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Education research: evaluating acute altered mental status: are incoming interns prepared?

Lee, Jessica D; Erickson, Jay C; Short, Matthew W; Roth, Bernard J.
Neurology ; 71(18): e50-3, 2008 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-18955679

BACKGROUND:

Clinical evaluation of hospitalized patients with acute altered mental status (AMS) is a common task of interns, regardless of medical specialty. The effectiveness of medical education to ensure competence in this area is unknown.

OBJECTIVE:

To measure competency of new interns in the evaluation and management of AMS using an Objective Structured Clinical Examination (OSCE).

METHODS:

A cohort study was conducted with 61 medical school graduates entering internship at a single teaching hospital in 2006. Interns from all major specialty fields were included. The OSCE consisted of a 12-minute simulated encounter with a human patient simulator and nurse actor. Each intern's performance was graded by the same neurologist, using criteria agreed upon by consensus of the neurology faculty. Competency in obtaining a history, performing a neurologic examination, generating a differential diagnosis, and ordering diagnostic studies was graded. Overall performance was scored on a percentage scale from 0 to 100.

RESULTS:

Overall performance scores ranged from 19 to 43 with a mean of 31.4 (SD +/- 5.6). Hypoglycemia was identified as a potential cause of AMS by 72.1% of interns, while fewer identified urinary tract infection (45.9%) and seizure (13.1%). While many interns ordered a CXR (86.9%) and head CT (80.3%), few requested a toxicology screen (21.3%) or lumbar puncture (3.3%). Only 41% of interns performed a neurologic examination.

CONCLUSION:

New interns are not well-prepared to evaluate patients with altered mental status in the inpatient setting as measured by an Objective Structured Clinical Examination.