INTRODUCTIONPlanning a high-stake clinical examination requires the evaluation of several psychometric and logistical variables. The authors conducted generalisability and decision studies to answer the following research questions in the context of the surgical long case: (1) Does the addition of a third examiner have any added benefit, vis-à-vis reliability, to the examination? (2) Is global marking more reliable than an itemised marking template? (3) What would be the impact on reliability if there was a reduction in the number of examinees that each panel of examiners is required to assess?

METHODSA third examiner and global marking were introduced. Separate generalisability and decision studies were carried out for both the two- and three-examiner models as well as for itemised and global scores.

RESULTSThe introduction of a third examiner resulted in a modest gain of reliability by 0.05-0.07. Gain in reliability was higher when each candidate was allowed to undertake a higher number of clinical cases. Both the global and itemised scores provided equivalent reliability (generalisability coefficient 0.74-0.89).

CONCLUSIONOur results showed that only a modest improvement in reliability of the surgical long case is achieved through the introduction of an additional examiner. Although the reliability of global scoring and the itemised marking template was comparable, the latter may provide opportunities for individualised feedback to examinees.

Clinical Competence ; Education, Medical, Undergraduate ; methods ; standards ; Educational Measurement ; methods ; Humans ; Medical History Taking ; methods ; Observation ; Professional-Patient Relations ; Psychometrics ; methods ; Reproducibility of Results ; Schools, Medical ; Singapore

This study aimed to determine the effect of the SNAPPS (summarize, narrow, analyze, probe, plan, and select) method versus teacher-centered education on the clinical skills of midwifery students in Iran. In this clinical trial, 36 midwifery students in their 4th year of education in 2015 were enrolled and divided into 6 groups, 3 groups for teacher-centered education and 3 groups for the SNAPPS method, with each group spending 10 days in the outpatient gynecology clinic. A questionnaire and a checklist were used to gather data. An independent t-test and chi-square test were used to analyze the data. Ability to gain the trust of the patient, verbal and nonverbal communication skills, history taking, preparation of the patient for gynecological examination, and diagnosis and treatment of common diseases were significantly better in the SNAPPS group compared to the teacher-centered education group (P<0.05). The SNAPPS education method can significantly improve the clinical skills of midwifery students in gynecology, in particular history taking, differential diagnosis, and treatment of common diseases.
Checklist ; Clinical Competence ; Diagnosis ; Diagnosis, Differential ; Education* ; Gynecological Examination ; Gynecology* ; Humans ; Iran* ; Medical History Taking ; Methods* ; Midwifery* ; Nonverbal Communication ; Outpatients

OBJECTIVE: To investigate the completeness of pedigree and of number of pedigree analysis to know the acceptable familial history in Korean women with ovarian cancer. METHODS: Interview was conducted in 50 ovarian cancer patients for obtaining familial history three times over the 6 weeks. The completeness of pedigree is estimated in terms of familial history of disease (cancer), health status (health living, disease and death), and onset age of disease and death. RESULTS: The completion of pedigree was 79.3, 85.1, and 85.6% at the 1st, 2nd, and 3rd time of interview and the time for pedigree analysis was 34.3, 10.8, and 3.1 minutes, respectively. The factors limiting pedigree analysis were as follows: out of contact with their relatives (38%), no living ancestors who know the family history (34%), dispersed family member because of the Korean War (16%), unknown cause of death (12%), reluctance to ask medical history of relatives (10%), and concealing their ovarian cancer (10%). The percentage of cancers revealed in 1st (2%) and 2nd degree (8%) relatives were increasing through surveys, especially colorectal cancer related with Lynch syndrome (4%). CONCLUSION: Analysis of pedigree at least two times is acceptable in Korean woman with ovarian cancer from the first study. The completion of pedigree is increasing, while time to take family history is decreasing during three time survey.
Adult ; Age Distribution ; Age of Onset ; Aged ; Colorectal Neoplasms, Hereditary Nonpolyposis/genetics ; Cross-Sectional Studies ; Female ; Genetic Predisposition to Disease ; Humans ; Medical History Taking/*methods ; Middle Aged ; Neoplasm Staging ; Ovarian Neoplasms/*genetics/pathology ; Pedigree ; Young Adult

OBJECTIVEMammography is the principle imaging modality used for early diagnosis of breast cancer in Western countries. It has not been well-established whether this Western diagnostic modality is adoptable for Chinese women. The aim of this study was to evaluate the respective accuracy of the common diagnostic tools for breast cancer including history-taking, physical examination, ultrasound and mammography.

METHODSClinical presentation and investigations for consecutive patients undergoing history-taking, physical examination, ultrasound, mammography and pathological assessment at Peking Union Medical College Hospital were prospectively recorded between April 2010 and September 2011. Breast cancer high-risk factors acquired by history-taking were input into the risk assessment model established previously by Eleventh Five Year Key Programs for Science and Technology Development of China (Grant No. 2006BAI02A09) and classified into low-, medium-, high- and extremely high-risk groups. The low- and medium-risk groups were defined as test negative, while the high- and extremely high-risk groups were defined as test positive. Each mammogram and ultrasound was reported prospectively using a five-point reporting scale of the American College of Radiology (ACR) Breast Imaging Reporting and Data System (BI-RADS). Clinical data were compared with pathological findings. Sensitivity, specificity, positive predictive value (PRV), negative predictive value (NPV) and accuracy of respective diagnostic methods were calculated and compared. The patients were divided into two groups, above and below 50 years of age for subgroup analysis.

RESULTSA total of 1468 patients (1475 breast lesions) constituted the study population. The median age was 44 (range 13 - 92) years. Five hundred and fifty-one patients were diagnosed as breast cancer. The median age at diagnosis was 51 years and breast cancer peaked in the age group of 40 - 60 years. The sensitivity of risk assessment model, physical examination, ultrasound and mammogram was 47.5%, 86.2%, 89.8% and 79.3%, respectively; specificity was 68.8%, 83.3%, 81.0% and 88.7%, respectively; PRV was 47.6%, 75.5%, 73.8% and 80.8%, respectively; NPV was 68.8%, 91.0%, 93.0% and 87.8%, respectively; and accuracy was 60.9%, 84.4%, 84.3% and 85.2%, respectively. Further subgroup analysis demonstrated that age is an important factor influencing the sensitivity and specificity of physical examination, ultrasound and mammography.

CONCLUSIONSUltrasound is more sensitive than mammography for early diagnosis of breast cancer in Chinese women and should be routinely used as a first-line diagnostic tool. Only a single diagnostic method is not enough sometimes and combined examination is needed for some high-risk populations.

Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Breast Diseases ; diagnosis ; diagnostic imaging ; Breast Neoplasms ; diagnosis ; diagnostic imaging ; Carcinoma in Situ ; diagnosis ; diagnostic imaging ; Carcinoma, Ductal, Breast ; diagnosis ; diagnostic imaging ; China ; Early Detection of Cancer ; methods ; Female ; Humans ; Mammography ; Medical History Taking ; Middle Aged ; Physical Examination ; Prospective Studies ; Risk Assessment ; Sensitivity and Specificity ; Ultrasonography, Mammary ; Young Adult

Anesthetics, Local ; chemistry ; pharmacology ; toxicity ; Central Nervous System ; drug effects ; Ethyl Chloride ; chemistry ; pharmacology ; toxicity ; Humans ; Inhalation ; Male ; Medical History Taking ; Neurologic Examination ; Patient Care Management ; methods ; Psychotropic Drugs ; chemistry ; pharmacology ; toxicity ; Substance-Related Disorders ; etiology ; physiopathology ; psychology ; therapy ; Treatment Outcome ; Volatilization ; Young Adult