Management of esophagcal varices at Suratthani Hospital.

This is a retrospective study of 279 patients with bleeding esophageal varices in the medical department of Suratthani Hospital from 1 July 1996 to 30 April 2003. All patients were treated with endoscopic interventions (endoscopic sclerotherpy and/or rubber band ligation). The patients consisted of 67% men, and had an average of 54.9 years. Underlying diseases included liver cirrhosis (98.2%) and was alcoholic cirrhosis (59.5%), Child Pugh class B and C (77.7%), and EV grade III (62.1%). Clinical bleeding was considered moderate to severe upper GI hemorrhage in 64.4%) of patients. The patients were already in a high risk group, so mortality the rate was high (22.2%). Secondary prevention of recurrent bleeding with propanolol and endoscopic intervention should be widely used in general hospitals to decrease the rate of rebleeding and increase and increase early detection of esophageal varices in high risk patients.

The validity and reliability of clinical performance assessment of residents in the general surgery residency program.

A retrospective study of clinical performance assessment of residents in the general surgery residency program at the Department of Surgery,Faculty of Medicine Siriraj Hospital, during the 200-2001 and 2001-2002 academic years was done to evaluate the inter-rater reliability, internal structure, and ducational discriminant validity of the assessment. The inter-rater reliabilities were determined by using the intraclass correlation. Correlations between individual performance ratings were checked to determine how well faculty members differentiate their ratings with individual clinical skills. Finally, the percentage of marginal or unsatisfactory ratings was checked to demonstrate how sensitive the ratings were in identifying performance deficiencies among residents. From the evaluation of 42 residents in the 2000-2001 academic year, inter-rater reliability coefficients of individual ratings ranged from 0.06 to 0.93 with an average of 0.51. From the evaluation of 47 residents in the 2001-2002 academic year, inter-rater reliability coefficients ranged from 0.04 to 0.85 with an average of 0.49. Inter-rater reliabilities of performance ratings of third-year residents were at an acceptable standard for a medium-stake assessment. However, those of first and second-year residents should need some improvement. Tasks performed by first and second-year residents seem to have been inadequate for faculty members to evaluate their performance reliably. The correlation study between individual performance ratings demonstrated the lack of discrimination between many clinical skills in faculty ratings. Faculty members need some guidelines to differentiate between many items including relationship with patients, relationship with other doctors, and relationship with other workers; knowledge and judgment; work concentration and work effectiveness; and punctuality and responsibility. About ten percent of ratings were marginal or unsatisfactory which indicated that these ratings were sensitive enough to identify performance deficiencies among residents.

A Trial of Surgical Clerkship for Developing Clinical Competency

PURPOSE: The surgery clerkship, focusing on the clinical competency, including critical thinking, problem solving, self-directed learning, autonomy and professionalism, were revised. The purposes of this study were to evaluate the students' assessment of the revised surgery clerkship program in order to improve the quality of surgical education. METHODS: Clinical competency was classified into 6 dimensions: intelligence, skill, relationship, attitude, problem solving performance, and autonomy. Problem based learning (PBL), procedural skill training, surgical anatomy, case discussion, pre-diagnosis at outpatient clinics, quiz, clinical performance assessment (CPA) and modified essay question (MEQ) were performed. Forty-nine 3rd year medical students participated during 2002. All students were asked to rate how far they had progressed in the 6 dimensions, in order to evaluate the course, and each program, and to suggest improvements at the end of the rotation. RESULTS: The students responded extremely positively and became been more motivated. They evaluated that the new clerkship had helped them increase their abilities in clinical reasoning, self-directed learning, problem solving and clinical techology, and to develop professionalism and autonomy. Most of students revealed that the PBL, case discussion, pre-diagnosis at outpatient clinics, CPA and MEQ programs were very helpful. They felt that procedural skill training and surgical anatomy programs required further improvements. CONCLUSION: The implementation of the new surgery clerkship was successful. The PBL, case discussion, pre-diagnosis at outpatient clinics, CPA and MEQ were valuable learning tools. More tools should be developed for procedural skill training and surgical anatomy education.

A Trial of Surgical Clerkship for Developing Clinical Competency

PURPOSE: The surgery clerkship, focusing on the clinical competency, including critical thinking, problem solving, self-directed learning, autonomy and professionalism, were revised. The purposes of this study were to evaluate the students' assessment of the revised surgery clerkship program in order to improve the quality of surgical education. METHODS: Clinical competency was classified into 6 dimensions: intelligence, skill, relationship, attitude, problem solving performance, and autonomy. Problem based learning (PBL), procedural skill training, surgical anatomy, case discussion, pre-diagnosis at outpatient clinics, quiz, clinical performance assessment (CPA) and modified essay question (MEQ) were performed. Forty-nine 3rd year medical students participated during 2002. All students were asked to rate how far they had progressed in the 6 dimensions, in order to evaluate the course, and each program, and to suggest improvements at the end of the rotation. RESULTS: The students responded extremely positively and became been more motivated. They evaluated that the new clerkship had helped them increase their abilities in clinical reasoning, self-directed learning, problem solving and clinical techology, and to develop professionalism and autonomy. Most of students revealed that the PBL, case discussion, pre-diagnosis at outpatient clinics, CPA and MEQ programs were very helpful. They felt that procedural skill training and surgical anatomy programs required further improvements. CONCLUSION: The implementation of the new surgery clerkship was successful. The PBL, case discussion, pre-diagnosis at outpatient clinics, CPA and MEQ were valuable learning tools. More tools should be developed for procedural skill training and surgical anatomy education.

An Experience of OSCE for Introducing Clinical Performance Assessment to Korean Medical Licensure Examination / 한국의학교육

BACKGROUND: Evaluation of clinical performance is an essential area of Medical Licensure Examination. Yet, clinical skills has been neither uniformly well taught nor adequately assessed. This study was done as a part of preliminary study to introduce clinical performance assessment to Korean Medical Licensure Examination. The goals of this study were to identify the potential logistic problems and to examine the feasibility of OSCE to Medical Licensure Examination. METHODS: 48 minutes long OSCE, which consist of eight 5-minute stations, was developed. The same examination was administered to students over a four-week period. RESULTS: Total 26 volunteer fourth-year medical students were tested. 11 students were examined at the first administration and the rest of them were evaluated four-week later. Cronbach alpha of the total stations was 0.52. Any big administration problems were not revealed. There was no significant total score difference between early examinee and later ones. Students evaluated the OSCE contents and process positively. CONCLUSION: To acquire more reliable and valid examination, we need to develop more objective checklist and evaluator and SP training.