Medical education research study quality instrument: an objective instrument susceptible to subjectivity.

BACKGROUND: The medical education research study quality instrument (MERSQI) was designed to appraise medical education research quality based on study design criteria. As with many such tools, application of the results may have unintended consequences. This study applied the MERSQI to published medical education research identified in a bibliometric analysis. METHODS: A bibliometric analysis identified highly cited articles in medical education that two authors independently evaluated using the MERSQI. After screening duplicate or non-research articles, the authors reviewed 21 articles with the quality instrument. Initially, five articles were reviewed independently and results were compared to ensure agreed upon understanding of the instrument items. The remainder of the articles were independently reviewed. Overall scores for the articles were analyzed with a paired samples t-test and individual item ratings were analyzed for inter-rater reliability. RESULTS: There was a significant difference in mean MERSQI score between reviewers. Inter-rater reliability for MERSQI items labeled response rate, validity and outcomes were considered unacceptable. CONCLUSIONS: Based on these results there is evidence that MERSQI items can be significantly influenced by interpretation, which lead to a difference in scoring. The MERSQI is a useful guide for identifying research methodologies. However, it should not be used to make judgments on the overall quality of medical education research methodology in its current format. The authors make specific recommendations for how the instrument could be revised for greater clarity and accuracy.

Unusual clinical presentations of cutaneous squamous cell involving distal extremities in four patients: the importance of tissue sampling.

INTRODUCTION: cSCC is the second most common cutaneous malignancy worldwide behind basal cell carcinoma. Typically, SCC is diagnosed early before it infiltrates local subcutaneous tissue or metastasizes. However, unusual presentations are possible and can lead to delayed treatment and possibly worse outcomes. MATERIALS AND METHODS: All patients were White of non-Hispanic or Latino decent. Three-quarters of the cases were male, and a quarter female. The age range was 45 to 78 years. The documented sizes of lesions ranged from 6 cm to 10 cm in diameter. Three of the cases were initially diagnosed as nonhealing wounds, and one was diagnosed as cellulitis. RESULTS: The authors observed that SCC can present unusually by mimicking nonhealing infected ulcers or skin infections such as cellulitis. Over 18 months, the authors' practice recorded 4 cases of cSCC that were initially treated as persistent infections, which potentially lead to worse outcomes. CONCLUSION: These cases provide patterns and clues to potentially expedite the diagnosis and treatment of cSCC. Any skin lesion thought to be infectious but not responding to treatment should undergo tissue sampling.