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Biomedical subjects

G Dunnington

Publications and source records attributed to G Dunnington.

10 recordsLinked to original sources
PubMed1991

A model for the assessment of students' physician-patient interaction skills on the surgical clerkship.

Physician-patient interaction skills are predominantly taught by successful role modeling but are rarely evaluated formally and systematically. This study describes a new model for the assessment of student physician-patient interaction skills and reports results of use in 78 third-year medical students on clerkships at two institutions. A single nurse instructor at each institution evaluated these skills using an 18-item checklist during student performance of wound care and dressing changes. Students were focused on the evaluation of their technical skills and were unaware of the evaluation of their interaction skills. Immediate feedback on performance was provided. The mean percentage score for the interaction skills was 35%, and no improvement was noted with greater clinical experience (later rotations). We conclude that there is a striking deficiency in physician-patient interaction skills among third-year students. The model described is effective for both evaluation and feedback.

Clinical Clerkship↗
PubMed1991

Teaching mechanical ventilation.

Participants have stated that having actually experienced the modes of the ventilator and the components of weaning parameters, they are better able to understand and manage ventilated patients, as opposed to trying to memorize them as in the past. They also have a much greater appreciation for the discomfort experienced by the ventilated patient. (Most students cannot tolerate a PEEP of 10 centimeters of H2O for more than a few minutes). Many remarked that they are much more tolerant with their agitated, intubated patients because they can now understand their agitation. The session has proved to be an effective teaching tool. It is cost effective, does not take long and is enthusiastically received by the participants who believe they have gained a better understanding of how to properly care for their anxious, intubated patients.

Education, Medical↗
PubMed1990

Structured single-observer methods of evaluation for the assessment of ward performance on the surgical clerkship.

This study compares the traditional method (TM) of evaluating ward performance on the surgical clerkship with four structured, single-observer methods (SSOM) of evaluating the clinical skills demonstrated in patient workups, progress notes, physical examination, and technical performance. SSOM differed from TM in preciseness of evaluation criteria, training of evaluator, and amount of direct observation of clinical performance. SSOM appeared to be a more precise measurement instrument than TM and far more sensitive to the detection of clinical improvement. The study documents the significant contribution of a nurse-educator to the evaluation process, as this contribution correlates well with TM yet provides a unique and independent perspective. Finally, SSOM of evaluation correlated significantly with oral examination and the National Board of Medical Examiners (NBME) test results. Addition of SSOM to TM is recommended for clerkship evaluation of ward performance.

Clinical Clerkship↗
PubMed1990

Test performance of a local examination at a nonlocal site for evaluation of surgical clerks.

Surgical clerkships frequently use locally prepared examinations or nationally available test item banks as an alternative to Surgery Shelf Examinations from the National Board of Medical Examiners (SSNBME) for student evaluation. This study examines performance of a well-designed, item-analyzed local examination (available nationally through the Association for Surgical Education) at a nonlocal site. A 100-item test with a stratified sample from a 442-item bank was administered to 72 third-year students in addition to the SSNBME. The Pearson product moment correlation coefficient between the two examinations was 0.61 (p less than 0.001). Test performance between the local site and nonlocal site was compared by the Kuder-Richardson formula 20 for subtest reliability (internal consistency) and difficulty index (percent correct responses) and the point biserial correlation coefficient (correlation of a student's performance on one item with performance on the rest of the items) for test item analysis. Data show that despite fair correlation with SSNBME, significant deteriorations in both test item performance and reliability occur with the use of a local examination at a nonlocal site. This likely results from problems with content validity at the nonlocal site. Clerkships that use local examinations or national test bank items are strongly advised to evaluate test performance and revise appropriately before using results for formal student evaluation.

Clinical Clerkship↗
PubMed1988

Graft appendiceal fistulas.

We report the fifth case of a graft appendiceal fistula. The four previously reported cases are reviewed. This is the first report of the utility of the tagged red blood cell study in the evaluation of a patient with a graft appendiceal fistula.

Aged↗
PubMed1987

Natural history of cholelithiasis in patients with alcoholic cirrhosis (cholelithiasis in cirrhotic patients).

To assess the natural history of cholelithiasis in patients with cirrhosis, 32 charts coded for both diseases were retrospectively reviewed. Cholecystectomy was performed in 22 patients. Only two patients met criteria for acute cholecystitis and two patients had suspected choledocholithiasis. Despite the high incidence of preoperative jaundice (32%), no common duct stones were documented. There was no operative mortality. The complication rate was 45%. In 10 patients not operated upon, two patients died of liver failure and the remaining eight patients are alive 8 months to 13 years after diagnosis (mean: 46 months) with no active biliary disease. It is concluded that: jaundice in this subpopulation most often reflects hepatocellular injury and rarely biliary tract obstruction, there appears to be a much lower incidence of acute cholecystitis and choledocholithiasis in cirrhotic patients with cholelithiasis than in the normal population, and patients with cirrhosis and asymptomatic cholelithiasis can be safely managed without operation.

Adult↗
PubMed1987

A comparison of the teaching effectiveness of the didactic lecture and the problem-oriented small group session: a prospective study.

A prospective study was designed to assess the teaching effectiveness of active learning in problem-oriented small group sessions (POSGS) compared with passive learning in didactic lectures (DL). Third-year medical students participated in a POSGS on breast disease and a standardized DL on thyroid disease (N = 23) or participated in a POSGS on thyroid disease and a DL on breast disease (N = 19). Students were tested with a multiple-choice examination (MCQ) and a highly structured oral examination (OE) administered by faculty members blinded about student group. Results of a between-within analysis of variance performed separately for breast and thyroid disease yielded significant group differences because of instructional method for thyroid disease (p = 0.003) and approached significance for breast disease (p = 0.095). Although no significant interactions were detected with percentage scores, a significant interaction between group membership and test type was noted for thyroid disease when the percentage scores were transformed to Z scores. We conclude that regardless of topic or testing method, students in POSGS tended to perform better than students in a DL and that the POSGS offers significant advantages over the DL in teaching surgery to third-year medical students.

Breast Diseases↗
PubMed1977

Multiple germ cell tumors: reports of 3 cases, 1 with 3 primary lesions.

Tumors may develop in both testes, either concomitantly or sequentially. We herein report 3 cases of bilateral testicular neoplasms. One patient had concomitant seminomas of the testes and another had sequential germ cell tumors separated by an 11-year interval. The third patient is an unusual case in that he had bilateral testicular germ cell tumors diagnosed concomitantly 8 years after irradiation of an extragonadal, histologically proved, seminoma in the mediastinum. Evidence suggests that all 3 sites, each testis and the mediastinum, were primary lesions. Standard methods of therapy should be used in the treatment of malignancies.

Adult↗