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Biomedical subjects

Geoff Norman

Publications and source records attributed to Geoff Norman.

At least 19 recordsLinked to original sources
PubMed2006

Impact of field of study, college and year on calculation of cumulative grade point average.

A consistent finding from many reviews is that undergraduate Grade Point Average (uGPA) is a key predictor of academic success in medical school. Curiously, while uGPA has established predictive validity, little is known about its reliability. For a variety of reasons, medical schools use different weighting schemas to combine years of study. Additional concerns relate to the equivalence of grades obtained from different fields of study and institutions, with little hard data to guide conclusions. At the Michael G. DeGroote School of Medicine Class of 2007 at McMaster University, every undergraduate grade of 2,138 applicants, along with field of study and post-secondary educational institution, was analyzed. Individual grades were aggregated into an overall uGPA using published algorithms from several medical school, and correlated with a non-weighted sum. Correlations of the different schemas with equal weights ranged from 0.973 to 0.990. The extent of the difference between fields of study was small, accounting for only 1.5% of the variance. However, differences among 16 Ontario universities were larger, and accounted for 9.3% of the variance. The results of this study suggest that all weighting schemas are virtually equivalent, making any formulation reasonable. Differences by field of study are small, but do not show any bias against non-science students. Differences by institution are larger, amounting to a range in average score from 78.7 to 84.6; however it is not clear whether this reflects candidate ability or institutional policy, so attempts to correct for institution may be difficult.

Algorithms↗
PubMed2006

Patients undergoing knee surgery provided accurate ratings of preoperative quality of life and function 2 weeks after surgery.

OBJECTIVE: To evaluate patients' ability to recall their preoperative self-reported quality of life, function, and general health 2 weeks postoperatively. STUDY DESIGN AND SETTING: We randomized consecutive patients undergoing arthroscopic knee surgery to group I (assessments at 4 weeks preoperatively, on the day of surgery, and 2 weeks and 12 months postoperatively) or group II (assessments at 2 weeks and 12 months postoperatively). At each visit patients completed disease-specific, knee-specific, and generic health rating scales. At a median of 2 weeks postoperative (range, 0.6 to 14 weeks), patients completed questionnaires according to their recollection of their health 2 weeks before surgery. RESULTS: Agreement between actual and recalled data was excellent for disease-specific (ICC(WOMET)=0.88 (95% CI 0.82-0.91), ICC(ACL-QOL)=0.86 (95% CI 0.75-0.91)), knee-specific (ICC(IKDC)=0.92 (95% CI 0.90-0.94), ICC(KOOS)=0.93 (95% CI 0.91 to 0.95), and general physical health (ICC(SF-36(PCS))=0.81 (95% CI 0.75-0.86)) instruments. Agreement for general mental health was moderate (ICC(SF-36(MCS))=0.67 (95% CI 0.58-0.75). Greater error associated with recalled ratings contributed to small increases in sample size requirements or small decreases in power to detect differences between groups. CONCLUSION: Patients recalled their preoperative quality of life, function, and general health at 2 weeks postoperative with sufficiently high accuracy to warrant substituting prospectively collected baseline data with recalled ratings.

Adult↗
PubMed2006

Competence and cognitive difficulty in physicians: a follow-up study.

PURPOSE: Remediation of incompetent physicians has proven difficult and sometimes impossible. The authors wished to determine whether such physicians had neuropsychological impairment sufficient to explain their incompetence and their failure to improve after remedial continuing medical education (CME). METHOD: Between 1997 and 2001, the authors undertook neuropsychological screening of 45 participants of a physician competency assessment program. For those physicians reassessed after a period of remediation, the authors relate the findings of the physicians' competence reassessments to their neuropsychological scores. RESULTS: Nearly all physicians performing well on competency assessment had no or mild cognitive impairment. Conversely, a significant number of physicians performing poorly on competency assessment had sufficient neuropsychological difficulty to explain their poor performance. The cognitive impairment was more marked in elderly physicians, and referencing the neuropsychological scores to an age-matched normative population underestimates the impairment. No physician with moderate or severe neuropsychological dysfunction had successful competency reassessment. Increasing age was associated with poor performance on competency testing, but was less strongly associated with unsuccessful reassessment. CONCLUSION: A large minority of the physicians who fell significantly below desired levels of competence had cognitive impairment sufficient to explain their lack of competence and their failure to improve with remedial CME.

Adult↗
PubMed2005

Changing attitudes towards polio vaccination: a randomized trial of an evidence-based presentation versus a presentation from a polio survivor.

We compared the impact of epidemiological evidence and anecdotal evidence on changing vaccination attitudes amongst alternative medical students. Ninety-seven students were randomized to either an evidence-based lecture on the benefits of the polio vaccine on population health or a presentation from a visibly affected victim of polio. We compared change in responses to a survey measuring vaccination attitudes between the two groups. The follow-up rate was 73%. There was no statistically significant difference between the two groups in change in response to any of the survey questions. In a post hoc analysis we found that 25% of students were less likely to recommend the vaccine after being provided with evidence supporting vaccination. These findings suggest that confronting deeply held beliefs regarding vaccination may paradoxically strengthen these belief systems.

Adult↗
PubMed2005

Serum creatinine: a surrogate measurement of lean body mass in children with acute lymphoblastic leukemia.

BACKGROUND: Since creatinine is formed almost exclusively in skeletal muscle, the hypothesis of a relationship between serum creatinine (SC) and lean body mass (LBM), determined by dual-energy X-ray absorptiometry (DXA), was tested. METHODS: Two cohorts of patients were analyzed: 37 children with acute lymphoblastic leukemia (ALL) and 20 children with primary muscular disorders (PMD). The latter cohort was used as a comparative group. Statistical analyses were performed using linear regressions. RESULTS: A strong correlation was demonstrated between SC and LBM in the patients with PMD (r = 0.77) and in patients with ALL (r = 0.83 at diagnosis; r = 0.77 on therapy; and r = 0.56 off therapy). The correlation between SC and body size (body mass index) was much weaker (r = 0.38; r = -0.09; r = 0.29 at the successive observations in the ALL cohort and r = 0.05 in the PMD cohort). These data provide support for the initial hypothesis. CONCLUSIONS: Further investigations with a wider variety of diseases are needed for this will allow the consideration of SC as a general surrogate measure of LBM and consequently of nutritional status.

Biomarkers↗
PubMed2003

Interactive voice response to assess residents' laparoscopic skills: an instrument validation study.

OBJECTIVE: The study was undertaken to evaluate the psychometric properties of the Interactive Voice Response (IVR) instrument to assess laparoscopic surgical skills of residents. STUDY DESIGN: Surgical competence of obstetric-gynecologic residents at the University of Ottawa (Canada) was evaluated after observed performance of skills. Three questions addressing general domains of surgical skill were rated per surgery using a 5-point Likert scale: overall, 993 surgical ratings were made by 29 residents and 13 faculty preceptors. RESULTS: With use of a generalizability study, a minimum of 12 preceptor ratings (G=0.80) are needed to obtain reliable measures of residents' surgical skills. Item analysis indicated that the three items on the instrument were highly correlated (Cronbach alpha=.92). Elements of construct validity were evident for diagnostic and simple laparoscopic procedures. CONCLUSION: The IVR instrument can be a valid and reliable measure of residents' surgical skills. The IVR ratings functioned as a global rating scale, capturing overall elements of surgical skills. The ratings on the IVR tool had construct validity with improved performance with increased surgical training and experience.

Clinical Competence↗