PURPOSE: The purpose of the study is to analyse the appropriateness of using standardized patients' (SPs) assessment scores of medical students in clinical performance examination (CPX). METHODS: 110 fourth year medical students in year four were divided into two large groups (group A and group B). Each group of students performed four different cases and overall, eight cases were tested. The examination were done by professors and the SPs using the same examination paper. Test scores were analysed per station and per each test domain. The differences between the two examiners were studied using paired t-test. RESULTS: There were significant differences in the scores given out by the professors' and the SP' s in four out of the eight stations. According to the examination results of each domain, four cases showed significant differences in the history taking category, three cases in the physical examination, one case in the information sharing, four cases in clinical courtesy, and two cases in physician-patient relationship category. Cronbach' s alpha scores of all stations were over 0.6, reflecting that the test items were appropriate for the examination. CONCLUSION: From the result of this study and according to many preceding studies, using SPs' evaluation scores in CPX is appropriate. Some limitation of this study and ideas for improvement in using SPs in CPX are suggested.
Humans ; Information Dissemination ; Physical Examination ; Students, Medical

PURPOSE: Communication skills are essential skills which medical students need to acquire in order to become a doctor. More attention is being given to the subject but not many studies have been done in the medical education field. As communication skills are provided to students as a subject in medical educational curriculum, the assessment of its effectiveness needs to be undertaken. METHODS: In the year 2005 and 2006, second year pre-medical students at The Catholic University College of Medicine took 'Communication Skills' course in total, 180 second year pre-medical students' survey results were used in the evaluation of the study question. The instrument used in the study was the modified and translated version of 'Beyer-Fetzer's Essential Elements of Communication Skills Assessment Sheet.' The assessment sheets were used as the pre-test and post-test to analyse the differences, which were put through the paired t-test. RESULTS: All categories of communication skills showed an improvement. For year 2005, meaningful differences were shown in 'opening the discussion (p=.005)' and 'sharing information (p=.008)', whereas in 2006, improvements were shown in all areas. CONCLUSION: From the result, it is clear that in order to create an effective communication skills program, the content should be more structured and focused on the program objectives.
Curriculum ; Education, Medical ; Humans ; Students, Medical

PURPOSE: To analyze the characteristics of the interface membrane around loose Cementless Self-Cutting Titanium(CST) acetabular components. MATERIALS AND METHOD: The authors reviewed radiographs of one hundred and thirty-four hips which underwent total hip arthroplasty using Cementless Self-Cutting Titanium(CST) acetabular components, and performed histomorphological analysis on thirteen periprosthetic membranes which were taken out at the time of revision. RESULTS: After a mean follow-up of 82 months, thirteen hips(10%) underwent revision for acetabular loosening and migration. Histologic evaluation of the periprosthetic membranes showed evidence of abundant polyethylene and metal wear particles. The interface membrane was composed of a well vascularized loose connective tissue with macrophages. Polarized microscopy revealed numerous polyethylene wear particles. Ultrastructurally, numerous, variable-sized, irregular-shaped phagosomes containing electron-dense material were seen within the cytoplasm. Tissue digestion of the periprosthetic tissue eluted numerous polyethylene and metal particles. Energy dispersive X-ray spectroscopic analysis for these wear particles revealed high concentration of titanium and carbon component suggesting that the majority of the metal particles were titanium component and polyethylene particle. CONCLUSION: This study supports the concept that wear particles in total hip arthroplasty can be a strong stimulus for a foreign body response and that this reaction causes periprosthetic osteolysis and loosening.
Acetabulum ; Arthroplasty ; Arthroplasty, Replacement, Hip* ; Carbon ; Connective Tissue ; Cytoplasm ; Digestion ; Follow-Up Studies ; Foreign Bodies ; Hip ; Macrophages ; Membranes* ; Microscopy ; Osteolysis ; Phagosomes ; Polyethylene ; Titanium*

Symptoms of a peritoneal progression from ovarian cancer are nonspecific such as abdominal pain, abdominal distention and more. Many imaging studies and serum CA-125 help diagnosis. However, it is difficult to exclude the instances of the diffuse peritoneal diseases that mimic carcinomatosis. The elevated CA-125 level usually correlates with the peritoneal carcimatosis, but it is often found in other peritoneal diseases. Therefore, the pathologic confirmation is necessary because of other mimicking diseases. In our case, CA-125 levels were elevated. Abdominal computed tomography finding was suspected a peritoneal tuberculosis but the pathologic result was the peritoneal carcimatosis, eventually.
Abdominal Pain ; Carcinoma* ; Diagnosis ; Ovarian Neoplasms ; Peritoneal Diseases ; Peritonitis, Tuberculous*

Visual disturbances are common among women with pre-eclampsia. The obstetricians should have an understanding of the various conditions associated with visual impairments. We report a case of Purtscher-like retinopathy developed after pre-eclampsia combined with acute pancreatitis. A 33-year-old primigravida with twin pregnancy was admitted to the department of obstetrics and gynecology for preterm labor and pre-eclampsia at 36+4 weeks gestation. After a cesarean section, she complained of abdominal pain and visual acuity loss. She was diagnosed with Purtscher-like retinopathy combined with acute pancreatitis after ophthalmologic examination and an abdominal computed tomography scan. Purtscher-like retinopathy, most often observed after trauma, is very rare in pre-eclampsia. In addition, while visual disturbances from other conditions are transient, it can result in persistent visual impairments. Thus, when a patient with pre-eclampsia complains of visual problems for a long period of time, obstetricians should consider an ophthalmologic evaluation and treatments during the earliest stage of the disease.
Abdominal Pain ; Cesarean Section ; Female ; Gynecology ; Humans ; Obstetric Labor, Premature ; Obstetrics ; Pancreatitis ; Pre-Eclampsia ; Pregnancy ; Pregnancy, Twin ; Retinal Diseases ; Vision Disorders ; Visual Acuity

PURPOSE: The purpose of this study was to compare the perception of learning outcomes between faculty and students in medical schools. METHODS: A total of 1,766 medical students and 436 faculty members participated in the survey. They responded to the perception of four learning outcomes: medical knowledge and problem solving, clinical skills, medical ethics, and clinical communication. The participants responded to the education and achievement levels of the learning outcomes. RESULTS: In all four learning outcomes, the student's perception of education level differed by educational system, and the students in mixed systems had the highest scores. Students differed significantly in achievement level of medical ethics between genders, wherein male students perceived their achievement level to be higher than females. Students perceived their achievement level to be lower than the education level. The students' clinical skills were the highest in the education and achievement levels. The faculty perceived the education level to be higher than the student's achievement level. In particular, the faculty's perception of education level of medical knowledge and problem solving was the highest, whereas the students' achievement level of it was lower. The faculty assessed the education level to be higher than students. The students showed higher perception of achievement level than faculty. CONCLUSION: There were perceptual differences in learning outcomes between students and faculty. The results of this study are expected to be used to design outcome-based learning methods.
Clinical Competence ; Education* ; Ethics, Medical ; Female ; Humans ; Learning* ; Male ; Problem Solving ; Schools, Medical* ; Students, Medical

The purpose of this study was to classify the spinal nerve compositions of the terminal branches of the lumbosacral plexus, providing data of their participating quantities. Twenty-five sides of the lumbosacral plexus extracted from Korean adult cadavers were used in this study. The iliohypogastric nerve was mostly arisen from L1 (88.2%, thickness L1 0.7 mm). The ilioinguinal nerve was arisen from only L1 (100%, thickness L1 0.6 mm). The genitofemoral nerve was commonly arisen from L1 and L2 (62.5%, thickness L1 0.6 mm, L2 0.7 mm). The lateral femoral cutaneous nerve was classified into 4 types, and the most common type was that L2 and L3 composed this nerve (56.0%, thickness L2 0.8 mm, L3 0.4 mm). The femoral nerve was classified into 2 types, and it was usually composed of L2, L3 and L4 (88.0%, thickness L2 1.4 mm, L3 2.7 mm, L4 2.3 mm). The obturator nerve was arisen from L2, L3 and L4 in all cases (100%, thickness L2 0.5 mm, L3 1.3 mm, L4 1.1 mm). The common fibular component of sciatic nerve was mostly arisen from L4, L5, S1 and S2 (84.0%, thickness L4 0.9 mm, L5 2.0 mm, S1 2.1 mm, S2 1.2 mm). The tibial component of sciatic nerve was mainly arisen from L4, L5, S1 and S2 (96.0%, thickness L4 0.9 mm, L5 1.9 mm, S1 2.2 mm, S2 1.9 mm). The superior gluteal nerve was commonly derived from L4, L5 and S1 (56.0%, thickness L4 0.7 mm, L5 1.1 mm, S1 0.9 mm). The inferior gluteal nerve was comprised of L5, S1 and S2 in several cases (54.2%, thickness L5 0.9 mm, S1 1.3 mm, S2 0.8 mm). The posterior femoral cutaneous nerve was composed of S1 and S2 in higher freqeuncy (40.0%, thickness S1 0.9 mm, S2 1.0 mm, S3 0.8 mm). The perforating cutaneous nerve was arisen from S2 and S3 in higher frequency (56.0%, thickness S1 0.7 mm, S2 0.9 mm, S3 1.1 mm). The pudendal nerve was derived from S3 in many cases (52.9%, thickness S3 1.5 mm). These anatomical results may be helpful to predict the spinal nerve root lesions of the lumbosacral plexus.
Adult ; Cadaver ; Femoral Nerve ; Humans ; Lumbosacral Plexus ; Obturator Nerve ; Pudendal Nerve ; Sciatic Nerve ; Spinal Nerve Roots ; Spinal Nerves

This study aimed to confirm the presence of motor fibers in the cervical nerves distributing to the trapezius muscle. Thirteen cases were examined. Motor fibers were present in C3 in 7 of 9 cases (77.8%) and were absent in 2 of 9 cases (22.3%); the other 4 cases were damaged during dissection. C4 exhibited motor fibers in 9 of 10 cases (90.0%), whereas motor fibers were absent in 1 of 10 cases (10.0%); and 3 cases were damaged. The motor fibers in C3 were of medium size (57.1%; 4/7 cases), whereas those in C4 were large (44.4%; 4/9 cases). The average number of motor fibers in C3 and C4 were 114+/-112 and 219+/-167, respectively. These results show that C4 is more important in terms of the frequency and size of the cervical motor fibers distributing to the trapezius muscle.
Muscles

This study aimed to confirm the presence of motor fibers in the cervical nerves distributing to the trapezius muscle. Thirteen cases were examined. Motor fibers were present in C3 in 7 of 9 cases (77.8%) and were absent in 2 of 9 cases (22.3%); the other 4 cases were damaged during dissection. C4 exhibited motor fibers in 9 of 10 cases (90.0%), whereas motor fibers were absent in 1 of 10 cases (10.0%); and 3 cases were damaged. The motor fibers in C3 were of medium size (57.1%; 4/7 cases), whereas those in C4 were large (44.4%; 4/9 cases). The average number of motor fibers in C3 and C4 were 114+/-112 and 219+/-167, respectively. These results show that C4 is more important in terms of the frequency and size of the cervical motor fibers distributing to the trapezius muscle.
Muscles

Biliary atresia (BA) is an uncommon neonatal surgical disease that has a fatal outcome if not properly treated. The survival rates of the patients with native liver after Kasai's operation in countries outside Japan are not so good. We reviewed the results of 22 cases of biliary atresia treated in Kosin University Hospital between October 1987 and March 2001. There were 13 males and 9 females aged from 21 to 106 days (mean 52 days). There were 3 cases of Type I (13.6%), and 3 of Type II (13.6%), and 16 Type III (72.7%). The operative methods were resection of the common bile duct remnant and cyst followed by Roux-en-Y hepaticojejunostomy in 3 cases for Type I BA; Kasai I in 15 cases, Kasai II in 1 case, and Ueda's operation in 3 cases for Types II and III BA. There was no death within the first 30 days after operation. We were able to follow 21 of the 22 patients (95.4%) for more than 5 years. The actual 5 year survival rate (YSR) was 40.9%. One Type I case received a living-related liver transplantation at 6 years of age because of the multiple intrahepatic stones and liver cirrhosis. Five YSR after biliostomy group (Kasai II and Ueda op.) was 75% (3/4) while that of Kasai I was 20% (3/15). One case had no bile duct in the resected fibrotic plaque on microscopic review and died 8 months after Kasai I operation, would have been a strong candidate for early liver transplantation. From the above result, our conclusions are as follows; (1) early liver transplantation should be considered for cases of no bile duct after pathologic examination of the resected specimen, (2) measures to prevent postoperative cholangitis and prevention of postoperative liver cirrhosis are needed, (3) liver transplantation program should be available for failed cases.
Bile Ducts ; Biliary Atresia ; Cholangitis ; Common Bile Duct ; Fatal Outcome ; Female ; Humans ; Japan ; Liver ; Liver Cirrhosis ; Liver Transplantation ; Male ; Survival Rate