Breast Examination Instruction by a Standardized Patient Instructor / 한국의학교육

PURPOSE: The purpose of this research was to identify the effectiveness of a standardized patient (SP) instructor. The study was performed to compare the effects of two types of instruction on breast examination skills by an SP instructor and a professor. METHODS: Fifty-four medical students in the third year and 4 SPs participated in the study. In a pretest, each student was judged by the SP individually in performing a breast examination and completed a questionnaire about perception. Next, students were randomly assigned to 2 experimental groups (small-group instruction by an SP instructor or professor). A posttest of performance and perception was administered using the same procedures as in the pretest. To identify the effectiveness of the SP instructor, differences in student scores between the groups were analyzed by t-test. RESULTS: In the posttest of student performance on the breast examination, there was no significant difference between the groups (p=0.270). With regard to student perception, scores on self-confidence in the breast examination were significantly different (p=0.026) between the groups, of which students who received instruction from the professor showed a higher level. Additionally, there was a significant effect on students' perceived reliability of instruction by the SP instructor (p=0.011), and students who were instructed by the SP demonstrated higher reliability compared with professor-taught students. CONCLUSION: Instruction by an SP instructor has the same effectiveness as instruction by a professor. SP instructors have very powerful effects on student performance and perception.

Conventional Angiogram versus Multi-detector Row Helical Computed Tomography Angiogram for Preoperative Diagnostic Imaging in Low Extremity Arterial Surgery

PURPOSE: We performed this study to assess the suitability of conventional angiography (CA) vs. multi-detector row helical CT angiogram (MD-CTA) as a method of preoperative diagnostic imaging for low extremity arterial surgery. METHODS: From February 2004 to September 2006, 23 patients (4 claudicants, 19 limb-threatening ischemia) were studied with CA and MD-CTA preoperatively. The site and degree of stenotic or occlusive lesions in arterial segments from the renal artery to the dorsalis pedis artery were compared with both methods. We also compared the surgical inflow and outflow site changes in preoperative planning based on CA and MD-CTA and the final outcome. Additional diagnostic value and test-related complications were also analyzed. RESULTS: The median age of patients was 68 years old (range: 43~89 years), with a male to female ratio of 1.3:1. Twenty-three patients had CA after an MD-CTA scan. One hundred fifty lesions were detected in these patients. The total ratio of consistency for occlusion in CA vs. MD-CTA was 69.6%. Three patients received amputation treatment and eleven patients received a bypass operation. The agreement between the preoperative plan based on MD-CTA and the final operation was 100%, even in critical limb ischemia. There were no serious complications related to the tests. CONCLUSION: These findings suggest that MD-CTA is an adequate preoperative imaging study of infrainguinal arterial surgery and may be substituted for conventional angiography without any serious complications.

The Accuracy of Standardized Patients' Rating according to the Order of Examinees in Clinical Performance Examination / 한국의학교육

PURPOSE: The purpose of this study is to evaluate the accuracy of standardized patients'(SP) rating according to the order of examinees in clinical performance examination. METHODS: In the clinical performance examination which was administered in 2005 at Seoul National University College of Medicine, each SP evaluated 16 students consecutively. For all 16 SPs(2 SPs per station), accuracy of rating was evaluated by comparing the individual records of each SP to the 'recording keys' made by two SPs from reviewing a video recording of performances by examinees. RESULTS: The average number of items incorrectly rated by SP was 3.8(range, 0~12), 2.8 in female SPs and 4.8 in male SPs(p<0.001). No statistical correlation was observed between the number of errors and the order of examinees(p=0.843). Even after stratification by gender or age of the SPs or domains of examination, the number of items incorrectly rated did not differ significantly according to the order of examinees. CONCLUSION: An increase in SP's rating error with time after the start of examinations was not observed within the 16 consecutive encounters in clinical performance examination. The effect of SP's fatigue on the accuracy of simulation as an examination progresses remains to be studied.

Correlation of CPX Scores with the Scores of the Clinical Clerkship Assessments and Written Examinations / 한국의학교육

PURPOSE: Recently, the clinical performance examination (CPX) using standardized patients has been introduced to several Korean medical schools. The purpose of this paper is to evaluate the correlation of CPX scores with the scores of other clinical clerkship assessments and written examinations. METHODS: We evaluated the correlation of the scores of CPX, which was administered to third-year medical students (n=230) at Seoul National University College of Medicine in January 2005, with the scores of a slide examination in internal medicine, an objective structured clinical examination (OSCE) in pediatrics and obstetrics/gynecology, and the written examinations in internal medicine and general surgery. RESULTS: CPX scores showed a mild correlation with the scores of the slide examination in internal medicine and OSCE in pediatrics and obstetrics/gynecology (r=0.19, 0.28, 0.30). CPX scores were also mildly correlated with written examination scores in internal medicine but not associated with those in general surgery. CONCLUSION: Considering the mild correlation of CPX scores with scores of other clinical clerkship assessments and written examinations, CPX should be affirmatively considered as an examination complementary to previous examinations.