The use of peer physical examination in undergraduate health professions education: Exploring the perceptions of students and educators in a multicultural, multiracial institution

Teaching clinical skills is core content of the medical and allied health curricula of the Faculty of Health Sciences (FoHS) at the University of the Free State (UFS) in South Africa. A major pedagogical tool used for this purpose across the faculty is peer physical examination (PPE). Objective. To investigate the lived experience and perceptions of students and educators on the use of PPE in undergraduate health professions education at a multicultural and multiracial institution. Suggestions on guidelines for a PPE policy for the FoHS at the UFS were also obtained from the participants.Methods. This research was designed as a qualitative study that used focus group interviews involving 26 participants (19 students and 7 educators) to obtain verbal statements that described their experience and perceptions of the use of PPE in undergraduate health professions education. Results. Participants reported that PPE was useful to create a safe learning environment and to prepare students for the clinical aspects of their training. Enhancing students' empathy, competency and clinical confidence were among the advantages attributed to using PPE; it also encouraged peer-assisted learning. Some of the disadvantages ascribed to PPE were that it made it difficult to maintain classroom discipline, and that it could promote memorisation over understanding. Finally, participants suggested that a guideline for PPE policy should address matters of consent, confidentiality, participation and gender, cultural, religious and racial considerations.Conclusions. The findings of this study reveal that PPE is an acceptable and useful learning strategy for the majority of students and educators. Issues relating to consent, confidentiality and cultural, religious and racial considerations are some of the potential problems associated with the use of PPE at the UFS. We believe that the suggestions given by the participants of this study will inform the establishment of a PPE policy for the FoHS of the UFS

Cardiovascular physical examination as a screening tool for congenital heart disease in newborns at a teaching hospital in Ghana

Objectives: To determine the usefulness of cardiovascular physical examination (CPE) as a screening tool in a lowresource setting for detecting congenital heart disease (CHD) in newborns delivered at the Maternity Unit of Korle Bu Teaching Hospital (KBTH), Accra, Ghana. Design: A hospital-based cross-sectional study with a comparison group component. Setting: Maternity Unit of the KBTH, Accra, Ghana. Participants: Over eight months, newborns aged 1-14 days delivered at ≥ 34 weeks' gestation at the Maternity Unit, KBTH, were recruited into the study. Intervention: Each newborn was examined using a set of CPE parameters for the presence of congenital heart disease. Those with suggestive features of CHD had a confirmatory echocardiogram test. Main Outcome Measure: Abnormal CPE features and their corresponding echocardiogram findings. Results: A total of 1607 were screened, with 52 newborns showing signs of CHD on CPE, of which 20 newborns were proven on echocardiogram to have congenital heart disease. Abnormal CPE parameter that was associated with CHD was murmur (P=0.001), dysmorphism (p=0.01), newborns with chest recessions (p=0.01) and lethargy (p=0.02). CPE's sensitivity, specificity, and positive and negative predictive values were 95%, 60.7%, 36.5% and 98,1%, respectively. The most common acyanotic CHD found was isolated atrial septal defect (ASD), followed by patent ductus arteriosus (PDA). The only cyanotic CHD found was a case of tricuspid atresia. Conclusion: Cardiovascular physical examination at birth is an effective and inexpensive screening tool for detecting CHD in newborns, which can easily be utilised in low-resource settings.

Mastering your Fellowship

The series, "Mastering your Fellowship", provides examples of the question format encountered in the FCFP(SA) examination. The series aims to help family medicine registrars and their supervisors prepare for this examination. Model answers are available online

Reliability of physiology MCQs' examinations at the Faculty of Medicine, University of Khartoum

Background: One of the major challenges that face exam constructors is generating highly reliable exams. An assessment cannot be viewed as valid unless it is reliable. Test reliability, which is the best single measure of test accuracy, is the extent to which test results are consistent, stable, reproducible and free of error variance. Reliability isinfluenced by internal factors related to exam construction, as well as external factors which depend on the situation of test administration. Objective: To estimate the reliability of multiple choice questions (MCQs) of physiology exams as part of an overall quality assessment at the Faculty of Medicine, University of Khartoum.Methods:Reliability influential factors related to exam construction and administration were controlled and catered for by departmental and administrative staff according to the exam regulations of the faculty. Remark software was used for post-examination analysis of scores of ten consecutive summative physiology MCQ exams at the Faculty of Medicine, University of Khartoum. The number of the examinees who sat for each of the ten exams ranged from 332­359. In addition to reliability coefficients, item difficulty index (DIF I) and point-biserial correlation coefficient (rpbis)as a measure of item discrimination ability, were calculated as part of item analysis results.Results:The study revealed high exams' reliability (0.84-0.95) as measured by different formulas [Kuder-Richard-son Formulas (KR-20, KR-21) and Cronbach's-Alpha], and low standard error of measurement/SEM (3.073.80).Factorswhichcontributed to the high reliability of our ten exams were: their high discrimination power (0.32-0.47), their recommended mean difficulty (48.62-65.67%), and the relatively large numbers of items (60­80) per each exam.Conclusion:The high exams reliability of this study was an indicator of the precise control of external and internal factors influencing reliability. The most important contributing factor was the proper construction of exams with high quality items; in addition to careful exam administration and meticulous scoring system

Apport du bilan médical chez le travailleur de mines au Burkina Faso

L'inhalation de la poussière de silice issue de l'exploitation minière artisanale au Burkina Faso est associée à bon nombre de cas de pneumoconiose. Un bilan médical avant et après l'embauche du mineur devrait permettre d'en faire le diagnostic. Matériel et méthode : Il s'est agi d'une étude transversale rétrospective à visée descriptive de janvier 2010 à décembre 2012 chez des mineurs reçus dans des structures de soins de la ville de Ouagadougou pour des bilans de santé. Les données ont été collectées à l'aide d'un questionnaire renseigné au cours de l'exploitation de leurs dossiers. Résultats : Les 331 mineurs, tous de sexe masculin avaient un âge moyen de 33, 05 ± 5,9 ans [21- 54]. Parmi eux, 224 (67,7%) étaient venus pour une visite médicale d'embauche (VME). La consommation de tabac et d'alcool étaient retrouvée chez plus de 40% des mineurs à la VME. Aucun signe fonctionnel respiratoire et très peu d'anomalies radiographiques thoraciques (RT) avaient été rapportés chez les mineurs lors VME. A la visite médicale annuelle (VMA) les signes fonctionnels respiratoires étaient retrouvés chez 63,9% des mineurs, et dominés par la dyspnée d'effort (19,6%). La spirométrie révélait des troubles ventilatoires obstructifs (TVO) chez 40,9% des mineurs. La RT montrait des petites opacités arrondies de types « p » et « q » dans 33,3% des cas. Au total 57 mineurs (25,4%) ont été déclarés inaptes lors de cette VME. Conclusion : Le bilan de santé reste un maillon fort pour la prévention de l'apparition des maladies professionnelles dont la pneumoconiose chez tout travailleur de mines. Il devrait être complété aussi bien par des mesures préventives individuelles que collectives

Utility of Routine Chest Radiographs in Kenya

Background: Many otherwise healthy Kenyans are required to obtain chest radiographs as part of routine medical examination to exclude pulmonary TB; a condition of significant public health concern. Many of these people are required to have these radiographs taken yearly as part of routine check-up. No local data is available to support this practice. Though a quick procedure to perform and readily available throughout the country; chest radiograph exposes the individual to a dose of ionising radiation. Ionising radiation is associated with increased risk of malignancy. The cost is also substantial. Objective: To determine the prevalence of radiological findings consistent with PTB among routine medical examination chest radiographs. Design: A cross-sectional descriptive study. Settings: Department of Radiology Kenyatta National Hospital;Department of Imaging and Radiation Medicine; University of Nairobi; Plaza Imaging Solutions; a private radiology practice in Nairobi and Department of Radiology; the Nairobi Hospital. Subjects: Four hundred and two chest radiographs of patients presenting for routine medical examinations were analysed. Results: Sixty three radiographs had abnormal but clinically insignificant findings (16). Only one radiograph (0.25). Only one radiograph (0.25) had radiological features of PTB. The rest were reported as normal (84). Conclusion: In this study; the diagnostic yield for the intended purpose (to include/ exclude PTB) was extremely low (0.25). It is recommended that routine chest radiographs as screening tools for active pulmonary tuberculosis be reconsidered due to poor diagnostic yield. The authors propose a bigger nation wide study before a policy decision can be proposed

Assessing the Role of Routine Chest Radiography in Asymptomatic Students during Registration at a University in an Endemic area of Tuberculosis

Context: Routine chest radiographs are usually obtained from asymptomatic individuals during routine medical visits probably to detect the presence of occult disease. In sub-Saharan countries tuberculosis is endemic among young individuals; primary tuberculosis might be the most probable occult disease sought for. Aims: The aim was to determine the diagnostic yield and cost effective- ness of routine chest radiography in an asymptomatic student population in Yaounde during registration at a university. Settings and Design: A cross-sectional descriptive study carried out in a University-affiliated hospital in Yaounde; Cameroon. Materials and Methods: Postero-anterior (PA) chest radiographs were obtained from students during a routine medical visit before university admission. Radiographic results were coded as normal; minor; or major findings. The estimated cost per radiograph was that of the study setting at the time of the study. Statistical Analysis Used: Epi Info software version 3.3.2 of February 9 2005 (CDC Atlanta) was used for statistical analysis. Results: Of 758 students enrolled; there were 280 males and 478 females (sex ratio 1:2). The mean age of the study population was 21 years (age range 15-33 years). All enrolled cases were asymptomatic. There were 739 normal radiographs (97.5); while 19 radiographs (2.5 ) showed minor abnormalities. No major abnormality was seen. The estimated direct cost of all the radiographs obtained was 3;941;600 F CFA ($ 8;760). Conclusions: Routine chest radiography has a low diagnostic yield in asymptomatic students even in a setting where tuberculosis is endemic; and is therefore not cost-effective

Presence of Lupus anticoagulant in an asymptomatic Nigerian

Background:The lupus anticoagulant (LA) is one of the antiphospholipid antibodies (aPL); which prolong phospholipid- dependent coagulation tests by interfering with coagulation reactions that depend on protein - phospholipid complexes in vitro. Method: A 25 year old 'healthy' male Nigerian was screened for the presence of any coagulation abnormality using the KCT; PT and platelet count; after volunteering for his plasma to be used in the preparation of normal pooled plasma in a study. Results: He was disco- vered to have a prolonged KCT; PT and normal platelet count. Based on the prolonged KCT his plasma was subjected to mixing studies with various concentration of normal pooled plasma; the KCT index was calculated and a curve was plotted. His KCT index was 1.6 and the curve convex in the left axis suggesting the presence of LA. His past medical history and physical examination were not remarkable.Three months after the initial study; a repeat KCT index was 1.4 and the subject asymptomatic. Conclusion: From literature review this is the first report of LA in an asymptomatic adult Nigerian; the importance of this finding is discussed

Evaluation of clinical signs to diagnose anaemia in Uganda and Bangladesh, in areas with and without malaria

The object of this study was to assess the ability of pallor and other clinical signs, including those in the Integrated Management of Childhood Illness (IMCI) guidelines developed by WHO and UNICEF, to identify severe anaemia and some anaemia in developing country settings with and without malaria. A total of 1226 and 668 children aged 2 months to 5 years were prospectively sampled from patients presenting at, respectively, a district hospital in rural Uganda and a children's hospital in Dhaka, Bangladesh. The study physicians obtained a standardized history and carried out a physical examination that included pallor, signs of respiratory distress, and the remaining IMCI referral signs. The haematocrit or haemoglobin level was determined in all children with conjunctival or palmar pallor, and in a sample of the rest. Children with a blood level measurement and assessment of pallor at both sites were included in the anaemia analysis. Using the haematocrit or haemoglobin level as the reference standard, the correctness of assessments using severe and some pallor and other clinical signs in classifying severe and some anaemia was determined. While the full IMCI process would have referred most of the children in Uganda and nearly all the children in Bangladesh with severe anaemia to hospital, few would have received a diagnosis of severe anaemia. Severe palmar and conjunctival pallor, individually and together, had 10-50% sensitivity and 99% specificity for severe anaemia; the addition of grunting increased the sensitivity to 37-80% while maintaining a reasonable positive predictive value. Palmar pallor did not work as well as conjunctival pallor in Bangladesh for the detection for severe or some anaemia. Combining "conjunctival or palmar pallor" detected 71-87% of moderate anaemia and half or more of mild anaemia. About half the children with no anaemia were incorrectly classified as having "moderate or mild" anaemia. Anaemia was more easily diagnosed in Uganda in children with malaria. Our results show that simple clinical signs can correctly classify the anaemia status of most children. Grunting may serve as a useful adjunct to pallor in the diagnosis of severe anaemia. Conjunctival pallor should be added to the IMCI anaemia box, or the guidelines need to be adapted in regions where palmar pallor may not readily be detected

Chilaiditi's syndrome in surgical practice. [case report]

Transients or persistent hepatodiaphragmic interposition of the colon or small intestine; so called chilaiditi's syndrome; is a frequent and general asymptomatic condition; known to all radiologists. All authors agree; the syndrome is commonest in elderly patient. The case reported here is that of 78-year-old man with a long history of abdominal pain; constipation; abdominal distension; loss of appetite; loss of weight and general weakness. Physical examination at admission revealed a cachetic man; dehydrated; with a soft; tympanic; distended abdomen. Routine chest and abdominal x-rays confirmed chilaiditi's syndrome

A study of the effect of nifedipine in reversing left ventricular hypertrophy in hypertensive patients

Using WHO hypertensive criteria; 184 patients with hypertension were chosen (102 male; 82 female); aged 58-78 years old. Other heart diseases were ruled out by physical examination; electrocardiographic examination; chest-ray and echocardiography. All the cases had one or more criteria of left ventricular hypertrophy (LVH): Interventricular septal thickness at diastole; left ventricular posterior wall thickness at end diastole and left ventricular mass index. The findings in this study imply that it is good practise to include nifedipine in the treatment regimen of patients whose hypertension is complicated with LVH and (or) ischaemic heart disease