Proposal of a minimally invasive approach diagnosing desquamative gingivitis-associated diseases

Background

We aimed to present a minimally invasive clinical approach to collect a suitable sample for the laboratory diagnosis of desquamative gingivitis.

Materials and Methods

The proposed technique involves Nikolsky's test for the collection of tissue samples. It consists of the histopathological analysis of the bullous membrane formed in cases with positive Nikolsky's sign (NS). Three patients without a previous diagnosis of the disease agreed to undergo this protocol before a biopsy.

Results

The diagnoses of the three cases reported here were mucous pemphigoid (MP), pemphigus vulgaris (PV), and lichen planus (LP). The tissue samples collected using this technique were sufficient to microscopically observe partial-thickness epithelium (diagnosing PV) or full-thickness epithelium (diagnosing MP). The diagnosis of LP was only possible by conventional biopsy.

Conclusion

We observed, for different cases, some advantages of the proposed technique: minimally invasive, potentially superior to exfoliative cytology, easily performed, and with low costs.

Prompting Candidates in Oral Assessment Contexts: A Taxonomy and Guiding Principles

Prompting is an aspect of oral assessment that deserves more attention. There appears to be considerable variation in how practitioners conceptualise prompting and how it is deployed in practice. In order to unpack the term and promote the validity of its use in performance assessments, we present a taxonomy of prompting as a continuum of types, namely: presenting the task; repeating information; clarifying questions; probing questions; and finally, leading questions. We offer general principles for consideration when using prompting in oral assessment: neutrality; consistency; transparency; and reflexivity. Whenever oral assessment is planned, assessors should be appropriately trained in the type and degree of prompting required, and candidates suitably briefed to know what to expect. Overall, we aim to raise awareness that quite different behaviours tend to be subsumed under the general term 'prompting'. This paper provides concrete guidelines for implementing the defensible and effective use of prompting in oral examinations, applicable to a wide range of assessment contexts.

A Regional Experience With Vascular Surgery Mock Oral Examinations

INTRODUCTION

In 2006 the Southern Association for Vascular Surgery (SAVS) implemented a mock oral examination program to prepare trainees for the Vascular Surgery Certifying Examination (VCE).

METHODS

Participating examinees and examiners were identified from SAVS Recorder records and contacted via e-mail with a request to participate in an anonymous online survey. Examinees were asked about passage on American Board of Surgery examinations and perceptions of the mock oral program. Examiners were asked for their perceptions of the examination, applicant performance, and perceived areas for training improvement. Board passage rates for the group and national comparison data were provided in a de-identified fashion by American Board of Surgery.

RESULTS

From 2006 to 2014, 158 examinees and 86 examiners participated in the SAVS mock orals program. In all, 33% of examinees and 35% of examiners completed the anonymous survey. Of the examinees, 27 (60%) reported passage of the mock oral examination on their first attempt and 7 of 9 (78%) reported passage on the second attempt. Second year in training was significantly associated with passage of the mock oral (p = 0.002). Of the examinees questioned, 100% "would recommend" the SAVS mock oral examinations to future trainees. Of the responding examiners, 90% felt that the SAVS mock oral examinations were "comparable" to the VCE and 87% "strongly agreed" that the exercise was a valuable preparatory tool. Examiners identified "ability to describe technical aspects of open vascular techniques" and "management of complications associated with vascular disease processes and operations" as commonly displayed deficits among examinees (80% and 77%, respectively). In all, 115 examinee participants from the SAVS mock orals had taken the VCE between 2006 and 2014. Of them, 90 (78%) passed the VCE on their first attempt. During the same time interval, the national first-time pass rate for the VCE was 86%.

CONCLUSIONS

Although participation in the SAVS mock orals was overwhelmingly assessed as a positive preparatory experience by examinees and examiners, no incremental advantage in VCE passage was observed. Explanations for the worse-than-average performance on the VCE are not clear but likely involve numerous factors, including participation bias. Importantly, examiners in the SAVS mock oral process felt that the exercise closely simulated the VCE and uniformly reported pervasive deficits in the areas of demonstrated understanding of open surgical techniques and management of complications. This investigation guides further examination of VCE simulation exercises to assist in guiding the use of educational resources at both institutional and professional society levels.

ORGANIZATION OF A COMPREHENSIVE ANESTHESIOLOGY ORAL PRACTICE EXAMINATION PROGRAM: Planning, Structure, Startup, Administration, Growth and Evaluation

BACKGROUND

Oral practice examinations (OPEs) are used in many anesthesiology programs to familiarize residents with the format of the oral qualifying examination given by the American Board of Anesthesiology (ABA). The purpose of this communication is to describe the planning, structure, startup, administration, growth and evaluation of a comprehensive oral examination program at a sizeable residency program in the Midwest.

METHODS AND RESULTS

A committee of three experienced faculty was formed to plan the effort. Planning involved consideration of format and frequency of administration, timing for best resident and faculty availability, communication, forms design, clerical support, record keeping and quality monitoring. To accommodate resident rotation and faculty work schedules, a semiannual administration schedule on 3-4 consecutive Mondays was chosen. The mock oral format was deliberately constructed to resemble that used by the ABA so as to enhance resident familiarity and comfort with ABA style oral exams. Continued quality improvement tools put in place consisted of regular examiner and examinee inservice sessions, communication and feedback from ABA associate examiners to faculty examiners as well as review of examinee exit questionnaires. A set of OPE databases were constructed so as to facilitate quality monitoring and educational research efforts. Continued administration of the OPE program required ongoing construction of a pool of guided case-oriented questions, selection of appropriate questions based on examinee training exposure, advance publication of the exam calendar and scheduling of recurring examiner and examinee activities. Significant issues which required action by the governing committee were exam timing, avoidance of conflict with clinical demands, use of OPE results, and procurement of training resources. Despite initial skepticism, the OPE program was begun successfully and grew substantially from 56 exams in the first year to 120 exams by year three. The OPE was perceived positively by the majority of residents. 90.2% of exit questionnaires acknowledged specific learning about oral exam technique, while only 0.3% indicated lack of meaningful information exchange at OPE sessions. Fewer than 10% of responses indicated misleading questions or badgering by examiners. Although anxiety remained constant over time, resident preparedness increased with repeat OPE exposure.

SUMMARY

A comprehensive mock oral examination of substantial scope was successfully planned, initiated, and developed at our anesthesiology resident training program. It is well accepted by residents and faculty. Its inception was associated with an increase in resident preparedness. Now in its tenth year of existence it continues to be an asset and essential component of our training program.