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Louis Sibert

Publications and source records attributed to Louis Sibert.

17 recordsLinked to original sources
PubMed2006

On line clinical reasoning assessment with Script Concordance test in urology: results of a French pilot study.

BACKGROUND: The Script Concordance test (SC) test is an assessment tool that measures the capacity to solve ill-defined problems, that is, reasoning in a context of uncertainty. This study assesses the feasibility, reliability and validity of the SC test made available on the Web to French urologists. METHODS: A 97 items SC test was developed based on major educational objectives of French urology training programmes. A secure Web site was created with two sequential modules: a) The first one for the reference panel to elaborate the scoring system; b) The second for candidates with different levels of experience in urology: Board certified urologists, chief-residents, residents, medical students. All participants were recruited on a voluntary basis. Statistical analysis included descriptive statistics of the participants' scores and factorial analysis of variance (ANOVA) to study differences between groups' means. Reliability was evaluated with Cronbach's alpha coefficient. RESULTS: The on line SC test has been operational since June 2004. Twenty-six faculty members constituted the reference panel. During the following 10 months, 207 participants took the test online (124 urologists, 29 chief-residents, 38 residents, 16 students). No technical problem was encountered. Forty-five percent of the participants completed the test partially only. Differences between the means scores for the 4 groups were statistically significant (P = 0.0123). The Bonferroni post-hoc correction indicated that significant differences were present between students and chief-residents, between students and urologists. There were no differences between chief-residents and urologists. Reliability coefficient was 0.734 for the total group of participants. CONCLUSION: Feasibility of Web-based SC test was proved successful by the large number of participants who participated in a few months. This Web site has permitted to quickly confirm reliability of the SC test and develop strategy to improve construct validity of the test when applied in the field of urology. Nevertheless, optimisation of the SC test content, with a smaller number of items will be necessary. Virtual medical education initiative such as this SC test delivered on the Internet warrants consideration in the current context of national pre-residency certification examination in France.

Academic Medical Centers↗
PubMed2006

A web-based teaching resource to prepare for final undergraduate examination: a French pilot study.

Access to accurate and quality-controlled health information on the Internet for medical students is not an easy task. CISMeF is the search tool of a MeSH-indexed directory of medical Internet resources in French. Since 2004, a new French Pre-Residency Examination (PRE) is compulsory for all medical students in the 6th year of the curriculum. The goal of this study is to evaluate CISMeF as a tool to provide teaching resources available on the Internet covering PRE material. The CISMeF terminology and the PRE CISMeF module are described. To assess the CISMeF performance in covering PRE program, its precision (number of relevant resources/number of overall resources extracted by CISMeF) and coverage (number of PRE questions covered by at least one resource in the CISMeF gateway) were computed. The CISMeF module for the new French Pre-Residency Examination is efficient as it already covers 95.7% of the program with a precision of 82.2%. Our data demonstrates that CISMeF is acceptable to guide students' learning and should be a useful teaching resource for the preparation of the French Pre-Residency Examination.

Education, Medical, Undergraduate↗
PubMed2006

[Randomized study comparing piroxicam analgesia and tramadol analgesia during outpatient electromagnetic extracorporeal lithotripsy].

OBJECTIVE: To analyse the efficacy of two types of analgesia protocols during outpatient electromagnetic extracorporeal lithotripsy (ESWL) with a STORZ Modulith SLX second generation lithotriptor. MATERIAL AND METHODS: One hundred and seventy one patients were prospectively randomized to 2 groups. Group 1 (n-82) received 40 mg of Piroxicam IM, and group 2 (n=89) received 100 mg Tramadol IV Lithotripsy was performed in 2 sequences, T1 and T2, during which quantitative evaluation of pain (VE) was performed according to a VAS scale and qualitative evaluation of pain (QE) was performed according to the McGill questionnaire. Endpoints included the mean VE and QE pain scores at T1 and T2, the maximum power tolerated at T2, the postoperative pain at the 6th, 12th and 24th hours after ESWL, the pain score according to the power and according to the frequency and adverse effects. Comparisons were performed by analyses of variance (significant for p < 0.05). RESULTS: No significant difference was observed between the two groups for stone dimensions, duration and number of ESWL shots (p > 0.05) and significant difference was observedfor pain with the two drugs used. Pain was more severe as frequency and power increased. Only one intervention was stopped because of pain. Data analysis suggests that tramadol induces more adverse effects. CONCLUSION: Piroxicam and tramadol are two analgesics commonly used in clinical practice and both are suitable for the treatment of pain during outpatient extracorporeal lithotripsy.

Ambulatory Care↗
PubMed2005

Online clinical reasoning assessment with the Script Concordance test: a feasibility study.

BACKGROUND: The script concordance (SC) test is an assessment tool that measures capacity to solve ill-defined problems, that is, reasoning in context of uncertainty. This tool has been used up to now mainly in medicine. The purpose of this pilot study is to assess the feasibility of the test delivered on the Web to French urologists. METHODS: The principle of SC test construction and the development of the Web site are described. A secure Web site was created with two sequential modules: (a) The first one for the reference panel (n = 26) with two sub-tasks: to validate the content of the test and to elaborate the scoring system; (b) The second for candidates with different levels of experience in Urology: Board certified urologists, residents, medical students (5 or 6th year). Minimum expected number of participants is 150 for urologists, 100 for residents and 50 for medical students. Each candidate is provided with an individual access code to this Web site. He/she may complete the Script Concordance test several times during his/her curriculum. RESULTS: The Web site has been operational since April 2004. The reference panel validated the test in June of the same year during the annual seminar of the French Society of Urology. The Web site is available for the candidates since September 2004. In six months, 80% of the target figure for the urologists, 68% of the target figure for the residents and 20% of the target figure for the student passed the test online. During these six months, no technical problem was encountered. CONCLUSION: The feasibility of the web-based SC test is successful as two-thirds of the expected number of participants was included within six months. Psychometric properties (validity, reliability) of the test will be evaluated on a large scale (N = 300). If positive, educational impact of this assessment tool will be useful to help urologists during their curriculum for the acquisition of clinical reasoning skills, which is crucial for professional competence.

Clinical Competence↗
PubMed2005

From spermatocytes to spermatozoa in an infertile XYY male.

Sex chromosome distribution and aneuploidy as well as germ cell degeneration were evaluated in meiotic and post-meiotic cells from an infertile XYY male. Sex chromosome distribution was assessed by multicolour fluorescence in situ hybridization on meiotic preparations. Post-meiotic cell aneuploidy was characterized by a method combining multicolour fluorescence in situ hybridization and immunocytochemistry using the proacrosin-specific monoclonal antibody (mAb 4D4). TUNEL assay was carried out on seminiferous tubules to evaluate germ cell degeneration. At the prophase stage of the first meiotic division, 63.64% of cells at the pachytene stage carried three sex chromosomes. The ratio of X-bearing to Y-bearing spermatids and spermatozoa differed significantly from 1 : 1 with an excess of Y-bearing spermatids and spermatozoa. The frequency of hyperhaploid XY spermatids was increased in the XYY male, as well as the incidence of YY, XY and disomic 18 ejaculated spermatozoa. A preferential elimination of germ cells by apoptosis occurred in spermatocytes I. The persistence of the extra Y chromosome during meiosis of an XYY male is associated with a high rate of spermatocyte I degeneration and a low rate of aneuploid spermatozoa.

Adult↗
PubMed2005

[Lomboscopic surgery for renin-secreting tumour].

Renin-secreting tumour is a rare, benign entity, responsible for hypertension due to secondary hyperaldosteronism. It must be treated surgically. In the light of a review of the literature, the authors report the first published case of resection of a juxtaglomerular tumour of the kidney by laparoscopic partial nephrectomy using an ultrasound scalpel.

Adult↗
PubMed2004

[Can transobturator tape for urinary incontinence cause complete urinary retention?].

The surgical management of stress urinary incontinence has been revolutionized with the development of minimally invasive suburethral tape techniques, which ensure a high continence rate by means of a rapid procedure with a short hospital stay. Although morbidity and adverse effects are uncommon, they must be kept in mind in order to adopt an appropriate strategy designed to prevent their development. Urinary retention is the most frequent postoperative complication of retropubic tape. The recent transobturator tape technique modifies the location of the tape with an angulation more close resembling that of fascial support tissues, thereby decreasing the theoretical risk of retention. The authors report the first case of complete urinary retention and discuss the mechanism and therapeutic strategy.

Aged↗
PubMed2003

[Impact of rectal prolapse and rectocele on TVT results].

OBJECTIVES: The comorbidity between rectal repair surgery and stress urinary incontinence (SUI) repair by TVT (simplified suburethral sling procedure) is a poorly defined entity. The objective of this study was to evaluate the influence of this combination on the quality of postoperative voiding and urinary continence. METHODS: Retrospective analysis of 12 patients (group 1) simultaneously treated by TVT and rectocele repair by anterior rectal mucosectomy (Sullivan: 6 cases) or rectal prolapse repair (open rectal fixation: 6 cases). They were compared to a group of 12 randomly selected patients (group 2) treated by TVT alone during the same period. RESULTS: A significant post-voiding residual urine volume was observed in 4 women of group 1 versus only one woman of group 2. All patients subsequently and spontaneously resumed satisfactory voiding except for one woman of group 1, in whom self-catheterization had to be maintained. After a mean follow-up of 18 months for group 1 and 17 months for group 2, only one woman, in group 2, was still incontinent. CONCLUSION: Rectal repair surgery, combined with TVT, increases the risk of transient postoperative urinary retention. This surgical combination does not appear to modify the medium-term result of the urological procedure.

Female↗
PubMed2003

[Solitary fibrous tumour of the kidney and other sites in the urogenital tract: morphological and immunohistochemical characteristics].

Solitary fibrous tumours are spindle cell tumours initially described in the pleura, but which can also occur in a large number of other sites. The authors report a case of solitary fibrous tumour involving the kidney and present a brief review of the main sites currently described in the urogenital tract and the most characteristic elements of the diagnosis based on histological and immunohistochemical examination designed to improve their subsequent recognition within the wide range of spindle cell tumours.

Female↗
PubMed2002

Assessment of clinical reasoning competence in urology with the script concordance test: an exploratory study across two sites from different countries.

OBJECTIVES: The script concordance (SC) test is designed to measure the organisation of knowledge that allows interpretation of data in clinical reasoning. This study explores the use of this new written examination tool in urology. MATERIALS AND METHODS: An 80 items SC test was administered to participants from a French and a Canadian university. Three levels of experience were tested: urologists (n = 22), residents in urology (n = 25) and students (n = 23). Scores between groups were compared by analysis of variance. Reliability analysis was studied with Cronbach alpha coefficient. RESULTS: Mean global scores were 51.45 +/- 5.29 for students, 58.19 +/- 3.81 for residents and 62.27 +/- 5.46 for urologists. The difference between the three groups was statistically significant (P < 0.00001). Interaction between levels of expertise and sites was apparently not significant (P = 0.326). Cronbach alpha was 0.79 for the test. CONCLUSIONS: This study shows that the SC test is able to discriminate among participants according to their levels of clinical experience in urology. The results are similar in two different learning environments. The SC test appears as a simple and direct approach to testing organisation and use of knowledge in urology.

Clinical Competence↗
PubMed2002

Stability of clinical reasoning assessment results with the Script Concordance test across two different linguistic, cultural and learning environments.

The Script Concordance (SC) test is designed to measure the organization of knowledge that allows interpretation of data in clinical reasoning. An originality of the test is that answer keys use an aggregate scoring method based on answers given by a panel of experts. Previous studies have shown that the SC test has good construct validity. This study, done in urology, explores (1) the stability of the construct validity of the test across two different linguistic and learning environments and (2) the effect of the use of experts who belong to different environments. An 80-item SC test was administered to participants from a French and a Canadian university. Two levels of experience were tested: 25 residents in urology (11 from the French university and 14 from the Canadian university) and 23 students (15 from the French faculty, eight from the Canadian faculty). Reliability analysis was studied with Cronbach's alpha coefficient. Scores between groups were compared by analysis of variance. Reliability coefficient of the 80 items test was 0.794 for the French participants and 0.795 for the Canadian participants. Scores increased with clinical experience in urology in the two sites. Candidates obtained higher scores when correction was done using the answer key provided by the experts from the same country. These data support the stability of the construct validity of the tool across different learning environments.

Adult↗
PubMed2002

Communication between consultants and referring physicians: a qualitative study to define learning and assessment objectives in a specialty residency program.

BACKGROUND: Outpatient consultation constitutes a major part of medical practice. However, little is known about the skills which should be taught to residents in order for them to improve their consultant-referring physician relationships. PURPOSES: To specify the consultant skills which are required to ensure an effective communication between specialists and referring physicians. METHODS: A qualitative study based on (a) a literature search and (b) focus group interviews. RESULTS: Skills thus identified and described are classified in two groups: observable skills and principles/attitudes. CONCLUSIONS: The consensual specification of these abilities permits a greater efficacy in the teaching of consultant skills.

Ambulatory Care↗
PubMed2002

[Systematic planning of technical training in urologic surgery: methodologic trial].

OBJECTIVES: Trainee urologists must be helped and guided in order to acquire surgical techniques and professional skills. This methodological trial was designed to define the training objectives based on the needs formulated in terms of basic technical procedures. MATERIALS AND METHODS: Systematic planning based on the training cycle was used in this study. Training needs were identified by a questionnaire sent to 4 groups composed of a limited number (about twelve) of urologists, but representative of the various modes of urological practice in several regions of France. Data were acquired according to the Delphi method. RESULTS: A list of 10 operations to be mastered at the end of urology training was defined consensually based on the replies (79.2%) to the questionnaire. This list was used as the basis for the design of general and specific training objectives for each operation. These objectives were validated by the urologists consulted. Three examples of these objectives are presented. CONCLUSION: A clear determination of the surgical technique training needs and objectives could lead to standardization of the practical training of urology residents. This would subsequently need to be completed by determination of the methods of evaluation of achievement of these objectives for tutors and trainee urologists.

Education, Medical↗
PubMed2002

[Testicular microlithiasis and cancer of the testis].

The authors report the case of a patient with a history of testicular cryptorchidism followed for 4 years for infertility and who developed seminoma. Bilateral testicular microlithiasis was initially detected on ultrasonography. On the basis of this case and a review of the literature, the authors discuss the aetiopathogenesis and management of these microscopic stones in a context of cancer.

Adult↗
PubMed2002

[Breast metastasis of kidney cancer. Diagnostic and therapeutic features].

The breast is a rare site of metastasis from renal cancer and the preoperative diagnosis is often difficult. The treatment recommended for this type of metastasis is tumourectomy associated with frozen section examination, while mastectomy and lymph node dissection are unnecessary. The prognosis is often poor with a life expectancy rarely exceeding one year. The authors report a case of isolated right breast metastasis occurring two and a half years after left radical nephrectomy for renal cell carcinoma. Tumourectomy and frozen section examination were performed. The patient died four years later in a context of disseminated metastases despite immunotherapy.

Adenocarcinoma, Clear Cell↗
PubMed2001

Introducing the objective structured clinical examination to a general practice residency programme: results of a French pilot study.

OSCE for evaluating clinical competence still remains limited in France. This study presents the results of the first experimental use of an OSCE as a formative assessment of French general practice trainees. Fifty trainees rotated through a circuit of 15 standardized patient-based OSCE cases. Differences in scores were determined by analysis of variance. Reliability was calculated with the coefficient alpha. Pearson correlations were used to determine the relationship between station scores and overall OSCE score. Written questionnaires based on Likert-type scales were used to measure OSCE feasibility. No difference was found between total session scores. Significant item-total score correlations were found for 12 of the 15 clinical problems. The reliability of the examination was 0.58. Most participants agreed that the clinical situations were realistic, simulated patients were believable and sampling of cases was representative of general practice. These data confirm the feasibility of OSCE in assessing performance of general practice trainees. Optimal training of observers should improve examination reliability. This study warrants further development to confirm its usefulness as a summative assessment tool.

Journal Article↗