Utility of an oral examination in a surgical clerkship.

To evaluate the utility of the oral examination in a surgical clerkship, we designed a prospective and randomized study to relate the subjective impressions of experienced examiners with an objective measure of cognitive knowledge. The examiners were asked to score the student's performance as honors, high satisfactory, satisfactory, or unsatisfactory, according to their subjective impression of the student's ability. Student performance was grouped according to oral examination performance. The cognitive performance in the honors group was significantly better than that of the other groups (Student's t-test, p = 0.05). There was a significant difference in cognitive performance for oral examination groups throughout the rotations (analysis of variance, p = 0.000; Kruskal Wallis, p = 0.05). The oral examination is useful to identify a high level of cognitive achievement but cannot discriminate between groups of median to low competence. It should be used for educational feedback, career counseling, residency recommendations, and professional development.

Experience as a surgeon determines resident knowledge.

BACKGROUND: This is a prospective study that compares operative experience with performance on the American Board of Surgery Inservice Training Examination (ABSITE) to establish the primacy of procedural experience in the graduate training environment. METHODS: Operative experience was determined from a computerized log of surgical procedures. The Report D of the 1991 ABSITE was used to assign each test item to specific operative procedures and to determine the frequency of the correct response (Fcr) for each item. The fraction of operative procedures (Fs) was determined for each category of surgical procedures (Fs = Number of procedures as surgeon/Total number of procedures). The Fcr was compared to the Fs by use of the Pearson correlation coefficient with significance at 95% confidence. RESULTS: Forty-two residents reported doing 8357 surgical procedures as surgeon in 12 months. Report D contained 209 test items. Of these, 162 items could be assigned to 26 categories of surgical procedures. The Fcr correlated directly with the Fs (p = 0.002, r = 0.605). CONCLUSIONS: A significant correlation exists between the experience of surgical residents as surgeon and their performance on the ABSITE:

Increased numbers of higher left intraocular pressures in 428 patients referred to the glaucoma clinic.

Seventy-four per cent of 428 patients referred to the glaucoma clinic at Concord Hospital exhibited intraocular pressure (IOP) asymmetry. There was a preponderance of left eyes, in that two-thirds of the patients with asymmetrical pressures had the higher IOP in the left eye. As the degree of asymmetry increased, this trend became more pronounced. In addition, the statistically significant difference between right and left mean IOP among the glaucoma patients was not found among normal controls, even when the order of testing the eyes was reversed.

Tonography, Valsalva manoeuvre and central visual fields. A study of 429 patients.

Four hundred and twenty nine patients (846 eyes) referred to the glaucoma clinic at Concord Hospital between 1979 and 1989, were included in a prospective study. This study investigated the circulatory status of each eye during tonography, by using a modified Valsalva manoeuvre to induce changes in intraocular pressure (IOP) and amplitude of tonography pulse pressure (TPP). Of the large falls in IOP, 85% of the eyes had a Po/C greater than 150. The average IOP without medication, on the morning of the test, was 20 mmHg (2.67 kPa). Central visual field defects were found in 495 eyes, and these were far more prevalent in the Po/C greater than 150 category. An unexpected finding was the ratio of 67:33 right to left eyes in the Po/C less than 100 category. The commonest reasons for referral were intermittent rises of IOP, suspicious optic disc cupping, and the need to confirm a previously made diagnosis.

The role of pediatric surgery in the medical school curriculum.

In most medical schools, exposure to pediatric surgery is presented as a subspecialty elective. We have offered it as an integral part of the surgical clerkship for 10 years in the belief that it provides an excellent educational environment. To confirm this concept, the quizzes (Q), final examinations (FE), and grades of students assigned to the pediatric surgical service were prospectively studied. All students (N = 139) in the surgical clerkship entered the study. Thirty-two students were randomly selected and assigned to the surgical service of a major pediatric hospital (P-Surg) for 50% of their clerkship. The other students (N = 107) were assigned to a variety of adult surgical services (G-Surg) and served as the control group. All students attended the same seminars, used the same educational materials, were examined with the same test items, and were evaluated by the same oral examiners. Test items were electronically scored and the database was analyzed on an IBM computer. The statistical analysis was performed using a Student's t test and chi 2 analysis. There was no significant difference in the demonstrated cognitive performance and grades awarded to the two groups of students. We conclude that a pediatric surgical service provides an atmosphere that is educationally comparable to the adult general surgical service.

The human pineal gland: a review of the "third eye" and the effect of light.

The human pineal gland is an extremely active neuroendocrine transducer. Environmental light acts through the retina and entrains the pineal gland's circadian rhythms by way of the hypothalamus and sympathetic nervous system. Light depresses pinealocyte activity. It is possible to do without the pineal, but this tiny gland is considered to be the "regulator of regulators" and important in general homeostasis. A direct retino-hypothalamic pathway is probably involved; and a system of synchronizing potentially independent oscillators is postulated.

Laser trabeculoplasty and its effect on tonography, central visual fields, and anterior chamber depth. A preliminary study.

A preliminary study of ten patients with glaucoma, each of whom has undergone laser trabeculoplasty to one or both eyes, is presented. Tonography-on-treatment was performed on each patient approximately four weeks prior to laser, and repeated approximately ten weeks afterwards. Central fields and anterior chamber depth measurements before and after laser trabeculoplasty are also presented. Intraocular pressures fell by a mean of 12.34 mm (SD +/- 8.5, range 3-23) in all 12 lasered eyes. Central fields improved in ten eyes, and the anterior chamber of treated eyes became shallower by an average of 0.27 mm, compared with untreated eyes (p less than 0.05). Po/C values improved in 11 treated eyes. Very little attempt was made to alter medical treatment during the period outlined above.

Repositioning of Descemet's membrane: a case report.

An 80-year-old Australian was admitted to Concord Hospital for right cataract extraction and intraocular implant. During the procedure under local anaesthesia, two-thirds of Descemet's membrane was stripped down into the anterior chamber. The membrane was later repositioned by air injection into the anterior chamber. Sixteen months later, her right visual acuity is 6/9 and she reads the newspapers.

Optic neuritis and computed tomography.

A forty year old Lebanese man presented to Royal Prince Alfred Hospital with unilateral visual loss and disc oedema. Computed Tomography (CT) of his orbit demonstrated diffuse thickening and tortuosity consistent with an optic nerve tumour. Surgical exploration of the orbit was averted when the patient reported subjective visual improvement. Two months later, CT demonstrated an optic nerve which was well within normal limits.