Margaret Duerson

Jejunoileal Bypass for Morbid Obesity: Late Follow-up in 100 Cases

To evaluate the results of jejunoileal bypass for morbid obesity, we studied 100 patients with intact bypasses an average of more than five years after surgery. Mean weight loss at five years was 102.7 lb (46.6 kg) (33 per cent). Although nearly half the patients regained some weight between one and five years after surgery, only 17 per cent regained 20 lb (9 kg) or more. Medical benefits (such as improved glucose tolerance and lowered blood pressure) were maintained at five years, but side effects and complications continued to occur in the late postoperative period. Diarrhea (more than three stools per day) persisted in 58 per cent of the patients, and electrolyte disturbances occurred in over a third. Diminished levels of B12 or folate or both were present in 88 per cent. Twenty-one per cent of the patients had nephrolithiasis, and 20 per cent of those who were at risk required cholecystectomy. Progressive hepatic structural abnormalities occurred in 29 per cent of the patients, and there was a 7 per cent incidence of cirrhosis. Although 81 per cent of the patients had satisfactory results at five years, side effects and complications continued to occur, mandating careful follow-up indefinitely. The risk-to-benefit ratio at five years after surgery seems acceptable, but the continued untoward effects of the bypass in the late postoperative period have led us to abandon this procedure in favor of gastric bypass. Only continued longitudinal follow-up will determine whether on balance jejunoileal bypass represents such a serious long-term health hazard that prophylactic restoration of intestinal continuity is indicated.

Comparing Interpersonal Interactions with a Virtual Human to Those with a Real Human

This paper provides key insights into the construction and evaluation of interpersonal simulators¿systems that enable interpersonal interaction with virtual humans. Using an interpersonal simulator, two studies were conducted that compare interactions with a virtual human to interactions with a similar real human. The specific interpersonal scenario employed was that of a medical interview. Medical students interacted with either a virtual human simulating appendicitis or a real human pretending to have the same symptoms. In Study I (n = 24), medical students elicited the same information from the virtual and real human, indicating that the content of the virtual and real interactions were similar. However, participants appeared less engaged and insincere with the virtual human. These behavioral differences likely stemmed from the virtual humans limited expressive behavior. Study II (n = 58) explored participant behavior using new measures. Nonverbal behavior appeared to communicate lower interest and a poorer attitude toward the virtual human. Some subjective measures of participant behavior yielded contradictory results, highlighting the need for objective, physically-based measures in future studies.

Evaluating evidence-based medicine skills during a performance-based examination.

Purpose To measure students’ competencies in evidence-based medicine (EBM) skills [clinical decision making using evidence from published literature (content) and in transmitting clinical information to patients (communication)] within the context of a performance-based examination (PBE). Method In 2002–03, under the direction of a Performance-Based Examination Oversight Committee, 16 EBM queries were developed for a pair of third-year PBEs. At the last station of the PBE, the standardized patient (SP) for that station asked a clinical EBM question relating to their “disease process.” Students were asked to develop an appropriate clinical question, perform a Medline search for appropriate articles, critically appraise a complete selected article, reach a conclusion to their question, and transmit the information to the SP. Each students clinical question, search terms, selected articles, and rationale were evaluated by faculty question-writers, clinical librarians, and the EBM course director using a five-point Likert scale, with 1 being inadequate performance and 5 being superior performance. The SP evaluated the communication skills using a checklist. Results Students’ performances were very good, with means of 3.7 to 4.0 in each area. Agreement between the course director and station developers was good. Seventy-five percent of the students performed adequate Medline searches. Students averaged over 93% on the performance of four communication skills. Conclusion The evaluation of EBM skills can be carried out during a performance-based examination. Results can assist in developing students’ skills and directing curricular efforts.

Impacting Faculty Teaching and Student Performance: Nine Years' Experience With the Objective Structured Clinical Examination

Background: The impetus for administering the 2nd-year Objective Structured Clinical Examination (OSCE) came from the great variability in student performance observed by 3rd-year clerkship directors. Purpose: To document the effects of the OSCE on faculty teaching, student performance, and the curriculum over 9 years of administration of the examinations to more than 1,000 second-year medical students. Method: A 20-station OSCE was administered to all medical students at the end of their 2nd year. Using predetermined criteria, clinical faculty served as evaluators in each station. A mix of 1st-, 3rd-, and 4th-year medical students were recruited to serve as simulated patients. Faculty evaluators and examinees completed a questionnaire evaluating their experience with the OSCE. Students received a report card of their performance. Small-group leaders of the Introduction to Clinical Medicine course received feedback on their groups performance on each station compared to the class mean. Summative data on class performance was reported to the curriculum committee. The academic status committee received data on students who performed unsatisfactorily. Results: Faculty and examinee ratings of the OSCE experience were very positive. Over the 9-year period, student performance improved showing less variability and significantly fewer failed stations. Conclusion: The OSCE has proven to be a technically feasible, authentic evaluation method yielding valuable information for decisions regarding student performance, faculty teaching, and curriculum planning.

Late hepatic histopathology after jejunoileal bypass for morbid obesity: Relation of abnormalities on biopsy and clinical course☆

Late biopsy results in 53 patients after jejunoileal bypass were reviewed and compared with 1 year postoperative biopsies. Patients were divided into groups based on clinical course and liver function tests. Of 24 patients with normal liver function tests and no clinical symptoms of liver failure, 8 (33 percent) had new or progressive lesions on late biopsy, while 1 of these 8 patients had cirrhosis. Thirty percent (6 of 20) of patients with liver function abnormalities but no evidence of liver failure showed evidence of progression on biopsy; 4 of these 6 patients had cirrhosis. Of those with clinical evidence of liver failure in the first year after operation, 44 percent had evidence of progression, but none had cirrhosis. Clinical parameters and liver function tests did not correlate with liver biopsies. In this series of patients, new and progressive lesions were found in the late postoperative period. Long-term serial biopsies are advisable in all patients after jejunoileal bypass to determine whether progressive deterioration in liver histology had occurred.

Computation of Localized Flow for Steady and Unsteady Vector Fields and Its Applications

This paper provides key insights into the construction and evaluation of interpersonal simulators - systems that enable interpersonal interaction with virtual humans. Using an interpersonal simulator, two studies were conducted that compare interactions with a virtual human to interactions with a similar real human. The specific interpersonal scenario employed was that of a medical interview. Medical students interacted with either a virtual human simulating appendicitis or a real human pretending to have the same symptoms. In study I (n=24), medical students elicited the same information from the virtual and real human, indicating that the content of the virtual and real interactions were similar. However, participants appeared less engaged and insincere with the virtual human. These behavioral differences likely stemmed from the virtual humans limited expressive behavior. Study II (n=58) explored participant behavior using new measures. Nonverbal behavior appeared to communicate lower interest and a poorer attitude toward the virtual human. Some subjective measures of participant behavior yielded contradictory results, highlighting the need for objective, physically-based measures in future studiesThis paper provides key insights into the construction and evaluation of interpersonal simulators - systems that enable interpersonal interaction with virtual humans. Using an interpersonal simulator, two studies were conducted that compare interactions with a virtual human to interactions with a similar real human. The specific interpersonal scenario employed was that of a medical interview. Medical students interacted with either a virtual human simulating appendicitis or a real human pretending to have the same symptoms. In study I (n=24), medical students elicited the same information from the virtual and real human, indicating that the content of the virtual and real interactions were similar. However, participants appeared less engaged and insincere with the virtual human. These behavioral differences likely stemmed from the virtual humans limited expressive behavior. Study II (n=58) explored participant behavior using new measures. Nonverbal behavior appeared to communicate lower interest and a poorer attitude toward the virtual human. Some subjective measures of participant behavior yielded contradictory results, highlighting the need for objective, physically-based measures in future studies

A Multi-Institutional Pilot Study to Evaluate the Use of Virtual Patients to Teach Health Professions Students History-Taking and Communication Skills

UF Medical Student MCG Medical Student Thomas Bernard BS , Amy Stevens MD 3,4 4 , Peggy Wagner PhD , Nicole Bernard BS , Lori Schumacher PhD Kyle Johnsen, Robert Dickerson, Andrew Raij, Benjamin Lok PhD 7 , Margaret Duerson PhD , Marc Cohen MD, D. Scott Lind MD Departments of Surgery, OB/GYN 3 4 5 , Family Medicine , Clinical Skills Center , School of Nursing Medical College of Georgia, Augusta, GA Colleges of Engineering and Medicine, University of Florida, Gainesville, FL

The effect of lecture and a standardized patient encounter on medical student rape myth acceptance and attitudes toward screening patients for a history of sexual assault.

Background: Most physicians fail to routinely screen patients for a history of sexual assault. Purposes: This study aimed to gauge medical student support for routinely screening patients for a history of sexual assault, examine potential barriers to screening, and determine if attitudes can be changed through educational interventions. Methods: One hundred three 2nd-year medical students completed a survey before and after a lecture on sexual assault (response rate = 94/103 and 90/103, respectively). The questionnaire was administered a third time following a standardized patient encounter with a female rape victim (response rate = 102/103). Results: Most medical students agreed that patients should be screened for sexual victimization. Students showed low levels of rape myth acceptance. Agreement with rape myths correlated with increased screening hesitancy. Statistically significant gender differences were observed. Following educational sessions, students expressed less rape myth acceptance and more comfort screening. Conclusions: Sexual assault education can diminish rape myth acceptance and promote screening for sexual assault.