RESUMO
BACKGROUND: The clinical competency test (CCT) was introduced by the Irish College of General Practitioners (ICGP) in 2015. Similar to the clinical skills assessment (CSA) of the Membership of the Royal College of General Practitioners exam (MRCGP), the CCT is a modified objective structured clinical examination (OSCE). AIM: The aim of this study was to evaluate the MICGP CCT from the candidates' perspective, to gain an insight into their views of its fairness, relevance, and acceptability. DESIGN & SETTING: This mixed-methods study was conducted with GP registrars in Ireland. METHOD: The study was conducted in two phases. Firstly, focus groups were conducted with participants who had previously undertaken the CCT to explore their experience of the CCT. Secondly, findings from the focus groups informed the development of an online questionnaire, which was sent to all GP registrars who completed the CCT in the 2017 summer sitting. RESULTS: Two focus groups were held with a total of nine participants. Following this, the online questionnaire was emailed to 134 registrars. Of these, 83 registrars completed the questionnaire in full. Registrars reported that the CCT is a fair exam and is relevant to daily general practice. They considered the exam to be a comprehensive assessment that has a positive educational impact. However, they were challenged by time restrictions, and found it financially and emotionally stressful. CONCLUSION: This is the first study to evaluate the candidate's perspective of an exiting GP membership exam in the UK or Ireland. The CCT is well-regarded by registrars. The study results will help to inform the future development of the CCT exam.
RESUMO
A study was undertaken to examine the population structure of viridans group streptococci (VGS) isolated the upper respiratory tract of adult and paediatric patients within the community. VGS are common commensal bacterial inhabitants of the upper respiratory tract and valuable sentinel reporters of underlying antibiotic resistance (AR). Laboratory examination of the colonising VGS species may provide a valuable ecological description of the species isolated from the upper respiratory tract and their antibiotic susceptibility, including an estimation of the AR reservoir in this population. Freshly obtained nasal and oropharyngeal swabs from 84 patients were examined by selective conventional culture on Mitis-Salivarius agar and yielded 363 isolates of VGS. Sequence analyses of the rpnB and 16-23S rRNA ITS genes identified these isolates to belong to 10 species of VGS and included S. anginosus, S. australis, S. constellatus, S. infantis, S. mitis, S. oralis, S. parasanguinis, S. salivarius, S. sanguinis and S. vestibularis. The most frequent VGS organisms isolated was S. salivarius (282/363; 78.0%), followed by S. sanguinis (23/363; 6.3%), S. parasanguinis (21/363; 5.8%), S. mitis (18/363; 5.0%), S. anginosus (5/363; 1.4%), S. vestibularis (5/363; 1.4%), S. australis (3/363; 0.8%), S. oralis (3/363; 0.8%), S. infantis (1/363; 0.3%) and S. constellatus (1/363; 0.3%). All patients examined carried at least one VGS organism, where there were 17 combination patterns of carriage of the 10 species of VGS species isolated, where 54.2%, 37.3%, 7.2% and 1.2% of patients harboured one, two, three and four different VGS species, respectively. Antibiotic susceptibility was determined by standard disk diffusion assay testing against four classes of antibiotics, including the b-lactams [cefotaxime, cefuroxime], the tetracyclines [doxycycline], the fluoroquinolones [levofloxacin] and the macrolides [erythromycin]. Overall, there was no resistance to levofloxacin and cefuroxime, with limited resistance to cefotaxime (3.3%) and doxycycline (9.8%). Antibiotic resistance was highest in erythromycin, where 40.9% of isolates were resistant. S. vestibularis was the most antibiotic resistance of all VGS species examined (S. vestibularis v S. salivarius p=0.011), followed by S. anginosis. S. salivarius was the most antibiotic susceptible VGS species examined. Overall, given their infrequency in causing infection, relatively few studies to date have attempted to examine their ecology in their preferred body niche, namely the upper respiratory tract. However, knowing their prevalence is becoming increasingly important in relation to their ability to exclude significant respiratory pathogens, including Streptococcus pneumoniae. In conclusion, these data indicate that VGS colonisation of the upper respiratory tract in individuals within the community is dominated mainly with relatively antibiotic susceptible S. salivarius.
