ABSTRACT
Background: Assessment of clinical competence involves the assessment of cognition and assessment of clinical performance (behaviour in practice). The limitations of the traditional long case examination (LCE) in the assessment of clinical performance led to its replacement with the objective structured clinical examination (OSCE) by many institutions. Aims: To determine and compare the abilities of the OSCE and LCE to predict candidates' performance in the tests of cognitive knowledge in the fellowship examination of the National Postgraduate Medical College of Nigeria in the Faculty of Surgery. Materials and Methods: The results of the OSCE, LCE, written papers, picture tests (PTs), vivas, and the total clinical score (TCS) of surgical residents who took part in the fellowship examination over six consecutive examination periods were compared by using the Pearson's correlation coefficient. A P-value less than.01 was considered as significant. Results: The OSCE had a weak but statistically significant positive correlation (.175) with the LCE. Both the OSCE and LCE had similar correlations with the total written papers (TWP) and PTs. The viva had a higher correlation with the OSCE than the LCE. The TCS when compared with either the OSCE or LCE alone had a higher correlation with most of the tests of cognitive knowledge. Conclusion: Neither the OSCE nor the LCE showed any superiority over the other in terms of the ability to predict performance in the tests of cognition. The TCS appears superior to either the OSCE or the LCE as a predictor of the candidates' overall knowledge of surgery. Therefore, both the OSCE and the LCE should be retained as part of the examination.
Contexte: L'évaluation de la compétence clinique implique l'évaluation de la cognition et l'évaluation de la performance clinique (comportement dans la pratique). Les limites de l'examen de cas long traditionnel (LCE) dans l'évaluation de la performance clinique ont conduit à son remplacement par l'examen clinique objectif structuré (ECOS) par de nombreuses institutions. Objectifs: Déterminer et comparer les capacités de l'ECOS et du LCE à prédire les performances des candidats aux tests de connaissances cognitives lors de l'examen de bourse de la faculté de chirurgie du Nigerian National Postgraduate Medical College. Méthodes: Les résultats de l'ECOS, du LCE, des documents écrits, des tests d'image, des vivas et du score clinique total (TCS) des résidents en chirurgie qui ont participé à l'examen de bourse sur six périodes d'examen consécutives ont été comparés en utilisant le coefficient de corrélation de Pearson. Une valeur de p inférieure à 0,01 était considérée comme significative. Résultats: L'ECOS avait une corrélation positive faible mais statistiquement significative (0,175) avec le LCE. L'ECOS et le LCE avaient des corrélations similaires avec le nombre total d'épreuves écrites (TWP) et les tests d'images. La soutenance avait une corrélation plus élevée avec l'ECOS que le LCE. Le score clinique total (TCS), comparé à l'ECOS ou au LCE seul, présentait une corrélation plus élevée avec la plupart des tests de connaissances cognitives. Conclusion: Ni l'OSCE ni le LCE n'ont montré de supériorité sur l'autre en termes de capacité à prédire la performance dans les tests de cognition. Le TCS semble supérieur à l'ECOS ou au LCE en tant que prédicteur des connaissances globales des candidats en chirurgie. Par conséquent, l'ECOS et le LCE devraient être retenus dans le cadre de l'examen.
ABSTRACT
PURPOSE: Comorbidities have been indicated to influence cancer care and outcome, with strong associations between the presence of comorbidities and patient survival. The objective of this study is to determine the magnitude and pattern of comorbidities in Nigerian cancer populations, and demonstrate the use of comorbidity indices in predicting mortality/survival rates of cancer patients. METHODS: Using a retrospective study design, data were extracted from hospital reports of patients presenting for oncology care between January 2015 and December 2016 at two tertiary health facilities in Lagos, Nigeria. Patient comorbidities were ranked and weighted using the Charlson comorbidity index (CCI). RESULTS: The mean age for the 848 cancer patients identified was 53.9 ± 13.6 years, with 657 (77.5%) females and 191 (22.5%) males. Breast (50.1%), cervical (11.1%) and colorectal (6.3%) cancers occurred most frequently. Comorbidities were present in 228 (26.9%) patients, with the most common being hypertension (20.4%), diabetes (6.7%) and peptic ulcer disease (2.1%). Hypertension-augmented CCI scores were 0 (15.6%), 1-3 (62.1%), 4-6 (21.7%) and ≥7 (0.6%). The mean CCI scores of patients ≤50 years (0.8 ± 0.9) and ≥51 years (3.3 ± 1.2) were significantly different (p < 0.05). Patients with lower mean CCI scores were more likely to receive chemotherapy (2.2 ± 1.6 versus 2.5 ± 1.9; p < 0.05) and/or surgery (2.1 ± 1.5 versus 2.4 ± 1.7; p < 0.05). CONCLUSION: Comorbidities occur significantly in Nigerian cancer patients and influence the prognosis, treatment outcome and survival rates of these patients. There is a need to routinely evaluate cancer patients for comorbidities with the aim of instituting appropriate multidisciplinary management measures where necessary.
