Development of a validated assessment tool for medical students using simulated patients: an 8-year panel survey.

BACKGROUND: The use of simulated patients (SPs) to assess medical students' clinical performance is gaining prominence, underscored by patient safety perspective. However, few reports have investigated the validity of such assessment. Here, we examined the validity and reliability of an assessment tool that serves as a standardized tool for SPs to assess medical students' medical interview. METHODS: This longitudinal survey was conducted at Keio University School of Medicine in Japan from 2014 to 2021. To establish content validity, the simulated patient assessment tool (SPAT) was developed by several medical education specialists from 2008 to 2013. A cohort of 36 SPs assessed the performance of 831 medical students in clinical practice medical interview sessions from April 2014 to December 2021. The assessment's internal structure was analyzed using descriptive statistics (maximum, minimum, median, mean, and standard deviation) for the SPAT's 13 item total scores. Structural validity was examined with exploratory factor analysis, and internal consistency with Cronbach's alpha coefficients. The mean SPAT total scores across different SPs and scenarios were compared using one way analysis of variance (ANOVA). Convergent validity was determined by correlating SPAT with the post-clinical clerkship obstructive structured clinical examination (post-CC OSCE) total scores using Pearson's correlation coefficient. RESULTS: Of the 831 assessment sheets, 36 with missing values were excluded, leaving 795 for analysis. Thirty-five SPs, excluding one SP who quit in 2014, completed 795 assessments, for a response rate of 95.6%. Exploratory factor analysis revealed two factors, communication and physician performance. The overall Cronbach's alpha coefficient was 0.929. Significant differences in SPAT total scores were observed across SPs and scenarios via one-way ANOVA. A moderate correlation (r =.212, p <.05) was found between SPAT and post-CC OSCE total scores, indicating convergent validity. CONCLUSIONS: Evidence for the validity of SPAT was examined. These findings may be useful in the standardization of SP assessment of the scenario-based clinical performance of medical students.

[Distribution of toxicity in liver of wild pufferfish Takifugu rubripes].

Livers from wild pufferfish, Takifugu rubripes, can be described as having a smooth frontal side and an upper-region that is attached to the hepatic portal vein. Based on this description, the liver can be divided into 10 parts (L1-5 and R1-5), and in this work, the lethal potency of each part was determined by mouse bioassay. Among the raw livers from 58 individuals, all 10 parts of 16 individuals, and some parts of 4 individuals showed mouse lethality, but no toxicity was detected in any part of the liver from 22 individuals. In the livers of 4 individuals that were partially toxic, the lethal potency of the toxic parts was less than 4 mouse units (MU)/g, and no part showed especially high toxicity. The remaining 16 individuals were considered non-toxic based on the assay of only one part. Among 13 frozen livers, all parts of 9 individuals were toxic, while all parts of 4 individuals were non-toxic. Liquid chromatography-mass spectrometry analysis revealed that all parts of a weakly toxic raw liver and a strongly toxic frozen liver had tetrodotoxin as the major toxin. Regarding the 16 raw and 9 frozen livers, whose parts were all toxic, the relative lethal potency of each part to the mean lethal potency of the individual (8.9-709 MU/g) was calculated, and subjected to a two-way analysis of variance with 2 factors (left/right and top/bottom) for each group of livers (raw or frozen). The analysis indicated non-significance among factors and interactions at a significance level of 5% in the frozen livers. However, in the raw livers, although no interaction between the 2 factors was detected, the right-side and the 4th-portion from the top were significantly higher than the left-side and the other portions, respectively. Therefore, we concluded that individual inspection using R4, which is the region that lies below the right-center location of the liver, is suitable for toxicity evaluation of liver to ensure the safe consumption of pufferfish.

Direct determination of p-hydroxymethamphetamine glucuronide in human urine by high-performance liquid chromatography.

High-performance liquid chromatography (HPLC) with UV detection for the simultaneous determination of the free form of p-hydroxymethamphetamine (p-OHMA) and its metabolite, glucuronide (p-OHMAG) was accomplished for the first time. We achieved this by employing 1) an ion pair reagent for retention of sample to a solid-phase extraction (SPE) cartridge, Sep-Pak Light C18 and 2) a simple two-step stepwise elution technique for subsequent ion pair RP-HPLC. The proposed method was optimized for resolution of p-OHMAG, p-OHMA and MA. The method was successfully applied to urine samples collected from MA abusers.

Synthesis of methyl 1-O-(4-hydroxymethamphetaminyl)-alpha-D-glucopyranouronate.

For the purpose of the direct characterization of the intact conjugated form in the urine of a methamphetamine (MA) abuser, 4-hydroxymethamphetamine (4-OHMA) glucuronate, corresponding to one of the metabolites of MA, was synthesized from the commercially available methyl 4-hydroxyphenylacetate.