The hyperventilation challenge test. Another means of identifying coronary vasospasm in patients with angina-like chest pain.
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Acetylcholine↗
Biomedical subjects
D J Mazur
Publications and source records attributed to D J Mazur.
Evaluation of students in medicine clerkships.
This article reports the results of a survey of the 124 medical schools in the United States and Puerto Rico, mailed in late 1986; the majority of the responses from 101 schools were received in early 1987. The authors report their findings concerning the overall process used by these schools to evaluate medicine clerks, specifically identifying the importance given to subjective evaluations, made by attending physicians and/or housestaff, compared with the importance given to clerks' performances on objective means of evaluation based on written and/or oral examinations, whether national or faculty-developed. The study reveals that the subjective evaluations of clerks by faculty attending physicians and by housestaff working with the clerks were used by 98 and 83 of the responding schools, respectively, and were given the greatest evaluative weight. Examinations of all types were used by 87 of the responding schools. The National Board of Medical Examiners (NBME) Part II Medicine Examination was the most frequently used and heavily weighted examination, followed by written faculty examinations. Oral examinations were the least frequently used evaluative tools, carried the least weight, and were rarely used without another examination. In light of their findings, the authors maintain that further research should be done to clarify whether the NBME Part II Medicine Examination is an appropriate instrument to measure the knowledge acquired during clerkship experiences.
Clinical Clerkship↗
A national survey of grading systems used in medicine clerkships.
To better understand the variety in U.S. medicine clerkship grading terminology, the number of grading levels, and the distribution of grades within each level, the authors surveyed medicine clerkship directors in the United States and Puerto Rico in 1986 and 1987. Completed questionnaires were returned from 101 of the 124 medical schools (81%). Descriptor grades were the most commonly used form of grading of medicine clerks, used in 68 of the 101 responding schools; letter grades were used by another 28 of the schools; and four schools used a numerical grading system. Although descriptor grades were most commonly used for grading medicine clerks, there was lack of consistency in their use between schools. The authors discuss the data related to letter grades and descriptor grades across this representative sample of U.S. medical schools.
Achievement↗
Usefulness of physical examination in detecting the presence or absence of anemia.
Previous studies addressing the usefulness of pallor in anemia are deficient because of observer or spectrum bias. Three internists made individual assessments of conjunctivae, face, nails, palms, and palmar creases in 98 male and 5 female hospitalized patients at a Veterans Administration Medical Center. The true-positive rates (sensitivities) were highest for pallor at any one of three sites (ie, the conjunctivae, face, or palms; 0.65) and for pallor of the palms (0.53). True-negative rates (specificities) were best for palmar creases (1.00), for pallor at conjunctivae, face, and palms (all three in combination; 0.95), and for the face (0.90). Receiver operator characteristic curve analysis revealed that the examination of the nailbeds is inferior to all other sites or combinations. Interobserver variability K scores were negative for palmar creases but ranged from .16 to .51 for other sites. We conclude that (1) the absence of pallor does not rule out anemia, and therefore this sign is not useful for screening an asymptomatic population; (2) pallor of the conjunctivae, face, and palms together is of benefit in confirming the presence of anemia; and (3) neither the nailbeds nor palmar creases are of value in assessing the presence or absence of anemia.
Anemia↗
The role of attorneys on hospital ethics committees: potential influence on committee decisionmaking.
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Data Collection↗
What should patients be told prior to a medical procedure? Ethical and legal perspectives on medical informed consent.
Ethicists and the medicolegal system agree that patients have rights to information prior to an elective medical procedure. Yet, it is far from clear whether there is at the present time an adequate framework for informing patients. Medicolegally, court cases as early as the 1900s strongly emphasized the preservation of individual rights to information in the patient-physician relationship. Most recently, an increasing number of states use the criterion of what a "reasonable man" would want as the basis for medical informed consent. Medical ethicists also have offered general principles for consideration by physicians: the importance of patient autonomy and preferences in decisions related to their own health care. This report examines the historical development of informed consent in the United States, legal and ethical perspectives in medical informed consent, and the pragmatic issues yet to be considered by physicians in keeping their duty to inform patients prior to a medical procedure.
Decision Making↗
Why the goals of informed consent are not realized: treatise on informed consent for the primary care physician.
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Cognition↗
The procedural and interpretive skills that third-year medicine clerks should master: views of medicine clerkship directors.
The authors surveyed medicine clerkship directors to determine which procedural and interpretive skills they felt third-year medical students should acquire. Of the 101 (81%) who responded, 91 felt that specific procedural and interpretive skills should be achieved by the end of the third-year medicine clerkship. Twenty-seven percent of these 91 reported having students keep a record of their activities; 35% reported testing students in the interpretation of various tests used in the evaluation of hospitalized patients on medicine services; and one clerkship director reported that his students were tested in their abilities to perform procedures. There was substantial disagreement by medicine clerkship directors over the procedural and test/study-interpretation skills in which medicine clerks should become proficient during the third-year medicine clerkship.
Clinical Clerkship↗
Does performance on the NBME Part II Medicine Examination when used as a clerkship examination reflect knowledge acquired during the medicine clerkship?
OBJECTIVE: The purpose of this study was to examine whether the National Board of Medical Examiners (NBME) Medicine Examination provides a reasonable assessment tool for testing students' knowledge acquired during a medicine clerkship. DESIGN: Comparison of the performances of two classes of medical students on the NBME Part II Medicine Examination on the first and last days of 12-week medicine clerkships in a two-year period (1985-87). PARTICIPANTS: 176 medical students in two consecutive classes at the Oregon Health Sciences University. MEASUREMENTS AND RESULTS: There was no significant difference in students' performances on the NBME Part II Medicine Examination on the first day of the medicine clerkship, regardless of the quarter in which they took the clerkship. Prior clerkship experiences did not appear to influence the baseline pre-clerkship internal medicine knowledge base as defined by NBME Part II Medicine Examination performances. Students in the second half of the year, however, demonstrated greater gains in post-clerkship NBME Part II Medicine Examination performances than did their counterparts from the first half of the year, despite similar pre-clerkship testing performances.
Clinical Clerkship↗
Patients' interpretations of probability terms.
STUDY OBJECTIVES: To assess the meaning ascribed by patients to qualitative expressions of probability commonly used in medical care and to determine patient preferences for obtaining information when communicating with their physicians about medical risk numerically and/or qualitatively. DESIGN: Cross-sectional survey of consecutive patients. SETTING: A university-based Department of Veterans Affairs medical center. PARTICIPANTS: 133 patients sequentially seen in a general medicine clinic. MEASUREMENTS AND MAIN RESULTS: Subjects were given a randomly ordered list of 12 common terms, each a qualitative expression of probability. They were asked to indicate what they understood to be the numerical meaning of each word. The patients' probability estimates were found to comprise two groups of five terms each, with high intercorrelations among the probabilities assigned to the terms in each group. Mean probabilities assigned to terms in the first group all were greater than 60%, and mean probabilities assigned to terms in the second group all were below 50%. When asked whether they wanted chance information to be provided in numerical or qualitative terms, 32% reported that they wanted it only numerically; 35.3% wanted it only qualitatively; 21.8% wanted the information either way; and 8.3% wanted the information both ways. CONCLUSIONS: The numerical meanings that patients ascribe to probability terms fall into identifiable patterns. While patients vary in the actual values they assign to terms, the relative meanings of terms show consistent trends.
Analysis of Variance↗
Interpretation of graphic data by patients in a general medicine clinic.
OBJECTIVE: To assess how patients use graphic data to decide on preferences between alternative treatments. DESIGN: Cross-sectional survey of patients, physicians, and medical students. The physicians and medical students served as a control group with which to compare the patients' responses. SETTING: A university-based Department of Veterans Affairs Medical Center. PARTICIPANTS: 152 patients seen in a general medicine clinic, 57 medical students, and 11 physicians. MEASUREMENTS AND RESULTS: Subjects were given a survival graph showing the patient outcomes for two different unidentified treatments for an unidentified serious disease. They were asked to indicate which treatment they preferred and which portion(s) of the curves most influenced their preference. A large majority of both patients and health professionals preferred the treatment that had worse short-term and better long-term survival. Eleven percent of patients and 51% of health professionals identified mid-curve data (points other than the curve end-points) as most influencing their preferences. CONCLUSIONS: A graphic survival curve appears to provide enough information to assess patient preferences between two alternative treatments. Patients appeared to differ from physicians and medical students in their interpretation of the curves.
Attitude to Health↗
Information disclosure and beyond: how do patients understand and use the information they report they want?
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Canada↗