Stability of the sternoclavicular joint. A retrospective study.

Enlargement of the sternoclavicular joint is a well-documented but little recognised complication of radical neck dissection [AJR 3 (1971) 584]. We examined the stability of the sternoclavicular joint in 61 patients who had had radical neck dissection, functional neck dissection or sternomastoid division in the treatment of torticollis. Our findings support the hypothesis that postoperative stability of the sternoclavicular joint depends on the integrity of the accessory nerve and probably the proprioceptive branches of C3 and C4 of the cervical plexus. We conclude that in patients who require surgical section of the sternomastoid muscle in the treatment of torticollis, or for venous access in microvascular reconstruction, enlargement of the sternoclavicular joint should not occur as a postoperative complication, unlike those patients who have radical neck dissection with resection of the accessory nerve.

How well prepared are graduates for the role of pre-registration house officer? A comparison of the perceptions of new graduates and educational supervisors.

OBJECTIVE: The principal aim of undergraduate medical education is to produce competent pre-registration house officers (PRHOs). We examined and compared the perceptions of graduates and educational supervisors concerning how well prepared graduates were for their first post. METHODS: A postal questionnaire was sent to house officers who had graduated from Manchester 3 months earlier and also to educational supervisors of PRHOs in the North-west Region. The questionnaires were based on the competencies set out by the General Medical Council of the United Kingdom. RESULTS: The response rates were 66% from the graduates and 76% from the supervisors. Of the 18 broad areas of competence listed, only four were rated more than 'quite well prepared' by at least 50% of the graduates ('understanding disease processes', 'communicating effectively', 'awareness of limitations' and 'working in a team'). Similarly, more than half of educational supervisors rated graduates as more than quite competent in only three areas ('awareness of limitations', 'keeping accurate records' and 'working in a team'). Within the competencies surveyed, there were differences between the perceptions of graduates and educational supervisors on the preparedness of graduates for the skills they may require as a pre-registration house officer. CONCLUSION: Overall, given that most graduates and supervisors perceived the preparedness as 'quite well' or less, the undergraduate course had only partially met its objectives. A mismatch in ratings could be attributed to either inappropriate expectations on the part of the educational supervisors or the graduates or an inaccurate assessment by either group of respondents.

Assessment of preclinical problem-based learning versus lecture-based learning.

Academic performance on a standardized oral comprehensive exam (OCE) was compared for students taught basic science in a problem-based learning (PBL) curriculum and a lecture-based learning (LBL) curriculum. The OCE was administered to the graduating classes of 1991-1994 (n approximately 20/class) six months after completion of their basic science courses. The OCE contained six components including: Organization and Thoroughness, Diagnosis, Primary Treatment Plan, Alternate Treatment Plan, Science and Medical Knowledge, and Dental Knowledge. Six to eight examiners graded each of the students by using a standardized scoring system and by subjective comments. The class of 1991 was taught by LBL, classes of 1993 and 1994 by PBL, and the class of 1992 by an incomplete PBL teaching method. Mean OCE scores were not significantly different between classes; however, the Science and Medical Knowledge component score was significantly better for the class of 1994 than for 1991 (p < 0.05). There was a non-significant 40 percent increase (p = 0.07) in honors and a 269 percent (p < 0.001) increase in cumulative positive examiner comments between 1991 and 1994.

Anatomy teaching: students' perceptions.

The goal of this study was to analyse students' perceptions of anatomy teaching. A questionnaire was distributed to two classes of first year dental students taught anatomy in both problem-based learning (PBL) and traditional formats. The questionnaire explored the students' most preferred techniques for learning anatomy, their examination preferences and their perceived level of mastery of anatomy. Fifty-seven (95%) students completed the survey. The most commonly used study aids were atlases, dissection and lecture notes (in descending order). Students expressed the desire for the final examination to include both written and oral components. Six months after the final examination, the students reported their perceived level of mastery of anatomy as either "very good" or "OK". Even in the PBL curriculum 39% of both classes felt it is necessary to have quizzes during the course to motivate and guide them in studying anatomy.

The referral practice of general medical practitioners to the surgical specialties: implications for the future.

With increasing numbers of general medical practitioners (GMPs) becoming purchasers of health care, providers of surgical services need to understand factors influencing GMP referrals. Using an anonymous postal questionnaire, criteria used by 400 randomly selected general medical practitioners to make referral decisions were assessed. Issues regarding the importance of waiting lists, cost, distance and communication were assessed, along with previous training and fundholding status. The findings of this study reveal that waiting list times for consultation and treatment, along with communication, are the most important criteria influencing referral. Cost, travel and literature from each specialty were the least important factors. General medical practitioners are shown, in the majority, to remain unaware of the range of conditions managed by oral and maxillofacial surgeons. A series of strategies are outlined, which might be used to broaden the referral base for maxillofacial surgery. The need for active education of practitioners is emphasised and the possible effects of regionalisation of the service is discussed.

Impact of patient perceptions on compliance with treatment for hypertension.

Patient noncompliance with medical regimens is a major obstacle in achieving hypertension control. In this study the relationships between patients' perceptions of health, disease and medical treatment and compliance were examined in personal interviews with 142 patients under treatment for hypertension. Compliance was measured in terms of blood pressure control, self-reported medication-taking, and appointment keeping. A multivariate log linear technique was used to control confounding. Blood pressure control was found to be associated with the perceived effficacy of the antihypertensive regimen, having medications prescribed for other chronic conditions, a high level of anxiety when hypertension was first diagnosed, the impact of hypertension and its treatment on lifestyle, and a higher educational level. For self-reported medication-taking, the perceived severity of hypertension, having medications prescribed for other chronic conditions and older age were predictive. Blood pressure control and self-reported medication-taking were highly correlated with each other(p = .02). Older age and being employed were the only variables that contributed independently to improved appointment keeping behavior. From these findings, it might be expected that emphasis on the effectiveness of treatment and on the potential threat posed by hypertension would motivate improved blood pressure control.