PURPOSE: Occasionally, in nonglaucomatous optic atrophy, the optic nerve head may appear to be cupped to such a degree that normal tension glaucoma is suspected. We report such a case of visual field defects from schizencephaly in a patient initially suspected to have normal tension glaucoma, using ophthalmoscopic examination only. METHODS: An 18-year-old male patient visited our clinic because of bilateral visual disturbance which had developed 5 years previously. Ophthalmoscopic examination revealed an increased cup to disc ratio, peripapillary atrophy, and loss of temporal neuroretinal rim tissue. The authors suspected normal tension glaucoma in both eyes. However, because the patient was too young and the visual field test revealed atypical field defects of the left superior quadrants in both eyes, we performed MRI. The results showed right schizencephaly with an absence of septum pellucidum. In order to rule out hypothalamic- pituitary dysfunction which can coexist with the absence of septum pellucidum, we conducted combined pituitary function test (cocktail test) which revealed normal results. RESULTS: The patient was initially suspected to have normal tension glaucoma on ophthalmoscopic examination alone. However, because the patient was too young and showed nonglaucomatous visual field defects, MRI was performed and revealed right schizencephaly.
Adolescent ; Atrophy ; Humans ; Low Tension Glaucoma* ; Magnetic Resonance Imaging ; Male ; Malformations of Cortical Development* ; Optic Atrophy ; Optic Disk ; Pituitary Function Tests ; Septum Pellucidum ; Visual Field Tests ; Visual Fields

PURPOSE: This study was designed to investigate the effects of information sharing between students on results of clinical performance examination (CPX). METHODS: 143 third-year students, who completed their core clinical clerkship, were randomly assigned to one day of a 3-day, 6 station CPX. Station checklists, scored by the SP(s), consisted of history taking, physical examination, information sharing, clinical courtesy and patient-physician interaction. We compared the CPX station scores, CPX domain scores, self assessment scores and GPA of the three groups tested on different days with ANOVA, and analyzed the differences in CPX scores, after controlling for GPA, with ANCOVA. The correlations among the CPX total and domain scores, self assessment and the GPA of the 3rd year students were calculated. Data regarding information sharing between students and self-assessment were obtained through student questionnaires. RESULTS: CPX total scores, self assessment scores and GPA of 3rd year students from day-2 were significantly higher than scores from day-1 or day-3. Checklist analysis showed that PE, CC and PPI scores were significantly higher on day-2, but Hx and IS scores were not significantly different. Results from questionnaires showed that 43% of students shared evaluation information. And CPX total scores had little correlation with self assessment scores. GPA of 3rd year students showed a similar pattern with the CPX totalscore. CONCLUSION: There is information sharing occurring between students during clinical performance examinations. Although there are significant differences in CPXscores for the treatment group, it seemed that CPX scores are not affected by information sharing between students. Reliability of information sharing from other students is low. The generalization of this study should be interpreted carefully.
Checklist ; Clinical Clerkship ; Generalization (Psychology) ; Humans ; Information Dissemination* ; Physical Examination ; Self-Assessment ; Surveys and Questionnaires

PURPOSE: The purpose of this study is to assess the effects of case type and gender of standardized patient on student performance in a clinical performance examination(CPX). METHODS: During 2005, an eight-station CPX was administered to fourth-year students from 4 medical schools. A total of 306 students, of which 206(67%) were male, participated in the exam. Station checklists, scored by the SPs, consisted of history taking(Hx), physical examination(PE), information sharing(IS), clinical courtesy(CC) and patient-physician interaction(PPI). A measurement of students' perceived difficulty was obtained through student questionnaires. The difference of CPX scores between male and female students were studied using Mann-Whitney's U. RESULTS: Across the gender-neutral cases, female students scored better in Hx in 2 cases. In PE, IS and CC, the only difference seen was with CC in 1 case(female students scored higher). In PPI, female students performed better than male students in all female SP cases and one male SP case, but, there was a significant student gender-SP gender interaction when averaging all cases. For the gender sensitive case, there was no significant difference in all checklist categories in the male case when student gender was considered. In the female case, female students performed better than male students only in PPI. Student questionnaires revealed that there was no significant difference in perceived difficulty between male and female students. RESULTS: The standardized patients' ratings in gender sensitive cases are not affected by the gender of standardized patients and students, except in PPI with a female case where female students performed better than male students.
Checklist ; Female ; Humans ; Male ; Schools, Medical ; Surveys and Questionnaires

Objective: Ultrasound is widely used in the clinical field. However, training on use of ultrasound is insufficient. Newer models and techniques cannot be introduced for use by doctors without training and knowledge of its clinical utility. We produced a unique ultrasound education model and investigated if the use of the model could enhance the ability of clinicians to use ultrasound. Methods: A gelatin ultrasound practice model that can be transformed into various shapes was created using a cubeshaped plastic trainer. Residents and interns working in tertiary hospitals were surveyed for their awareness of the use of ultrasound through a questionnaire. Subsequently, ultrasound education was conducted, and a test was administered using a cube-shaped ultrasound education model. After the education and testing, awareness of the use of ultrasound was investigated through a questionnaire once again, and the test results were evaluated. Results: A total of 20 people participated in the evaluation and survey using the practice model. Of these, 11 people (55%) had procedural experience of using ultrasound. The Spearman’s correlation test was performed to compare previous ultrasound procedural experience with the number of correct answers, time spent on the test, and the number of attempts, and the results were 0.278 (P=0.235), -0.513 (P=0.021), and -0.369 (P=0.110), respectively. The correlation coefficients between the previous ultrasound knowledge level and changes in the knowledge level, preference, and confidence about ultrasound examination before and after practice were 0.261 (P=0.281), 0.638 (P=0.003), and 0.705 (P< 0.001), respectively. Conclusion Our cube-shaped ultrasound educational model can spark interest in the use of ultrasound, improve knowledge levels, and increase procedural skills in using ultrasound.

Background: Point-of-care ultrasound (POCUS) is an essential tool in emergency medicine (EM). We aimed to investigate the current status and perception of POCUS use in emergency medical centers in Korea. Methods: A cross-sectional, nationwide survey was conducted using a mobile survey of physicians at emergency medical centers in Korea. The first message was sent on November 27, 2020, and the second message was sent on December 3, 2020 to the non-responders.The questionnaire comprised 6 categories and 24 questionnaires on demographics, current practice, education, perception, and barriers to the use of POCUS. Results: A total of 467 physicians participated in the survey (a response rate of 32% among 1,458 target physicians), of which 43% were residents and 57% were EM specialists. Most of the respondents (96%) answered that they use POCUS, of which 89% reported using it at least once a week. The most frequently used types of POCUS were focused assessment with sonography for trauma (68%) and echocardiography (66%). Musculoskeletal, male genital, and pediatric scans were rarely performed tests but ranked as of the scans physicians most wanted to learn. About 73% of the respondents received ultrasound education, and 41% received ultrasound education at their own institutions. Nevertheless, educationrelated barriers are still the biggest deterrent to POCUS use (60%). In addition, multivariate multinomial logistic regression analysis revealed that the greater the number of ultrasound devices and the total number of physicians in the emergency center, the more likely they were to use POCUS every day. Conclusion This study found that most physicians currently working in emergency medical centers in Korea more frequently perform various types of ultrasound scans compared to those 10 years prior. To further promote the use of POCUS, it is important to have an appropriate number of ultrasound devices and physicians in the emergency center along with systematic POCUS education.

Objective: Cardiac tamponade with hemodynamic collapse requires immediate treatment, and ultrasound-guided pericardiocentesis is the treatment of choice. Although an essential skill for emergency physicians, there is a lack of training. We created a phantom that could practice ultrasound-guided pericardiocentesis using readily available materials. The pros and cons of the materials used were then compared. Methods: Cardiac tamponade phantoms were made from gelatin, and included a heart, liver, and rib cage. We conducted a model-specific satisfaction questionnaire targeting 15 emergency physicians. The questionnaire was designed to be answered on a Likert 5-point scale. Results: Creating the gelatin model took 6 hours. At room temperature, the gelatin model was able to retain its shape for 3 days. Fifteen physicians participated in the questionnaire, comprising five subjects having actual pericardiocentesis experience. In the questionnaire, our model achieved high satisfaction with all questions. Conclusion In our study, the pericardiocentesis phantom made from gelatin could maintain its shape for a long time, there was better recognition of the needle tip, and the model was more similar to the actual cardiac tamponade situation. Considering these positive characteristics, we recommend the phantom as a model for pericardiocentesis training.

Background: Point-of-care ultrasound (POCUS) is an essential tool in emergency medicine (EM). We aimed to investigate the current status and perception of POCUS use in emergency medical centers in Korea. Methods: A cross-sectional, nationwide survey was conducted using a mobile survey of physicians at emergency medical centers in Korea. The first message was sent on November 27, 2020, and the second message was sent on December 3, 2020 to the non-responders.The questionnaire comprised 6 categories and 24 questionnaires on demographics, current practice, education, perception, and barriers to the use of POCUS. Results: A total of 467 physicians participated in the survey (a response rate of 32% among 1,458 target physicians), of which 43% were residents and 57% were EM specialists. Most of the respondents (96%) answered that they use POCUS, of which 89% reported using it at least once a week. The most frequently used types of POCUS were focused assessment with sonography for trauma (68%) and echocardiography (66%). Musculoskeletal, male genital, and pediatric scans were rarely performed tests but ranked as of the scans physicians most wanted to learn. About 73% of the respondents received ultrasound education, and 41% received ultrasound education at their own institutions. Nevertheless, educationrelated barriers are still the biggest deterrent to POCUS use (60%). In addition, multivariate multinomial logistic regression analysis revealed that the greater the number of ultrasound devices and the total number of physicians in the emergency center, the more likely they were to use POCUS every day. Conclusion This study found that most physicians currently working in emergency medical centers in Korea more frequently perform various types of ultrasound scans compared to those 10 years prior. To further promote the use of POCUS, it is important to have an appropriate number of ultrasound devices and physicians in the emergency center along with systematic POCUS education.