RESUMO
Objective To evaluate the assessment index system of internal medicine, and to analyze the factors of practical effects on internal medicine. Methods The assessment index system of clinical skills was developed by expert group based on the clinical syllabus and objectives. Internal medicine index system was divided into four items such as history-taking, physical examination, hos-pital records and case questions. 49 five-year clinical interns who took internal medicine exams were researched. Reliability, validity, discrimination, difficulty were used to analyze the quality of assess-ment index system. Gender, teaching hospital and the preparation of postgraduate examination were used to explore the influencing factors of practical effects with independent t-test and Wilcoxon signed rank tests. Results The reliability, discrimination, difficulty of the assessment index system were 0.50, 0.15 and 0.85, respectively. The removing item coefficient of history collection, physical ex-amination, hospital records, case questions were 0.38, 0.26, 0.47 and 0.53, separately, and the discrimination were 0.18, 0.17,0.27 and 0.37, separately, and the difficulty were 0.87, 0.89, 0.79, and 0.78, respectively. The scores of assessment index system of girls were higher than those of the boys(P0.05). The students who prepared the postgraduate examination scored lower than the others(P<0.05). Conclusions The assessment index system of internal medicine is reason-able and reliable, but the assessment of case questions still needs to be standardized. Teaching hospi-tals have little effect on internship while gender and the preparation for postgraduate examination influence practice effects in internal medicine.
RESUMO
Objective To investigate the clinical features and management of bile duct injury caused by laparoscopic cholecysteetomy by using harmonic scalpel (UHS-LC), and its prevention. Methods The clinical data of 1863 UHS-LC cases from April 2003 to February 2008 were retrospectively analyzed. There were 11 patients suffering from UHS-LC related iatrogenic bile duct injury including intraoperatively immediate recognized injuries in 9 cases, and postoperatively found injuries in 2 cases. For those patients in which bile duct injury was found during the UHS-LC procedure, the patient was converted to open surgery, the injury was repaired accordingly by end-to-end bile duet anastomosis or Roux-en-Y procedure. For the injuries found postoperatively (all two cases were of CBD perforation), CBD was sutured by second stage. Results All the 11 patients recovered well and no biliary stricture occurred during the follow up of 1-5 years. Conclusions While UHS-LC is suitable for most cases of choleeystectomy, it causes significant porcentage of bile duct injury (0. 6% ) in hands of unskillful surgeons. It is important to be on alert against iatrugenic bile duct injuries.
