Strategies for training standardized patient instructors for a competency exam.

The Common Achievement Test (CAT) in Japan, which will be implemented in 2005, involves a medical interview that is the core task to be completed by students during an Objective Structured Clinical Examination (OSCE). Standardized/Simulated Patient instructors (SPs), posing as patients in medical interviews, are trained in standard fashion in terms of expression of symptoms as well as the emotional affect of actual patients. Institution of appropriate training programs for SP instructors in the CAT is also necessary. We trained seven individuals to function as standardized patients (in-school SPs) during a three-day SP training program described in this article. Following completion of the OSCE, we conducted a comparison study among evaluations completed by the evaluators and two types of SP instructors. We observed high correlation, according to Spearman significance testing, between scores of evaluators and those of both newly trained in-school SPs and veteran SPs who had more than five years of experience. Correlation coefficients between the veteran SPs (r=0.77) and the in-school SPs (r=0.73) were nearly identical. These results suggest that our training program for SP instructors is an effective protocol, particularly with respect to reliability and efficiency.

Long-term study of dental implants placed into alveolar cleft sites.

OBJECTIVE: To evaluate the long-term prognosis of dental implants placed into cleft sites after bone grafting in a relatively large number of cases in order to clarify the usefulness of the modality. PATIENTS: Forty-seven patients with unilateral (dental, n=32) or bilateral (n=15) clefts of the alveolar process were included in this study. INTERVENTIONS: A total of 71 implants, including smooth- or rough-surface titanium, and hydroxyapatite (HA)-coated implants, were placed after bone grafting from the anterior iliac crest and/or mandible. The placed implants were 13 to 15 mm in length. MAIN OUTCOME: The follow-up period was from 21 to 120 months (average=60 months). Implant survival rates were calculated as cumulative survival. Marginal bone loss (MBL) from the implant shoulder was examined, with statistical analyses performed on the influence of simultaneous bone graft and surface characteristics. RESULTS: At the end of the clinical follow-up period, all implants except one were in situ and stable. Thus, the overall survival rate was 98.6% at the end of the first year and remained the same until the end of observation. Titanium implants with smooth surfaces had the lowest MBL with almost negligible regression slope, although some implants had relatively high MBL by the end of the first year. CONCLUSIONS: Implant therapy in the cleft site offers a reliable option for patients. Particular attention should be focused preoperatively on whether bone volume can provide primary implant stability.