L. F. H. Theyse

Programmatic assessment of competency-based workplace learning: when theory meets practice

BackgroundIn competency-based medical education emphasis has shifted towards outcomes, capabilities, and learner-centeredness. Together with a focus on sustained evidence of professional competence this calls for new methods of teaching and assessment. Recently, medical educators advocated the use of a holistic, programmatic approach towards assessment. Besides maximum facilitation of learning it should improve the validity and reliability of measurements and documentation of competence development. We explored how, in a competency-based curriculum, current theories on programmatic assessment interacted with educational practice.MethodsIn a development study including evaluation, we investigated the implementation of a theory-based programme of assessment. Between April 2011 and May 2012 quantitative evaluation data were collected and used to guide group interviews that explored the experiences of students and clinical supervisors with the assessment programme. We coded the transcripts and emerging topics were organised into a list of lessons learned.ResultsThe programme mainly focuses on the integration of learning and assessment by motivating and supporting students to seek and accumulate feedback. The assessment instruments were aligned to cover predefined competencies to enable aggregation of information in a structured and meaningful way. Assessments that were designed as formative learning experiences were increasingly perceived as summative by students. Peer feedback was experienced as a valuable method for formative feedback. Social interaction and external guidance seemed to be of crucial importance to scaffold self-directed learning. Aggregating data from individual assessments into a holistic portfolio judgement required expertise and extensive training and supervision of judges.ConclusionsA programme of assessment with low-stakes assessments providing simultaneously formative feedback and input for summative decisions proved not easy to implement. Careful preparation and guidance of the implementation process was crucial. Assessment for learning requires meaningful feedback with each assessment. Special attention should be paid to the quality of feedback at individual assessment moments. Comprehensive attention for faculty development and training for students is essential for the successful implementation of an assessment programme.

Phenotypic and genetic evaluation of elbow dysplasia in Dutch Labrador Retrievers, Golden Retrievers, and Bernese Mountain dogs.

Canine elbow dysplasia encompasses four developmental diseases: ununited anconeal process, osteochondrosis of the medial part of the humeral condyle, fragmented medial coronoid process (FCP), and incongruity of the elbow joint. Four radiographic views per joint were used to evaluate 2693 Labrador Retrievers (LRs), 1213 Golden Retrievers (GRs), and 974 Bernese Mountain Dogs (BMDs) for the presence of elbow dysplasia between 2002 and 2009 in the Netherlands. The views were also graded for signs of osteoarthritis and sclerosis. FCP was diagnosed most frequently in LRs, GRs and BMDs, with an incidence of 6%, 5%, and 15%, and a heritability of 0.17, 0.24, and 0.06, respectively. Heritabilities were estimated using a sire model and all available ancestors. Sclerosis at the base of the medial coronoid process was the radiographic sign most strongly correlated with FCP (r=0.95, 0.92, and 0.95 in LRs, GRs and BMDs, respectively). The sex of the dog was significantly correlated with the presence of osteoarthritis in LRs, but not in GRs and BMDs. Male LRs were 1.7-fold more frequently, but not more severely, affected by osteoarthritis than female dogs. Age at radiographic examination was significantly associated with osteoarthritis in all three breeds. The heritability estimates in Retrievers were high enough to warrant including FCP findings in the breeding policy, but until the biomechanical and genetic background of elbow dysplasia are better understood, correct phenotyping with a sensitive technique is essential.

Evaluation of surgical treatment of medial patellar luxation in Pomeranian dogs

In a prospective study, the outcome of surgical correction of medial patellar luxation of 70 stifle joints in 55 Pomeranian dogs was evaluated. Trochlear block recession alone was performed in 46 stifle joints, or in combination with tibial tuberosity transposition in 24 stifle joints in cases with grade II, III or IV medial patellar luxation. Additional procedures were performed to restore lateral and medial retinacular function. The recurrence of patellar luxation and the degree of lameness were evaluated up to at least 16 weeks after surgery. The overall recurrence rate was 10%. The outcome of surgery was considered good for grade II luxation with a 100% success rate. Recurrent medial patellar luxation was diagnosed in approximately 11% of dogs with grade III and in 36% of dogs with grade IV luxation. The postoperative lameness score decreased significantly in comparison with the preoperative score at four weeks and thereafter until the end of the study.

Prevalence and co-occurrence of hip dysplasia and elbow dysplasia in Dutch pure-bred dogs.

Hip as well as elbow dysplasia (HD, ED) are developmental disorders leading to malformation of their respective joints. For a long time both disorders have been scored and targeted for improvement using selective breeding in several Dutch dog populations. In this paper all scores for both HD and ED, given to pure bred dogs in the Netherlands from 2002 to 2010, were analyzed. Heritabilities and correlations between HD and ED were calculated for the 4 most frequently scored breeds. Heritabilities ranged from 0.0 to 0.37 for HD related traits (FCI-score, osteoarthritis, congruity, shape and laxity (Norberg angle); FCI: Fédération Cynologique Internationale) and from 0.0 to 0.39 for ED related traits (IEWG score, osteoarthritis, sclerosis and indentation; IEWG: International Elbow Working Group). HD related traits showed high genetic and residual correlations among each other but were only to a minor extent correlated with ED related traits, which also showed high correlations among each other. Genetic correlations were higher than residual correlations. Phenotypic and genetic trends since 2001 for the four most scored breeds were slightly positive but decreasing over time, indicating that selection over the past decade has not been effective.

Incidence and genetic aspects of patellar luxation in Pomeranian dogs in Thailand

There is a high incidence of patellar luxation (PL) in Pomeranian dogs from Thailand. DNA samples were collected from 59 dogs originating from 15 families. PL was present in 75% of the dogs with a male:female ratio of 1:1.95. Polymorphic microsatellites situated close to the COL6A1, COL6A3, COL9A1, COL9A2, and COL9A3 genes were analyzed for linkage to the phenotype. Sibling-pair analysis revealed that none of the collagen markers analyzed had a high non-parametric linkage score with the highest score, 1.56, for COL9A2 (P=0.07). The low LOD scores for these collagen genes indicated a non-involvement in the pathogenesis of PL in Pomeranians. An association study with a low density single nucleotide polymorphism (SNP) set indicated the possible involvement of a region on chromosome 7. The association of this region remained indicative when larger groups of 43 cases and 40 controls were compared (Chi square test P=0.01).

Expression of osteotropic growth factors and growth hormone receptor in a canine distraction osteogenesis model.

Osteotropic growth factors play an important role in bone metabolism. Nevertheless, knowledge about their expression in relation to distraction osteogenesis remains limited. The aim of the present study was to determine the expression of growth hormone (GH), growth hormone receptor (GHR), insulin-like growth factor I (IGF-I), insulin-like growth factor II (IGF-II), and bone morphogenetic protein 2 (BMP-2) in distraction-induced bone regeneration. Expression of these factors was assessed during the consolidation phase, comparing distraction osteogenesis with osteotomy-induced bone formation. Real-time PCR was performed as a semiquantitative measurement of mRNA, and the relative expression levels of these factors were determined. In addition, plasma GH profiles and plasma concentrations of IGF-I, IGF-II, and insulin-like growth factor-binding protein 4 and -6 (IGFBP-4 and -6) were measured to assess their potential systemic role during bone formation. Expression of GHR, IGF-I, and BMP-2 had significantly increased in comparison with the expression of these factors in mature bone. Expression of GHR was significantly higher in distraction-induced bone regenerate than in osteotomy-induced bone. No significant differences were found for the expression of IGF-I and BMP-2 between distraction and osteotomy. Plasma concentrations of GH, IGF-I, IGF-II, IGFBP-4, and IGFBP-6 did not demonstrate any significant differences between treatment groups and controls. Upregulation of GHR expression in distraction osteogenesis may enhance sensitivity to endogenous systemic GH and thus promote consolidation of the regenerated bone. Changes in the systemic osteotropic growth factors GH, IGF-I, IGF-II, IGFBP-4, and IGFBP-6 do not seem to be of importance during distraction osteogenesis.

Growth hormone stimulates bone healing in a critical-sized bone defect model.

Growth hormone plays an important role in bone metabolism. Treating bone deficits is a major topic in orthopaedic surgery. Our hypothesis was that local continuous growth hormone administration stimulates bone healing in a canine critical-sized bone defect model. Bone formation in the defects was quantified using densitometric image analysis and histomorphometry. After growth hormone treatment, expression levels of insulin-like growth factors-I and II, and growth hormone receptor were determined in the bone regenerate of the original defects. Circulating plasma concentrations of insulin-like growth factors-I and II, and insulin- like growth factor binding proteins-4, and 6 were measured during treatment. Growth hormone administration resulted in healing of bone defects but without an additional effect of local infusion. Expression of insulin-like growth factor-I in the bone regenerate was lower in the growth hormonetreated dogs, whereas insulin-like growth factor-II and growth hormone receptor expression were not increased. Growth hormone increased circulating insulin-like growth factor-I and growth factor-II plasma concentrations. Continuous infusion of growth hormone stimulated bone healing in a canine critical-sized bone defect model. Local delivery of growth hormone did not additionally enhance bone healing. Increased circulating plasma concentrations of insulin-like growth factors-I and II most likely induced bone formation.

Radiographic, computed tomographic, and arthroscopic findings in labrador retrievers with medial coronoid disease.

Objective To describe the radiographic, computed tomographic (CT), and arthroscopic findings in different age groups of Labrador Retrievers diagnosed with medial coronoid disease (MCD), and to compare the ulnar subtrochlear sclerosis (STS) observed on radiographs with the ratio between the mean attenuation of the ulnar subtrochlear bone and the mean attenuation of the cortical bone measured on CT. Study Design Prospective clinical study. Animals Dogs (n = 31; 31 elbow joints) and 6 healthy Labrador Retrievers (6 elbow joints). Methods Radiographic, CT, and intraoperative arthroscopic images (2008–2012) were evaluated. Statistical analysis was performed for the descriptive study to evaluate the difference in findings between age groups and to investigate the correlation between radiographic and CT evaluated ulnar STS. Results Ulnar STS (87.6%) was the most common radiographic findings in dogs ≤12 months and blurring of the cranial edge of the medial coronoid process (MCP; 66.7%) was the most common radiographic findings in dogs >12 months. MCP fragmentation was the most common CT finding in both age groups (93.8% [≤12 months]; 66.7% [>12 months]). A displaced fragment (68.8%) was the most common arthroscopic finding in dogs ≤12 months whereas osteochondromalacia (53.3%) was the most common finding in dogs >12 months. Sensitivity of radiography in detecting MCD was 93.8% (≤12 months) and 73.3% (>12 months) and for CT was 93.8% (≤12 months) and 66.7% (>12 months). Radiographic evaluated ulnar STS was strongly correlated with CT evaluated ulnar STS. Conclusion Wide ranges of radiographic, CT, and arthroscopic findings in Labrador Retrievers diagnosed with medial coronoid disease were identified.OBJECTIVE To describe the radiographic, computed tomographic (CT), and arthroscopic findings in different age groups of Labrador Retrievers diagnosed with medial coronoid disease (MCD), and to compare the ulnar subtrochlear sclerosis (STS) observed on radiographs with the ratio between the mean attenuation of the ulnar subtrochlear bone and the mean attenuation of the cortical bone measured on CT. STUDY DESIGN Prospective clinical study. ANIMALS Dogs (n = 31; 31 elbow joints) and 6 healthy Labrador Retrievers (6 elbow joints). METHODS Radiographic, CT, and intraoperative arthroscopic images (2008-2012) were evaluated. Statistical analysis was performed for the descriptive study to evaluate the difference in findings between age groups and to investigate the correlation between radiographic and CT evaluated ulnar STS. RESULTS Ulnar STS (87.6%) was the most common radiographic findings in dogs ≤12 months and blurring of the cranial edge of the medial coronoid process (MCP; 66.7%) was the most common radiographic findings in dogs >12 months. MCP fragmentation was the most common CT finding in both age groups (93.8% [≤12 months]; 66.7% [>12 months]). A displaced fragment (68.8%) was the most common arthroscopic finding in dogs ≤12 months whereas osteochondromalacia (53.3%) was the most common finding in dogs >12 months. Sensitivity of radiography in detecting MCD was 93.8% (≤12 months) and 73.3% (>12 months) and for CT was 93.8% (≤12 months) and 66.7% (>12 months). Radiographic evaluated ulnar STS was strongly correlated with CT evaluated ulnar STS. CONCLUSION Wide ranges of radiographic, CT, and arthroscopic findings in Labrador Retrievers diagnosed with medial coronoid disease were identified.

The role of osteonecrosis in canine coronoid dysplasia: Arthroscopic and histopathological findings

Coronoid dysplasia (CD) or medial coronoid disease is part of canine elbow dysplasia and eventually results in osteoarthrosis. Although CD was originally attributed to disturbed endochondral ossification, more recent data point to the subchondral bone. The objective of this study was to assess dysplastic bone and cartilage of dogs that underwent unilateral or bilateral arthroscopic subtotal coronoidectomy for the treatment of CD. Arthroscopic findings and histopathology of bone and cartilage removed from elbow joints with CD were compared. The most common arthroscopic finding was fragmentation with softening of the subchondral bone of the central part of the medial coronoid process. In dogs without obvious fragmentation, CD was characterised by bone softening and chondromalacia. During arthroscopic intervention dysplastic bone and cartilage were collected for histopathological assessment. Forty-five slices of formalin-fixed, paraffin-embedded bone and cartilage samples were stained using haematoxylin and eosin and evaluated. Histopathological findings primarily consisted of osteonecrosis of subchondral bone with necrosis within the marrow spaces. Histopathological changes in the articular cartilage were characterised by fibrillation, chondrocyte clone formation, and focal cartilage necrosis. The pathology was found primarily in the subchondral bone and not in the articular cartilage. Vascular compromise may play a role in the pathogenesis of osteonecrosis in CD.

Proximo-distal patellar position in three small dog breeds with medial patellar luxation

INTRODUCTION Medial patellar luxation is thought to be associated with a high proximal position of the patella in the trochlear groove. OBJECTIVE To determine whether the ratio of patellar ligament length and patellar length (L:P) is influenced by the stifle angle (75°, 96°, 113°, 130°, and 148°) in small dog breeds and to compare the L:P ratio in dogs of three small dog breeds with and without medial patellar luxation. METHODS A mediolateral radiograph of the stifle joint was used to measure the L:P ratio in the stifle joints of dogs of three small breeds with and without medial patellar luxation. The L:P ratio was evaluated at five stifle angles (75°, 96°, 113°, 130°, and 148°) in 14 cadavers (26 stifle joints) of small dog breeds in order to identify the best stifle angle to measure the L:P ratio. Then the mean ± SD L:P ratio was calculated for normal stifles and stifles with medial patellar luxation grades 1, 2, and 3 in 194 Pomeranians, 74 Chihuahuas, and 41 Toy or Standard Poodles. RESULTS The L:P ratio was the same for all five stifle angles in the cadavers (p = 0.195). It was also not significantly different in the three breeds (p = 0.135), in normal and medial patellar luxation-affected stifles overall (p = 0.354), and in normal and medial patellar luxation-affected joints within each breed (p = 0.19). CLINICAL SIGNIFICANCE We conclude that a proximo-distal patellar position is not associated with medial patellar luxation in Pomeranians, Chihuahuas, and Toy or Standard Poodles. Thus a longer patellar ligament length does not play a role in the pathophysiology of medial patellar luxation in these small dog breeds.