The final examination in medicine : time for change?

Most medical programmes culminate in a final assessment, in order that participants may be tested and graded. In June 1995, at the University of Malta, a group of 53 medical students sat for their final examination; medicine was one of the three co-equal component subjects of this statutory qualifying examination. The scope of this paper is to analyze the results obtained in the final examination in medicine and to use this data to address such issues as aims of this examination, method and quality assurance of assessment. The result obtained by candidates in the final examination in medicine was correlated with their university entry qualifications. The composite mark for each candidate was split into its components and analysis took the form of description, correlation and clustering. Computation of Cronbach’s alpha facilitated anlaysis of reliability of each of the three parts of the examination. The findings of this paper suggest that there is room for improving the quality of assessment methods. A review of methods and procedures, with the dual purpose of decreasing bias and increasing specificity and sensitivity of this statutory examination will not only benefit candidates, but ultimately also the University of Malta. The final qualifying examination in medicine should have clearly defined objectives and methods of assessment should be aimed specifically at reaching them. It needs to be able to assess the ability to think critically about diagnosis and management and to ensure that the candidate has a satisfactory base of factual knowledge. It also needs to assess objectively the adequacy of basic clinical skills and candidates’ facility of communication.peer-reviewe

Concordance with the British Society of Rheumatology (BSR) 2010 recommendations on eligibility criteria for the first biologic agent

Aims: The aim of this study is to assess concordance with the British Society of Rheumatology (BSR) 2010 recommendations on the use of biologic therapy in Rheumatoid Arthritis (RA). The Disease Activity Score in 28 joints (DAS 28), a composite numerical score is included in these recommendations to assess disease activity and response to treatment. Methods: Clinical notes of fifty patients who were commenced on biologic treatment between March 2010 and June 2011 were reviewed for documentation of DAS 28 scores at baseline, after approximately 6 months of commencement of treatment and at approximately 6 monthly intervals during treatment. Results: Twenty two patients were eligible for this audit. Of these patients only half had a DAS 28 score performed prior to starting treatment, four patients had the score performed within 3-9 months of commencement of therapy and only 2 patients had continuous scores performed at six monthly intervals during treatment. Conclusions: This audit shows that we are not adhering to the BSR recommendations. In order to improve our adherence we plan to train all staff in contact with patients on biologic treatment to perform DAS 28 scores and have a DAS 28 calculator readily available at out patients. A proforma is being developed for patients on biologic therapy to ensure that DAS 28 scores are performed at baseline and during treatment.peer-reviewe

Malignant lymphoma of the intestine : a report of three cases

Tumours arising in the small intestine are uncommon; those of them originating in the lymphoid tissues are said to be even less frequent than adennocarcinomas. Three cases hereby are reported, outlining the respective diagnosis and treatment. All the three cases were diagnosed histologically as Lymphosarcoma. It is interesting to note that in published series, Lymphosarcomas and Reticulum Cell Sarcomas have been about equally represented, and together accounted for the vast majority of cases. Various gross features have been reported, the commonest being polypoid, annular, ulcerative and aneurismal. An important feature of these tumours is that they have little connective tissue stroma. This, together with infiltration of the muscle coat, is said to account for the aneurismal varieties of the growth. Age incidence studies show that most cases occur in the age group 45 to 60 years, but no age group is exempt. As for signs and symptoms, it is true to say that no definite syndrome is produced by this disease. In general, it may be said that cases have presented either as surgical emergencies or insidiously. There is general consensus regarding the value of post-operative radiotherapy in unresectable growths, and in those with regional lymph node metastasis. What is uncertain is the value of radiotherapy where no evidence of lymph node spread is present.peer-reviewe

Concordance with the British Society of Rheumatology (BSR)

Abstract Aims: The aim of this study is to assess concordance with the Britis

Urban heritages: how history and housing finance matter to housing form and homeownership rates

Contemporary Western cities are not uniform but display a variety of different housing forms and tenures, both between and within countries. We distinguish three general city types in this paper: low rise, single-family dwelling cities where owner-occupation is the most prevalent tenure form; multi-dwelling building cities where tenants comprise the majority and; multi-dwelling building cities where owner occupation is the principal tenure form. We argue that historical developments beginning in the nineteenth century are crucial to understanding this diversity in urban form and tenure composition across Western cities. Our path-dependent argument is twofold. First, we claim that different housing finance institutions engendered different forms of urban development during the late-nineteenth century and had helped to establish the difference between single-family dwelling cities and multi-dwelling building cities by 1914. Second, rather than stemming from countries’ welfare systems or ‘variety of capitalism’, we argue that these historical distinctions have a significant and enduring impact on today’s urban housing forms and tenures. Our argument is supported by a unique collection of data of 1095 historical cities across 27 countries

European regional railways and real income, 1870–1910: a preliminary report

This article introduces our project on the relationship between railways and real income levels across European regions between 1870 and 1910. While similar relationships have been analysed for the USA, India and individual European countries, our project is the first to take a pan-European regional perspective. We discuss the reasons for the neglect to date, highlighting the need to drill deeper into the changing directional effects of railways on income, the importance or necessity of using regional-level data and the amount of research that still needs to be done. To this end, we present preliminary insights from our novel database on European regional per capita income and railway mileage, after discussing our data sources in depth. We also outline our research agenda, showing our intended conceptual and analytical approach for future work