Students' interviewing skills are now commonly evaluated with standardized patient-based assessment methods. Four pairs of instructors at Nihon University School of Medicine used objective structured clinical examinations to evaluate the medical interviewing skills of 122 fifth-year medical students. The results were then analyzed to improve the accuracy of rating with objective structured clinical examinations. Interrater variability was significant among the two pairs of instructors. Variability was greatest when instructors evaluated a student's performance but was minimal when they judged whether a student had carried out a task. The number of standardized patients was 8, with the average score of each standardized patient ranging from 52.5 to 73.3 (full score, 100). These results suggest that the rating process for each item should be further refined and that the standard for evaluation should be clarified.

Methods: We examined 242 patients (age >60 years) who underwent surgery for thoracic to lumbar spine fractures from 2010 to 2020. Subsequently, the maxVB was classified into three groups: maxVB (0), maxVB (2–8), and maxVB (9–18), and parameters, including fracture morphology (new Association of Osteosynthesis classification), fracture level, and neurological deficits were compared. In a sub-analysis, 146 patients with thoracolumbar spine fractures were classified into the three aforementioned groups based on the maxVB and compared to determine the optimal operative technique and evaluate surgical outcomes. Results: Regarding the fracture morphology, the maxVB (0) group had more A3 and A4 fractures, whereas the maxVB (2–8) group had less A4 and more B1 and B2 fractures. The maxVB (9–18) group exhibited an increased frequency of B3 and C fractures. Regarding the fracture level, the maxVB (0) group tended to have more fractures in the thoracolumbar transition region. Furthermore, the maxVB (2–8) group had a higher fracture frequency in the lumbar spine area, whereas the maxVB (9–18) group had a higher fracture frequency in the thoracic spine area than the maxVB (0) group. The maxVB (9–18) group had fewer preoperative neurological deficits but a higher reoperation rate and postoperative mortality than the other groups. Conclusions The maxVB was identified as a factor influencing fracture level, fracture type, and preoperative neurological deficits. Thus, understanding the maxVB could help elucidate fracture mechanics and assist in perioperative patient management.