ABSTRACT
Resumen: Antecedentes: La reconstrucción del ligamento cruzado anterior (LCA) tiene como objetivo la restauración de la anatomía original. El resultado clínico puede ser imperfecto cuando la colocación del injerto no se encuentra en una posición anatómica; además, la reconstrucción del LCA transtibial convencional -que a menudo localiza el injerto lejos de la ubicación anatómica- conduce a un comportamiento biomecánico y cinemática anormal de la rodilla. El objetivo de este trabajo fue comprobar la importancia de la reconstrucción angular del ligamento cruzado anterior durante la sustitución artroscópica y compararla con los resultados funcionales postquirúrgicos. Material y métodos: Se estudiaron 21 pacientes; se aplicó formulario IKDC 2000 de valoración objetiva y subjetiva; evaluación radiográfica en proyección anteroposterior y lateral a 30o de flexión. Se realizó análisis estadístico con P de Pearson, correlacionando la angulación en proyección anteroposterior y lateral de la dirección del injerto y la función subjetiva de la rodilla intervenida, así como la edad y el tiempo de evolución con la función subjetiva de la rodilla intervenida. Resultados: Fueron 21 pacientes de 18 a 56 años, tiempo de seguimiento: de uno a tres años. Evaluación objetiva: 95.24% normales y 4.76% casi normales. Valoración subjetiva promedio: 84.31% (rango: de 70.93 a 97.99%), IC 95%. Ángulo AP: 68.8o, rango: de 62o a 77o. Ángulo sagital promedio: 64.9o, rango: de 58o a 75o. Correlaciones: ángulo en AP y función subjetiva -0.19, ángulo en sagital y función subjetiva -0.54, edad y función subjetiva -0.77, tiempo de evolución y función subjetiva -0.74. Discusión: La reconstrucción angular anatómica del injerto LCA es punto clave para la estabilidad de la rodilla, los pacientes estudiados obtuvieron una dirección más parecida a la del LCA nativo, mejores resultados de estabilidad y función de la rodilla.
Abstract: Background: Reconstruction of the anterior cruciate ligament (ACL) aims to restore the original anatomy. The clinical outcome could be imperfect when graft placement is not in an anatomical position; moreover, the conventional transtibial reconstruction of the ACL often locates the graft away from the anatomical site, leading to abnormal biomechanical behavior and kinematics of the knee. The objective of this work was to assess the importance of the angular reconstruction of the anterior cruciate ligament during arthroscopic replacement and to compare the postoperative functional results. Material and methods: We studied 21 patients to whom the IKDC 2000 form of objective and subjective evaluation was applied; radiographic evaluation in anteroposterior and lateral bending at 30o. We made an statistical analysis with Pearson P, correlating the anteroposterior and lateral angulation of the graft direction and the subjective projection of the operated knee function, as well as age and time of evolution with the operated knee. Results: We included 21 patients of 18 to 56 years of age; follow-up: one to three years. Objective evaluation: 95.24% normal and 4.76% almost normal. Subjective assessment: average 84.31% (range 70.93 to 97.99%), CI 95%. AP angle: 68.8o, range: 62o to 77o. Average sagittal angle: 64.9o, range: 58o to 75o. Correlations: AP angle and subjective function -0.19, angle in sagittal and subjective function -0.54, age and subjective function -0.77, duration and subjective function -0.74. Function average: 84.31%. Discussion: The anatomical angular reconstruction of the ACL graft is key to the stability of the knee; the evaluated patients got a more similar direction to that of the native ACL, better stability and knee function.
Subject(s)
Humans , Adolescent , Adult , Young Adult , Anterior Cruciate Ligament Reconstruction , Anterior Cruciate Ligament Injuries , Knee Joint/anatomy & histology , Postoperative Period , Anterior Cruciate Ligament , Treatment Outcome , Joint Instability , Middle AgedABSTRACT
Background and Objectives: Assessment is a matter of continuing concern for medical teacher as it is supposed to steer student learning. Globally there is an increasing trend to move from subjectivity to objectivity. While the universities are custodial for modifying the examinations system as a summative assessment, what is more important for teachers is to mould their formative assessment. University examinations are criticized to be highly subjective and inadequate for covering full range of topics in Pharmacology. Further there is little scope for providing feedback to the students for continuous learning and improvement. In response to this it was decided to introduce multiple choice questions (MCQs) as a tool for formative assessment. Methodology: In the present study, the multiple choice questions were given along with the subjective questionsfrom the same topic to the students. The main aim was to improve the objectivity in students’ assessment by introducing MCQs as a formative assessment tool. To evaluate the affectivity of this pattern of assessment from the student’s viewpoint, we designed a feed back questionnaire which was analyzed. The MCQs were evaluated by doing Item analysis. Results: The overall feedback revealed that 89% of the students were of opinion that MCQs preparation and examination helped them in learning the subject, self studying, reasoning and enhancement of clinical skills. The present study also clearly indicates that MCQs alone are not sufficient to assess learning and should be used along with subjective tests. Conclusion: To make testing and assessment both fair and consequently valid, MCQs should be used strategically to test important subject content and it should be aligned with subjective tests.
ABSTRACT
Resumo: Neste trabalho, descrevemos os resultados da aplicação, do exame clínico objetivo estruturado por estações, com emprego de pacientes padronizados, para avaliação final de 41 estudantes que concluíram a disciplina de Semiologia Geral da Faculdade de Medicina de Ribeirão Preto . Foram construídas 6 estações, com duração de 6 minutos cada, para avaliação de aspectos da tomada da história clínica em pacientes simulados e da realização do exame clínico em pacientes reais. Uma semana após o exame, os estudantes responderam a um questionário com itens sobre sua percepção da prova. A aplicação destes métodos permitiu a obtenção de informações muito detalhadas, tanto sobre o desempenho geral dos estudantes, como sobre virtudes e defeitos da disciplina que os mesmos haviam acabado de cursar. A percepção dos estudantes sobre aspectos gerais do exame, como seleção de tarefas, casos e conteúdos foi satisfatória. No entanto, relataram dificuldades importantes com o controle do tempo em cada estação e referiram que o exame foi muito estressante. Estes fatores, que podem estar ligados a aspectos de ordem cultural mais amplos, devem ser levados em consideração quando da introdução, em outros centros, destes métodos inovadores de avaliação de habilidades clínicas, já consagrados em outros países.
Summary We describe the application of an Objective Structured Clinical Examination (OSCE) Standardized Patients (SP) for the assessment of basic clinical skills of Junior medical students at Ribeirão Preto Medical School. This OSCE comprised 6 stations lastng 6 min each. Two stations were staffed by Sps for evaluation of history-taking skills. The other stations had real patients with true signs, for assessment of physical examination skills. Performance of the examinees was evaluated by faculty members using detailed checklists. One week later, students answered a questionnaire with items on their perception of the examination. Faculty members were impressed with the quality of the information provided by the exam, which allowed them to confidently discriminate students regarding their performance level. Also, the assessment revealed a number of flaws in the course, which prompted the relevant corrections backed by objective data. Students were fairly comfortable with clinical cases, tasks and contents, but reported serious difficulties with time management and regarded the examination to be remarkably stressful. These factors, which might be associated with broader cultural aspects, should be taken into consideration when running OSCEs for the first time.
ABSTRACT
Resumo Neste trabalho, descreve-se a sistemática adotada para a aplicação, de dois métodos inovadores de avaliação objetiva de habilidades clínicas. A técnica de exame clínico objetivo estruturado por estações, com o uso de pacientes padronizados, foi preparada para ser aplicada na avaliação final dos estudantes que concluirem uma disciplina que visa ensinar a realização da Observação Clínica (Anamnese e Exame Físico) na Faculdade de Medicina de Ribeirão Preto. Foram elaboradas 6 estações com duração de 6 minutos cada. Duas estações foram ocupadas por pacientes simulados, para avaliação de tomada de história clínica. As 4 estações restantes foram ocupadas com pacientes reais para a avaliação de aspectos do exame físico. Em todas as estações previu-se também, avaliar a interação do estudante com os pacientes. Nas 4 estações de exame físico, o estudante tem, ainda, que responder a questões breves sobre os achados encontrados. O desempenho dos estudantes em cada estação será avaliado por docentes com o emprego de protocolos de observação estruturados e padronizados, cujos conteúdos são descritos neste artigo.
Summary: We describe the procedures adapted for the application, of an Objective Structured Clinical Examination (OSCE) using Standardized Patients (SP) for the assessment of basic clinical skills of junior medical students at Ribeirão Preto Medical School. This OSCE comprised 6 stations lasting 6 min each. Two stations were staffed by Sps for evaluation of history-taking skills. The other stations had real patients with true signs, for assessment of physical examination skills. Performance of the examinees was evaluate by faculty members using detailed checklists, the contents of which are fully described in this paper.
ABSTRACT
It is well known that even examinees with incomplete knowledge can figure out the correct answer on an objective test. The Examination Committee of the Ministry of Health concluded that objective tests using answer code (K type questions) can not adequately evaluate an examinee's knowledge. For this reason, the Committee recommended using X2 or X3 type questions on the national board examination instead of K type questions. The X2 type question is a multiple true-false method of testing with 2 true and 3 false items.<BR>I believe that the Committee has been mislead, since the X2 type question is really a test with ten answer codes, and an examinee with incomplete knowledge can still figure out the correct answer for it.
ABSTRACT
The X2 type question consists of a multiple true-false method of testing, with 2 true and 3 false items. Its standard score rate is 56.6%, and its accidental score rate is 10%. Since the standard score rate of the present national board examination is almost 71%, the number of unsuccessful examinees will increase when the X2 type question is used while maintaining the same passing mark. Quantitative analysis shows that the score rate of X2 type questions is determined mostly by correct thinking on the most difficult true item and the most difficult false item. These results are important to the development of future examinations using X2 type questions.