devoted to social pharmacology and the other to the use of learning based on social services to improve understanding of this important area. Finally, the use of Objective Structured Clinical Evaluation in pharmacology allows to know how this approach can help to better evaluate clinical pharmacology students. In conclusion, this article allows to know new pedagogical methods resources used in some Spanish universities that may help to improve the teaching of pharmacology.

White matter microstructure of children with sensory over-responsivity is associated with affective behavior.

Sensory processing dysfunction (SPD) is linked to altered white matter (WM) microstructure in school-age children. Sensory over-responsivity (SOR), a form of SPD, affects at least 2.5% of all children and has substantial deleterious impact on learning and mental health. However, SOR has not been well studied using microstructural imaging such as diffusion MRI (dMRI). Since SOR involves hypersensitivity to external stimuli, we test the hypothesis that children with SOR require compensatory neuroplasticity in the form of superior WM microstructural integrity to protect against internalizing behavior, leaving those with impaired WM microstructure vulnerable to somatization and depression. Children ages 8-12years old with neurodevelopmental concerns were assessed for SOR using a comprehensive structured clinical evaluation, the Sensory Processing 3 Dimensions Assessment, and underwent 3 Tesla MRI with multishell multiband dMRI. Tract-based spatial statistics was used to measure diffusion tensor imaging (DTI) and neurite orientation dispersion and density imaging (NODDI) metrics from global WM and nineteen selected WM tracts. Correlations of DTI and NODDI measures with measures of somatization and emotional disturbance from the Behavioral Assessment System for Children, 3rd edition (BASC-3), were computed in the SOR group and in matched children with neurodevelopmental concerns but not SOR. Global WM fractional anisotropy (FA) is negatively correlated with somatization and with emotional disturbance in the SOR group but not the non-SOR group. Also observed in children with SOR are positive correlations of radial diffusivity (RD) and free water fraction (FISO) with somatization and, in most cases, emotional disturbance. These effects are significant in boys with SOR, whereas the study is underpowered for girls. The most affected white matter are medial lemniscus and internal capsule sensory tracts, although effects of SOR are observed in many cerebral, cerebellar, and brainstem tracts. White matter microstructure is related to affective behavior in children with SOR.

Distribution of hand function by age in individuals with Rett syndrome.

To determine the longitudinal distribution of hand function skills in individuals with classic Rett Syndrome (RTT), an X-linked dominant neurodevelopmental disorder, and correlate with MECP2 variants. We conducted a longitudinal study of 946 girls and young women with typical RTT seen between 2006 and 2021 in the US Natural History Study (NHS) featuring a structured clinical evaluation to assess the level of hand function skills. The specific focus in this study was to assess longitudinal variation of hand skills from age 2 through age 18 years in relation to specific MECP2 variant groups. Following the initial regression period, hand function continues to decline across the age spectrum in individuals with RTT. Specific differences are noted with steeper declines in hand function among those with milder variants (Group A: R133C, R294X, R306C, and C-terminal truncations) compared to groups composed of individuals with more severe variants. These temporal variations in hand use represent specific considerations which could influence the design of clinical trials that test therapies aiming to ameliorate specific functional limitations in individuals with RTT. Furthermore, the distinct impact of specific MECP2 variants on clinical severity, especially related to hand use, should be considered in such interventional trials.

Comparison of three methods of cardiopulmonary resuscitation training in terms of improving the skills of emergency medical technicians; a pretest–posttest study

Objective: There are several methods for teaching emergency medical technicians (EMTs) cardiopulmonary resuscitation (CPR); but choosing the most effective option depends on several factors. This study was designed to compare the effectiveness of three different CPR training methods, including traditional, peer, and virtual methods, for EMTs.&#x0D; Methods: This study was a pretest-posttest study, which was performed from March to September 2020 in Tehran, Iran. Participants were EMTs working in the operations department of the EMS center. In the first step, for the pretest evaluation, an Objective Structured Clinical Evaluation (OSCE) exam was held for all participants. Thereafter, the subjects were divided into 3 groups including master-centered traditional collective education, peer training, and virtual courses. Then the participants underwent educational intervention and after that, another OSCE exam was held about 1 week after the sessions to evaluate the effect of interventions.&#x0D; Results: At first, 156 volunteers entered the study and participated in the pretest OSCE exam, of which 125 volunteers participated in the posttest OSCE exam. Of these, 51 volunteers participated in the peer education group, 35 volunteers were in the virtual education group, and 39 volunteers in the classic education group. The mean score of the participants in all 4 assessed skills, including endotracheal intubation, laryngeal mask airway insertion, basic life support, and advanced life support, increased significantly after educational intervention in all 3 groups (p&lt;0.05); and this increase was higher in the virtual group compared to the other two groups (p&lt;0.05).&#x0D; Conclusion: We found that virtual training was more effective than classic and peer training for CPR training of EMTs.

Evaluation of Point-of-Care Ultrasound Training for Family Physicians Using Teleultrasound.

The goal of this study was to assess family physicians' change in knowledge and ability to perform abdominal aorta ultrasound after implementation of a novel teleultrasound curriculum. This was a prospective, observational study conducted at a single academic institution. Family physicians completed a preassessment, test, and objective structured clinical evaluation (OSCE). Physicians then individually completed a standard curriculum consisting of online content and an hour-long, hands-on training session on abdominal aorta ultrasound using teleultrasound technology. Physicians then performed a minimum of 10 independent examinations over a period of 8 weeks. After physicians completed the training curriculum and 10 independent scans, we administered a postassessment, test, and OSCE. We analyzed differences between pre- and postcurriculum responses using Fisher exact and Wilcoxon signed rank tests. Thirteen family physicians completed the curriculum. Comparing pre- to postcurriculum responses, we found significant reductions in barriers to using aorta POCUS and improved confidence in using, obtaining, and interpreting aorta POCUS (P&lt;0.01). Knowledge improved from a median score of 70% to 90% (P&lt;0.01), and OSCE scores improved from a median of 80% to 100% (P=0.012). Overall, 211 aorta ultrasound examinations were independently acquired with a median image quality of 4 (scale 1 to 4). After an 8-week teleultrasound curriculum, family physicians with minimal experience with POCUS showed improved knowledge and psychomotor skill in abdominal aorta POCUS.

Medical Students’ Perspectives on Professionalism: A Phenomenological Study from a Medical School in Southern Philippines

Professionalism in relation to the medical profession is up to now debatable of what it really means. The study aimed to explore the perspectives of the medical students on professionalism. The phenomenological research was conducted in one of the medical schools in Southern Philippines with 24 national medical students, 12 were in their third year and the other half were in their fourth-year level. Data were gathered through in-depth interviews and focus group discussions. The study generated 16 themes. Based on the identified themes, it showed that the medical students already recognized specific and fundamental knowledge in professionalism. It gradually increased as they entered the clinical environment. All participants highlighted clinical decorum and fundamental values. The increasing trend of undesirable behaviors observed during their clinical years is correlated with their prolonged exposures. The implication of the findings revealed that professionalism should be strengthened and reinforced through actual practice and role modeling among faculty members, administrative staff, and clinical preceptors. Evaluation and practice through simulation and objective structured clinical evaluation can also be done. The lifetime commitment and stringent conformity to the medical code of ethics and professional conduct must be reiterated and role-modeled. Keywords: Medicine, professionalism, lived experiences, medical students, phenomenology, thematic analysis, Philippines DOI: 10.7176/JEP/14-6-08 Publication date: February 28 th 2023

A Novel Point-of-care Ultrasound Curriculum for Air Critical Care Personnel.

Point-of care-ultrasound (POCUS) has become ubiquitous in emergency medicine practice for the management of emergent pathophysiology. There is growing interest in its potential as a diagnostic tool in the prehospital setting. Few studies have examined the feasibility or efficacy of curricula targeted at teaching POCUS to prehospital personnel. Our objective in this study was to investigate a curriculum for the extended focused assessment with sonography in trauma (eFAST) exam in helicopter emergency medical services (HEMS) crews. This was a pre/post intervention study of HEMS personnel at a tertiary care center. Subjects were administered a pre-intervention written test and an observed structured clinical evaluation (OSCE). Subsequently, they participated in an educational intervention intended to impart proficiency in performing the eFAST. Subjects underwent post-intervention written exams and OSCEs. We analyzed pre- and post-intervention test performance along with the number and quality of practice ultrasound examinations achieved. Sixteen subjects were enrolled (62.5% male, mean age 44.1). After undergoing the intervention, the mean written test score increased 22.1% (t=3.41; P <0.001) and the mean OSCE score increased by 64.5% (t=6.87, P <0.001). All subjects met "passing" criteria for the written test and OSCE on their post-intervention attempt. Subjects accomplished a mean of 21.1 clinically interpretable eFAST sonographs. Most subjects reported the curriculum was useful (90.1%) and that they would incorporate this skill into clinical practice (90.1%). A targeted POCUS curriculum was feasible and effective in establishing clinical proficiency in HEMS crews for performing and interpreting the eFAST exam.

A Study to Assess the Effectiveness of Objective Structured Clinical Evaluation [OSCE] on Knowledge and Skills Regarding Management of Eclampsia Among Nurses Working in Primary Health Care Centers

Background Pregnancy is a phenomenon of joy and pain. An expectant mother during pregnancy has to handle associated wellness and illness. The phase of pregnancy is challenging for every mother a significant number of physical physiological and psychological changes occur during pregnancy. These changes can cause minor problems and major complications. One such commonly occurring complication is eclampsia. The present study was designed to assess and manage eclampsia skills of nurses working in primary health care centers.Methodology One group pretest posttest design was used in this study which was conducted among 83 nurses working in selected primary health care centers in selected district of Karnataka. A structured knowledge and skill questionnaire was designed to assess the skills of nurses on management of eclampsia. The present study used the technique of OSCE Objective Structured Clinical Examination for imparting the knowledge and skills.Results The present study found that the knowledge and skill of nurses in pretest was low compared to posttest. OSCE as method of teaching was effective in improving the knowledge and skill scores in the selected nurses in managing eclampsia.Conclusion The present study was designed with an aim to develop and improve the knowledge and skill of nurses working in primary health care centers as 70 of rural population seek health care services from these peripheral health service providers. Nurses are the key health personnel available 24X7 in these healthcare facilities. Nurses equipped with knowledge and skills for initial management of eclampsia can play a significant role in reducing mortality and morbidity of expectant mothers by better managing eclampsia. The study recommended that nurses should be well equipped with skills for management of complications of labor to promote maternal and child health care.

Electrocardiogram, Echocardiogram and NT-proBNP in Screening for Thromboembolism Pulmonary Hypertension in Patients after Pulmonary Embolism.

Background: The annual mortality of patients with untreated chronic thromboembolism pulmonary hypertension (CTEPH) is approximately 50% unless a timely diagnosis is followed by adequate treatment. In pulmonary embolism (PE) survivors with functional limitation, the diagnostic work-up starts with echocardiography. It is followed by lung scintigraphy and right heart catheterization. However, noninvasive tests providing diagnostic clues to CTEPH, or ascertaining this diagnosis as very unlikely, would be extremely useful since the majority of post PE functional limitations are caused by deconditioning. Methods: Patients after acute PE underwent a structured clinical evaluation with electrocardiogram, routine laboratory tests including NT-proBNP and echocardiography. The aim of this study was to verify whether the parameters from echocardiographic or perhaps electrocardiographic examination and NT-proBNP concentration best determine the risk of CTEPH. Results: Out of the total number of patients (n = 261, male n = 123) after PE who were included in the study, in the group of 155 patients (59.4%) with reported functional impairment, 13 patients (8.4%) had CTEPH and 7 PE survivors had chronic thromboembolic pulmonary disease (CTEPD) (4.5%). Echo parameters differed significantly between CTEPH/CTEPD cases and other symptomatic PE survivors. Patients with CTEPH/CTEPD also had higher levels of NT-proBNP (p = 0.022) but concentration of NT-proBNP above 125 pg/mL did not differentiate patients with CTEPH/CTEPD (p > 0.05). Additionally, the proportion of patients with right bundle brunch block registered in ECG was higher in the CTEPH/CTED group (23.5% vs. 5.8%, p = 0.034) but there were no differences between the other ECG characteristics of right ventricle overload. Conclusions: Screening for CTEPH/CTEPD should be performed in patients with reduced exercise tolerance compared to the pre PE period. It is not effective in asymptomatic PE survivors. Patients with CTEPH/CTED predominantly had abnormalities indicating chronic thromboembolism in the echocardiographic assessment. NT-proBNP and electrocardiographic characteristics of right ventricle overload proved to be insufficient in predicting CTEPH/CTEPD development.

Autonomic stress response of physiotherapy student in the different scenarios of an objective structured clinical examination

The aim of the present research was to analyse modifications in the autonomic stress response of Physiotherapy students undergoing a 12-scenario Objective Structured Clinical Evaluation (OSCE). A total of 86 last year students of the Physiotherapy bachelor’s degree (27.29 years (SD = 6.66); 36 females and 50 males) randomly assigned were monitored during the complete OSCE to measure heart rate variability (HRV) in temporal, frequency, and non-linear domains. The HRV analysed showed a large anticipatory stress response of students maintained during the entire evaluation. The stress response varied regarding OSCE station complexity and demands and the highest sympathetic response was not found in higher emotional scenarios.The autonomic modulation monitoring allows teachers to design OSCE scenarios more adapted to the students, limiting the effect of the stress response to allow a better performance.

Prehospital Care of Coronary Artery Disease and Its Major Risk Factors in Geropsychiatric Inpatients.

Older adults with serious mental illness have a high prevalence of coronary artery disease and of its major risk factors, that is, arterial hypertension, dyslipidemia, and diabetes mellitus. The prevalence and clinical control of these conditions have not been compared in geropsychiatric inpatients with dementia versus those with mood or psychotic disorders. What is the prevalence and acuity of coronary artery disease, arterial hypertension, dyslipidemia, and diabetes mellitus among patients with dementia, mood, and psychotic disorders admitted for geropsychiatric care? Patients 65 years of age or older were identified in a cohort of 1000 patients consecutively admitted over a 3-year period to the geropsychiatric unit of a 200-bed mental health hospital in suburban New York. All patients had a structured clinical and laboratory evaluation within 72 hours of admission. Primary psychiatric diagnoses, medical history, the frequency of poorly controlled cardiometabolic comorbidity requiring an immediate change in the management plan, and the Charlson Comorbidity Index (CCI). The 65 years and older patient sample (N = 689) had a mean age of 74.8 years, and 58.8% of the subjects were women. The 205 patients with dementia were older ( P < 0.001) than the 337 patients with mood disorders and the 147 patients with psychotic syndromes. The numbers of medical conditions and the CCI after exclusion of dementia were similar in patients with dementia versus patients without dementia. A substantial number of patients had poorly controlled arterial hypertension (51.2%), dyslipidemia (25.4%), diabetes (24.2%), and coronary artery disease (15.4%). Patients with dementia had a lower prevalence of poorly controlled dyslipidemia ( P = 0.0006), diabetes ( P = 0.0089), and coronary artery disease ( P = 0.045). Compared with mood or psychotic disorder, a diagnosis of dementia with behavioral disturbance seemed to be associated with better control of coronary artery disease, dyslipidemia, and diabetes mellitus in geropsychiatric inpatients.

Pharmacological Management of insomnia Associated with Parkinson’s Disease

IntroductionParkinson’s disease (PD) is a progressive neurological disorder that associates multiple psychiatric symptoms and disorders, like depression, neurocognitive impairment, sleeping disorders, etc. Insomnia is frequently detected in this population, with a prevalence of over 50% according to several studies.ObjectivesTo present a case series dedicated to the treatment of insomnia in patients diagnosed with PD, who did not meet diagnostic criteria for any other psychiatric disorder.MethodsA number of three patients (2 male, one female, mean age 65.2 years) diagnosed with PD, were evaluated for insomnia. They were all initiated on quetiapine XR 50 mg QD, and up-titrated according to the individual response. All these patients were undergoing treatment for their neurological disease, which remained stable for the next 3 months. A structured clinical evaluation was performed monthly, and safety measurements were also performed. All patients self-evaluated their insomnia severity on a 10-point visual analogic scale (VAS).ResultsAfter 3 months, patients reported a favorable evolution of their insomnia- VAS score improved significantly to baseline (from 7.3 to 3.3), without significant adverse events (metabolic parameters and QTc values did not change significantly during the treatment period). Daytime sleepiness was not reported as being significant by any of these patients. The mean dose of quetiapine XR used was 75 mg QD (50-150 mg QD), and the mean duration of the needed treatment for insomnia was 8.3 weeks (4-11 weeks).Conclusions Quetiapine XR could be useful in patients with PD-related insomnia, and the mean dose is usually below 100 mg QD.DisclosureNo significant relationships.

Normal Physiologic Birth Continuing Professional Development: From a National Health Priority to Expanded Capacity.

Background:The Republic of Liberia has experienced many barriers to maintaining the quality of its healthcare workforce. The Resilient and Responsive Health Systems (RRHS) Initiative supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) has responded to Liberian identified health priorities. Liberia’s maternal morbidity and mortality rates continue to rank among the highest in the world. Recent country regulations have put forth required continuing professional development (CPD) for all licensed healthcare workers for re-licensure.Methods:The Model for Improvement was the guiding framework for this CPD to improve midwifery and nursing competencies in assisting birthing women. Two novel activities were used in the CPD. We tested the formal CPD application and approval process as this is a recent regulatory body policy. We also included the use of simulation and its processes as a pedagogical method. Over a two-year period, we developed a two-day CPD module, using didactic training and clinical simulation, for Liberian midwives. We then piloted the module in Liberia, training a group of 21 participants, including midwives and nurses, including pre- and post-test surveys as well as observational evaluation of participant skills.Findings:There were no significant changes in knowledge acquisition noted in the post-test. Small tests of change were implemented during the program, supporting the stages of the Model of Improvement. Observation of skill acquisition was done; however, using a formal observation checklist, such as an Observed Structured Clinical Evaluation (OSCE), would add more robust findings. The CPD and follow-up activity highlighted the need for human and financial support to maintain the simulation kits and to create sustainability for future trainings. Videotaping the didactic and simulation two-day continuing professional development train-the-trainer workshop expands the sustainability beyond newly prepared trainers. Simultaneous with this CPD, the Liberian Board for Nursing and Midwifery (LBNM) worked with a partner to create a CPD portal. The CPD partners created modules from the videos and have uploaded these modules to the LBNM’s new CPD portal.Conclusions:Using a quality improvement model as a framework for developing and implementing CPDs provides a clear structure and supports the dynamic interactions in learning and clinical care. It is too soon to determine measurable health outcomes resulting from this project. Anecdotal feedback from clinicians and leaders was not directly related to the content of the CPD; however, it does demonstrate an increased awareness of examining changes in practice to support expanded health outcomes. Further research to examine methods and processes to determine the quality and safety outcomes of CPD trainings is necessary.

Validity Argument for a Simulation-Based Objective Structured Clinical Examination Scenario for Evaluation of Surgical Skills in Trauma

Trauma is one of the main causes of death globally, and appropriate surgical care is crucial to impact mortality. However, resident-performed trauma cases have diminished in the last 10 years. Simulation-based tools have proven to be effective to evaluate practical skills in a variety of settings. However, there is a lack of evidence regarding proper validation of trauma surgery models. The aim of this study was to evaluate under a contemporary validity framework, an objective structured clinical evaluation (OSCE) scenario for the assessment of basic and advanced surgical skills in trauma and emergency surgery. An OSCE-type simulation assessment program was developed incorporating six stations representing basic and advanced surgical skills that are essential in trauma surgery. Each station was designed using ex-vivo animal tissue. The stations included basic knots and sutures, bowel resection and anastomosis, vascular end-to-end anastomosis, lung injury repair, cardiac injury repair, and laparoscopic suturing. Eight postgraduate year 2 (PY-2), eight recently graduated surgeons (RGS), and 3 experts were recruited, and their performance was blindly assessed by experts using the validated general rating scale OSATS (Objective Structured Assessment of Technical Skills) as well as the time taken to complete the procedure. Significant differences were identified among groups. The average OSATS score was 82 for the PY2 group, 113 for the RGS group, and 147 for the experts (P < 0.01). The average procedural time to complete all the stations was 98 minutes for the PY2 group, 68 minutes for the RGS group, and 35 minutes for the expert surgeons (P < 0.01). An OSCE scenario designed using ex-vivo tissue met 4 out of 5 criteria of the Messick validity framework: content, relation to other variables, response process and consequences of the test. The results show it is a valid strategy for the evaluation of practical skills in trauma surgery.

Objective structured clinical examination (OSCE) to assess the clinical skills of physical therapy students when using physical agents

Introduction: The use of physical agents in physical therapy (PT) requires clinical reasoning, as well as knowledge of their risks and contraindications; however, deficiencies may be observed when used in clinical practice. Objective: To implement the Objective Structured Clinical Evaluation (OSCE) method for the assessment of clinical skills among physical therapy specialty students when using physical agents. Materials and methods: A pilot, non-experimental, cross-sectional study was conducted in 114 physical therapy students enrolled during the first semester of 2019 in a physical agents course offered at the Universidad Andres Bello, Santiago, Chile. The OSCE consisted of 7 peer-validated stations, in which various skills were implemented in simulated clinical scenarios to achieve learning outcomes associated with the use of physical agents, namely: S1: connective tissue flexibility; S2: muscle relaxation; S3: analgesia; S4: drainage; S5: muscle strengthening; S6: parameter interpretation; and S7: equipment installation. Observers at each station assessed students’ clinical skills and decision-making using a checklist. OSCE scores were described using medians and interquartile ranges, representing the data dispersion between the 25th and 75th percentile (P25-P75). Station scores by sex were compared using the Mann-Whitney U test. Results: Median scores were higher than the minimum passing score in stations S1 (66, IQR: 52-70), S2 (55, IQR: 45-60), S3 (60, IQR: 50-69), S4 (65, IQR: 55-73), and S7 (40, IQR: 33-45), but they were below the passing score in stations S5 (54, IQR:46-65) and S6 (10, IQR: 9-13). In addition, 101 (88.59%) students had a global passing score in the OSCE. Conclusion: The OSCE scores obtained by the participants show their attainment of clinical skills when using physical agents since most of them obtained a global passing score; however, reinforcing the clinical skills for parameter interpretation is necessary, considering that the lowest mean score was obtained in said station.

Teaching Physiotherapy Students Physical Examination Skills by Using Photogrammetry: A Randomized Control Trial of 3- Versus 2-Dimensional Images.

Education research explains how healthcare professional training could be more efficient and effective by integrating simulation technology. Despite its relevance in training medical students, the evidence of its effectiveness in the manual skill training of physiotherapy students remains limited. The aim of this study was to compare the effectiveness of 3-dimensional (3D) images of real objects produced by photogrammetry and traditional 2-dimensional (2D) images when introducing manual therapy skills to undergraduate physiotherapy students via an online course. In a randomized controlled trial, a group of first-year physiotherapy bachelor honor degree students participated in a 2-hour online course on 3 manual assessment skills: cervical compression, distraction, and flexion-rotation tests. They demonstrated 2 sets of learning materials, including either 3D images of real rotating objects using close-range photogrammetry (experimental group) or traditional 2D images (control group). After their respective training, an Objective Structured Clinical Evaluation procedure was conducted to demonstrate their knowledge about the techniques. A standardized 9-item practical performance test was used as the primary outcome measure for the analyses. Seventy-seven students participated in the study. The average Objective Structured Clinical Evaluation score for the experimental group (n = 40) was 41.3/50 (±3.9) and the control group (n = 37) was 39.1/50 (±4.5, P = 0.02). For learning 3 cervical spine assessment skills, this study shows that photogrammetry creates 3D images of real rotating objects that are more effective than 2D images for first-year physiotherapy students.

Phenomenological approach of the Live Experiences of the midwifery students on the final examination course the method Objective Structured Clinical Evaluation (OSCE)

Phenomenological approach of the Live Experiences of the midwifery students on the final examination course the method Objective Structured Clinical Evaluation (OSCE)

Validación de la versión en español de un instrumento de evaluación de la comunicación centrada en el paciente en OSCE

ObjectiveThe aim of this study was to validate the Spanish version of the Communication Assessment Tool (CAT) to be used in an Objective Structured Clinical Evaluation (OSCE) to assess communication skills. MethodsData were collected from standardized patients evaluating 125 recent medical school graduates during a 12-station OSCE. A total of 1,500 completed CAT instruments were analyzed. Exploratory and confirmatory factorial analysis were performed and tested the internal consistency of the tool. ResultsWe found a single factor solution in the Spanish version of the instrument, similar to that described by the original author. Cronbach's alpha was high, ranging from 0.93 to 0.97. The overall mean percentage of ‘excellent’ ratings for the recent graduates was 38.07%. ConclusionsThe Spanish version of CAT is a feasible tool to be used in OSCE by standardized patients to assess communication skills in a standardized manner.