Thomas Kropmans

Extracurricular research experience of medical students and their scientific output after graduation

graduation compared with peers without such experience. The subjects of this study were graduates (n ¼ 318) who were admitted for medical training in 1982 and 1983. Data concerning extracurricular research and articles published before graduation were collected by structured interviews in 1997 (n ¼ 274). Data concerning scientific output after graduation were gathered by a literature search in MEDLINE in 2002. The articles were traced by searching on author name and other clues such as publication year, co-authors and subject. Students who gained extracurricular research experience publish more articles after graduation (average ¼ 4 articles) than students without such experience (average ¼ 1 article). Of students who gained extracurricular research experience (n ¼ 103) approximately 50% (n ¼ 51) also published an article before graduation. The latter published an average of six articles after graduation compared to an average of two articles published after graduation by students who did not publish before graduation.

Reliability and validity of OSCE checklists used to assess the communication skills of undergraduate medical students: A systematic review☆

OBJECTIVES To explore inter-rater agreement between reviewers comparing reliability and validity of checklist forms that claim to assess the communication skills of undergraduate medical students in Objective Structured Clinical Examinations (OSCEs). METHODS Papers explaining rubrics of OSCE checklist forms were identified from Pubmed, Embase, PsycINFO, and the ProQuest Education Databases up to 2013. Included were those studies that report empirical validity or reliability values for the communication skills assessment checklists used. Excluded were those papers that did not report reliability or validity. RESULTS Papers focusing on generic communication skills, history taking, physician-patient communication, interviewing, negotiating treatment, information giving, empathy and 18 other domains (ICC -0.12-1) were identified. Regarding the validity and reliability of the communication skills checklists, agreement between reviewers was 0.45. CONCLUSIONS Heterogeneity in the rubrics used in the assessment of communication skills and a lack of agreement between reviewers makes comparison of student competences within and across institutions difficult. PRACTICE IMPLICATIONS Consideration should be afforded to the adoption of a standardized measurement instrument to assess communication skills in undergraduate medical education. Future research will focus upon evaluating the potential impact of adoption of a standardized measurement instrument.

The Effects of Spinal Cord Stimulation on Quality of Life in Patients with Therapeutically Chronic Refractory Angina Pectoris

Objective. For patients with refractory angina pectoris, spinal cord stimulation (SCS) is a beneficial and safe adjuvant therapy. However, it has not yet been established whether SCS alters the quality of life (QoL) in these patients.

Interobserver reliability of physical examination of shoulder girdle

The object of this study was to assess interobserver reliability in 23 tests concerning physical examination of the shoulder girdle. A physical therapist and a physical therapist/manual therapist independently performed a physical examination of the shoulder girdle in 91 patients with shoulder complaints of varying severity and duration. The observers assessed 23 items in total: active and passive abductions, passive external rotation, hand in neck (HIN) test, hand in back (HIB) test, impingement test according to Neer, springing test of the first rib and joint play test of the acromioclavicular joint. The interobserver reliability was evaluated by means of a Cohens Kappa, the weighted Kappa and the intraclass correlation (ICC). Criteria for acceptable reliability were: Kappa value>or=0.60, ICC>or=0.75 or an absolute agreement>or=80%. The results showed that Kappa values varied from 0.09 (springing test first rib, stiffness) to 0.66 (springing test first rib, pain), weighted Kappa varied from 0.35 (pain during HIB) to 0.73 (range of motion HIB) and ICC varied from 0.54 (abduction passive starting point painful arc) to 0.96 (active and passive ranges of motion in abduction). In total 11 (48%) items fulfilled the criteria of acceptable reliability. In conclusion, there appears to be a great deal of variation in the reliability of the tests used in the physical examination of the shoulder girdle. Over 50% of the tests did not meet the statistical criteria for acceptable reliability.

MODIFIED USE OF A DYNAMIC BITE OPENER - TREATMENT AND PREVENTION OF TRISMUS IN A CHILD WITH HEAD AND NECK-CANCER - A CASE-REPORT

Trismus may be a complication arising during or after treatment of patients with head and neck cancer. Treatment of trismus is difficult, making prevention very important. To prevent and treat trismus in a patient with a nasopharyngeal tumor, the Contract-Relax-Antagonist-Contract (CRAC) technique was applied, with the aid of a custom-made dynamic bite opener (DBO). The CRAC technique in combination with the DBO, as a therapy/prevention program for trismus, is not referred to in the literature. The combination of CRAC and DBO appeared to be a gentle and effective method well tolerated by the patient.

Repeated assessment of temporomandibular joint pain: Reasoned decision-making with use of unidimensional and multidimensional pain scales

BackgroundThere are no reports in the literature about patients with painfully restricted temporomandibular joints concerning the reliability of unidimensional and multidimensional pain scales on the basis of a generalizability and decision study. Generalizability and decision studies are designed to aid in reasoned decision-making and therefore are complementary to classic psychometric analyses, in which correlation coefficients express the reliability of a measurement design. The smallest detectable difference as an outcome of the decision study is the smallest statistically significant change that can be detected. PatientsTwenty-five consecutive patients (5 males and 20 females) with painfully restricted mandibular function participated in the current study. DesignRepeated measurements of three levels of unidimensional experienced pain (average, minimal, and maximal pain before the week of assessment; n = 200) and the multidimensional pain rating index of the MPQ (n = 100) were used. The measurement sessions were supervised by two observers on two separate measurement days, 1 week apart, with each measurement repeated twice. ResultsInconsistency in measurement results analyzed in terms of absolute error variance (i.e., the measurement facets plus all the interactions) represented at least 24% of total variance. The smallest detectable difference of visual analog scales varied from 43 to 15 mm, depending on the amount of repetitions, whereas for the pain rating index it varied from 22.7 to 14.4 units. ConclusionsFor statistically and clinically successful treatment of patients with painfully restricted temporomandibular joints, clinicians must overcome at least the smallest detectable difference and 38% of the initial average pain level.

The oblique radiographic technique for bone height measurements on edentulous mandibles - A preclinical study and an introduction to the clinical use

OBJECTIVE The aim of this study was to quantify the effect of mandibular angulation, position, and shape of the edentulous mandible on the distortion of its image on lateral oblique radiographs in a preclinical study. Suggestions for the clinical use of this technique are made. STUDY DESIGN Five edentulous dry mandibles were used, varying in size from small to wide and equipped with metal bars in and on top of the mandible. The mandibles were radiographed at 9 different positions by tilting the mandible around the intercondylar axis and by using the oblique projection technique in a cephalostat. RESULTS The length of the images of the metal bars varied significantly when we tilted the mandibles from 20 degrees to -20 degrees. As a result of the effects of magnification and distortion, the image size varied from between 0.96% and 1.06% of the real size. Neither the size of the mandible nor the position of the bars was related to the degree of magnification. CONCLUSION The oblique projection technique has limited geometric errors in depicting the edentulous mandible. For evaluative bone height measurements in patients with extremely resorbed mandibles treated with dental implants, it is a promising technique if the patient (specifically the mandible) can be positioned reproducibly in the apparatus.

The fairness, predictive validity and acceptability of multiple mini interview in an internationally diverse student population- a mixed methods study

BackgroundInternational medical students, those attending medical school outside of their country of citizenship, account for a growing proportion of medical undergraduates worldwide. This study aimed to establish the fairness, predictive validity and acceptability of Multiple Mini Interview (MMI) in an internationally diverse student population.MethodsThis was an explanatory sequential, mixed methods study. All students in First Year Medicine, National University of Ireland Galway 2012 were eligible to sit a previously validated 10 station MMI. Quantitative data comprised: demographics, selection tool scores and First Year Assessment scores. Qualitative data comprised separate focus groups with MMI Assessors, EU and Non-EU students.Results109 students participated (45% of class). Of this 41.3% (n = 45) were Non-EU and 35.8% (n = 39) did not have English as first language. Age, gender and socioeconomic class did not impact on MMI scores. Non-EU students and those for whom English was not a first language achieved significantly lower scores on MMI than their EU and English speaking counterparts (difference in mean 11.9% and 12.2% respectively, P<0.001). MMI score was associated with English language proficiency (IELTS) (r = 0.5, P<0.01). Correlations emerged between First Year results and IELTS (r = 0.44; p = 0.006; n = 38) and EU school exit exam (r = 0.52; p<0.001; n = 56). MMI predicted EU student OSCE performance (r = 0.27; p = 0.03; n = 64). In the analysis of focus group data two overarching themes emerged: Authenticity and Cultural Awareness. MMI was considered a highly authentic assessment that offered a deeper understanding of the applicant than traditional tools, with an immediate relevance to clinical practice. Cultural specificity of some stations and English language proficiency were seen to disadvantage international students. Recommendations included cultural awareness training for MMI assessors, designing and piloting culturally neutral stations, lengthening station duration and providing high quality advance information to candidates.ConclusionMMI is a welcome addition to assessment armamentarium for selection, particularly with regard to stakeholder acceptability. Understanding the mediating and moderating influences for differences in performance of international candidates is essential to ensure that MMI complies with the metrics of good assessment practice and principles of both distributive and procedural justice for all applicants, irrespective of nationality and cultural background.

Comparing the clinical-effectiveness and cost-effectiveness of an internet-delivered Acceptance and Commitment Therapy (ACT) intervention with a waiting list control among adults with chronic pain: study protocol for a randomised controlled trial

Introduction Internet-delivered psychological interventions among people with chronic pain have the potential to overcome environmental and economic barriers to the provision of evidence-based psychological treatment in the Irish health service context. While the use of internet-delivered cognitive–behavioural therapy programmes has been consistently shown to have small-to-moderate effects in the management of chronic pain, there is a paucity in the research regarding the effectiveness of an internet-delivered Acceptance and Commitment Therapy (ACT) programme among people with chronic pain. The current study will compare the clinical-effectiveness and cost-effectiveness of an online ACT intervention with a waitlist control condition in terms of the management of pain-related functional interference among people with chronic pain. Methods and analysis Participants with non-malignant pain that persists for at least 3 months will be randomised to one of two study conditions. The experimental group will undergo an eight-session internet-delivered ACT programme over an 8-week period. The control group will be a waiting list group and will be offered the ACT intervention after the 3-month follow-up period. Participants will be assessed preintervention, postintervention and at a 3-month follow-up. The primary outcome will be pain-related functional interference. Secondary outcomes will include: pain intensity, depression, global impression of change, acceptance of chronic pain and quality of life. A qualitative evaluation of the perspectives of the participants regarding the ACT intervention will be completed after the trial. Ethics and dissemination The study will be performed in agreement with the Declaration of Helsinki and is approved by the National University of Ireland Galway Research Ethics Committee (12/05/05). The results of the trial will be published according to the CONSORT statement and will be presented at conferences and reported in peer-reviewed journals. Trial registration number ISRCTN18166896.

How we implemented an integrated professionalism curriculum to 2nd year medical students at the National University of Ireland Galway Medical School, with examples from students' final output.

Since the introduction of professionalism in medical curricula worldwide, little evidence has been published to exemplify good educational practice. The Medical school at the National University of Ireland Galway teaches professionalism in an interdisciplinary manner, integrating the learning objectives of health informatics, understanding health & illness in society, medical law and ethics. Students work in small groups on clinical cases. Enquiry-based learning is used as the teaching method following a few introductory lectures on specific objectives. Students present their work in the format of a scientific essay. The latter is assessed by a board of reviewers. The purpose of this article is to demonstrate evidence of excellent professional output and illustrate the benefits to a fully integrated professionalism curriculum.