Validity Study of an End-of-Clerkship Oral Examination in Obstetrics and Gynecology.

OBJECTIVE: Surgical clerkships frequently include oral exams to assess students' ability to critically analyze data and utilize clinical judgment during common scenarios. Limited guidance exists for the interpretation of oral exam score validity, thus making improvements difficult to target. We examined the development, administration, and scoring of a clerkship oral exam from a validity evidence framework. DESIGN: This was a retrospective study of a third-year, end-of-clerkship oral exam in obstetrics and gynecology (OBGYN). Content, response process, internal structure, and relationship to other variables validity evidence was collected and evaluated for 5 versions of the oral exam. SETTING: Albert Einstein College of Medicine, Bronx, New York City. PARTICIPANTS: Participants were 186 third-year medical students who completed the OBGYN clerkship in the academic year 2020 to 2021. RESULTS: The average number of objectives assessed per oral exam version were uniform, but the distribution of questions per Bloom's level of cognition was uneven. Student scores on all questions regardless of Bloom's level of cognition were >87%, and reliability (Cronbach's alpha) of item scores varied from 0.58 to 0.74. There was a moderate, positive correlation (Spearman's rho) between the oral exam scores and national shelf exam scores (0.35). There were low correlations between oral exam scores and (a) clinical performance ratings (0.14) and (b) formal presentation scores (-0.19). CONCLUSIONS: This study provides an example of how to examine the validity of oral exam scores for targeted improvements. Further modifications are needed before using scores for high stakes decisions. The authors provide recommendations for additional sources of validity evidence to collect in order to better meet the goals of any surgical clerkship oral exam.

Development and Validation of a Mental Practice Tool for Total Abdominal Hysterectomy.

OBJECTIVE: Total abdominal hysterectomy (TAH) is a common operation performed by obstetrician-gynecologists. Training opportunities for this procedure are declining. Mental practice (MP), the use of mental imagery to rehearse a task symbolically before performance, has been used successfully in sports and music to enhance skill. This strategy demonstrates benefit in existing surgical education literature. We aimed to develop and validate a MP tool (MPT) for resident training in TAH. DESIGN: A prospective survey study was performed in a large, urban, academic medical center in Philadelphia, Pennsylvania, USA. A MPT was developed by guiding expert surgeons through a cognitive walk-through of TAH to identify key procedural cues. For validation, a convenience sample of 22 residents and attendings (N = 11 per group) mentally rehearsed TAH. Motivation, confidence, quality of imagery, and utility of the activity were assessed with a previously validated Mental Imagery Questionnaire (MIQ) before and after exposure to the MPT. RESULTS: Residents, but not attendings, found MP to be useful in preparation for surgery (residents, p = 0.01; attendings, p = 0.34) and had increased confidence following this exercise (residents, p = 0.01; attendings, p = 0.08). Significant improvement in global imagery score after use of the tool was shown by residents (p = 0.01) but not by the attendings (p = 0.08), with residents having lower imagery skills than attendings both pre-MP and post-MP. Reliability testing of the MIQ indicated internal consistency (pre-MPT, 0.91; post-MPT, 0.90). CONCLUSIONS: MP may serve as a potentially effective, portable, and inexpensive resident surgical training tool in preparation for TAH. Attendings may benefit from certain aspects of MP. The MIQ may serve as a measure of imagery skills in future experiments of MP in preparation for surgery.

Encefalopatía necrotizante aguda de la infancia. Diagnóstico por imágenes: Presentación de caso / Acute Necrotizing Encephalopathy of Childhood. Diagnosis by Images: Case Report

La historia de la encefalopatía necrotizante aguda de la infancia (ANEC) o ANE por sus siglas en inglés (acute necrotizing encephalopathy of childhood), ha evolucionado a lo largo del tiempo. Primero se pensó que era de origen viral, pero recientemente se ha encontrado asociación con la mutación del gen RANBP2 en una forma familiar de tipo autosómico dominante. Su mortalidad es alta y las secuelas neurológicas recidivantes son bastante severas, aunque con el desarrollo de nuevas técnicas de diagnóstico y tratamiento precoz, estas no son tan graves como se creía. Por esto, el radiólogo debe conocer esta entidad y diagnosticarla precozmente con el fin de iniciar el tratamiento y darle el soporte que estos pacientes necesitan para disminuir las secuelas neurológicas que se pudieran presentar. Esta revisión de un caso se hace con el fin de orientar a los radiólogos y médicos en general al diagnóstico basado en las imágenes de esta poco frecuente, pero importante enfermedad.

The history of the acute necrotizing encephalopathy of childhood (ANEC), has evolved over time. At first it was thought to be secondary to a viral origin, but an association has recently been found with familial autosomal dominant form due to mutations in the RANBP2 gene. Their mortality is high and relapsing neurological sequelae are quite severe, but with the development of new techniques for early diagnosis and treatment, these are not as severe as previously thought. For this reason, the radiologist should know this entity and diagnose early in order to start treatment and give support that these patients need to reduce neurological damage that could arise. This review of a case based on images is performed in order to guide radiologists and physicians to diagnose this important but rare disease.

Physical activity reduces risk for colon polyps in a multiethnic colorectal cancer screening population.

BACKGROUND: Identifying modifiable factors that influence the epidemiology of colorectal cancer incidence among multiethnic groups might be informative for the development of public health strategies targeting the disease. Minimal data exists describing the impact of physical activity on colorectal polyp risk in United States minority populations. The aim of this study is to evaluate the relationship of exercise on the prevalence of polyps in a multiethnic colorectal cancer screening population. RESULTS: We enrolled 982 patients: 558 Hispanic, 202 Asian,149 Black, and 69 White. Patients who reported exercising one or more hours weekly had a lower prevalence of any polyps (25.3% vs 33.2%, P = 0.008) as well as adenomas (13.8 vs. 18.9%, P = 0.03) compared to those who did not exercise. Black and Hispanic patients and those who were overweight or obese also had lower prevalence of polyps if they led an active lifestyle. Multivariate analysis revealed that age >55, male sex, and Black race/ethnicity were positively associated with the presence of adenomas, while a history of exercising one hour or more weekly was an independent negative predictor for the presence of adenomas anywhere in the colon (OR 0.67; 95% CI 0.4 - 0.9, P = 0.03). CONCLUSIONS: Exercising one hour per week was associated with a lower prevalence of polyps and adenomas when compared to those who exercised less or not at all. An active lifestyle provides benefits to groups who are at risk for colorectal cancer, such as Blacks. It also provides significant protection to overweight and obese individuals. Public health initiatives should promote physical activity as a cancer prevention tool in multiethnic populations. TRIAL REGISTRATION: none.

Malformación arteriovenosa pulmonar: reporte de caso / Pulmonary arteriovenous malformation: case report

Las malformaciones arteriovenosas pulmonares (MAVP ) son comunicaciones anormales entre los sistemas arterial y venoso pulmonar. Son infrecuentes, pero a su vez importantes, por la asociación con potenciales complicaciones fatales. Las formas más frecuentes (85) consisten en comunicaciones únicas entre una arteria aferente y una vena eferente. En ningún caso existe territorio capilar entre ambas estructuras. Más del 70 de las MAVP se presentan asociadas a malformaciones arteriovenosas de la piel, membranas mucosas y otros órganos, que configuran el síndrome de Rendu-Osler o telangiectasia hemorrágica hereditaria. En este artículo se presenta el caso de una mujer de 48 años de edad con un cuadro clínico de dolor pleurítico en quien se realizó diagnóstico de MAVP mediante hallazgos radiológicos.

El signo de sacacorcho en una malrotación intestinal: reporte de caso / The sign of corkscrew in intestinal malrotation: case report

Malrotación es el término general para cualquier variación anormal de la rotación intestinal. La mala posición intestinal no causa problemas por sí sola; sin embargo, se acompaña habitualmente de mala fijación que puede tener graves consecuencias. En este artículo se presenta el caso de un neonato de 17 días de vida con cuadro clínico de obstrucción intestinal en quien se llegó al diagnóstico de malrotación intestinal por hallazgos radiológicos y posterior confirmación médico-quirúrgicas.

Intestinal malrotation is a condition that is a congenital disease associated with failure in the embryological process of intestinal rotation. It has variable clinical presentations and diagnosis should be done early to avoid complications. A case of a 17 day neonate with clinical symptoms of intestinal obstruction in whom the diagnosis was intestinal malrotation with the radiological findings and subsequent surgical confirmation.

Malformación congénita del oído interno y conducto auditivo interno en un paciente con hipoacusia neurosensorial profunda bilateral: reporte de caso / Congenital abnormality of the inner ear and internal auditory canal in a patient with deep sensorineural hearing loss: a case report

La tomografía computarizada y la resonancia magnética son estudios complementarios que han demostrado ser las mejores ayudas radiológicas dentro del tamizaje en niños con hipoacusia neurosensorial uni o bilateral. Aproximadamente sólo el 20% de los pacientes que presentan hipoacusia neurosensorial congénita tiene manifestaciones en imágenes, y debido a que la mayoría de estas manifestaciones son óseas, se prefiere iniciar los estudios con tomografía computarizada. La resonancia magnética se indica ante la sospecha de agenesia, neuropatía, aplasia o hipoplasia vestibulococlear, frecuentemente asociadas en este tipo de hipoacusias. Se presenta el caso de un niño de seis años de edad con hipoacusia neurosensorial profunda bilateral, con evaluación radiológica para determinar si es un potencial candidato para implante coclear o de tallo cerebral, como rehabilitación auditiva.

CT and MRI are complementary studies that have proven to be the best radiological tools in screening of children with unilateral or bilateral sensorineural hearing loss. Only about a 20% of the patients with congenital sensor neural hearing loss have manifestations in images. Due to the fact that most of these manifestations initiate in the bone, the CT is the first line of image study. MRI is indicatedin the evaluation of suspected agenesis, neuropathy, aplasia or hypoplasia of the vestibulocochlear nerve, often associated with this type of hearing loss. We present a case of a 6 year old patient with deep bilateral sensor neural hearing loss, with radiological studies to determine a potential candidate for a cochlear or auditory brainstem implant as hearing rehabilitation.

Pielonefritis enfisematosa: reporte de caso / Emphysematous pyelonephritis: case report

La pielonefritis enfisematosa es una infección poco común y potencialmente mortal de infección renal que se presenta predominantemente en los pacientes con diabetes mellitus y se caracteriza por la presencia de bacterias anaerobias facultativas y por la producción de gas. La afectación puede ser del parénquima renal, el sistema colector, el espacio perirrenal o retroperitoneal. La presentación clínica no suele correlacionarse con la gravedad de la infección y las imágenes, principalmente la escanografía, desempeñan un papel importante en su diagnóstico y clasificación para definir el manejo. El tratamiento de esta enfermedad ha sido tradicionalmente agresivo y se consideraba indispensable el drenaje percutáneo con catéteres o la nefrectomía.

Emphysematous pyelonephritis is a rare and potentially fatal kidney infection that occurs mainly in patients with diabetes mellitus and is characterized by the presence of facultative anaerobicbacteria and gas production. It compromises the renal parenchyma, collecting system, perirenal space or retro peritoneal. The clinical presentation is usually not correlated with the severity of infection and the images, mainly the scan images, play an important role in diagnosis andclassification to define management. The treatment of this disease has traditionally been aggressive and was considered essential percutaneous catheter drainage and / or nephrectomy.