Diagnostic Skills (diagnostic + skill)

Distribution by Scientific Domains

Selected Abstracts

An Assessment of the Ability of Diplomates, Practitioners, and Students to Describe and Interpret Recordings of Heart Murmurs and Arrhythmia

Jonathan M. Naylor
The ability of clinicians, ie, 10 veterinary students, 10 general practitioners, and 10 board certified internists, to describe and interpret common normal and abnormal heart sounds was assessed. Recordings of heart sounds from 7 horses with a variety of normal and abnormal rhythms, heart sounds, and murmurs were analyzed by digital sonography. The perception of the presence or absence of the heart sounds S1, S2, and S4 was similar for clinicians irrespective of their level of training and was in agreement with the sonographic interpretation on 89, 82, and 78% of occasions, respectively. However, practitioners were less likely to correctly describe the presence of S3. The heart rhythm was correctly described as being regular or irregular on 89% of occasions, and this outcome was not affected by level of training. Differentiation of the type of irregularity was less reliable. The perception of the intensity of a heart murmur was accurate and correlated with the grade assigned in the living horses, R2= .68, and with sonographic measurements of the murmur's intensity, R2= .69. Clinicians overestimated the duration of cardiac murmurs, particularly that of the loud systolic murmur. Only diplomates could reliably differentiate systolic from diastolic murmurs. The ability to diagnose the underlying cardiac problem was significantly affected by training; diplomates, practitioners, and undergraduates made the correct diagnosis on 53, 33, and 29% of occasions, respectively. The poor diagnostic ability of practitioners and the lack of improvement in diagnostic skill after the 2nd year of veterinary school emphasizes the need for better teaching of these skills. Digital sonograms that combine sound files with synchronous visual interpretations may be useful in this regard. [source]

Affordable diagnostics,Changing the paradigm in India,,

CYTOMETRY, Issue S1 2008
Bala S. Manian
Abstract A successful strategy for developing affordable diagnostics begins with a shift in viewpoint. Diagnostics is a tool for generating clinical information. Amassed experience in different parts of the globe has shown that this process of generating and utilizing clinical information is not only different among various countries but also different in microenvironments within the same country. The development of affordable diagnostics requires consideration not only of the component costs such as hardware and consumables but also other related costs that contribute to the generation and delivery of that information. It is important to recognize that these costs associated with public health in resource-poor settings cannot remain at the mercy of charitable contributions from western nations. Therefore, the challenge of technological innovation is to create solutions that are locally affordable and sustainable in the long run within the local macroeconomic constraints. The solutions should permit generation of local economic activity that will reinforce long-term economic sustainability. For this reason it is essential not only to analyze the diagnostic process but also to define a pathway by which local healthcare systems in recipient nations can be endowed with elements that empower them to acquire and practice up-to-date modern diagnostic skills. The objective of this paper is to provide a wider view of diagnostic cost components and to show how solutions developed and delivered locally have resulted in economically affordable as well as sustainable products. © 2008 Clinical Cytometry Society [source]

Virtual microscopy: An educator's tool for the enhancement of cytotechnology students' locator skills

Jimmie Stewart III M.D.
Abstract Virtual microscopy (VM) is being utilized as an educational tool in many areas of pathology. The aim of this study is to analyze the locator and diagnostic skills of cytotechnology students by using the Aperio T3 ScanScope®, and examine VM's viability as an educational tool in cytotechnology. Ten validated cytology slides were digitized and reviewed by three senior cytotechnologist instructors. Each technologist made annotations indicating diagnostic areas on the virtual slide. A subset of the slides was used for locator skill evaluation. Cytotechnology students examined a pristine copy of the virtual slide and made annotations for comparison to those made by experienced instructors. Annotations of the subset were then scored based on the degree of correlation between students and cytotechnologists. A cytopathologist performed a final review of the students' marks; points were then added or subtracted based on this interpretation. Students were graded based on their correlation to senior cytotechnologists. A statistical analysis using modified interrater calculations ranked the students as to locator ability, producing illuminating results. This study shows that VM has promise as a cytotechnology educational tool by allowing the instructor to evaluate students' locator and diagnostic abilities. We have attempted to implement a simple scoring system for evaluation of locator skills where students are compared versus expert cytotechnologists. We anticipate further technological improvements as the products mature. Diagn. Cytopathol. 2008;36:363,368. © 2008 Wiley-Liss, Inc. [source]

Effectiveness of basic clinical skills training programmes: a cross-sectional comparison of four medical schools

Roy Remmen
Objective Training in physical diagnostic skills is an important part of undergraduate medical education. The objective of this study was to study the outcome of skills training at four medical schools. Context At the time of the study, three schools had a traditional lecture-based curriculum and one school had a problem-based learning curriculum with a longitudinal skills training programme. All schools offer extended exposure to clerkships. Method A cross-sectional study in four medical schools was performed, using a written test of skills that has good correlation with actual student performance. The scores attained from four student groups were compared within and between the four medical schools. A total of 859 volunteer students from the later four years at each medical school participated in the study. Results The mean scores in the traditional medical schools increased with the start of skill training and the hands-on experience offered during the clerkships. Students from the school with the longitudinal skills training programme and the problem-based learning approach had significantly higher mean scores at the start of the clerkships, and maintained their lead in the subsequent clinical years. Conclusions Longitudinal skills training seems to offer the students a superior preparation for clerkships as well as influencing the students' learning abilities during the clerkships. The effect of the problem-based learning approach, also related to the innovative philosophy of the curriculum, could not be accounted for. [source]

Prospective study to assess general practitioners' dermatological diagnostic skills in a referral setting

Gilberto Moreno
SUMMARY A prospective study was conducted to assess general practitioners' diagnostic skills in a referral setting. The primary objective was to identify general practitioners' strengths and weaknesses in diagnosing a broad spectrum of skin conditions. The diagnoses of 315 skin conditions made by 165 general practitioners were compared with a reference standard. The reference standard was made up of 73 histopathological diagnoses, 119 dermatologists' clinical diagnoses and 123 dermatologists' diagnoses plus follow up. The diagnoses assigned by referring general practitioners were consistent with dermatologists' clinical diagnoses and histology (where available) in 57% of cases. General practitioners made the correct diagnosis in 44% of cases when compared with histopathology. General practitioners were generally good at diagnosing conditions such as acne, warts, rosacea, molluscum contagiosum, vitiligo and skin tags. The proportion of correct diagnoses for premalignant and malignant skin tumours was 47%, and that of skin rashes requiring a diagnosis was 44%. Further education of general practitioners would help to improve their diagnostic skills in certain skin conditions. [source]

Impact of skin cancer education on medical students' diagnostic skills

S. Cliff
Summary Skin cancer is increasingly common, and the skills involved in its diagnosis should be promoted in UK medical schools. However, there has been no scientific evaluation of the teaching methods employed by dermatology departments. The aim of this study was to evaluate, using traditional audiovisual methods, the impact of an illustrated booklet on skin cancer, coupled with a lecture, on undergraduates' diagnostic skills. The ability of 27 final-year medical students to recognize a variety of skin lesions, using projected images from clinical slides, was assessed. They were tested without warning on two occasions. Immediately after the first test, students were given an illustrated booklet on skin tumours and pigmented lesions which was supplemented with a lecture based on the booklet. Two weeks later, a second test was employed using a series of slides deemed to be of equal diagnostic difficulty. Our results showed a significant increase in the median number of correct diagnoses between the first and second tests (P < 0.001). However, there remained wide variation at the second test in the percentage of correct answers (30 to 80%) amongst students. Our study highlights the need to develop effective methods for improving the diagnostic skills of undergraduates in dermatology, and the importance of evaluating teaching methods. The methods of evaluation, such as ours, can be simple and inexpensive. [source]