A comparison of the objective structured clinical examination results across campuses of the University of the West Indies (2001 and 2002) / Una Comparación del Examen Clínico Objetivo Estructurado Resultados en los Campus de la Universidad de West Indies (2001 y 2002)

OBJECTIVE: To compare the performance of medical students in the Objective Structured Clinical Examination (OSCE) of thefinal MBBS Examination across the four campuses of The University of the West Indies, over a two-year period DESIGN AND METHODS: All final examination results of the Medicine and Therapeutics OSCE were collectedfrom the Faculty of Medical Science at the four campuses of The University of the West Indies and analyzed using both parametric (t-tests and ANOVAs) and non-parametric tests (chi-squared tests). RESULTS: Results indicated that students achieved significantly higher mean scores in the 2002 examination than in 2001 (t = 3.85, df = 415, p = 0.000). There were no significant differences between campuses with regards to the mean corrected score in 2001. Also in 2001, in adult stations, all campuses achieved significantly higher scores than Jamaica. However, in Jamaica, mean child health station scores were significantly higher than all other campuses and, the mean score in Trinidad and Tobago was higher than the Bahamas and Barbados. In 2002, all other campuses achieved significantly higher scores than Trinidad and Tobago and females performed significantly better than males with regards to overall mean scores (t = 2.814, df = 189, p = 0.005). Also in 2002, Barbados achieved significantly higher mean corrected scores than Trinidad and Tobago (F = 4.649, df = 3191; p = 0.004) and Barbados and Trinidad and Tobago both obtained significantly higher mean child health station scores than Jamaica. CONCLUSIONS: The important conclusion from this study is that the OSCE scores in Medicine and Therapeutics are generally uniform across the four campuses of the University, thereby confirming the consistency of the approach to teaching and helping to validate the efficacy and veracity of the medical graduate being produced by The University of the West Indies

Objetivo: Comparar el rendimiento académico de los estudiantes de medicina en el examen clínico objetivo estructurado del examen final de MBBS, en los cuatro campus de La Universidad de West Indies, en un período de dos años. Diseño y métodos: Se recopilaron todos los resultados del examen final de ECOE de Medicina y Terapéutica de la Facultad de Ciencias Médicas, en los cuatro campus de la Universidad de West Indies. Los datos fueron analizados usando tanto tests paramétricos (tests t y ANOVAs) como tests no paramétricos (tests de chi-quadrado). Resultados: Los resultados indicaron que los estudiantes alcanzaron puntuaciones significativamente más altas en el examen del 2001 que en el del 2002 (t = 3.85, df = 415, p = .000). No hubo diferencias significativas entre los distintos campus con respecto a los resultados corregidos promedios 2001. También en 2001, en las unidades asistenciales de adultos, todos los campus lograron resultados significativamente más altos que Jamaica. Sin embargo, en Jamaica, los resultados promedios de las unidades pediátricas fueron significativamente más altos que en todos los otros campus, y el resultado promedio en Trinidad y Tobago fue más alto que en Bahamas y Barbados. En 2002, todos los otros campus lograron resultados significativamente más altos que Trinidad y Tobago, y las mujeres obtuvieron rendimientos significativamente mejores que los de los hombres, con respecto a los resultados promedios generales (t = 2.814, df = 189, p = .005). También en 2002, Barbados alcanzó resultados corregidos promedios significativamente más altos que Trinidad y Tobago (F = 4.649, df = 3,191; p = .004), mientras que Barbados así como Trinidad y Tobago, obtuvieron resultados significativamente más altos en la unidades pediátricas, en comparación con Jamaica. Conclusiones: La conclusión principal de este estudio es que los resultados del OSCE en Medicina y Terapéutica son generalmente uniformes en los cuatro campus de la Universidad, confirmando de ese modo la solidez del enfoque de la enseñanza, y contribuyendo a validar la eficacia y calidad del graduado de medicina egresado de la Universidad de West Indies.

Fifty years of clinical examinations at the University of the West Indies

The University of the West Indies was founded at Mona, Jamaica, in 1948. After fifty-two years, the format of the final Bachelor of Medicine clinical examination in Medicine and Therapeutics has been radically revised. The change from the traditional to an evidence-based, objective structured clinical examination (OSCE) was undertaken in November/December 2000. Assessment drives learning and both the methods chosen for assessment and the manner in which they are applied determine how students learn. The philosophical underpinnings of the change in format are discussed in this paper.

Renal replacement by regular haemodialysis therapy and renal transplantation in Barbados: 1979 to 1997

We have reviewed our delivery of highly sophisticated medical therapy, haemodialysis and renal transplantation in a Caribbean setting. The purpose has been to reflect local outcomes in relation to mortality and survival, but comparisons with a vastly larger database have been attempted. Such comparisons are extremely difficult due to methodological differences and the fact that facilities contributing to that database vary considerably with regard to patient age, gender, ethnicity and comorbidity. Nonetheless, the crude data available provide important justification for the existence of regular haemodialysis and its adjunctive therapy of renal transplantation in the Caribbean.

Neuroleptic malignant syndrome among acute psychiatric admissions in Barbados

The main features of the Neuroleptic Malignant Syndrome (NMS), a complication of neuroleptic therapy, are fever, muscle rigidity, autonomic dysfunction, and an alteration in consciousness level. We describe five cases of NMS comprising 0.6 per cent of acute neuroleptically-treated admissions to a psychiatric hospital over a one-year period. All patients, four females aged 26 to 63 years, and one male, aged 65 years, were of African origin and received multiple neuroleptic drugs, at least one of which was a depot preparation. Four were being treated for functional psychiatric disorders while one had dementia. All patients had fever and depressed consciousness level while four had rigidity and autonomic dysfunction. Serum creatine phosphokinase was elevated in 4 cases, and there was indirect evidence of myoglobinuria in 3 cases suggested by a positive urine dipstick test for blood despite the absence of red cells on microscopy. Rhabdomyolysis was associated with renal failure in one case. Both bromocriptine mesylate and dantrolene sodium were given in two cases. Three patients died in hospital, one with persistent rigidity and progressive decubitus ulceration, one from peritonitis following dialysis, and another suddenly. Early recognition of NMS is important; it should be considered in any patient on neuroleptic therapy who develops fever, rigidity or alteration in consciousness level.

Hypoglycaemia in chronic renal failure

Persistant symptomatic hypoglycaemia devceloped in a 26-year-old woman with chronic renal failure. Several factors, including the use of sulfametethroxaole, recent peritonresl dialysis, and poor nutrition may have combined with defective glycogenolysis and gluconeogenesis present in chronic renal failure to play a role in its aetiology. Increases awareness of this condition is necessary because chronic renal failure is common in the Caribbean.

Leptospirosis in Barbados: a clinical study

A 39-month clinical study of leptospirosis was undertaken at the Queen Elizabeth Hospital, Barbados, Eighty-eight patients had a confirmed diagnosis of the disease during the period. The major serogroups identified were autumnalis (including a new serovar bim), icterohaemorrhagiae, ballum and canicola. The majority of patients presented with jaundice (95%,) anorexia and headaches (85%), fever (76%) and conjunctival suffusion (54%). While abnormal creatinine levels were seen in 49% of patients on admission, only 16% were judged to have had renal failure. The urine to plasma urea ratio showed high sensitivity and specificity in the diagnosis of pre-renal azotemia. Cardiac arrhythmias and myocarditis occurred in 18% of patients and pericarditis in 6%. An elevated serum amylase was found in 65% of cases. The bilirubin level took 5.5 weeks to return to normal. Thrombocytopenia was shown not to be due to a disseminated intravascular coagulation, and a randomised trial of high dose penicillin did not reveal any benefit to jaundiced patients. The overall mortality during the study was 5.7%

Urinary diagnostic indices in the management of leptospirosis: selection of patients for dialysis therapy

Cases of leptospirosis admitted to the Queen Elizabeth Hospital (QEH), Barbado, were assessed for the presence of "pre-renal azotaemia" (NON-ARF) as opposed to "acute renal failure" (ARF). Distinction between the two diagnoses was made on the basis of clinical course. Peritoneal dialysis was inappropriately utilised in 26% of patients receiving such therapy. This study evaluates diagnóstic tests for pre-renal azotaemia, and acute renal failure in leptospsirosis, and indicates guidelines for the management of azotaemia in such patientes. U/P urea and osmolar ratios show high sensitivity in diagnosing pre-renal azotaemia. While "early" dialysis is essential for patients with acute leptospiral renal failure, in those with plasma creatinines less than 600 micronmol/litre on entry and indices indicating NON-ARF, decisions regarding dialysis con safely be delayed for 48-72 hours while the effect of rehydration is assessed

Membranous glomerulonephritis and the nephrotic syndrome in a patient with Landry-Guillain-Barré-Strohl syndrome

Membranous glomerulonephritis and the nephrotic syndrome concurrent with the Miller-Fisher variant of the Landry-Guillain-Barré-Strohl syndrome (LGBS), acute post-infective polyneuritis, is reported in a 49-year-old man. The onset of heavy proteinuria coincided with the development of the neurological disturbance. While immunosuppressive therapy appeared to hasten improvemente in the neurological disease, no such improvemente occurred in the glomerulopathy

Coexistence of Porphyria cutanea tarda and systemic lupus erythematosus

The association of porphyria cutanea tarda with a well-documented case of systemic of systemic lupus erythematosus is reported. Renal histopathology is presented. Both conditions have been quiescent during the past year of follow-up