ABSTRACT
BACKGROUND: Virtual education has been described before and during the COVID-19 pandemic. Studies evaluating virtual objective structured clinical examinations with postgraduate learners are lacking. This study (1) evaluated the experiences of all participants in a virtual objective structured clinical examination and (2) assessed the validity and reliability of selected virtual objective structured clinical examination stations for skills in physical medicine and rehabilitation. METHODS: Convergent mixed-methods design was used. Participants included three physical medicine and rehabilitation residency programs holding a joint virtual objective structured clinical examination. Analysis included descriptive statistics and thematic analysis. Performance of virtual to previous in-person objective structured clinical examination was compared using independent t tests. RESULTS: Survey response rate was 85%. No participants had previous experience with virtual objective structured clinical examination. Participants found the virtual objective structured clinical examination to be acceptable (79.4%), believable (84.4%), and valuable for learning (93.9%). No significant differences between in-person and virtual objective structured clinical examination scores was found for three-fourth stations and improved scores in one fourth. Four themes were identified: (1) virtual objective structured clinical examinations are better for communication stations; (2) significant organization is required to run a virtual objective structured clinical examination; (3) adaptations are required compared with in-person objective structured clinical examinations; and (4) virtual objective structured clinical examinations provide improved accessibility and useful practice for virtual clinical encounters. CONCLUSIONS: Utility of virtual objective structured clinical examinations as a component of a program of assessment should be carefully considered and may provide valuable learning opportunities going forward.
Subject(s)
COVID-19 , Internship and Residency , Physical and Rehabilitation Medicine , Clinical Competence , Educational Measurement/methods , Humans , Pandemics , Physical Examination , Reproducibility of ResultsABSTRACT
Amiodarone is an antiarrhythmic medication with many side effects. Neuromyopathy is a rare adverse effect. We present an 87-year-old woman with bilateral leg pain and weakness in the context of amiodarone. She was admitted to the Acute Geriatric Unit in Calgary, Alberta, Canada. On examination, hip flexor and extensor strength were 2/5 bilaterally while knee flexor and extensor strength were 4/5 and 3/5, respectively. Creatine kinase and C-reactive protein levels were normal. MRI of the lumbar spine showed mild central canal stenosis. Electromyography and nerve conduction testing showed a severe axonal length-dependent polyneuropathy of the left lower extremity. There was evidence of myopathic changes to the left iliopsoas muscle. Overall, a neuromyopathic process affecting the lower extremities was supported. After discontinuation of amiodarone, mobility and function significantly improved. Although a rare complication of amiodarone, neuromyopathy should be considered in patients with compatible symptomatology.
Subject(s)
Amiodarone/adverse effects , Muscle, Skeletal/physiopathology , Neuromuscular Diseases/chemically induced , Aged, 80 and over , Anti-Arrhythmia Agents/adverse effects , Atrial Fibrillation/drug therapy , Electromyography , Female , Humans , Lower Extremity , Muscle, Skeletal/drug effects , Neuromuscular Diseases/diagnosis , Neuromuscular Diseases/physiopathology , Tomography, X-Ray ComputedABSTRACT
INTRODUCTION: Medical education experiences, particularly in clinical years, are reported determinants of career choice. Less is known about features of clinical education experiences including length, discipline, setting and choice, which may serve as landmarks in career choice decisions. This study's purpose was to explore the benefits of a free choice clerkship elective, and more specifically, its role in clarifying career choice. METHODS: Using framework and content analysis methodology, we analysed University of British Columbia, third-year medical student anonymised assignments regarding free choice and 2-week clerkship elective experiences. This clerkship was designed to provide students with clerkship experiences outside the conventional curricular model, while encouraging student choice of ambulatory and community settings. Assignment questions included: reasons for choosing elective; whether learning objectives were met; influence of elective on career choice; and unique elective experiences. Iterative review, coding, analysis and indexing of assignments were carried out to identify themes and corroborate findings. RESULTS: Emergent themes included: positive views of experience; transferable knowledge and skills; and influencer of future education and career choices. Although students were encouraged to choose clerkship experiences outside the conventional curricular model, most students chose the elective to clarify future career decisions. DISCUSSION: This qualitative descriptive study highlights the influence of highly regarded, free choice clerkship elective experiences in the career decision making process in medical education. Further examination of the details of clerkship elective experiences which influence career choice is recommended.
