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Biomedical subjects

B Joorabchi

Publications and source records attributed to B Joorabchi.

18 recordsLinked to original sources
PubMed1996

Evaluation of clinical competence: the gap between expectation and performance.

OBJECTIVE: To evaluate a 3-year experience with the Objective Structured Clinical Examinations (OSCEs) and to compare faculty expectations with resident performance. DESIGN: Descriptive analysis of measures of resident performance. SETTING: Community-based pediatric residency program in Michigan. PARTICIPANTS: One hundred twenty-six pediatric residents at all levels of training. METHODS: The three examinations consisted of 36 to 42 5-minute stations, testing skills in physical examination, history, counseling, telephone management, and test interpretation. A committee of faculty and chief residents predetermined minimum pass levels for each resident level. Results were compared with other indices of resident performance. RESULTS: There was evidence for content, construct, and concurrent validity, as well as a high degree of reliability. However, 40% to 96% of residents scored below the minimum pass levels for their levels. In each examination, third-year residents had the highest failure rates, yet they scored well on the American Board of Pediatrics in-training examination and on their monthly clinical evaluations. Furthermore, for residents at all levels, the scores reflecting application of data were significantly lower than those assessing data gathering. CONCLUSIONS: The gaps between expectations and performance, and between data gathering and application, have important implications for institutional educational philosophy, suggesting a shift toward more clinically oriented and learner-directed strategies in the design of instructional and evaluation methods.

Clinical Competence↗
PubMed1994

Radiographic inversion of pulmonary blood flow in acute asthma.

Chest radiographs are obtained routinely in children hospitalized with asthma but are considered to be of low utility. We describe a previously unreported radiographic inversion of pulmonary artery flow patterns in the chest films of a majority of children and young adults hospitalized for asthma. Seventy-five hospital records of 65 patients aged 2 to 25 years (mean 9.2) admitted for asthma during the calendar year 1991 were reviewed. As compared with the normal pattern, patients with inverted vascularity were younger (mean age 6.75 years), tended to be admitted through the emergency department, and had significantly more signs of labored breathing, such as tachypnea, retractions, nasal flaring, and tachycardia. We propose that the exaggerated respiratory effort in these children raises the transmural pulmonary artery pressure, impeding pulmonary blood flow. This results in distension of the right ventricle, which then compresses the left ventricle in the confines of the pericardium by posterior displacement of the interventricular septum. The resultant loss of left-sided compliance raises the left atrial and pulmonary venous pressures, leading to inversion of vascular markings through the same mechanism as seen in left-heart failure. We conclude that attention to this easily recognized sign will detect presence of the hemodynamically significant respiratory obstruction in asthmatic patients.

Adolescent↗
PubMed1991

Objective structured clinical examination in a pediatric residency program.

This report describes and evaluates a 42-station objective structured clinical examination (OSCE) administered to 29 pediatric residents and six medical students. In half of the stations, residents spent 5 minutes performing a clearly defined clinical task while being rated by an observer. In the other half of the stations, they answered questions based on the data just gathered. There were six interviews with real or simulated patients, four physical examinations, six laboratory tests or procedures, and one chart review. Eight rest stops were provided. The results of the OSCE were compared with those of resident performance ratings and the Pediatric Board's in-training examination. The OSCE scores could clearly separate the students from the residents and each class of residents from all others (construct validity). The in-training examination could not separate first-year post-graduate level and second-year postgraduate level residents. Resident performance ratings could distinguish only first-year postgraduate level from third-year postgraduate level residents. Residents uniformly agreed that the OSCE measured important clinical objectives attesting to its content validity. Reliability for the OSCE was calculated at the 0.8 to 0.83 range. It is concluded that valid and reliable clinical examinations in pediatrics are feasible, practical, and highly desirable.

Analysis of Variance↗
PubMed1989

Medical information processing skills: guide posts to clinical assessment.

This is a review of the skills involved in processing medical information in order to solve medical problems. The review starts by describing recognized stages in problem solving then moves on to offer practical suggestions on how to obtain medical information, how to record it, and how to present it.

Clinical Competence↗
PubMed1979

The beginning doctor: a problem-based course for first year medical and dental students.

A problem-based course designated as 'Beginning Doctor' was given to 136 first year medical and dental students. The students were divided into small groups and under guidance of a tutor studied largely unfamiliar clinical problems presented to them as written résumés. They determined what further information they required, obtained the information on their own and described it to the oters in plenary sessions. The tutors acted as facilitators of student learning rather than as sources of information. Contrary to the widely held assumption that students in these parts of the world are passive learners, incapable of taking direct responsibility for their own learning, the staff was pleasantly surprised to see the enthusiasm and the competence with which the students tackled the problems and easily adopted the self-learning mode.

Clinical Competence↗
PubMed1979

The emergence of cardiac nondisease among children in Iran.

In a prospective study over a one-year period, 476 new patients, aged three days to 21 years, were seen in a pediatric cardiology clinic held three times a week in two hospitals. Of these patients, 290 (61%) were normal; in 238 (82%) of these a physician had made a definite diagnosis of heart disease. The usual bases for a diagnosis of heart disease in these cases of "cardiac nondisease" were an "elevated" antistreptolysin O titer, growing pains, hyperventilation and functional murmurs, or a combination of these. Of these 238 cardiac nondisease patients, 188 (79%) were under active treatment for up to seven years (mean, 1.23 years). This treatment included monthy penicillin injections for 104 patients for up to seven years; restriction of physical activity in 98 patients; up to six months of aspirin therapy for 25; up to three months of bed rest for 23; steroids for 17; and 'prophylactic" tonsillectomies for 11 patients. Some patients with comfirmed heart disease (35 of 97) were receiving grossly inappropriate treatment. All this represents a significant change in the pattern of pediatric care from that which existed 10 years ago, when cardiac nondisease was nonexistent and many cases of heart disease went unrecognized and untreated. In this report, possible reasons for the emergence of cardiac nondisease are discussed.

Adolescent↗
PubMed1975

Effects of a short educational planning workshop on attitudes of three groups of medical educators.

A series of short (3 days) educational planning workshops was held in three African faculties of medicine. The purpose of this study was to ascertain the effect of such a workshop on educational attitudes of teachers from three conservative traditional schools. An attitudes questionnaire given before and after the workshop allowed the participants to express opinions and feelings on a number of statements with a bipolar theme of teacher-orientation vs. student-orientation. The results showed that using experiential learning methods in small groups with little or no didactic presentation, it was possible in a short time to change long-held educational views of diverse groups of medical educator.

Attitude of Health Personnel↗
PubMed1975

Multiple choice questions. The debate goes on.

The clinical comprehensive examination given to Pahlavi University medical students in their last year was designed to include three types of questions: multiple choice questions (MCQ's) testing factual recall, MCQ's measuring clinical problems solving ability, and simulated patient management problems (PMP's). The scores of the three types of questions were compared with the five-year cumulative class standing and with each other. It was found that the class standing was very highly correlated with MCQ's testing for recall of information. The relation progressively lessened with problem solving MCQ's and PMP's. In the extremes of class standing there was no significant correlation with problem solving MCQ's and a significant but negative correlation with PMP's. Similar results were obtained when recall type MCQ's were compared with problem solving MCQ's and PMP's. It is concluded that the various determinants of class standing (MCQ's, oral exams, 'performance' reports, etc) are probably based on ability for factual recall and that the usual variety of MCQ's are a poor discriminating index of medical competence. It is, however, possible to write MCQ's that are better able to measure the more significant objectives of medical education.

Education, Medical, Undergraduate↗