Development and use of checklists for assessment of medical students in clinical examinations on real patients: a preliminary study

Clinical performance examinations [CPE] are important methods for assessing medical students and postgraduate medical trainees. Unfortunately, assessment [scoring] in these exams as it is practiced in most medical schools is based mainly on the general impression and level of experience of the examiner. Hence, it has the disadvantage of being non-structured, subjective, and sometimes highly biased. The objective of this study was to develop objective structured tools [checklists], use them in the clinical examination, and to compare their scores to those given by the conventional way. Case-specific checklists were developed for some common long and short clinical examination cases. These were tried in the final undergraduate surgery exam at Alazhari University, August 2008. Scores [marks] given to the same student, using the conventional and the checklist systems were compared using the chi square and correlation statistics. Questionnaires were filled by the examiners after using the checklists. Checklist and conventional scores were strongly correlated in the long case exams. A significant difference between the scores was, however, noted in the short case exams. Care should be taken in interpretation because of the small number of data. Evaluators felt that the checklist system was more objective and structured and hence fairer than the conventional method. Although checklist final scores took a bit longer time to calculate, that was not significant practically. Examiners gave valuable feedback regarding the construction and the use of checklists. The use of checklists in the clinical examination was more objective, more structured, and more accurate than the conventional method. The development of checklists requires hard team work and frequent updating and use to develop experience. We propose using checklists as alternative tools of assessment with many advantages over the conventional method, and to prepare the examination culture to adopt the OSCE

Emergency operations for bleeding duodenal ulcer: a simple option to consider: Case report

We report a 46 years-old man who had severe bleeding from a posterior duodenal ulcer [DU] that was diagnosed but could not be treated endoscopically in another health facility. He went into shock as he was being admitted to the casualty at Khartoum North Teaching Hospital [KNTH]. His haemoglobin [Hb] dropped to five gram/dl. He required resuscitation and transfusion of six units of blood overnight. Emergency surgery was performed. Over sewing [OS] of the ulcer was done and the stenosed first part of duodenum was closed transversely [pyloroplasty]. No acid-reducing procedure [ARP] was done. The patient received anti- helicobacter therapy via the intravenous route preoperatively and continued postoperatively. This was later given orally after he started taking by mouth. He made an uneventful recovery with no recurrence of bleeding and was discharged home one week latter. Endoscopy was done at KNTH six weeks later. This showed complete healing of the ulcer with no evidence of Helicobacter pylori in the biopsies taken. We found simple OS of the bleeding DU together with anti-helicobacter therapy safe, efficient, and not associated with re-bleeding. We discuss the rationale of this simple treatment. We propose the need for a randomized controlled study comparing it with acid-reducing procedure [ARP] as options in the surgical treatment of bleeding DU