Workplace-based assessment; applications and educational impact

Workplace based assessment (WPBA) refers to a group of assessment modalities which evaluates trainees’ performance during the clinical settings. Hallmark of WPBA is the element of observation of the trainee’s performance in real workplace environment along with relevant feedback, thus fostering reflective practice. WPBA consists of observation of clinical performance (mini-clinical evaluation exercise, direct observation of procedural skills), discussion of clinical cases (case based discussion), and feedback from peers, coworkers, and patients (multisource feedback). This literature review was conducted on the databases of MEDLINE, EMBASE, CINAHL, and The Cochrane Library. Data were retrieved by connecting Medical Subject Headings (MeSH) keywords: ‘workplace based assessment’ AND ‘mini-clinical evaluation exercise’ AND ‘direct observation of procedural skills’ AND ‘case based discussion’ AND ‘multi-source feedback’. Additional studies were searched in the reference lists of all included articles. As WPBA is gaining popularity, there is a growing need for continuing faculty development and greater evidence regarding the validity and reliability of these instruments, which will allow the academia to embed this strategy in the existing curricula. As of today, there are conflicting reports about the educational impact of WPBA in terms of its validity and reliability. This review draws upon the spectrum of WPBA tools, their designs and applications, and an account of the existing educational impact of this emerging assessment strategy in medical education. Finally, the study reports some educational impact of WPBAs on learning and emphasises the need for more empirical research in endorsing its application worldwide.

Case history

A 38-year-old female presented with a 2-month history of left sided, painless, slowly growing abdominal mass. She denied any past surgery and estrogen intake. The patient had normal vital signs. Her abdominal examination revealed a non-tender, firm, and immobile mass in the lumbar area [Figure 1]. Her CT scan is shown in Figure 2. She underwent laparatomy and the mass was excised [Figure 3]. The histological report demonstrated a tumor composed of stellate and spindle cells arranged in a storiform pattern. [Figure 4]. What is the most probable diagnosis?

Breast cancer screening: implications and clinical perspectives

In the developed countries, breast cancer is the most commonly diagnosed malignancy in women and the global incidence of breast cancer is still increasing worldwide. Breast cancers can be detected during breast cancer screening program which offers the best chance to treat the disease at an earlier stage. Currently, there is no established breast cancer screening program in the Kingdom of Saudi Arabia. To address the objective significance of breast cancer screening, which detects and localizes breast cancer through a well-structured system of public awareness and follow up program. Treatment of breast cancer at an early stage will provide the maximum chance of cancer-cure with resultant better prognosis. A systematic literature search of English-language articles on MEDLINE, the Cochrane database of evidence-based reviews, and the Database of Abstracts of Reviews of Effects was performed for the period 1988-2008. Keywords "breast cancer". Breast cancer screening", "mammography", and "PET scan" were used for literature review. The breast cancer screening programs is various regions of the world were explored regarding the components of the screening program, strengths and weaknesses of each component, and the inference derived from the literature. Breast cancer screening program has a well-established role in the detection of early, impalpable, and asymptomatic lesions with consequent reduction of cancer-associated morbidity and morality

Malignant melanoma of the small bowel with unknown primary: a case report

Primary small bowel tumours are rare. However, alongwith stomach it is the most frequent site for metastatic tumours, malignant melanoma being the commonest tumour. The prevalence of malignant melanoma in the gastrointestinal tract without any evidence of a primary lesion in the skin or any other site is extremely rare

non surgical management of colonoscopic perforations: Worthwhile to take risk?

Colonoscopic procedures account for a substantial number of endoscopies performed for various reasons. Colonic perforations inflicted during colonoscopy pose a challenge to the surgeons in the wake of difficult emergency decisions and major colonic operations. Over a period of three years, a group of patients was referred from the Gastroenterology Unit, emergency room, and/or medical units to the Surgical on call team for the management of suspected colonoscopically induced colonic perforations. Following their transfer, the patients were closely monitored in the surgical unit and treatment was initiated by bowel rest, IV antibiotics and fluids, and analgesia. Patients' response to this regime was meticulously scrutinized to analyze the final outcome. 38 cases were incorporated in this series. Out of these, 35 were urgently operated due to various surgical indications and the remaining 3 cases were managed conservatively. These patients made an uneventful recovery. In selected patients, the Colonoscopic perforations leading to localized fecal peritonitis can be managed expectantly which can avoid moderate to major magnitude emergency colonic operations

use of 0.2% glyceryl trinirate oinment for anal fissures

To assess the clinical efficacy of 0.2% glyceryl trinitrate ointment in the management of acute and chronic anal fissures. A prospective clinical study conducted on consecutive patients presented to the surgical clinic of King Khalid University Hospital, Riyadh with acute and chronic anal fissures, from January to December 2003. These patients were treated with topical 0.2% glyceryl trinitrate paste in soft white paraffin three times a day. Patients were examined at regular intervals to evaluate the fissure status, adverse reactions, symptomatic control and recurrence. This study comprised 121 patients, six of them were lost to follow-up and 109 [94.7%] of the remaining 115 patients were cured. Of those cured, 13 patients [11.3%] presented with acute and 102 [88.7%] with chronic fissures. There were 98 male and 17 female patients with median age of 41 years [range, 14-70 years]. Complete symptomatic relief was achieved in all patients within one month of therapy. Two patients, with chronic anal fissures presented with recurrent symptoms within one month of the completion of therapy both of them were successfully treated with repeat glyceryl trinitrate course. Treatment had to be terminated in six [5.2%] patients: five [4.3%] experienced intolerable adverse effects and one [0.8%] patient failed to respond. All these patients were successfully treated with lateral internal sphincterotomy. No patient complained of change in continence. Glyceryl trinitrate ointment produces adequate symptomatic control and healing of the anal fissures and can be considered as one of the recommended treatment options

Changing etiological spectrum of acute peripheral vascular injuries: a clinico-epidemiological study

The overall incidence of acute peripheral vascular injuries is on a rise in civilian practice which is largely attributable to frequent use of firearms, terrorist violence and high speed road traffic accidents. This study reveals the clinical and operative details of 19 patients with peripheral vascular trauma which necessitated surgical intervention from August 1998 to February 2000. Present study also aims to highlight an emerging change in the etiological spectrum of vascular injuries with an alarming contribution by the drug addicts [15.7%], which demands a multi-disciplinary approach. An understanding of modes of presentation of vascular trauma with early diagnosis and appropriate treatment are essential for all surgeons to maximize the chances of limb salvage. Time is the prime factor in determining the final outcome of vascular repair