Validity of Medical Students Self-Assessment of Proficiency in Clinical Long Case Examination

@#Introduction: Self-assessment is a mechanism to evaluate one’s own performance and identify strengths and weaknesses. However, there is paucity of information on the the validity of self-assessment in the literature. This study is planned to assess the validity of medical students’ self-assessment skills in clinical examinations with long case during their postings in Obstetrics and Gynaecology. Methods: A cross sectional study was conducted during Obstetrics and Gynaecology (O&G) rotation assessing the students performance in the clinical long case examination. Participants were 80 fourth year medical students who were in their last week of their O&G rotation between August and December 2019. Each student was given a random case from the obstetric ward for the clinical long case examination during their final week of posting. At the end of examination, both student and examiner were tasked to independently evaluate the performance with a standardized grading sheet. Students were assessed in three areas namely Case Presentation (4 items), Case Discussion (4 items) and Professionalism and Overall approach to the practice of medicine (2 items). Results: The correlation coefficient was identified to be 0.307, p<0.01, indicating validity in self-assessment in the context of a clinical examination. The overall bias index was -0.97. Students underrated themselves in all areas with bias indexes of -0.35 in case presentation, -0.26 for case discussion and -0.35 in the professionalism and overall approach to practice. The correlation coefficients were 0.186, 0.360 and 0.170 respectively, indicating that in isolation only the component of case discussion showed significant correlation (p<0.01). Conclusion: Self-assessment in clinical examination is shown to be a valid assessment method when multiple assessment items are combined.

Applying the learning theories to medical education: A commentary

Medical education of today continues to evolve to meet the challenges of the stakeholders. Medical professionals today are expected to play multiple roles besides being experts. Thus, the curriculum has to be developed in a manner that facilitates learners to achieve the intended goal of becoming a medical professional with multiple competencies. The understanding of learning theories will be helpful in designing and delivering the curriculum to meet the demands of producing a medical professional who would meet the CanMEDS model. This commentary explores and reflects on the learning theories of behaviorism, cognitivism and constructivism as they have evolved over time and the application of these learning theories in medical education, particularly in the context of medical education in Malaysia. The authors are convinced that these three theories are not mutually exclusive but should be operationalized contextually and throughout the different stages of learning in the MBBS curriculum. Understanding these theories and their application will enhance the learning experience of students.

The ethical decision making model in obstetrics and gynaecology practice

This paper attempts to utilise clinical scenarios where ethical issues are embedded and requires appropriate application of the steps of the framework mentioned. A step by step sequential approach is adopted to illustrate how the ‘ethical decision model ‘can be used to resolve ethical problems to arrive at a reasonable conclusion. The UNESCO ethical method of reasoning is used as the framework for decision making. Physicianeducators should be competent to use ethical decision models as well as best available scientific evidence to be able to arrive at the best decision for patient care as well as teach health professional trainees how reasonable treatment decisions can be made within the perimeter of medical law and social justice.

Second stage fetal heart rate patterns and neonatal acid-base status

Background: Fetal surveillance in labour is performed mostly to identify fetuses at risk of hypoxia in order to reduce neonatal morbidity and mortality by initiating timely intervention. While normal and abnormal fetal heart rate (FHR) patterns have been well recognised and characterized for the first stage of labour, FHR patterns during the second stage of labour commonly showed some forms of abnormalities leading to problems in interpretation, particularly in predicting fetal hypoxia and acidosis. This study aims to identify patterns of FHR tracing during the second stage of labour associated with neonatal acidosis. Methods: A prospective cross sectional study was conducted in the Labour Ward of a state referral hospital. The study population were patients with low-risk singleton pregnancies between 37 to 42 weeks gestation who had normal cardiotocograph (CTG) tracing in the first stage of labour. CTG was recorded during the second stage of labour and neonatal umbilical cord blood was obtained for acid-base analysis immediately after birth prior to the delivery of placenta. FHR patterns were grouped according to modified Melchior and Barnard’s classification and matched with neonatal acid-base status. Patients with normal FHR pattern in the second stage acted as control. Results: A total of 111 matched pairs were analysed. Ninety nine (89.2%) second stage FHR tracings showed abnormal features when compared to control. There were significantly more neonatal acidosis and hypercapnia in type 1b, type 2a, type 2b and type 3 CTG patterns compared to control, in increasing order of severity. In addition, types 2b and 3 showed significant difference in the base excess. Conclusion: Certain second stage fetal heart rate patterns were found to be associated with neonatal acidosis.

The Role of Computed Tomography (CT) Scan in Assessment of the Parametrial Involvement in Early Stage Cervical Carcinoma

This retrospective study is aimed at evaluating the role of CT scan in predicting parametrium involvement in early stage of cervical carcinoma. It was conducted in a Gynaecologic Oncology Centre, Hospital Alor Star from January 2004 till December 2008. All patients with operable stage I and II cervical cancer had pelvic CT scan for evaluation of parametrium involvement before undergoing radical hysterectomy and pelvic lymphadenectomy. Parametrial streakiness or presence of infiltration suggested local invasion. Following radical hysterectomy, the specimens sent for histological confirmation and the correlation between the CT scan finding and the histopathology result was studied. The result revealed a total of 104 patients with operable stage cervical carcinoma had pelvic CT scan. The sensitivity and the specificity of CT scan in assessing parametrial involvement was 33.3% and 84.8%, respectively. In conclusion, CT scan had high specificity but low sensitivity in determining parametrial involvement in early stage of cervical cancer. Hence, routine preoperative pelvic CT scan has a limited role in assessing parametrial involvement in early stage cervical carcinoma.