Developing a Two-Tier Diagnostic Test to assess Arterial Blood Gases learning by students with different background knowledge in Anesthesiology.

Objectives: To develop a two-tier diagnostic test in medical education on the analysis of arterial blood gases (ABGs) by students with different background knowledge in anesthesiology, using a concept and knowledge map to determine table of specifications together with an open discussion and a feedback-providing method. Methods: A research and development study in which the developed diagnostic test was assessed for its efficiency by first-year residents, preclinical medical students and nurse anesthetist students who volunteered to join the project. Results: There were four major misconceptions in ABGs: First, they could not clarify the significance and relationship of the symbols. Second, they could not remember the formulas and use them appropriately. Third, they did not understand the analytical steps and lacked knowledge for clinical interpretation. Fourth, they could not apply the logical results as a guideline for patient management. Medical and nurse anesthetist students had problems mainly on the third/fourth misconceptions and partly on the first/second misconceptions. Nevertheless, residents had problems mainly on the fourth misconception and partly on the third misconception. The assessment of criterion-referenced test item difficulty, discrimination and reliability (internal consistency) was 0.59, 0.38 and 0.91 respectively. The item objective congruency (IOC) of the test was equal to 0.88. Conclusions: Using a concept and knowledge map to define the table of specifications in ABGs concepts together with an open discussion and feedback-providing method helped facilitate the scope of developing a two-tier diagnostic more practical test. Teachers can assess misconceptions of students with different background knowledge in a short period of time and have guidelines to improve pedagogy in response to their eagerness for learning.

EMLA cream and intraperitoneal lidocaine decrease intraoperative pain during postpartum tubal sterilization.

We conducted a randomized, double blinded, placebo controlled trial to evaluate the effectiveness of EMLA cream together with intraperitoneal lidocaine for pain relief in postpartum tubal ligation. In a factorial designed study, 90 postpartum patients were randomly assigned to have 5 g of EMLA or placebo cream applied to the skin in 2 groups of 45 patients and to have intraperitoneal instillation of 20 ml of either 1 per cent, 2 per cent lidocaine or normal saline in 3 groups of 30 patients. A numerical rating pain score (0-10) was used during skin check, skin infiltration and uterine tube manipulation. The pain scores were significantly lower in the EMLA group as compared with the placebo group during the skin forceps check (p < 0.001) and during local skin infiltration (p < 0.05). The pain scores were also significantly lower during intraabdominal manipulation in the group using either 1 per cent or 2 per cent intraperitoneal lidocaine as compared with the group using normal saline (p < 0.001), but no difference was found between the groups using 1 per cent and 2 per cent lidocaine. IMPLICATIONS: Five g of EMLA cream applied to the skin together with 20 ml of 1 per cent lidocaine instilled into the abdominal cavity effectively decrease intraoperative pain in patients undergoing postpartum tubal sterilization under local anesthesia.