Preliminary report of a Web-based instrument to assess and teach knowledge and clinical thinking to medical student.

OBJECTIVE: We report the preliminary development of a unique Web-based instrument for assessing and teaching knowledge and developing clinical thinking called the "Sequential Questions and Answers" (SQA) test. Included in this feasibility report are physicians' answers to the Sequential Questions and Answers pre- and posttests and their brief questionnaire replies. METHODS: The authors refined the SQA test case scenario for content, ease of modifications of case scenarios, test uploading and answer retrieval. Eleven geographically distant physicians evaluated the SQA test, taking the pretest and posttest within two weeks. These physicians completed a brief questionnaire about the SQA test. RESULTS: Eleven physicians completed the SQA pre- and posttest; all answers were downloaded for analysis. They reported the ease of website login and navigating within the test module together with many helpful suggestions. Their average posttest score gain was 53% (p=0.012). CONCLUSIONS: We report the successful launch of a unique Web-based instrument referred to as the Sequential Questions and Answers test. This distinctive test combines teaching organization of the clinical narrative into an assessment tool that promotes acquiring medical knowledge and clinical thinking. We successfully demonstrated the feasibility of geographically distant physicians to access the SQA instrument. The physicians' helpful suggestions will be added to future SQA test versions. Medical schools might explore the integration of this multi-language-capable SQA assessment and teaching instrument into their undergraduate medical curriculum.

Content analysis of medical students' seminars: a unique method of analyzing clinical thinking.

BACKGROUND: The study of communication skills of Asian medical students during structured Problem-based Learning (PBL) seminars represented a unique opportunity to assess their critical thinking development. This study reports the first application of the health education technology, content analysis (CA), to a Japanese web-based seminar (webinar). METHODS: The authors assigned twelve randomly selected medical students from two universities and two clinical instructors to two virtual classrooms for four PBL structured tutoring sessions that were audio-video captured for CA. Both of the instructors were US-trained physicians. This analysis consisted of coding the students' verbal comments into seven types, ranging from trivial to advanced knowledge integration comments that served as a proxy for clinical thinking. RESULTS: The most basic level of verbal simple responses accounted for a majority (85%) of the total students' verbal comments. Only 15% of the students' comments represented more advanced types of critical thinking. The male students responded more than the female students; male students attending University 2 responded more than male students from University 1. The total mean students' verbal response time for the four sessions with the male instructor was 6.9%; total mean students' verbal response time for the four sessions with the female instructor was 19% (p < 0.05). CONCLUSIONS: This report is the first to describe the application of CA to a multi-university real time audio and video PBL medical student clinical training webinar in two Japanese medical schools. These results are preliminary, mostly limited by a small sample size (n = 12) and limited time frame (four sessions). CA technology has the potential to improve clinical thinking for medical students. This report may stimulate improvements for implementation.

[Hypoxic ischemic encephalopathy with atypical findings on CT and MR imaging: two case reports].

We report 2 cases of hypoxic ischemic encephalopathy with atypical findings on computed tomographic (CT) and magnetic resonance (MR) imaging for the acute to subacute stage. Case 1: A 78-year-old man with larynx cancer suffered cardiac arrest after suffocation. Cardiopulmonary resuscitation, was performed; the patient then went into a deep coma and also developed severemyoclonus. CT scans on day 0 and day 3 after the arrest revealed no abnormalities MR imaging was performed on day 13 to evaluate cerebral anoxia; however, no abnormal findings were obtained. Since no abnormalities were detected both on CT and MR imaging, we expected that the prognosis would be good; however, the patients did not recover from coma and remains in a persistent vegetative state. Case 2: A 54-year-old man developed cardiac arrest after anaphylactic shock caused by insect bite. After cardiopulmonary resuscitation, the patient lapsed into a deep coma. CT scans performed on day 1 and 3 after the cardiac arrest revealed slight subarachnoid hemorrhage at the surface of the right cerebral cortex along the falx cerebri. MR images obtained on day 10 demonstrated slight hemorrhage at the surface of right cerebral cortex, but no abnormalities in basal ganglia, thalamus, cortex, and white matter. The transient damage of the blood brain barrier caused by hypoxia and ischemia was thought to induce the slight subarachnoid hemorrhage after cardiopulmonary resuscitation. The patient demonstrated early recovery and was almost completely recovered with slight agnosia. MR imaging to rule out hypoxic-ischemic encephalopathy may not have been timed appropriately in both the case, our radiological findings are usual as compare to the findings presented in other similar reports. The variations in the findings of CT and MR imaging in the case of hypoxic-ischemic encephalopathy should be clarified, and the prognosis and management of this condition should be planned on the basis of not only the neuroradiological images but also the neurological signs and symptoms.