With the tremendous advance in technology, imaging methods have fi nally entered clinical routine for the assessment of the peripheral nervous system, after having already been employed for a long time in the realm of the central nervous system. Although both Ultrasound (US) and Magnetic Resonance Imaging (MRI) show good soft tissue resolution, US is more suited to everyday clinical practice, boasting easy accessibility, superior spatial resolution and low cost. MRI’s main role lies with the imaging of deeper lying nervous structures and when US imaging is obscured by bony structures. Nerve US quantifi es and anatomically pinpoints changes in nerve size and echotexture and is therefore useful for the identifi cation of nerve entrapments, trauma, tumours and infl ammation. It is also important for clinicians to realise that US imaging can reveal conditions even in the absence of signifi cant neurophysiological abnormality. Furthermore, developments in nerve blood fl ow assessments have the potential for quantitating nerve blood fl ow, and thus providing new assessments of ischemic neuropathies.

The ulnar dorsal aspect of the hand is predominantly innervated by the dorsal ulnar cutaneous nerve with variable input from the superficial radial cutaneous nerve. This cross innervation can cause difficulty in interpreting low amplitude sensory nerve action potential for the dorsal ulnar cutaneous nerve particularly when facing suspected ulnar neuropathyat the elbow. In three subjects with low dorsal ulnar cutaneous sensory nerve action potential amplitude due to cross over with the superficial radial nerve, we compared amplitude with nerve circumference and fascicular count as measured by ultrasound. Dorsal ulnar cutaneous nerve circumference was significantly smaller where there was low sensory nerve action potential amplitude and showed fewer fascicles. Nerve ultrasonography may be a useful additional test modality to determine if low dorsal ulnar cutaneous nerve amplitude is physiological.

BACKGROUNDComputer-based testing (CBT) has become increasingly popular as a testing modality in under- and postgraduate medical education. Since 2004, our medical school has utilised CBT to conduct 2 papers for the third- and final-year assessments - Paper 3, with 30 multiple choice questions featuring clinical vignettes, and the modified essay question (MEQ) paper.

AIMSTo obtain feedback from final-year students on their preferred mode of testing for Paper 3 and MEQ components of the Medicine track examination, and the reasons underlying their preferences.

METHODSAn online survey was carried out on 213 final-year undergraduates, in which they were asked to provide feedback on Paper 3 and MEQ papers. Students were asked if they thought that the CBT format was preferable to the pen-and-paper (PNP) format for Paper 3 and the MEQ, and why.

RESULTSOne hundred and fourteen out of 213 (53.5%) students completed the online survey. For Paper 3, 91 (79.8%) felt that CBT was preferable to PNP, 11 (9.6%) preferred the PNP format and 12 (10.5%) were unsure. For the MEQ, 62 (54.4%) preferred CBT over PNP, 30 (26.3%) preferred the PNP format and 22 (19.3%) were unsure. Reasons given to explain preference for CBT over PNP for Paper 3 included independence from seating position, better image quality (as images were shown on personal computer screens instead of projected onto a common screen) and the fact that CBT allowed them to proceed at their own pace. For the MEQ, better image quality, neater answer scripts and better indication of answer length in CBT format were cited as reasons for their preference.

CONCLUSIONSOur survey indicated that whereas the majority of students preferred CBT over PNP for Paper 3, a smaller margin had the same preference for the MEQ.

Clinical Competence ; Computers ; Education, Medical ; methods ; standards ; Educational Measurement ; methods ; Humans ; Students, Medical

Arteriovenous Shunt, Surgical ; adverse effects ; Brachial Artery ; diagnostic imaging ; Diabetic Nephropathies ; complications ; therapy ; Hematoma ; complications ; diagnostic imaging ; Humans ; Magnetic Resonance Imaging ; Male ; Median Neuropathy ; diagnostic imaging ; etiology ; physiopathology ; Middle Aged ; Neural Conduction ; Renal Dialysis ; Ultrasonography