Assessing clinical reasoning: a method to monitor its development in a PBL curriculum

The aim of this study was to develop and trial a method to monitor the evolution of clinical reasoning in a PBL curriculum that is suitable for use in a large medical school. Termed Clinical Reasoning Problems (CRPs), it is based on the notion that clinical reasoning is dependent on the identification and correct interpretation of certain critical clinical features. Each problem consists of a clinical scenario comprising presentation, history and physical examination. Based on this information, subjects are asked to nominate the two most likely diagnoses and to list the clinical features that they considered in formulating their diagnoses, indicating whether these features supported or opposed the nominated diagnoses. Students at different levels of medical training completed a set of 10 CRPs as well as the Diagnostic Thinking Inventory, a self-reporting questionnaire designed to assess reasoning style. Responses were scored against those of a reference group of general practitioners. Results indicate that the CRPs are an easily administered, reliable and valid assessment of clinical reasoning, able to successfully monitor its development throughout medical training. Consequently, they can be employed to assess clinical reasoning skill in individual students and to evaluate the success of undergraduate medical schools in providing effective tuition in clinical reasoning.

Language choice of the Foochows in Sarawak, Malaysia

This paper investigates the factors affecting the language choices of the Chinese Foochows of Sarawak, focusing in particular on how the use of the Foochow dialect vis-a`-vis English and other languages might potentially result in a shift in language allegiance away from Foochow. In the context of Sarawak, the Foochows are a substantial, cohesive and homogeneous Chinese ethnic group with a distinctive language and ethnic identity. One would predict that they would engage in extensive language maintenance behaviour. Instead, Foochows living in non-Foochow dominant areas do not seem to have sufficient attachment to the language to transmit it to the next generation. Is this because the Foochows consider that accommodating to communicative norms is more important than preserving their native language as an inherent symbol of their ethnic identity? Or is it the result of the Foochows’ insecurity about the prestige of the dialect and the status of the Foochow people? These issues of accommodation and language allegiance are discussed, based on interview and questionnaire data from 11 Foochow participants. This data set is part of a larger study on the language use of different ethnic groups in multilingual organisational settings in Sarawak.

Characterisation of chronic lateral epicondylalgia using the McGill pain questionnaire, visual analog scales, and quantitative sensory tests

Aims: To characterise chronic lateral epicondylalgia using the McGill Pain Questionnaire, Visual Analog Scales for pain and function, and Quantitative Sensory Tests; and to examine the relationship between these tests in a population with chronic lateral epicondylalgia. Method: Fifty-six patients (29 female, 27 male) diagnosed with unilateral lateral epicondylalgia of 18.7 months (mean) duration (range 1-300), with a mean age of 50.7 years (range 27-73) participated in this study. Each participant underwent assessment with the McGill Pain Questionnaire (MPQ), Visual Analog Scales (VAS) for pain and function. and Quantitative Sensory Tests (QST) including thermal and pressure pain thresholds, pain free grip strength, and neuromeningeal tissue testing via the upper limb tension test 2b (ULTT 2b). Results: Moderate correlation (r = .338-.514, p = .000-.013) was found between all indices of the MPQ and VAS for pain experienced in the previous 24 hours and week. Thermal pain threshold was found to be significantly higher in males. A significant poor to moderate correlation was found between the Pain Rating Index (PRI) in the sensory category of the MPQ and ULTT2b scores (r = .353, p = .038). There was no other significant correlation between MPQ and QST data. Pain free grip strength was poorly yet significantly correlated with duration of pathology (r = 318, p = .038). Conclusion: The findings of this study are in agreement with others (Melzack and Katz, 1994) regarding the multidimensional nature of pain, in a condition conventionally conceived as a musculoskeletal pain state. The findings also suggest that utilisation of only one pain measurement tool is unlikely to provide a thorough clinical picture of pain experienced with chronic lateral epicondylalgia.

Cognitive style factors affecting database query performance

As end-user computing becomes more pervasive, an organization's success increasingly depends on the ability of end-users, usually in managerial positions, to extract appropriate data from both internal and external sources. Many of these data sources include or are derived from the organization's accounting information systems. Managerial end-users with different personal characteristics and approaches are likely to compose queries of differing levels of accuracy when searching the data contained within these accounting information systems. This research investigates how cognitive style elements of personality influence managerial end-user performance in database querying tasks. A laboratory experiment was conducted in which participants generated queries to retrieve information from an accounting information system to satisfy typical information requirements. The experiment investigated the influence of personality on the accuracy of queries of varying degrees of complexity. Relying on the Myers–Briggs personality instrument, results show that perceiving individuals (as opposed to judging individuals) who rely on intuition (as opposed to sensing) composed queries more accurately. As expected, query complexity and academic performance also explain the success of data extraction tasks.

Voice and speech characteristics and vocal hygiene in novice and professional voice broadcast journalists

Knowledge of differences in voice and speech characteristics between novice and professional broadcasters is essential for effective education of broadcast journalism students. Because newsreaders rely on optimal voice production, information pertaining to vocal hygiene is also important. The first aim of this study was to compare the voice and speech characteristics of professional newsreaders, student newsreaders and control participants. The second aim was to compare the awareness and use of vocal hygiene across these groups. Professional radio newsreaders, broadcast journalism students and two matched control groups were included in the study. Each participant recorded a news bulletin and completed a questionnaire on vocal hygiene. Data analysis of the recording included objective analysis and perceptual ratings by a panel of three judges. Significant student-professional differences were found. Compared to both the students and the control groups, the professional newsreaders had greater variation in speaking fundamental frequency, a faster rate of speech, fewer pronunciation errors and higher perceptual ratings on vocal quality, emphasis, continuity, phrasing and style of newsreading. Female professional newsreaders had a higher speaking fundamental frequency than both their control participants and the student newsreaders. Comparison of vocal hygiene awareness revealed few significant differences between any of the groups.