How often should patients be sigmoidoscoped? A mathematical perspective

A simple mathematical model is used to help determine suitable intervals for routine periodic sigmoidoscopy. Although annual examinations have been recommended in the past, our calculations indicate that such frequent examinations may only be needed for high-risk patients or very cautious examiners. Our calculations suggest examinations every 2 or 3 years for asymptomatic persons. These recommendations are intended as guides for physicians in their daily practice. They may not apply to large scale screening programs where costs and logistics factors require consideration.     

Use of nonphysician health care providers for skin cancer screening in the primary care setting

BACKGROUND: Nonphysician health care providers are in an optimal position to provide cancer prevention and screening services. METHODS: We conducted a survey of primary care physicians to determine physician use and amenability to use of nonphysician health care providers to perform skin cancer screening in comparison with other cancer screening examinations. RESULTS: A total of 1,363 eligible physicians completed the survey. Of these, 631 physicians (46%) reported a nurse practitioner or physician assistant performing at least one type of cancer screening examination on their patients. Twenty-nine and 22% of all physicians reported nurse practitioners or physician assistants performing skin cancer screening, respectively. Family physicians were more likely to use nurse practitioners and physician assistants to perform these cancer screening examinations than internists (chi(2) test, P = 0.001 for each examination). Skin examinations were performed less frequently by nurse practitioners and physician assistants than all other cancer screening examinations. A total of 73-79% of family physicians and 60-70% of internists were amenable to having a nonphysician health care provider perform one or more of these examinations. CONCLUSIONS: Primary care physicians are currently utilizing nonphysician health care providers to perform cancer screening examinations and the majority of those surveyed are amenable to the use of these providers for such examinations. This suggests that one possible strategy for increasing skin cancer screening is through an expanded role of nonphysician health care providers.     

From specialty-based to practice-based: a new blueprint for the American Board of Family Medicine cognitive examination

The American Board of Family Medicine (ABFM) is committed to offering cognitive examinations that are both pertinent to the specialty of family medicine and psychometrically sound. This article reviews the history of the development of the blueprint of the ABFM certification and recertification cognitive examinations and describes the creation of a new one. The design of the new blueprint represents a significant change. The intention of the new plan is to create a continuously evolving approach that will assure family physicians that the content of their specialty board certification/recertification examination is relevant to their practices and to the discipline. The ABFM anticipates that assessments based on the new blueprint will assist family physicians in attaining and maintaining the knowledge required to practice high quality family medicine by focusing their certification and recertification examinations and, therefore, studies for those examinations on material that is relevant to their practices.     

不同科室患者对医疗检查认知的情况分析

目的 了解医患双方对医疗检查合理性的认知,为有效开展医疗检查工作提供参考.方法 采取方便抽样和个别访谈,调查了58名医务人员和329例患者对合理医疗检查内涵和意义、影响医疗检查选择因素以及不合理医疗检查原因等问题的认知情况.结果 不同部门和职称医务人员的认知差异无统计学意义,P>0.05;而门诊与住院患者以及不同性别患者之间存在相当大的认知差异,医患双方的认知差异明显,P<0.05.结论 患者应该是医疗检查合理性的评价者,患者的利益应该是医疗检查合理性评价的核心内容.只有客观评价和正确处理医患双方对医疗检查的认知差异,才能保障医疗检查的合理使用.     

The assessment of an examination in pathology consisting of multiple-choice, practical and short essay questions

The rationale for assessing medical students' achievement in pathology with examinations consisting of multiple-choice, practical and short essay items is provided. In addition, these three-part examinations are assessed with reference to their reliabilities and their content, criterion and construct validities.     

Costs of mobile screening for diabetic retinopathy: a practical framework for rural populations

ABSTRACT: Australia's rural and remote residents experience considerably higher hospitalisation and death rates due to diabetes than their metropolitan counterparts. There is clearly a need for improved diabetes care services in these areas and interventions that target conditions associated with diabetes will yield beneficial results for the community. All people with diabetes are at risk for diabetic retinopathy, which can cause vision loss and blindness. Although vision loss and blindness due to diabetes is nearly 100% preventable through regular eye examinations, 35% of Victoria's rural population with diabetes do not have their eyes examined on a regular basis. A pilot, mobile screening program for the early detection of diabetic eye disease was conducted in rural Victoria and proved to be a successful model of adjunct eye care for people with diabetes. Actual costs from the pilot screening were applied to a permanent model for rural eye care. At A$41 per participant, costs for mobile screening were competitive with Medicare rebate costs for eye examinations. The model addresses barriers of accessibility and availability, targets a portion of the rural population with diabetes that is not otherwise having eye examinations, and is cost-saving to the Government.     

Nation-wide survey on radiation doses in diagnostic and interventional radiology in Switzerland in 1998

A nation-wide survey on radiation doses in diagnostic and interventional radiology was conducted in Switzerland in 1998 aiming at establishing their collective radiological impact on the Swiss population. The study consisted on the one hand of surveying the frequency of more than 250 types of examinations, covering conventional radiology, mammography, fluoroscopy, angiography, interventional radiology, CT, bone densitometry, conventional tomography and dental radiology. On the other hand, for each type of examination the associated patient dose was established by modeling. The results of this study show that about 9.5 million diagnostic and interventional examinations are performed annually in Switzerland (1.34 per caput) and that the associated annual collective dose is of the order of 7100 person.Sv (1.0 mSv per caput). Switzerland is similar to other European countries in terms of the frequency of examinations and the collective dose.     

Effect of ethnicity and gender on performance in undergraduate medical examinations

OBJECTIVE: To assess the effect of ethnicity and gender on medical student examination performance. DESIGN: Cohort study of Year 3 medical students in 2002 and 2003. SETTING: Royal Free and University College Medical School, Imperial College School of Medicine. SUBJECTS: A total of 1216 Year 3 medical students, of whom 528 were male and 688 female, and 737 were white European and 479 Asian. OUTCOME MEASURE: Performance in summative written and objective structured clinical examinations (OSCEs) in July 2002 and 2003. RESULTS: White females performed best in all OSCEs and in 3 out of 4 written examinations. Mean scores for each OSCE and 2 out of 4 written examinations were higher for white students than for Asian students. The overall size of the effect is relatively small, being around 1-2%. CONCLUSION: Students of Asian origin, of both genders, educated in the UK, using English as their first language, continue to perform less well in OSCEs and written assessments than their white European peers.     

MCQ and higher examinations as exemplified by the primary Fellowship of the Faculty of Anaesthetics, Royal College of Surgeons of England

A major problem of the use of multiple choice examinations is the inherent difficulty of the questions, a fact which cannot be assessed in relation to questions not previously used. Questions which have been used during previous examinations, however, will have an available measure of the difficulty in the form of candidates' previous scores. The performance of candidates in a current examination can be compared with that in a previous examination. On the strength of these differences it is possible to decide whether the candidates in any single examination are better prepared than their predecessors or less well prepared. Pass marks can be appropriately adjusted.     

Achieving acceptable reliability in oral examinations: an analysis of the Royal College of General Practitioners membership examination's oral component

BACKGROUND: The membership examination of the Royal College of General Practitioners (RCGP) uses structured oral examinations to assess candidates' decision making skills and professional values. AIM: To estimate three indices of reliability for these oral examinations. METHODS: In summer 1998, a revised system was introduced for the oral examinations. Candidates took two 20-minute (five topic) oral examinations with two examiner pairs. Areas for oral topics had been identified. Examiners set their own topics in three competency areas (communication, professional values and personal development) and four contexts (patient, teamwork, personal, society). They worked in two pairs (a quartet) to preplan questions on 10 topics. The results were analysed in detail. Generalisability theory was used to estimate three indices of reliability: (A) intercase (B) pass/fail decision and (C) standard error of measurement (SEM). For each index, a benchmark requirement was preset at (A) 0.8 (B) 0.9 and (C) 0.5. RESULTS: There were 896 candidates in total. Of these, 87 candidates (9.7%) failed. Total score variance was attributed to: 41% candidates, 32% oral content, 27% examiners and general error. Reliability coefficients were: (A) intercase 0.65; (B) pass/fail 0.85. The SEM was 0.52 (i.e. precise enough to distinguish within one unit on the rating scale). Extending testing time to four 20-minute oral examinations, each with two examiners, or five orals, each with one examiner, would improve intercase and pass/fail reliabilities to 0.78 and 0.94, respectively. CONCLUSION: Structured oral examinations can achieve reliabilities appropriate to high stakes examinations if sufficient resources are available.     

505名在职女教职工健康状况调查

目的了解哈尔滨医科大学在职女教职工身体健康状况,分析影响健康状况及疾病发生发展的因素,为提高教职工的健康水平,采取预防保健措施提供理论依据。方法查阅相关文献资料,确定研究方向和内容,统一体检表格,将体检结果录入Excel数据库进行数据分析。结果女教职工健康水平不高,消化系统疾病和心脑血管疾病对教职工的身体健康状况危害最大,脂肪肝、高血脂不容忽视。同时妇科疾病患病率很高,高达95.17%,宫颈炎和乳腺增生检出率最高。结论提高高校女教职工的健康水平,需要社会、学校和本人的多方协作,保持健康的生活方式,定期做体检,不断提高健康意识。     

Imprecise terms in UK medical multiple-choice questions: what examiners think they mean

Many multiple-choice questions (MCQs) used in medical education in the UK contain undefined, imprecise terms. They are particularly common in true/false items and can be found in classroom tests, published examples of MCQs and, more importantly, in high-stakes examinations which determine a candidate's graduation or membership of a professional body. This study investigated imprecise terms used in some MB BS finals examinations and the Part 1 Membership Examination of the Royal College of Physicians. It revealed that imprecise terms occur commonly, yet there is a wide range of opinion among the examiners themselves about their meanings. The numbers and variety of imprecise terms which were found in high-stakes MCQ examinations are described in this paper and details are given concerning the lack of consensus about their meanings as reported by the responsible examiners. A second type of construction error – disproportionately large numbers of `true' branches – was also recorded. Exemplary practices do exist in MCQ quality assurance, but in the UK they are very much the exception rather than the rule. The findings of this investigation strongly indicate a need for change.     

Health Examinations of Senior Staff in Industry

Of 228 senior staff participating in schemes for their health supervision who were asked for their opinions on the examinations, 26% said they had derived a lot of benefit, 53% a little, 20% no benefit, and 1% were unable to express an opinion. The degree of benefit felt was influenced by the number of routine examinations; age was relatively unimportant. Detection of hidden illness was considered the most important objective of the examinations, and the value of reassurance, usually in the absence of abnormal clinical findings, was mentioned by 65% of the respondents.

Ten per cent admitted to being worried by the idea of the examinations before they took place, and 32% said, retrospectively, that the examinations had reduced their concern about health. There was little criticism of the content of the examinations or the way the scheme was organized. The time given was considered to be of fundamental importance, as were also the personal qualities and interest of the examining doctor.

     

某电源科技公司铅作业工人健康水平和职业健康教育分析

目的了解深圳市龙岗区某电源科技公司铅作业工人健康水平和职业卫生防护知识及相关行为,为预防铅中毒提供科学保护措施。方法对深圳市龙岗区某电源科技公司494名铅作业工人进行职业卫生健康检查,采用调查问卷的方式,对494名铅作业工人的职业卫生相关知识的了解程度、认知态度及职业卫生行为进行调查。结果 494名铅作业工人各项体检指标中有一项以上异常者为328人,异常检出率为66.4%;各项体检指标全部正常者仅166人,正常率为33.6%。获取知识的途径主要为专业培训、职业卫生宣传手册和广播电视;73.3%的铅作业工人知道岗位存在职业病危害因素及自我防护等知识。结论定期对工人进行职业健康体检和职业健康教育,提高铅作业工人自我防护意识,养成良好的卫生习惯,减少铅危害的发生具有十分重要的意义。     

Teaching plastic surgery to medical students

A plastic surgery syllabus for third-year medical students is described. It is intended for a teaching programme in which plastic surgery is integrated into the surgical teaching on the same basis as the other surgical specialties. The syllabus was designed to concentrate on aspects of plastic surgery relevant to the needs of undergraduates. An audit of the teaching showed that the students were readily interested and considered the teaching to be relevant to their examinations and to their future as doctors. A survey of all plastic surgery centres in the British Isles showed that similar teaching was being undertaken in 11 centres out of 51.     

Student selection: are the school-leaving A-level grades in biology and chemistry important?

Summary. This study determined the relationships of grades in A-level biology and chemistry with examination success or failure during the medical course. By inspection of medical student records, A-level grades at entry to medical school and examination performance were obtained for 128 (91%) of the students who sat their final MBBCh examination at the University of Wales College of Medicine in June 1988. The majority, 92 (72%), completed their medical school careers with no professional examination failures; 15 failed examinations just in the period up to 2nd MB; 11 failed examinations in the clinical period only and 10 failed examinations in both periods. Whereas grade achieved in A-level chemistry was not associated with undergraduate examination performance, students with a grade A or B in A-level biology were less likely to have problems than the others (21% compared with 47%; the difference of 26% has a 95% confidence interval of 7% to 44%). Specifically, there appears to be a strong relationship between a low grade in biology and difficulties in the preclinical examinations. Moreover, for those who have difficulties at this stage, this association continues later in the course.     

Determination of inhalation pollution of the organism by chemicals--methodologic approach

To determine affecting environmental factors, epidemiological examinations are mainly performed to prove the methodology of the hygienic assessment of the real molestation (exposition). Merely ideas of the tendency of the alteration of the population's state of health can be obtained this way without giving a complete insight into their mechanism. A necessary step would be to elaborate a system of methods granting to analyse the adequate degree of endangering by chemicals for population's health in inhalative load. Animal experiments and examinations under real conditions of the environment have to be performed in parallel.     

“套餐医嘱”在医生工作站中的应用

本文介绍了医生工作站中“套餐医嘱”的维护和使用方法。在医生工作站中引入“套餐医嘱”的概念，其功能是将多条医嘱或检验检查进行组合，形成一个医嘱套餐或检验检查套餐，为就诊病人下医嘱、申请检验检查时直接选择预制好的医嘱套餐或检验检查套餐就可以将这组医嘱或检验检查一并开出，方便医生开医嘱、申请检验检查时使用。     

Students' attitudes towards computer testing in a basic science course

OBJECTIVES: The introduction of computerized testing offers several advantages for test administration, however, little research has examined students' attitudes toward computerized testing. This paper, reports the attitudes of 202 students in a first year cell biology and histology course toward computerized testing and its influence on their study habits over a three year period. DESIGN AND METHODS: Multiple choice and image-based extra credit examinations and summative image-based examinations have been successfully administered in the course. The results indicate that students readily accept computer exams and that their study habits were influenced in a positive manner by the computer administered extra-credit examinations. RESULTS: Our results provide further evidence that medical students like the use of computer administered examinations and that the examinations may actually accentuate the learning experience.