Are Commonly Used Resident Measurements Associated with Procedural Skills in Internal Medicine Residency Training?

BACKGROUND: Acquisition of competence in performing a variety of procedures is essential during Internal Medicine (IM) residency training. PURPOSES: Determine the rate of procedural complications by IM residents; determine whether there was a correlation between having 1 or more complications and institutional procedural certification status or attending ratings of resident procedural skill competence on the American Board of Internal Medicine (ABIM) monthly evaluation form (ABIM-MEF). Assess if an association exists between procedural complications and in-training examination and ABIM board certification scores. METHODS: We retrospectively reviewed all procedure log sheets, procedural certification status, ABIM-MEF procedural skills ratings, in-training exam and certifying examination (ABIM-CE) scores from the period 1990–1999 for IM residency program graduates from a training program. RESULTS: Among 69 graduates, 2,212 monthly procedure log sheets and 2,475 ABIM-MEFs were reviewed. The overall complication rate was 2.3/1,000 procedures (95% CI: 1.4–3.1/1,000 procedure). With the exception of procedural certification status as judged by institutional faculty, there was no association between our resident measurements and procedural complications. CONCLUSIONS: Our findings support the need for a resident procedural competence certification system based on direct observation. Our data support the ABIM’s action to remove resident procedural competence from the monthly ABIM-MEF ratings

Clinical Reasoning by Veterinary Students in the First-Opinion Setting: Is It Encouraged? Is It Practiced?

A mixed-methods study was performed to investigate the perceived importance and efficacy of teaching clinical reasoning (CR) skills among students and faculty in a university first-opinion veterinary practice, as this has not previously been described. Qualitative analysis of interview data, discussing objectives and factors considered important for effective learning and the understanding of CR, was performed alongside quantitative analysis of the Preceptor Thinking-Promotion Scale (PTPS) and the Learner Thinking-Behavior Scale (LTBS) (assessing the level of CR encouraged by clinicians and displayed by students) in peri-consultation discussions. Themes that emerged from analysis of the interviews regarding objectives included the desire to develop data acquisition and the need to improve data manipulation and CR. Themes associated with effective learning were a positive student-centered learning environment and feedback. Type II CR was fairly well described, but recognition of the importance of type I CR was poor among clinicians and students and, in some instances, was deemed to be inappropriate. Although many clinicians and students expressed a desire to develop student CR, there was little evidence of this actually occurring in the interactions analyzed, with low PTPS and LTBS scores achieved. There was also poor understanding of whether effective teaching of CR had occurred, demonstrated by a lack of correlation between LTBS and the interaction score for development of student CR. Further training of clinicians and students of the value of type I CR in first-opinion practice is required, as well as clinician education in how best to support the development of CR in students

An exploratory study of the cost-effectiveness of orthodontic care in seven European countries

This study investigated the orthodontic treatment of 429 consecutive patients [172 male (40.1 per cent) and 257 female (59.9 per cent)] carried out by 10 orthodontic specialist practitioners in seven European countries [two in the Czech Republic (A and B), two in Germany (A and B), Italy, Latvia, Lithuania, and Netherlands, and two in Slovenia (A and B)]. The median age of the patients at the start of treatment was 13.0 years (minimum 7.3 years maximum 50.3 years). The patients had a range of malocclusions and the majority (97 per cent) were treated with upper and lower fixed appliances

Anomalous diffusion in polymers: long-time behaviour

We study the Dirichlet boundary value problem for viscoelastic diffusion in polymers. We show that its weak solutions generate a dissipative semiflow. We construct the minimal trajectory attractor and the global attractor for this problem.Comment: 13 page

The use of contextualised standardised client simulation to develop clinical reasoning in final year veterinary students

Clinical reasoning is an important skill for veterinary students to develop before graduation. Simulation has been studied in medical education as a method for developing clinical reasoning in students, but evidence supporting it is limited. This study involved the creation of a contextualized, standardized client simulation session that aimed to improve the clinical reasoning ability and confidence of final-year veterinary students. Sixty-eight participants completed three simulated primary-care consultations, with the client played by an actor and the pet by a healthy animal. Survey data showed that all participants felt that the session improved their clinical decision-making ability. Quantitative clinical reasoning self-assessment, performed using a validated rubric, triangulated this finding, showing an improvement in students’ perception of several components of their clinical reasoning skill level from before the simulation to after it. Blinded researcher analysis of the consultation video recordings found that students showed a significant increase in ability on the history-taking and making-sense-of-data (including formation of a differential diagnosis) components of the assessment rubric. Thirty students took part in focus groups investigating their experience with the simulation. Two themes arose from thematic analysis of these data: variety of reasoning methods and “It’s a different way of thinking.” The latter highlights differences between the decision making students practice during their time in education and the decision making they will use once they are in practice. Our findings suggest that simulation can be used to develop clinical reasoning in veterinary students, and they demonstrate the need for further research in this area