Script concordance test: Insights from the literature and early stages of its implementation in osteopathy

Osteopathic pre-registration education aims to produce competent autonomous practitioners who are capable of dealing with and mastering the uncertainty of clinical practice. The students' preparedness for clinical practice is typically assessed using high fidelity long case exams, i.e., clinical competence assessments using real patients in a real clinical setting. In this paper, we critically review relevant literature concerning the validity, reliability and underpinning educational theory of the Script Concordance Test (SCT), and describe the development, implementation and initial critical evaluation of this assessment tool in the osteopathy programme at Oxford Brookes University. The SCT is an assessment tool aimed at assessing clinical reasoning in the context of uncertainty, which is being increasingly used as an assessment strategy in the field of medical education. Despite its limitations, we believe that the SCT is a useful addition to assessing clinical reasoning in osteopathy, particularly in situations of clinical uncertainty. It has the potential to effectively assess the students' diagnostic reasoning, evaluation of risk and patient safety, and ethical aspects of osteopathic care. Critically, it provides an important vehicle to assess the students' preparedness for autonomous clinical practice using a standardised format.     

黑水城出土西夏文“三仙丹”方考述

《俄藏黑水城文献》第10册所载编号为ИHB.NO.4384的医方计9页,其中第7页和第4页缀合后为一完整医方.此医方原无方名,其药物组成为川乌头、苍术、茴香.经核查汉文医籍,此医方应定名“三仙丹”,其来源可上溯至《陈氏经验方》.《陈氏经验方》已佚,但从其他医籍引文来看,其行文平铺直叙,与这则西夏文医方所用的歌诀形式不同.故,这则西夏文医方所依据的文本,很有可能为“淳祐”之后的某种汉文医籍.     

医院门急诊手写电子病历的应用

手写电子病历可将患者病历原样完整保留在医院数据库中,可作为患者就诊过程中院方医疗行为的记录,也是医疗质量好坏的评价、医疗纠纷举证及医师诊疗过程监督的凭证。通过后台操作,可进行病历质量考核,工作质量管理,医疗数质量分析,系统解决了门急诊病历及时采集、保留、管理以及统计分析等问题。     

Are script concordance tests suitable for the assessment of undergraduate students? A multicenter comparative study

IntroductionScript concordance tests (SCTs) have been developed to assess clinical reasoning in uncertain situations. Their reliability for the evaluation of undergraduate medical students has not been evaluated.MethodsTwenty internal medicine SCT cases were implemented in undergraduate students of two programs. The results obtained on the SCTs were compared to those obtained by the same students on clinical-based classical multiple-choice questions (MCQs).ResultsA total of 551/883 students (62%) answered the SCTs. The mean aggregate score (based on a total 20 points) was 11.54 (3.29). The success rate and mean score for each question did not differ depending on the modal response but the discrimination rate did. The results obtained by the students on the SCT test correlated with their scores on the MCQ tests. Among students, 446/517 (86%) considered the SCTs to be more difficult than classical MCQs, although the mean score did not differ between the SCT and MCQ tests.ConclusionThe use of SCTs is a feasible option for the evaluation of undergraduate students. The SCT scores correlated with those obtained on classical MCQ tests.     

老官山汉简的书法特点及在隶变分期中的早晚

在对成都老官山汉简书法分析单字笔划和结构特点的基础上,从整支和多支医简书法的角度进行研究,重点围绕其篆隶关系及与阜阳汉简、银雀山汉简的书法进行比较讨论。认为其篆书风格较马王堆汉墓简帛和张家山汉墓竹简等明显减弱,其隶书传承了秦简的风格特点,与银雀山汉简书法较为接近,但较其年代略晚。首次提出其出现不少楷书的早期形体和笔划特征,表现为朴拙厚重、端庄舒朗、扁纵并存,兼有少许篆楷笔意的隶书;其抄写时间当在与其墓葬时间相近的景帝或武帝初期,属于隶书迈向成熟的过渡期。