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.

Predictive power of resident selection criteria for clinical performance in general surgery residency.

To evaluate the ability of the resident selection criteria to predict clinical performance of general surgery residents, the application files and resident evaluations of 35 general surgery residents who were in the residency program of the Department of Surgery, Faculty of Medicine Siriraj Hospital during the 2000- 2001 and 2001- 2002 academic years were reviewed. A correlation study was done using scores from three selection criteria (medical school grades, letters of recommendation, and interview) predictors and clinical performance ratings as outcomes. The interview scores were the best predictor for overall performance of residents in the first and second years. The GPA scores were the best predictor for overall third–year performance. Each selection criterion contributed unique predictive ability for resident performance. The combination of interview scores, scores from letters of recommendation, GPA scores, and ages at admission could predict 60.5% of the total variance in the overall first-year performance scores (R=0.778, p=0.012). The combination of interview scores and score from letters of recommendation could predict 31.4% of the total variance in the overall performance score in the second year (R=0.56, p=0.049). None of the multiple regression models demonstrated statistically significant prediction for the third-year overall performance.