"Shadow" OSCE examiner. A cross-sectional study comparing the "shadow" examiner with the original OSCE examiner format

OBJECTIVES: Feedback is a powerful learning tool, but a lack of appropriate feedback is a very common complaint from learners to teachers. To improve opportunities for feedback on objective structured clinical examinations (OSCEs), a modified examiner role, termed the "shadow" examiner, was tested. This study aims to present and analyze comparisons between the "shadow" examiner and the original OSCE examiner format. METHODS: In 2011, experiments were carried out with modifications to the examiner's role to define the "shadow" examiner format. From February 2012 to May 2014, research was conducted with 415 6th-year medical students. Of these students, 316 were randomly assigned to assessments by both "shadow" and "fixed" examiners. Pearson correlation analysis with linear regression, Student's t-tests and Bland-Altman plots were the statistical methods used to compare the assessment modes. To strengthen the analysis, checklist items were classified by domain. RESULTS: High correlations between the "shadow" and "fixed" examiners' global scores were observed. The results of the analysis of specific domains demonstrated higher correlations for cognitive scores and lower correlations for affective scores. No statistically significant differences between the mean examiner global scores were found. The Bland-Altman analysis showed that the "shadow" examiners' affective scores were significantly higher than those of the "fixed" examiners, but the magnitude of this difference was small. CONCLUSION: The modified examiner role did not lead to any important bias in the students' scores compared with the original OSCE examiner format. This new strategy may provide important insights for formative assessments of clinical performance.

Comparative evaluation of three different recording criteria of dental fluorosis in a known endemic fluoride area of Haryana

Background & objectives: Various indices are available to record different grade of severity of dental fluorosis. These indices have chances of inter- and intra- examiner variability. Therefore, study was conducted to compare three different indices for recording dental fluorosis to find out the best and most practical index of recording dental fluorosis for field studies in children living in a fluoride endemic area. Methods: The severity grades were recorded in 300 schoolchildren aged 12-15 yr having dental fluorosis of low, medium and high fluoride areas using three different indices, viz. Dean's fluorosis index (1942), tooth surface index for fluorosis (TSIF, 1984) and ICMR index (2013). Dean's index was used as gold standard. Results: The occurrence of moderate and severe cases was higher as per the Dean's index and of mild and severe cases was higher as per the TSIF and the ICMR index. The mean time required for recording dental fluorosis as per Dean's index and TSIF was similar and almost double (1.25�05 min) of that required for ICMR index (0.68�20 min). The intra-examiner variability was found to be least in the ICMR index compared to Dean's index and TSIF. Interpretation & conclusions: The ICMR index is a simple index with objective scores and takes less time in recording the dental fluorosis as compared to Dean's index and TSIF in field studies.

Examiner seniority and experience are associated with bias when scoring communication, but not examination, skills in objective structured clinical examinations in Australia / 보건의료교육평가

PURPOSE: The biases that may influence objective structured clinical examination (OSCE) scoring are well understood, and recent research has attempted to establish the magnitude of their impact. However, the influence of examiner experience, clinical seniority, and occupation on communication and physical examination scores in OSCEs has not yet been clearly established. METHODS: We compared the mean scores awarded for generic and clinical communication and physical examination skills in 2 undergraduate medicine OSCEs in relation to examiner characteristics (gender, examining experience, occupation, seniority, and speciality). The statistical significance of the differences was calculated using the 2-tailed independent t-test and analysis of variance. RESULTS: Five hundred and seventeen students were examined by 237 examiners at the University of New South Wales in 2014 and 2016. Examiner gender, occupation (academic, clinician, or clinical tutor), and job type (specialist or generalist) did not significantly impact scores. Junior doctors gave consistently higher scores than senior doctors in all domains, and this difference was statistically significant for generic and clinical communication scores. Examiner experience was significantly inversely correlated with generic communication scores. CONCLUSION: We suggest that the assessment of examination skills may be less susceptible to bias because this process is fairly prescriptive, affording greater scoring objectivity. We recommend training to define the marking criteria, teaching curriculum, and expected level of performance in communication skills to reduce bias in OSCE assessment.

Concordancia inter-examinador en la evaluación de hallazgos periodontales mediante radiografías panorámicas / Inter-examiner concordance in the assessment of periodontal findings by means of panoramic X-rays

RESUMEN Objetivo Estimar el grado de concordancia inter-examinador en la interpretación de hallazgos periodontales en radiografías panorámicas en estudiantes de último año de la Facultad de Odontología de la Universidad de Cartagena. Material y métodos Se realizó un estudio descriptivo de concordancia-consistencia inter-observador para la interpretación de hallazgos periodontales en radiografías panorámicas entre estudiantes de último año de pregrado de la Facultad de Odontología de la Universidad de Cartagena, con relación a un especialista en periodoncia. La evaluación de la concordancia se realizó a través del coeficiente kappa utilizando SPSS Statistics 2.0. Resultados Se evaluaron a 80 estudiantes del último año de pregrado. Cada uno valoró dos radiografías panorámicas, para un total de 160 observaciones. La concordancia general estableció un valor de kappa mínimo de 0.011 y un valor máximo de 0.720. Conclusiones La concordancia entre los estudiantes observadores y el estándar de oro fue pobre. Lo que indica que los estudiantes no aplican los conocimientos obtenidos durante el pregrado de odontología, dando así una errónea impresión del estado periodonto.

ABSTRACT Objective To assess the degree of inter-examiner concordance in the interpretation of periodontal findings in panoramic X-rays in last year students of the School of Dentistry at the University of Colombia. Material and methods A descriptive inter-observer concordance-consistency study was conducted for interpretation of periodontal findings in panoramic X-rays among last year students of the School of Dentistry of the University of Colombia and compared results to thos obtained by a periodontics specialist. Concordance evaluation was achieved by means of a kappa coefficient using SPSS Statistics 2.0 program. Results 80 last year students (undergraduate seniors) were evaluated each one assessed two panoramic X-rays, for a total of 160 observations. General concordance established a minimum kappa value of 0.011, and maximum value of 0.720. Conclusions Concordance among observing students and the gold standard was poor. This indicated that students did not apply acquired knowledge during their undergraduate dental studies, and provided thus a misleading impression on the circumstances of the periodontium.

Methods and indices in measuring fluorosis: A review

exposure during enamel formation. Increased and decreased in fluorosis prevalence may also reflect to the different ways of measuring the disease. The choice of measuring fluorosis is depends on the objective of the assessment such as assessing public health significant of fluorosis in the population or assessing the detailed of biological effects of fluoride. These differences in requirement have led to the adoption of many indices and assessment methods of enamel fluorosis, which subsequently led to evaluation of examiner agreement between them. Several indices were developed to measure dental fluorosis in the 20th century. These include fluorosis specific indices such as Dean’s Index; the Thylstrup and Fejerskov Index; the Total Tooth Surface Index; and the Fluorosis Risk Index. Non-specific descriptive indices such as the Developmental Defects of Enamel index have also been used to record fluorosis. Fluorosis has most commonly been recorded using clinical examinations and photographs. Recent developments have seen the use of a Visual Analog Scale and automated grading systems such as Quantitative Light Fluorescence emerge as possible enhancements to fluorosis scoring. This article aims to review existing indices and new methods in measuring dental fluorosis, together with examiner reliability across different methods and indices.

Validation of ICMR index for identification of dental fluorosis in epidemiological studies.

Background & objectives: The Indian Council of Medical Research (ICMR) formulated a Task Force on dental fluorosis and recommended the subgroup to develop a simplified index for identification and grading of dental fluorosis to be used by the health workers. This study was conducted to pre-test the ‘ICMR Index for Dental Fluorosis’ in the field to check its reliability and reproducibility. Methods: A total of 600 photographs were taken, 150 in each grade of fluorosis by screening 14-17 yr school children from eight schools of Hisar (Haryana) and South west Delhi. Eighty photographs were finalized (20 in each grade) before calibration to be used for training of field workers. Calibration exercise was conducted involving the five member survey team on 100 diagnosed cases of dental fluorosis. The members again screened 74 children with dental fluorosis in the field to categorize in to different grades of fluorosis for assessment of inter-examiner reliability. Results: The ICMR criteria showed more difference in agreement in very mild and mild categories during calibration. The inter-examiner reliability (κ) ranged from 0.59-1. The criteria was further modified and inter- examiner reliability (κ) found to be 0.83-0.98 which was almost perfect agreement. Interpretation & conclusions: The tool developed by the ICMR to assess dental fluorosis can be used in a field set up by non-dental personnel reliably with high degree of reproducibility.

A Comparative Study on the Inter-Session and InterExaminer Reliability of Corneal Power Measurement Using Various Keratometry Instruments

The purpose of this study was to evaluate inter-session repeatability, inter-examiner reproducibility and inter-device agreement of corneal power measurements from manual keratometer, autokeratometer, topographer, Pentacam high resolution and IOLMaster. Methods: Two sets of mean corneal power measurements (n=40) were compared for inter-session repeatability and inter-examiner reproducibility in each instrument. Repeatability and reproducibility were evaluated by within-subject standard deviation (Sw), coefficient of variation (COV) and intraclass correlation coefficient (ICC). A oneway repeated measures analysis of variance was conducted to compare differences in the corneal power between each instrument pair. The Bland and Altman analysis and Pearson’s correlation were employed to assess agreement and determine strength of relationship between measurements. Results: There were no significant differences in mean corneal power measurements between 2 different visits (p > 0.05). The Sw and COV values between 2 visits were lower than 0.09 D and 0.20 % respectively. The ICCs were stronger than 0.99 in all instruments. For reproducibility of each instrument, differences of the measurements between 2 different examiners were also insignificant (p > 0.05). The Sw and COV values between 2 examiners were lower than 0.11 D and 0.23 % respectively. The ICCs were 0.99 and above in all instruments. The 95% limit of agreement between instruments ranged from -0.29 to 1.13 D and the r-values were stronger than 0.84. Conclusion: The corneal power measurements using these 5 instruments were repeatable and reproducible. These instruments can also be used interchangeably, however the topographer should be used with caution.

Oral Assessments in Postgraduate Exit Examinations in Forensic Medicine: a Point of View from Sri Lanka.

Postgraduate education, training and assessment in Forensic Medicine in Sri Lanka are managed by the Postgraduate Institute of Medicine (PGIM), University of Colombo. There are several components in the postgraduate examinations; theory, clinical case presentation, a full autopsy and presentation, Objective Structured Practical Examination (OSPE), Histopathology component and a viva voce examination where a pass grade is compulsory in each component. This includes the 20 minute viva voce examination as well. The viva voce can be used to test intellectual processes such as decision making and justification of opinions; abilities paramount to an effective expert medial witness. However, it has been dropped by many Examination Boards due to several shortcomings. Poor inter examiner reliability is one example that has been quoted as a serious drawback. Certain measures can be taken to increase the validity and reliability of the viva voce, some of which have been introduced in Sri Lanka by the Board of Study in Forensic Medicine, PGIM. Improvements to the viva voce should be an ongoing process. This paper will 1) discuss the value of the viva voce in postgraduate examinations in Forensic Medicine, 2) study its pass/fail reliability as a compulsory component, 3) examine how its shortcomings could be overcome, 4) examine the evolution of the viva voce in postgraduate examinations in Forensic Medicine in Sri Lanka and 5) make recommendations for the future.

Valoración de casos de habeas corpus, en la clínica médico forense del poder judicial, Costa Rica / Rating habeas corpus cases in forensic medical clinic judiciary, Costa Rica

En la Sección Clínica Médico Forense del Departamento de Medicina Legal se valoran pacientes enviados por la Sala Constitucional por interposición de Recursos de Hábeas Corpus, ésto, debido a las presuntas lesiones causadas por parte de funcionarios de alguna Autoridad Estatal. Este artículo pretende revisar qué es un Recurso de Hábeas Corpus y cómo se elabora, al unísono la relación directa con la valoración médico forense y las conclusiones médico legales respectivas, por lo que ejemplificamos un caso real de la Sección supra mencionada.

In Sección Clínica Médico Forense of Departamento de Medicina Legal we valued clients referred by the Constitutional Court by filing habeas corpus, this, because the alleged injuries caused by officials of any state authority. This article reviews what is a writ of habeas corpus and how it is produced, together with the direct and forensic evaluation forensic respective conclusions, so that exemplify a real case of above mentioned Section.

Historical Development of Forensic Pathology in the United States / 대한법의학회지

While forensic pathology has become a vital tool in solving crime over recent years, it remains a vague term to many criminal justice practitioners. Chronicling the development of autopsy and forensic pathology in the United States will introduce this modern field. An examination of forensic pathology will also explain how its role has evolved to accommodate legal and civil issues. The utility of forensic pathology extends well beyond the medical realm by affecting the core of the medicolegal investigative system in the United States.

Introduction to aerospace medicine

Recent reports show that over 2 billion people are travelling via air every year, and the number of countries involved in space exploration is growing. Aerospace medicine, one of the specialty areas in preventive medicine, focuses on the clinical care, research, and operational support of the health, safety, and performance of crewmembers and passengers of air and space vehicles. Flight surgeons are military medical officers who play an important role in these tasks. The civilian equivalent of the flight surgeon is the aviation medical examiner (AME). Among the challenges that we encounter at high altitudes are a change in pressure, noise, spa-tial disorientation, and acceleration. We should also overcome microgravity and radiation in space. The common in-flight medical emergencies are abdominal pain, diarrhea, chest pain, coll-apse, asthma, diabetes, and allergic reactions. There is only one aerospace medical institute, the Aerospace Medical Center, in the Republic of Korea. The Aerospace Medical Association of Korea, established in 1989, continues to grow. In the near future, aerospace medicine will be an important part of preventive medicine in the Republic of Korea.

Medicolegal Death Investigation System in America / 대한법의학회지

Medicolegal death investigations in the U.S. have become a critical part of crime investigations over the past several decades. additionally, the roles of medical examiners (MEs) and coroners have expanded beyond the field of criminal justice in recent years. despite the fact that these roles are becoming increasingly more important a systematic and comprehensive study of this complicated system is yet to be conducted. Since there is no national standard or federal system, medicolegal death investigations vary across states, districts, and counties in the U.S. In this paper, we attempted to classify the systems into three categories. We also examined the roles and work procedures that MEs and coroners commonly share across the country as well as the problems and challenges that the medicolegal death investigation system is facing today. In addition, we have also provided a brief summary of the Korean system in order to add a comparative perspective, since the Korean legal system differs substantially that of the U.S.

Developmental Dysplasia of Hip Screening Using Ortolani and Barlow Testing on Breech Delivered Neonates

Introduction: We conducted this study to compare the specificity and sensitivity of the Ortolani and Barlow tests performed by dedicated examiners, and to ascertain the incidence of developmental dysplasia of the hip (DDH) in breech babies. Methods: A dedicated examiner underwent specific training and testing by a paediatric orthopaedic surgeon. Routine examiners were medical officers who had basic training in medical school and were briefly trained by their superiors. The dedicated examiner examined 170 babies. Thirty babies including 5 babies with positive tests (according to the dedicated examiner) were examined by a blinded routine examiner. Results of Ortolani and Barlow tests on 30 babies were compared with ultrasound examination by blinded radiologist. Results: Five babies had positive Ortolani and Barlow tests. The routine examiner did not detect positive Ortolani and Barlow tests. Conclusion: The incidence of positive Ortolani and Barlow tests among breech babies was 2.8%. Result of Ortolani and Barlow tests by dedicated hip screener were better than results performed by routine examiner.

Diagnóstico de cárie secundária e substituição de restauração / Diagnosis of secondary caries and substitution of restoration

O objetivo deste estudo foi avaliar o grau de concordância entre Odontopediatras e Clínicos gerais quando ao diagnóstico de cárie secundária e substituição de restaurações em molares decíduos. Para isso, examinaram um quarenta (40) molares decíduos restaurados. Em seguida responderam a um questionário com três perguntas: 1. Em sua opinião existe cárie neste dente? 2. Em sua opinião essa restauração deveria ser substituída? 3. Caso sua resposta seja positiva, qual ou quais os motivos da substituição? O teste Kappa evidenciou um nível de concordância leve 0,14 (p<0,05) entre os Odontopediatras e Clínicos quanto ao diagnóstico de cárie secundária. Quanto a decisão de substituir ou não a restauração e qual o motivo, a concordância foi sofrível 0,28 (p<0,05) e 0,32 (p<0,05), respectivamente. Concluiu-se que entre os Odontopediatras e os Clínicos gerais houve divergência quanto ao diagnóstico e decisão de substituição de restauração; a cárie secundária foi o principal motivo da substituição. Existe a necessidade de estabelecer critérios para o diagnóstico de cárie secundária e substituição de restaurações.

The aim of this study was to evaluate the agreement degree between Pedodontist and General Dentist about the diagnosis of secondary caries and the restoration replacement in primary molars. One group of Pedodontist and another group of general practioners evaluated 40 restored primary molars. In the following stepe each examinator had to answer a questionary, which had three questions: 1. In your opinion, is there caries in this tooth? 2. In your opinion, should this restoration be replaced? 3. If your answer is positive, what are the reasons for the replacement? The Kappa statistics indicated a light level of agreement 0,14 (p<0,05) between Pedodontist and General Practitioners about the diagnosis of secondary caries. About the replacement decision of the restoration and the reason for it, the agreement was critical 0,28 (p<0,05) and 0,32 (p<0,05), respectively. It was concluded that there was divergency about the diagnosis and the replacement decision of restoration among the Pedodontists and Clinical Practitioners; the secondary caries was the main reason for the replacement. There is a need to establish criterials to judge the diagnosis of secondary caries and replace the restorations.

Title Assessment of 76 Cases of Bathing Accidents with Consciousness Disorder on Arrival at the Hospital / 日本温泉気候物理医学会雑誌

  Content We investigated 76 cases during the 6-year period from 1999 to 2005 in which a patient who developed a consciousness disorder while bathing was brought to the Emergency and Critical Care Center of Tokyo Women's Medical University Medical Center East. In. 86% of the cases the patient was in cardiopulmonary arrest, and they had a group of diseases with a poor prognosis in which the outcome was death, even the 6% of the patients who were resuscitated.<BR>The most common age group was the 70-to 79-year group, which contained 46% of the patients, and those 70 years of age and older accounted for 70% of the total.<BR>  Examination was possible in 16 cases, and the most common category, in 10 of them, was “drowning/suspicion of transient ischemic attack”. Adequate examinations were not performed on the patients who died in the outpatient department. Moreover, because the autopsy rate was low, it was impossible to make a definitive etiological diagnosis. However, the fact that “many were elderly persons whose autonomic nervous system's regulatory function is reduced” and that “the incidence was highest during the winter (53% during the 3 months from December to February)” suggests involvement of cardiovascular and cerebrovascular diseases secondary to changes in blood pressure. Many preventive measures have been described in the literature, and improvement in the resuscitation rate is expected as a result of becoming familiar with. and thoroughly implementing them. All 10 cases that occurred in public baths, where the time before discovery should have been short, were cases of cardiopulmonary arrest, and it is impossible to clearly explain why resuseitation attempts failed in all 10 of them. In order to identify the causative diseases we think it would be worthwhile to consider 1) performing a whole-body CT examination after confirming death, and 2) perforrning open-chest cardiac massage (only in patients brought to the hospital within a short time).

Is there any necessity of preservation of viscera even in cases where cause of death is already determined: A discussion.

During autopsy different viscerae are collected and preserved mainly for chemical examination to ascertain the cause of death. But many a times viscerae is preserved even in cases where cause of death is known. Police and prosecution side often question the merit of preservation of viscerae in such cases because defence lawyer often take this as opportunity to delay the prosecution till the Chemical Examiner’s report is available. Most of the time Chemical Examiner’s report is much delayed and sometimes West Bengal State Forensic Science Laboratory even refuse to accept the viscerae for chemical examination particularly where cause of death is given in P.M.report. In N.R.S. Medical College, Kolkata center around 3500 post mortem examinations are being done annually, on requisitions from Kolkata Police [K.P.], West Bengal Police [WBP] and General Railway Police (GRPS). Kolkata Police in almost all their requisitions request to preserve viscera and other medicolegal articles. An analysis was done on police requisition paper and autopsy report to find out the logical scientific solution.

Operational Status of Airman Medical Examinations in Korea / 항공우주의학회지

OBJECTIVES: International Civil Aviation Organization (ICAO) strongly supports that AME (Aviation Medical Examiner) system. AMEs are private physicians, trained and authorized by the government to perform airman medical examinations and to issue or deny medical certificates. In Korea, AME system was introduced in 2000. As of December 31, 2006, there were 48 AMEs in Korea. Applications for airman medical certificate which contain the results of the medical examination conducted by an AME, are typically forwarded to the advisory committee of Aerospace Medical Association of Korea. With a increasing demand for air travel, the number of civil airman population has increased, as a result, airman medical examinations have also increased. Although the number of airman medical examinations are increasing, research related to this field is nil. The purpose of this study was to examine the operational status of airman medical examinations in the calendar year 2006. METHODS: The data were based on the total reported applications of airmen medical certificate collected in the Aerospace Medical Association of Korea in the calendar year 2006. And all data were examined according to the three categories, which are fit, waiver, and deny. RESULTS: The total data were 5,713 airman medical examinations which were collected in the calendar year of 2006. This total included 5,292 applications for first class, 162 for second class, and 216 for third class medical certificates. The number of medical certificate issued were 5,010 as fit, 680 as waivers, and 23 as denials. The majority for waivers was consisted of cardiovascular diseases, otorhinolaryngologic and ophthalmologic diseases. Denials were due to phoria, refractive eye surgery, diabetes, and/or coronary artery disease. CONCLUSION: Some of the denials were made because of the failure to submit required subsequent evaluation reports to the advisory committee of Aerospace Medical Association of Korea. The consequence of negligent or wrongful certification which would permit an unqualified person to take the controls of an aircraft. may result in mishap. For proper issuance of airman medical certificate, the establishment of a guidebook for AME is necessary and database of previous medical records is required. Aeromedical standard is an important factor in flight safety. Therefore, in order to update on aeromedical standards in accordance with evidence-based medicine, more aeromedical research is required and its research findings should be reflected in the revision of standards of airman medical examination in the future.

Correlation between postmortem diagnosis and survival time in poisoning deaths.

Every deaths resulting from poisoning has to be investigated to establish cause of death. Difficulties in clinical diagnosis of poisoning cases is well known because many a time they present with non specific symptoms and signs or the features may simulate natural disease process. Same with Forensic Pathologist as many times postmortem findings are nonspecific. Some poisons are retained in the body for long time after deaths while others may be rapidly destroyed during metabolic activity. This study was undertaken to find out effect of survival time on the postmortem findings, and on chemical analysis of body tissue and body fluids in poisoning deaths. In majorities of cases death was due to insecticides. Toxicological report showed positive for poison in 70% of cases. Kerosene smell, which is present in Organophosphorus poisoning, is present maximum upto three days. Chemical analysis report showed positive in 94% of cases in first three days. There after chance of detection of poison in routine viscera decreases upto 50%. Suggestions have been made for postmortem diagnosis in poisoning victims.