Accuracy of Heart Auscultation Examination by General Practitioners From Various Levels of Competency in Detection of Heart Abnormality in Basic School Children

Background. Most of heart defects in children do not show typical clinical symptoms. Ten percent of the cases are late detected. Echocardiography is an examination with high sensitivity and specificity in detecting heart defects in children, but it cannot be performed by all health workers, expensive and not always available in hospitals. Auscultation is an important part of a physical examination that inexpensive, easy examination, and becomes a competency of all doctors. The aim of this study to determine the accuracy of the screening method by listening to murmurs on heart auscultation by various levels of physician competence. Methods. This is a diagnostic test of 250 elementary school children held in the pediatric ward of dr. Mohammad Hoesin Palembang from September to November 2019. The auscultation examination was performed by three pediatrics resident from three stages (i.e. junior, middle and senior), followed by echocardiography examinations by a pediatric cardiologist. Results. The highest sensitivity of auscultation was found in senior resident, 42.4%, while the lowest was found in junior resident, 12.1%. The results of the kappa analysis of the cardiac auscultation examination on the three examiners showed a poor level of agreement on junior stage compared to senior resident (k = 0.189; CI = 0.033-0.346) and the level of agreement was sufficient in junior stage compared to middle stage resident (k = 0.297; CI = 0.134 -0.461) and middle stage compared to senior resident (k = 0.301; CI = 0.147-0.456). Conclusion. Experience and length of learning will affect the accuracy of the auscultation examination in detecting heart defects in children.

Incidence of postoperative week 1 management changes after resident-performed phacoemulsification cataract surgery

Background The goal of this study was to investigate the incidence of departures from routine care at the postoperative week 1 (POW1) visit following uneventful resident-performed cataract surgery in asymptomatic patients who had a normal postoperative day 1 (POD1) examination. Methods A retrospective chart review of phacoemulsification surgeries performed by the senior resident class at Montefiore Medical Center between June 20, 2018 and April 1, 2019 was performed. The most recent preoperative visit note, operative report, POD1 visit note, and POW1 visit note were evaluated and variables were recorded. Exclusion criteria consisted of any complications that would have necessitated close follow-up and a POW1 visit, whether discovered preoperatively, intraoperatively, at the POD1 visit, or leading up to the POW1 visit. The primary outcome measure was the incidence of unanticipated management changes at the POW1 visit following resident-performed cataract surgery. Results The charts of 292 surgical cases of 234 patients that underwent phacoemulsification with intraocular lens implantation were reviewed. 226 cases (77%) had an uncomplicated pseudophakic fellow-eye history, with a routine surgery, and POD1 examination. 19 of these patients had symptomatic presentations at the POW1 timepoint, and an additional 30 had no POW1 visit at all. In total, 177 cases were included in the study, and only 4 of these cases (2.3%) had an unexpected management change at the POW1 visit. Conclusions Asymptomatic patients who underwent uncomplicated cataract surgeries performed by resident surgeons followed by a routine POD1 visit had a low incidence of unexpected management changes at the POW1 visit. These results suggest that regularly scheduled POW1 visits could potentially be omitted for patients deemed to be at low risk for complications, and instead performed on an as-needed basis.

Healing From a Distance: A Cross-sectional Study on the Diagnostic Reliability of Store-and-Forward Teledermatology (Preprint)

UNSTRUCTURED Telemedicine delivers health care services between two distant locations through the use of information and communication technology. Several medical specializations, such as dermatology, have incorporated telemedicine into their practice. Since dermatologists are trained to diagnose skin, hair, and nail conditions with a clinical eye, teledermatology may be an alternative when a traditional face-to-face clinic visit is not feasible. The purpose of this study was to evaluate the diagnostic reliability of teledermatology. A cross-sectional study was conducted among patients from 2 government hospitals. A total of 39 patients were seen in a face-to-face setting and diagnosed by a consultant dermatologist. A written history of their present illness and accompanying photographs were taken and were shown to 3 consultant teledermatologists, who then diagnosed their condition. Two senior dermatology residents then rated the face-to-face and teledermatology diagnoses as either complete agreement, partial agreement, or no agreement. Descriptive statistics was used to summarize the general and clinical characteristics of the participants. The Cohen kappa was used to assess agreement in the evaluations between the teledermatology and face-to-face diagnoses by senior resident raters #1 and #2. Over 70% of the diagnoses were deemed as either partial or in complete agreement with the face-to-face diagnosis for senior resident rater #1. Similarly, over 80% of the diagnoses were deemed as either partial or in complete agreement with the face-to-face diagnosis for senior resident rater #2. The agreement between the ratings of senior residents #1 and #2 ranged from fair to substantial. The findings of the study showed that the diagnostic concordance of in-person clinicians and teledermatologists ranges from fair to substantial, with over 70% of the diagnoses in partial or complete agreement. Although face-to-face consultations remain the gold standard, teledermatology is an important alternative where dermatologic care is not accessible.

Healing From a Distance: A Cross-sectional Study on the Diagnostic Reliability of Store-and-Forward Teledermatology

Background Telemedicine delivers health care services between two distant locations through the use of information and communication technology. Several medical specializations, such as dermatology, have incorporated telemedicine into their practice. Since dermatologists are trained to diagnose skin, hair, and nail conditions with a clinical eye, teledermatology may be an alternative when a traditional face-to-face clinic visit is not feasible. Objective The purpose of this study was to evaluate the diagnostic reliability of teledermatology. Methods A cross-sectional study was conducted among patients from 2 government hospitals. A total of 39 patients were seen in a face-to-face setting and diagnosed by a consultant dermatologist. A written history of their present illness and accompanying photographs were taken and were shown to 3 consultant teledermatologists, who then diagnosed their condition. Two senior dermatology residents then rated the face-to-face and teledermatology diagnoses as either complete agreement, partial agreement, or no agreement. Descriptive statistics was used to summarize the general and clinical characteristics of the participants. The Cohen kappa was used to assess agreement in the evaluations between the teledermatology and face-to-face diagnoses by senior resident raters #1 and #2. Results Over 70% of the diagnoses were deemed as either partial or in complete agreement with the face-to-face diagnosis for senior resident rater #1. Similarly, over 80% of the diagnoses were deemed as either partial or in complete agreement with the face-to-face diagnosis for senior resident rater #2. The agreement between the ratings of senior residents #1 and #2 ranged from fair to substantial. Conclusions The findings of the study showed that the diagnostic concordance of in-person clinicians and teledermatologists ranges from fair to substantial, with over 70% of the diagnoses in partial or complete agreement. Although face-to-face consultations remain the gold standard, teledermatology is an important alternative where dermatologic care is not accessible. Conflicts of Interest None declared.

Healing from a distance: A cross-sectional study on the diagnostic reliability of store-and-forward Teledermatology (Preprint)

BACKGROUND Telemedicine delivers health care services between two distant locations through the use of information and communication technology. Several medical specializations, such as dermatology, have incorporated telemedicine into their practice. Since dermatologists are trained to diagnose skin, hair and nail conditions with a clinical eye, teledermatology may be an alternative when a traditional face-to-face clinic visit is not feasible. OBJECTIVE The purpose of this study is to evaluate the diagnostic reliability of teledermatology. METHODS A cross-sectional study was conducted among patients from Culion Sanitarium and General Hospital and Rizal Medical Center. Thirty-nine patients were seen face-to-face and diagnosed by a consultant dermatologist. A written history of their present illness and accompanying photographs were taken, and were shown to three consultant teledermatologists who then diagnosed their condition. Two senior dermatology residents then rated the face-to-face and teledermatology diagnoses as either complete agreement, partial agreement, or no agreement. Descriptive statistics was used to summarize the general and clinical characteristics of the participants. Cohen’s Kappa was used to determine the agreement of the evaluations between the teledermatology and face to face diagnoses by senior residents 1 and 2. RESULTS Over 70% of the diagnoses were deemed as either partial or in complete agreement with the face-to-face diagnosis for senior resident rater 1. Similarly, over 80% of the diagnoses were deemed as either partial or in complete agreement with the face-to-face diagnosis for senior resident rater 2. The agreement between the agreement ratings of senior residents 1 and 2 were fair to substantial. CONCLUSIONS The findings of the study show that the diagnostic concordance of in-person clinicians and teledermatologists are fair to substantial, with over 70% of the diagnoses in partial or complete agreement. Though face-to-face consultations remain the gold standard, teledermatology is an important alternative where dermatologic care is not accessible.

Healing From a Distance: A Cross-sectional Study on the Diagnostic Reliability of Store-and-Forward Teledermatology (Preprint)

BACKGROUND Telemedicine delivers health care services between two distant locations through the use of information and communication technology. Several medical specializations, such as dermatology, have incorporated telemedicine into their practice. Since dermatologists are trained to diagnose skin, hair, and nail conditions with a clinical eye, teledermatology may be an alternative when a traditional face-to-face clinic visit is not feasible. OBJECTIVE The purpose of this study was to evaluate the diagnostic reliability of teledermatology. METHODS A cross-sectional study was conducted among patients from 2 government hospitals. A total of 39 patients were seen in a face-to-face setting and diagnosed by a consultant dermatologist. A written history of their present illness and accompanying photographs were taken and were shown to 3 consultant teledermatologists, who then diagnosed their condition. Two senior dermatology residents then rated the face-to-face and teledermatology diagnoses as either complete agreement, partial agreement, or no agreement. Descriptive statistics was used to summarize the general and clinical characteristics of the participants. The Cohen kappa was used to assess agreement in the evaluations between the teledermatology and face-to-face diagnoses by senior resident raters #1 and #2. RESULTS Over 70% of the diagnoses were deemed as either partial or in complete agreement with the face-to-face diagnosis for senior resident rater #1. Similarly, over 80% of the diagnoses were deemed as either partial or in complete agreement with the face-to-face diagnosis for senior resident rater #2. The agreement between the ratings of senior residents #1 and #2 ranged from fair to substantial. CONCLUSIONS The findings of the study showed that the diagnostic concordance of in-person clinicians and teledermatologists ranges from fair to substantial, with over 70% of the diagnoses in partial or complete agreement. Although face-to-face consultations remain the gold standard, teledermatology is an important alternative where dermatologic care is not accessible.

How reliable is assessment of joint swelling and tenderness over socks or stockings in patients with established rheumatoid arthritis?

ABSTRACT Objectives Physicians tend to omit examinations of the foot and ankle in routine practice because it consumes a lot of time when working within tight time constraints. Although barefoot examination is critical to assess disease activity of rheumatoid arthritis (RA), we think occasional examination of foot over socks or stockings is better than not examining foot at all. The aim of this study was to assess the accuracy of foot examinations over socks or stockings in patients with RA. Methods Sixty patients with RA were enrolled in this study. A rheumatologist and a senior resident performed foot examinations on each patient over socks, over stockings, and on bare foot to assess swelling and tenderness. Concordance rates between the barefoot examination and the examinations over socks or stockings by each examiner were investigated. Results The rheumatologist had a concordance rate of 94.4% over socks and 98.8% over stockings. The senior resident had a concordance rate of 95.6% over socks and 98.5% over stockings. Conclusions Foot examinations over socks and stockings had high concordance rates with the barefoot examination, and it may be an option for decreasing foot and ankle examination time in RA patients.

Addressing Transition to Practice: Assessing Perceived Effectiveness of a Competency Based Change to On-Call Responsibilities of Senior Cardiology Residents

Background There has been a paradigm shift in residency training over the last several years wherein Competency by Design (CBD) is being integrated to replace more traditional time-based models of training. The Residency Program Committee (RPC) for the Cardiology training program at Dalhousie University in Halifax, Canada addressed the Transition to Practice stage by approving a trial of adjusting the resident call responsibilities to reflect the transition to CBD curriculum. The goal of this adjustment was three-fold: i. Gradually increase accountability of the senior cardiology resident as they transition to practice; ii. Address a gap in training that allows the senior resident to have a gradual transition to the role of a practicing cardiologist while on call; iii. Allows further evolution of skills and abilities. Methods A survey was administered to the practitioners involved in this competency-based change to the call responsibilities. Surveys were distributed to the final year Cardiology Residents, Staff Cardiologists, and Senior Internal Medicine residents to assess their experience and opinions of the current, competency-based change of the on-call curriculum. The survey consisted of eleven questions, of which, four were assessed on a Likert scale and 3 were yes/no questions. Results Four PGY6 cardiology residents, five senior internal medicine residents and eleven staff cardiologists completed the survey. Amongst those who completed the survey there was agreement that the change to the on-call responsibilities improved cardiology residents’ skills, accountability and preparedness to practice. All groups felt the changes were useful for the cardiology training program. There was mild negative effect of perceived accountability by the internal medicine residents. Conclusion Overall the change in call structure led to improved perceived preparedness to practice amongst the cardiology residents and addressed a gap in the Transition to Practice phase of CBD training. This study provides some evidence to the potential benefit of CBD and specifically in the benefits towards transitioning to practice.

1006 Impact of The Human Factor on Student Interest in Orthopaedic Surgery: A Randomised Control Trial

Aim The positive learning experiences of students on surgical rotations which subsequently influence career choice may be delineated into practical and interpersonal themed factors. It remains unclear the relative impact each component has on the student experience and subsequent specialisation. We evaluated the influence of having senior resident mentor during practical simulation in orthopaedic surgery has on medical student interest in surgery; their comfort in theatre; and its role in enhancing knowledge acquisition within the rotation Method Medical students undergoing clinical rotations in a Regional University Hospital were randomised to undertaking a a virtual reality simulated operation independently or performing under the guidance of an experienced resident. Baseline levels of interest in surgery, comfort in theatre, perceived barriers to surgical learning and entry to surgery were established and compared to answers following completion of the tutorial. Qualitative feedback was collected regarding the benefits and limitations to the experience. Presented according to CONSORT guidelines. Results Participants in the resident guided group achieved significantly higher simulated performance scores compared to the control (p < 0001), with an increase in orthopaedic surgery from baseline expressed to a statistically significant degree (p = 0.04). 100% participants strongly agreed it was a beneficial learning experience which would be useful in surgical curricula. Conclusions Surgical trainee guided simulation led to improved performance and interest in orthopaedic surgery, while virtual practical experience was felt to be a useful learning tool independent of supervision. Further research is needed to establish the role of interpersonal interactions in student surgical experience.