Developing a Two-Tier Diagnostic Test to assess Arterial Blood Gases learning by students with different background knowledge in Anesthesiology.

Objectives: To develop a two-tier diagnostic test in medical education on the analysis of arterial blood gases (ABGs) by students with different background knowledge in anesthesiology, using a concept and knowledge map to determine table of specifications together with an open discussion and a feedback-providing method. Methods: A research and development study in which the developed diagnostic test was assessed for its efficiency by first-year residents, preclinical medical students and nurse anesthetist students who volunteered to join the project. Results: There were four major misconceptions in ABGs: First, they could not clarify the significance and relationship of the symbols. Second, they could not remember the formulas and use them appropriately. Third, they did not understand the analytical steps and lacked knowledge for clinical interpretation. Fourth, they could not apply the logical results as a guideline for patient management. Medical and nurse anesthetist students had problems mainly on the third/fourth misconceptions and partly on the first/second misconceptions. Nevertheless, residents had problems mainly on the fourth misconception and partly on the third misconception. The assessment of criterion-referenced test item difficulty, discrimination and reliability (internal consistency) was 0.59, 0.38 and 0.91 respectively. The item objective congruency (IOC) of the test was equal to 0.88. Conclusions: Using a concept and knowledge map to define the table of specifications in ABGs concepts together with an open discussion and feedback-providing method helped facilitate the scope of developing a two-tier diagnostic more practical test. Teachers can assess misconceptions of students with different background knowledge in a short period of time and have guidelines to improve pedagogy in response to their eagerness for learning.

Analgesic effect of intraperitoneal instillation of bupivacaine for postoperative laparoscopic cholecystectomy.

OBJECTIVE: To study the effectiveness of intraperitoneal instillation of bupivacaine for postoperative laparoscopic cholecystectomy pain relief, especially specific pain (visceral pain, shoulder pain and epigastric pain). PATIENTS AND METHOD: Eighty ASA (American Society of Anesthesiologists) 1 and 2 patients were randomly assigned to receive either 20 ml of 0.5 per cent bupivacaine (n=39) or the same volume of saline (n=41) instilled under direct vision into the hepatodiaphragmatic space, near and above the hepatoduodenal ligament and above the gall bladder bed at the end of surgery. The intensity of visceral pain, shoulder pain and epigastric pain was assessed at 1, 6, 24 and 48 h after surgery using a visual analogue scale (100 mm VAS) and verbal rating "Prince Henry" pain scale (VRS). The time when analgesia was first required and total analgesic consumption were also recorded. t-test, Chi-square, Mann-Whitney U test and Kaplan-Meier survival analysis were used for statistical analysis. RESULTS: Patient data were similar in the two groups except for body weight. There were no statistical differences between the two groups for the time when analgesia was first' required, VAS, VRS and total analgesic consumption. CONCLUSION: In this study, intraperitoneal instillation of bupivacaine does not show any advantage for postoperative analgesia after laparoscopic cholecystectomy.