An Assessment of the Correlation between Tests of Clinical Competence and Tests of Cognitive Knowledge amongst Nigerian Resident Doctors in Surgery.

Background: Assessment of clinical competence involves the assessment of cognition and assessment of clinical performance (behaviour in practice). The limitations of the traditional long case examination (LCE) in the assessment of clinical performance led to its replacement with the objective structured clinical examination (OSCE) by many institutions. Aims: To determine and compare the abilities of the OSCE and LCE to predict candidates' performance in the tests of cognitive knowledge in the fellowship examination of the National Postgraduate Medical College of Nigeria in the Faculty of Surgery. Materials and Methods: The results of the OSCE, LCE, written papers, picture tests (PTs), vivas, and the total clinical score (TCS) of surgical residents who took part in the fellowship examination over six consecutive examination periods were compared by using the Pearson's correlation coefficient. A P-value less than.01 was considered as significant. Results: The OSCE had a weak but statistically significant positive correlation (.175) with the LCE. Both the OSCE and LCE had similar correlations with the total written papers (TWP) and PTs. The viva had a higher correlation with the OSCE than the LCE. The TCS when compared with either the OSCE or LCE alone had a higher correlation with most of the tests of cognitive knowledge. Conclusion: Neither the OSCE nor the LCE showed any superiority over the other in terms of the ability to predict performance in the tests of cognition. The TCS appears superior to either the OSCE or the LCE as a predictor of the candidates' overall knowledge of surgery. Therefore, both the OSCE and the LCE should be retained as part of the examination.

Contexte: L'évaluation de la compétence clinique implique l'évaluation de la cognition et l'évaluation de la performance clinique (comportement dans la pratique). Les limites de l'examen de cas long traditionnel (LCE) dans l'évaluation de la performance clinique ont conduit à son remplacement par l'examen clinique objectif structuré (ECOS) par de nombreuses institutions. Objectifs: Déterminer et comparer les capacités de l'ECOS et du LCE à prédire les performances des candidats aux tests de connaissances cognitives lors de l'examen de bourse de la faculté de chirurgie du Nigerian National Postgraduate Medical College. Méthodes: Les résultats de l'ECOS, du LCE, des documents écrits, des tests d'image, des vivas et du score clinique total (TCS) des résidents en chirurgie qui ont participé à l'examen de bourse sur six périodes d'examen consécutives ont été comparés en utilisant le coefficient de corrélation de Pearson. Une valeur de p inférieure à 0,01 était considérée comme significative. Résultats: L'ECOS avait une corrélation positive faible mais statistiquement significative (0,175) avec le LCE. L'ECOS et le LCE avaient des corrélations similaires avec le nombre total d'épreuves écrites (TWP) et les tests d'images. La soutenance avait une corrélation plus élevée avec l'ECOS que le LCE. Le score clinique total (TCS), comparé à l'ECOS ou au LCE seul, présentait une corrélation plus élevée avec la plupart des tests de connaissances cognitives. Conclusion: Ni l'OSCE ni le LCE n'ont montré de supériorité sur l'autre en termes de capacité à prédire la performance dans les tests de cognition. Le TCS semble supérieur à l'ECOS ou au LCE en tant que prédicteur des connaissances globales des candidats en chirurgie. Par conséquent, l'ECOS et le LCE devraient être retenus dans le cadre de l'examen.

Differential diagnosis and management of giant fibroadenoma: comparing excision with reduction mammoplasty incision and excision with inframammary incision.

Giant fibroadenoma (GFA) may present with breast asymmetry and can be excised with an inframammary incision (IFI) or reduction mammoplasty incision (RMI). This study investigated the clinical presentation and compared excision with the IFI and RMI. All patients with benign breast tumours greater than 5 cm underwent core needle biopsy and a histopathological diagnosis. All confirmed GFA had their clinical details documented and randomised into two groups for excision with an IFI or RMI. Twenty-two patients were studied. The age range was 12-46 years, mean 21.18 ± 2.22 years. The patients were divided into two groups: a juvenile group (n = 16) (73%) aged 12-18 years, mean age 14.06 ± 0.42 years, and a perimenopausal group (n = 5) aged 28-46 years. The juvenile group showed cyclic increases in breast size monthly with menstruation while the perimenopausal showed an initial slow growth of 6-24 months followed by a rapid growth. Fifteen patients (68%) had excision biopsy with IMI and seven patients with RMI. Seven of the patients treated with IFI had minimal preoperative asymmetry and satisfactory aesthetic outcome. Among the patients with severe preoperative asymmetry treated with IFI (n = 8) and RMI (n = 7), those treated with IFI had persistent postoperative skin redundancy and asymmetry, which was not found in those treated with RMI. In conclusion, for patients with significant asymmetry, excision with the IFI was associated with persistent asymmetry while excision with RMI was associated with restoration of symmetry.