Search PubMed⌕ Search

Biomedical subjects

J A Shea

Publications and source records attributed to J A Shea.

At least 55 records · Page 3Linked to original sources
PubMed1991

Changes in the medical knowledge of candidates for certification.

PURPOSE: To determine whether the medical knowledge of candidates from different types of medical schools changed between 1983 and 1988. SUBJECTS: Candidates for certification who took the 1983 to 1988 examinations in internal medicine were divided into five groups according to the type and location of the medical school they had attended and, in some instances, their citizenship: graduates of U.S. medical schools, of Canadian medical schools, and of osteopathic medical schools as well as U.S. citizens who graduated from foreign medical schools and non-U.S. citizens who graduated from foreign medical schools. DESIGN: Performance on items that were common to four pairs of the 1983 to 1988 certifying examinations (1983 and 1985, 1984 and 1986, 1985 and 1987, and 1986 and 1988) was analyzed. RESULTS: The scores of graduates of U.S. medical schools decreased, and the scores of non-U.S. citizens who graduated from foreign medical schools increased. Trends in the performance of graduates of Canadian and osteopathic medical schools and of U.S. citizens who graduated from foreign medical schools were not discernible. CONCLUSIONS: The cumulative decline in the performance of graduates from U.S. medical schools and the progressive improvement in the performance of non-U.S. citizens who graduated from foreign medical schools may ultimately manifest itself in patient care.

Canada↗
PubMed1990

Resective operations for biliary carcinoma.

Records of 25 consecutive patients who underwent resection for proximal bile duct tumor (3 extended right hepatic lobectomies, 6 left hepatic lobectomies, 16 skeletonization resections) and records of 21 patients who underwent pancreatoduodenectomy for distal bile duct carcinoma were reviewed to assess the value of resective therapy. The operative mortality rate for patients with resected proximal bile duct tumor was 4 per cent (0 per cent for liver resection) and that of distal bile duct tumor, 4.6 per cent. The 3- and 5-year actuarial survival rates for patients with proximal bile duct tumor were 44 per cent and 35 per cent, respectively; all except one patient eventually died of disease. Survival was better for patients who had curative resection (margins microscopically free of tumor). The 5-year actuarial survival rate for patients with distal bile duct carcinoma was 58 +/- 12 (SE) per cent, with patients who had negative nodes surviving longer than patients with positive nodes. When major hepatic resection and pancreatoduodenectomy can be performed in selected patients with low operative mortality, patients with bile duct carcinoma should be assessed by an experienced hepatobiliary multidisciplinary group before a decision is made in favor of palliative, endoscopic, or percutaneous techniques because surgical resection appears to offer the best possible long-term survival and probably the best quality of palliation.

Actuarial Analysis↗
PubMed1990

Long-term results of pancreatic resection and segmental pancreatic autotransplantation for chronic pancreatitis.

Thirteen patients who underwent extensive pancreatic resection and segmental autotransplantation and who have a median follow-up of 62 months are presented. Eleven patients had technically successful grafts. Three of six patients who underwent total pancreatectomy and three of five patients who underwent near-total resection remain insulin-independent. Those patients who require insulin require small doses and have stable diabetes. Pain has recurred in 7 of the 11 patients who underwent distal subtotal resection; 5 of them required pancreatoduodenectomy and completion pancreatectomy for pain relief. Because of the high rate of recurrence of pain after distal resection, we favor pancreatoduodenectomy as the initial procedure of choice. When distal near-total or total pancreatectomy is required, the addition of segmental autotransplantation offers definitive, although at times transient, benefits in glucose homeostasis compared with no transplantation.

Adult↗
PubMed1990

Performances of U.S. osteopathic and Canadian medical school graduates on the American Board of Internal Medicine Certifying Examinations, 1984-1988.

The performances of Canadian medical school graduates and U.S. osteopathic medical school graduates who first took the American Board of Internal Medicine Certifying Examination between 1984 and 1988 were compared with the performances, during the same period, of U.S. and foreign medical school graduates. Approximately 100 Canadian graduates took the examination each year; by 1988 the number of osteopathic graduates taking it was 102, double the number participating in 1984. Nearly all the Canadian graduates attended university or university-affiliated residencies, whereas half of the osteopathic graduates attended non-university-affiliated programs. For their overall clinical competence and for the eight components of clinical competence, the Canadian graduates were rated highest, followed by the U.S., osteopathic, and foreign graduates. The Canadians' average examination scores were also highest. The authors discuss the relatively low level of performance of the osteopathic graduates, but conclude that these graduates appear to be an untapped source of talented physicians for internal medicine residencies. The limitations of studying self-selected groups of candidates are also discussed.

Canada↗
PubMed1990

Training and practice activities of hematology and medical oncology diplomates.

Diplomates of the American Board of Internal Medicine in hematology or medical oncology were surveyed about the content and setting of their practices, adequacy of training for professional activities, and preferences for certification. The response rate was 60% (N = 2516). Approximately 20% of cases seen by diplomates in hematology involve nonhematopoietic neoplasms, and 10% of cases managed by oncologists concern hematologic disorders. Diplomates were satisfied with training in areas corresponding to their own field(s) of certification, except for immune and/or acquired immunodeficiency syndrome-related and nonneoplastic leukocyte disorders. Training deficits most frequently recalled were office management skills and psychosocial/communication skills. Nearly half of the respondents preferred to maintain separate certificates. Data indicate that the two fields are distinct. However, the overlap in practice brings into question the adequacy of training for diplomates who manage problems outside of their field of certification and suggests that some degree of cross-fertilization in all training would be beneficial.

Certification↗
PubMed1989

First American Board of Internal Medicine critical care examination: process and results.

On November 10, 1987, 2,712 diplomates of the American Board of Internal Medicine (ABIM) took the initial examination recognizing added qualifications in critical care medicine (CCM). The 1-day examination, made up of one-best-answer and multiple true/false questions, covered a broad range of topics from the internal medicine domain of CCM. Diplomates were admitted to the examination through four pathways requiring formal training in CCM and two practice pathways; 89% of the diplomates entered through the practice pathways. The absolute standard for the examination resulted in a total group pass rate of 64% (n = 1,725); the pass rate for diplomates with training in CCM was 84%. Examination performance was positively associated with months of critical care training, earlier ABIM examination scores, certification in pulmonary medicine, program directors' ratings of overall clinical competence, and several factors associated with the critical care work environment.

Certification↗
PubMed1988

A criterion-referenced examination in cardiovascular disease.

This study described criterion-referenced tests of electrocardiograph reading skill and basic knowledge in cardiology, assessed their dependability and validity, and explored their impact on overall certification rates. Data indicated that the standard-setting processes and the two criterion-referenced tests produced dependable results both separately and together. Scores of each had the expected relationships with quality of residency training and experience with the examination. Moreover, these sections of the examination identified a small subset of examinees who failed the criterion-referenced sections but passed the norm-referenced examinations. Taken as a whole these results replicate the findings of an earlier study in terms of a criterion-referenced test of electrocardiograph reading skill and extended them to a criterion-referenced test of basic knowledge in cardiology.

Cardiology↗
PubMed1988

The validity of an experimental video examination.

This study investigated the validity of an experimental video examination that had previously been shown to be feasible and have reproducible scores for a sample of candidates taking the 1987 ABIM Cardiovascular Disease examination. Correlations of the three video formats of echocardiograms, ventriculograms, and arteriograms with traditional item formats, similar content multiple choice question scores, experience, and external measures suggest that the video formats could be a worthwhile addition to the examination.

Audiovisual Aids↗
PubMed1988

The reproducibility of scores from three video formats.

The purpose of this paper was to assess the reproducibility of three simulations presented on videotape: echocardiograms, ventriculograms, and arteriograms. The results indicate that roughly comparable numbers of cases, but different amounts of testing time, are required to achieve specified levels of reproducibility; score interpretation affected reproducibility in the expected ways.

Audiovisual Aids↗
PubMed1987

Performance of a dangerous answer subtest within a subspecialty certifying examination.

Previous studies have been reported suggesting that a population of candidates for specialty board certification can be identified who pass the certification examination but who give an unduly high number of 'dangerous' responses, indicating their acceptance of actively harmful actions. To confirm these results, a retrospective analysis was undertaken of a Subspecialty Board of Nephrology certification examination. Experts identified a subtest of 75 dangerous answers. The performance of candidates on this subtest was compared with their performance on the total examination. The subtest was moderately reliable, ranked criterion groups appropriately, had a correlation with the total test of 0.71, and using the standard used for the total examination, identified the certification status of 84% of candidates. However, when the correlation was corrected for unreliability, the correlation became 1.0, indicating that a dangerous answer subtest, at least in this examination and population, does not identify a unique population of certified but 'dangerous' doctors.

Certification↗
PubMed1986

Predictors of the performance of foreign medical graduates on the 1982 certifying examination in internal medicine.

This study describes a cohort of foreign medical school graduates (FMGs) who first sat for the American Board of Internal Medicine's (ABIM) 1982 certifying examination, compares their performance with that of US medical school graduates, describes differences between US citizen FMGs and alien FMGs, and examines which background factors predict success on the ABIM examination. Data for this study were derived by combining information retained by the Educational Commission for Foreign Medical Graduates with ABIM data. Most FMGs who took the 1982 ABIM certifying examination for the first time were educated in and citizens of Asia, but a sizable minority were US citizens educated in Europe. Scores and program directors' ratings were lower for FMGs than US medical school graduates, and they attended different types of training programs. United States citizen FMGs were very similar to alien FMGs. Foreign medical school graduates who did well on the ABIM examination had done well on the Educational Commission for Foreign Medical Graduates examination and were rated highly by their residency program director.

Achievement↗
PubMed1986

Paraesophageal hiatus hernia.

Fifty-five operations for paraesophageal hiatus hernia were performed at the Lahey Clinic, Burlington, Mass, between January 1970 and October 1985. Pain was present in 35 of 51 patients. Other less common symptoms were anemia and vomiting. Reflux symptoms were rare. Esophageal manometry disclosed a mean lower esophageal sphincter pressure of 18.2 mm Hg and a length of 3.5 cm. An anterior crural repair (Collis procedure) was employed in all patients. In 22 patients Stamm gastrostomies were also performed. In two patients, a Nissen fundoplication was also carried out because of coexisting gastroesophageal reflux. One patient died postoperatively of a pulmonary embolus. Of the patients, 88.4% benefited from the operation. Of the five poor results, four were due to hernial recurrence and only one was due to severe reflux symptoms. Gastroesophageal reflux is rare in patients with paraesophageal hiatus hernia. An antireflux procedure should be added to surgical correction of the anatomic defect only if evidence of a hypotensive lower esophageal sphincter is clearly present preoperatively or intraoperatively. The addition of gastrostomy to the procedure protects against recurrence of hernia.

Adult↗
PubMed1986

Segmental pancreatic autotransplantation with pancreatic ductal occlusion after near total or total pancreatic resection for chronic pancreatitis. Results at 5- to 54-month follow-up evaluation.

Reported are eight patients with idiopathic chronic pancreatitis and two patients with alcoholic pancreatitis who had near total distal pancreatectomy for disabling pain and underwent simultaneous segmental pancreatic autotransplantation of the body and tail of the gland to the femoral area in an attempt to prevent or delay the onset of diabetes. The median follow-up period was 31 months, and follow-up study in nine patients ranged from 24 to 54 months. Patency of the grafts was determined by angiography and selected percutaneous venous assays for insulin. Islet cell function was determined by oral glucose tolerance tests, intravenous (I.V.) glucose tolerance tests, and I.V. glucagon stimulation studies. Segmental autotransplantation was technically successful in eight patients, only one of whom required insulin (at 2 years after grafting). The other seven patients with technically successful grafts have remained insulin independent, including two patients who later underwent pyloric preserving pancreatoduodenectomy for completion pancreatectomy. Variable pain relief was observed in patients who underwent near total pancreatectomy, but pain was unrelieved in those patients who underwent limited distal resection. Patients with idiopathic pancreatitis appear to have better pain relief and preservation of endocrine function than alcoholic patients. Segmental pancreatic autotransplantation prevents or delays the onset of diabetes mellitus and should be considered as an alternative for those patients who require extensive pancreatic resection for chronic pancreatitis.

Adult↗
PubMed1986

A five to ten year follow-up study of parietal cell vagotomy.

Records of 51 consecutive patients who underwent parietal cell vagotomy at the Lahey Clinic Medical Center and who had follow-up studies of five to ten years were reviewed. Operation was performed for intractability in 25 patients, intractability and obstruction in 19 patients and bleeding in seven patients. Patients with pyloroduodenal stenosis underwent digital dilation. No operative deaths occurred. Ulcer recurred in two of 25 patients (8 per cent) treated for intractability, in three of 19 patients with obstruction and in two of seven patients operated upon for bleeding. Ulcers recurring in patients operated upon for obstruction developed in the first two years after operation and were frequently gastric. Recurrences in patients treated for intractability were seen throughout the ten years of follow-up study. Of the seven patients who had a recurrence of an ulceration, five were treated successfully with medical therapy and two required truncal vagotomy with antrectomy. Functional results graded according to the Visick criteria revealed excellent to good results in 27 of 32 (84 per cent) of patients without obstruction and in 11 of 19 patients (58 per cent) with obstruction before operation (p less than 0.05). Fair to poor results were attributed to recurrent ulcers in the group of patients without obstruction and to symptoms of delayed gastric emptying in the group of patients with obstruction. We consider parietal cell vagotomy the procedure of choice to use for patients with intractable duodenal ulcer, but we have abandoned use of pyloroduodenal dilation in the patient with appreciable obstruction from fibrosis.

Adolescent↗