Computer-based clinical examination (CCE) in surgery: would It complement or replace the OSCE in the post-COVID-19 era?

Objectives: Surgical clinical assessment of medical students is confronted by many challenges particularly the increasing numbers of students with limited resources, and pandemics. The search for new tools of assessment continues. Our objectives were: (1) To develop a computer-based clinical exam (CCE) and identify its characteristics (2) To assess its acceptability of the students. Method: The study was conducted at the Surgical Department, Alzaiem Alazhari University (AAU) between February and August, 2017. We used the modular object oriented dynamic learning environment (MOODLE) program as a platform to upload and deliver the exam. The exam consisted of 45 questions (stations). Each consisted of a clinical scenario accompanied by a photograph (of a patient or investigation) or short video followed by multiple choice questions (MCQs). A questionnaire was designed to get the students' feedback. We analyzed the questionnaire and scores obtained by the students and compared them to their performance in other tools of the surgical exam, using SPSS statistical program. Results: The study included 188 final year medical students. There was a highly significant correlation of the CCE scores of each student with their final result (r= 0.67), and with other tools of the surgery exam particularly the objective structured clinical examination (OSCE). Students' acceptability was high. Conclusion: The CCE is valid and practicable. It saves time and is popular with the students and tutors. It complements the OSCE in the assessment of clinical competency and allows wide coverage of the curriculum. It is expected to gain importance and popularity in the post-COVID-19 era.

Consideraciones de la enseñanza del método clínico en la formación médica superior / Considerations about the teaching of the clinical method in the higher medical formation

Se define el método clínico como el sistema de procedimientos dirigido al diagnóstico médico individual, es el método científico particularizado en la ciencia clínica. Esta definición revela una orientación positivista, reduccionista y simplista, al homologar los procedimientos del método científico con el método clínico, sin tener en cuenta los elementos culturales presentes en el primero, además no es favorable utilizar de forma tan inflexible el método investigativo de las ciencias naturales, en las ciencias sociales. A consecuencia se propone una investigación con el objetivo de explorar la enseñanza de los procedimientos del método clínico en la formación médica superior, se utiliza como metodología el paradigma cualitativo sustentado en métodos particulares como: análisis y síntesis, hermenéutico dialéctico y hipotético deductivo. Se concluye que el examen y el diagnóstico clínico son procedimientos esenciales del método clínico, al aportar el mayor número de variables culturales y se revela la existencia de insuficiencias en su proceso de enseñanza.

The diagnostic individual doctor is circumscribed to the clinical method like the how-to guided system, it is the scientific method particularized in clinical science. The definition reveals an orientation positivist, reductive and simplistic, when homologating the procedures of the scientific method with the clinical method not taking into account the cultural elements and is not nothing favorable to utilize of so inflexible form the investigating method of natural sciences in social sciences. An investigation for the sake the exploring the teaching of the procedures of the clinical method in the medical superior formation, is proposed to consequence, the qualitative paradigm is utilized like methodology, with particular methods: Analysis and synthesis, hermeneutical dialectician and hypothetic deductive and underlies the scientific method like general method. Concluding that the exam and clinical diagnosis are essential procedures of the clinical method when contributing the bigger number of cultural variables and the existence of irregularities in the teaching of the exam and clinical method.

Clinical exam protocol for the equine thoracolumbar spine / Protocolo de exame físico para a coluna toracolombar de equinos

Thoracolumbar injuries represent a challenge to the veterinarian that seeks to eliminate the pain, reinstitute the athletic use of the horse and minimize economic losses. The percentage of lost training days due to orthopedic conditions in race horses is of 72.1% and within those conditions is back pain, whicht represents from 4.35% to 20% of the lameness cases. The present study searched to establish a protocol based on score points for the thoracolumbar physical exam, by which it is able to determine the possible affected areas and the seriousness of the injuries. Along with the physical exam, it was performed an ultrasonographic exam of the thoracolumbar region to characterize and classify the injuries found, as to accompany its evolution after treatment. It was observed a clear reduction in the physical exam score sum in all animals between the exam days being that the exam of most of the animals presented a zero score at 60 days after the treatment. Relating the evolution of the clinical exam with the ultrasonography image tests, there was a positive association between the reduction score in the severity scale and the evolution of the ultrasonographic image of the evaluated structures. Thus, it can be concluded that gradation of the physical exam showed to be efficient and allowed the monitoring of the clinical evolution, as the answer of the injuries to the suggested treatment. Besides that, the results showed that 60 days is the ideal time for the first reevaluation of the animal after the treatment.

As enfermidades toracolombares representam um desafio ao veterinário, que busca eliminar a dor, restituir o uso atlético do cavalo e minimizar perdas econômicas. A porcentagem de dias de treino perdidos devido a afecções ortopédicas em cavalos de corrida é de 72,1% e dentro destas afecções estão as lombalgias, que representam de 4,35% a 20% dos casos de claudicação. O presente estudo procurou estabelecer um protocolo baseado em pontuação por escores para o exame físico da região toracolombar, por meio do qual se consiga determinar as possíveis regiões afetadas e a gravidade das lesões. Juntamente com o exame físico, foi realizada a ultrassonografia da região toracolombar, para caracterizar e classificar as lesões encontradas, assim como acompanhar sua evolução após o tratamento. Foi observada uma evidente redução na soma dos escores do exame físico em todos os animais entre os dias de exame, sendo que o exame da maioria dos animais apresentou escore zero aos 60 dias após o tratamento. Relacionando a evolução do exame clínico com os escores ultrassonográficos houve associação positiva entre a redução do escore na escala de severidade e a evolução da aparência ultrassonográfica das estruturas avaliadas. Sendo assim, pôde-se concluir que a gradação do exame físico se mostrou eficiente e permitiu o acompanhamento da evolução clínica, assim como da resposta das enfermidades ao tratamento proposto. Além disso, os resultados mostraram que 60 dias é o tempo ideal para a primeira reavaliação do animal após a realização do tratamento.