PubMed · 11365695
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L Engle. 1998. International developments.. https://pubmed.ncbi.nlm.nih.gov/11365695/
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CONTEXT: The College of Medicine and Medical Sciences at the Arabian Gulf University, Bahrain, replaced the traditional long case/short case clinical examination on the final MD examination with a direct observation clinical encounter examination (DOCEE). Each student encountered four real patients. Two pairs of examiners from different disciplines observed the students taking history and conducting physical examinations and jointly assessed their clinical competence. OBJECTIVES: To determine the reliability and validity of the DOCEE by investigating whether examiners agree when scoring, ranking and classifying students; to determine the number of cases and examiners necessary to produce a reliable examination, and to establish whether the examination has content and concurrent validity. SUBJECTS: Fifty-six final year medical students and 22 examiners (in pairs) participated in the DOCEE in 2001. METHODS: Generalisability theory, intraclass correlation, Pearson correlation and kappa were used to study reliability and agreement between the examiners. Case content and Pearson correlation between DOCEE and other examination components were used to study validity. RESULTS: Cronbach's alpha for DOCEE was 0.85. The intraclass and Pearson correlation of scores given by specialists and non-specialists ranged from 0.82 to 0.93. Kappa scores ranged from 0.56 to 1.00. The overall intraclass correlation of students' scores was 0.86. The generalisability coefficient with four cases and two raters was 0.84. Decision studies showed that increasing the cases from one to four improved reliability to above 0.8. However, increasing the number of raters had little impact on reliability. The use of a pre-examination blueprint for selecting the cases improved the content validity. The disattenuated Pearson correlations between DOCEE and other performance measures as a measure of concurrent validity ranged from 0.67 to 0.79. CONCLUSIONS: The DOCEE was shown to have good reliability and interrater agreement between two independent specialist and non-specialist examiners on the scoring, ranking and pass/fail classification of student performance. It has adequate content and concurrent validity and provides unique information about students' clinical competence.
The clinical, laboratory and cytological features of 2 Bahraini infants with Wolman's disease are described. While one of the cases showed the classical diagnostic features, the other case exhibited a few atypical features such as lack of adrenal calcification and unusual morphology of vacuolated marrow macrophages. Literature review shows that this disorder may not be rare in this region.
OBJECTIVE: To compare the changing trends of uterine rupture in 2 decades along with the maternal and fetal outcome in scarred and unscarred uterus. METHODS: The risk factors of the uterine ruptures, which occurred in the Ministry of Health Hospitals in Bahrain in 2 decades, were analyzed. The maternal and the fetal outcome was compared between the 2 decades (1981-2000) and between the scarred and unscarred uterus. RESULTS: The rise of uterine rupture in the 2nd decade (50) as compared with the first decade (25) was parallel to the increasing rate of cesarean section (CS). Instrumental deliveries and augmentation of labor were the main significant risk factors in the first decade while induction of labor was in the later decade. There was a significant decrease of maternal morbidity in the 2nd decade inspite of the increasing rate of uterine rupture. There was no maternal death; however, there were 11 perinatal deaths in the first group compared to 14 in the 2nd group. The maternal morbidity and perinatal mortality was significantly higher in the uterine ruptures of the intact uterus as compared to those with scarred uterus. CONCLUSION: Inspite of the high incidence rate of the uterine rupture in the later decade, the morbidity of the mother and the fetus show no increase. The increase in the incidence of the uterine rupture is connected to the increasing rate of CS. The rupture of the intact uterus is more catastrophic as compared to the scarred uterus.