Diseño e implementación de OSCE para evaluar competencias de egreso en estudiantes de medicina en un consorcio de universidades chilenas / A standardized objective structured clinical examination to assess clinical competencies in medical students

Background: Outcomes-based education is a trend in medical education and its assessment is one of the main challenges. The Objective Structured Clinical Examination (OSCE) is one of the tools used to assess clinical competencies. Although Chilean medical schools have used OSCEs for 18 years, there is a vast variability in the way these examinations are administered. Aim: To design and implement an integrated OSCE to assess clinical competencies at the end of the medical program in Chilean medical schools, aiming to reduce variability between these schools. Material and Methods: Seven medical schools, supported by experts from the National Board of Medical Examiners, designed a 12 station OSCE to measure clinical outcomes at the end of the seventh year of medical training. Unlike traditional OSCEs, this new examination incorporated the assessment of clinical reasoning and communication skills, evaluated from patients' perspective. Results: One hundred twenty-five volunteers took the same exam at five different venues. The internal consistency was 0.62. Following a compensatory approach, 85% of students passed the exam. Communication assessment showed poorer results than those reported in the literature. Conclusions: Among Chilean medical students, the assessment of clinical outcomes in a collaborative way, through a valid and reliable exam, is feasible. A consensus on how to teach and assess clinical reasoning across the medical curriculum is required. The assessment of students' communication skills requires further development.

[A standardized objective structured clinical examination to assess clinical competencies in medical students]. / Diseño e implementación de OSCE para evaluar competencias de egreso en estudiantes de medicina en un consorcio de universidades chilenas.

BACKGROUND: Outcomes-based education is a trend in medical education and its assessment is one of the main challenges. The Objective Structured Clinical Examination (OSCE) is one of the tools used to assess clinical competencies. Although Chilean medical schools have used OSCEs for 18 years, there is a vast variability in the way these examinations are administered. AIM: To design and implement an integrated OSCE to assess clinical competencies at the end of the medical program in Chilean medical schools, aiming to reduce variability between these schools. MATERIAL AND METHODS: Seven medical schools, supported by experts from the National Board of Medical Examiners, designed a 12 station OSCE to measure clinical outcomes at the end of the seventh year of medical training. Unlike traditional OSCEs, this new examination incorporated the assessment of clinical reasoning and communication skills, evaluated from patients' perspective. RESULTS: One hundred twenty-five volunteers took the same exam at five different venues. The internal consistency was 0.62. Following a compensatory approach, 85% of students passed the exam. Communication assessment showed poorer results than those reported in the literature. CONCLUSIONS: Among Chilean medical students, the assessment of clinical outcomes in a collaborative way, through a valid and reliable exam, is feasible. A consensus on how to teach and assess clinical reasoning across the medical curriculum is required. The assessment of students' communication skills requires further development.

Diferencias en la estimación de isquemia en SPECT de perfusión miocárdica con 99mTc-sestamibi usando bases de datos cuantitativos de ejercicio y dipiridamol / Different ischemia size estimation on exercise and dipyridamole quantitative databases with 99mTc-sestamibi myocardial SPECT

Introducción. Frecuentemente los estudios de perfusión miocárdica con dipiridamol (DIP) son analizados cuantitativamente usando bases de datos de ejercicio (EXE). Objetivo. Comparar un grupo de pacientes con enfermedad coronaria conocida, procesados con bases de datos de DIP y EXE. Métodos. Se analizó los SPECT de perfusión miocárdica con Tc99m-Sestamibi y DIP de 20 hombres y 19 mujeres. Luego de su procesamiento, las imágenes de DIP SPECT fueron comparadas con bases de datos de mapas polares de EXE y DIP. Se analizó la extensión (en pixeles) y la severidad (DS) de los defectos y de las zonas reversibles. Resultados. Hubo concordancia de 92 por ciento en las interpretaciones de los estudios que tenían necrosis, isquemia o ambos (kappa: 0,859). El tamaño de los defectos de estrés fue el mismo con ambas bases de datos tanto en hombres como en mujeres. Sin embargo, en hombres la reversibilidad fue mayor (156,4 +/- 107,7 versus 128,6 +/-113,6 píxeles; p=0,0251) y más severa (699,6 +/- 665,8 versus 486,6 +/- 551,9 SD; p=0,0003) con EXE. En mujeres la reversibilidad fue menor (92,8 +/- 110,3 versus 113 +/- 121,9 pixeles; p=0,0024) y menos severa (278,5 +/- 356,7 versus 363,8 +/-432,7 SD; p=0,0009) con EXE. Conclusiones. Los pacientes que se sometieron a DIP fueron clasificados correctamente como isquemia, necrosis o ambos usando bases de datos de mapas polares de EXE. No obstante, la base de datos EXE subestimó la extensión de los defectos en mujeres y la sobreestimó en hombres.

Background. Frequently, dipyridamole (DIP) myocardial perfusion SPECT is analyzed quantitatively using an exercise (EXE) database. Objective. To compare a group of patients with known coronary artery disease, processed with DIP and EXE polar maps. Method. We studied 20 males and 19 females with DIP Tc99m-Sestamibi myocardial SPECT. After similar processing, the DIP SPECT images were read using both EXE and DIP polar map databases. We analyzed defect and reversibility extension (in pixels) and severity in standard deviations. Results. Agreement to classify patients as having necrosis, ischemia or both was 92 percent (kappa: 0.859). Stress defect size was similar with both databases in males and females. However, in males reversibility resulted larger (156.4 +/- 107.7 versus 128.6 +/- 113.6 pixels; p=0.0251) and more severe (699.6 +/- 665.8 versus 486.6 +/- 551.9 SD; p=0.0003) with EXE. In females, reversibility resulted smaller (92.8 +/- 110.3 versus 113.0 +/- 121.9 pixels; p=0.0024) and less severe (278.5 +/- 356.7 versus 363.8 +/- 432.7 SD; p=0,0009) with EXE. Conclusion. Patients undergoing DIP stress were correctly classified as presenting ischemia, necrosis or both by EXE polar map database. However, EXE database underestimated ischemia extension in females and overestimated it in males.

The "bat sign" of pectoral rhabdomyolysis.

A 22-year-old man with foot pain was referred for evaluation of sesamoiditis. A Tc-99m methylene-diphosphonate bone scan was performed which revealed increased radiopharmaceutical uptake in the big toes, but also showed curious abnormal thoracic activity. Normal activity at sternoclavicular joints and sternum mimics ears, head and body of a bat, and the pectorals mimic the wings. The patient mentioned that he had started lifting weights a few days earlier. Clinical and echographic evaluations were diagnostic of pectoral inflammation suggesting rhabdomyolysis.

Scintigraphic evaluation of bone involvement in beta thalassemia major

En este artículo los autores presentan el caso de un hombre de 19 años de edad portador de beta talasemia mayor que fue referido para cintigrafía ósea con Tc99m metilendifosfonato (Tc99m MDP) por un cuadro de lumbalgia. Este caso muestra muchas de las repercusiones de la beta talasemia mayor en el esqueleto. Además, podemos observar signos indirectos de algunas endocrinopatías asociadas

Estudio de reflujo vesicoureteral en niños mediante uso de Tc99m DTPA endovenoso / Study of vesicoureteral reflux in children using endovenous Tc99m DTPA

Se estudiaron 24 niños por reflujo vesicoureteral (RVU) con cistografía indirecta usando Tc99m DTPA ev versus uretrocistografía radiológica (UCRx); 20 tenían infección, 14 RVU radiológico y 14 con malformaciones congénitas genitourinarias. El 54 por ciento era sexo femenino; edad promedio 6,9a (rango:6m-14a). Se utilizó Laxur ev en 83 por ciento. Se consideraron 48 unidades ureterales; 19 con RVU por UCRX. Se excluyeron 5 con RVU isotópicos indeterminados, por gran retención piélica. La concordancia (86 por ciento) entre los métodos tuvo kappa 0.71. La sensibilidad de la cistografía indirecta fue 83 por ciento, la especificidad 87 por ciento. Se detectaron todos los RVU grado III ó IV. Todos los RVU fueron durante la micción y 39 por ciento, además, premiccionales. Su severidad tuvo correlación 73 por ciento (kappa 0.53). No hubo diferencia significativa de función renal relativa en 20 riñones con Tc99m DMSA. Concluyendo, la cistografía indirecta permite evaluar RVU y función renal/excretora; es no invasiva y produce baja dosis de irradiación, Se aconseja evitarla en hidronefrosis