The American Board of Pathology is exploring alternate forms of assessment, and herein has undertaken a comparison between free-response, short-answer questions with paired, construct-equivalent standard multiple-choice, closed-response questions. Four short-answer, free-response questions were compared with four paired multiple-choice, closed-response questions that had equivalent stems and measured the same constructs. The percentage correct responses of the paired question types were compared using chi square analysis, with a level of significance set at P < 0.05. Candidates were surveyed regarding the perceived difficulty of the short-answer question type, the question type that they preferred, and why the preferred question type was favored. All four short-answer items had fewer correct responses compared with their paired multiple-choice questions. The percent-correct responses for the short-answer items compared with the paired multiple-choice items, respectively, were: item 1: 73.5% vs 91.6%, item 2: 79.0% vs 90.8%, item 3: 3.3% vs 28.6%, and item 4: 64.7% vs 90.0%. All differences were statistically significant at P < 0.01. The short-answer questions, even when liberally graded, were much more difficult compared with the corresponding multiple-choice questions, even though the questions targeted for this evaluation were simple recall type items. The short-answer item responses raised questions about the clarity of the stem for one item, whereas the response to another item clearly disclosed a lack of understanding concerning the construct tested. The candidate survey regarding these question types disclosed an overwhelming candidate preference for multiple-choice questions.
BACKGROUND:The OPTION trial demonstrated that, after atrial fibrillation ablation, left atrial appendage closure (LAAC) reduced nonprocedural bleeding and was noninferior to oral anticoagulation (OAC) with respect to death, stroke, or systemic embolism. OBJECTIVE:This study aimed to evaluate event rates in relation to patients' baseline stroke risk. METHODS:The primary safety endpoint was nonprocedural major or clinically relevant nonmajor bleeding, and the primary efficacy endpoint was a composite of death, stroke, or systemic embolism, measured at 3 years. Patients were stratified based on a CHA2DS2-VASc score of ≥4 vs ≤3. RESULTS:The trial enrolled 1600 patients aged 70 ± 8 years, with 738 and 862 patients having CHA2DS2-VASc scores of ≥4 and ≤3, respectively. The primary efficacy outcome was similar for the OAC and LAAC arms both among patients with a CHA2DS2-VASc score of ≥4 (9.4% vs 7.8%; P = .37) and those with a CHA2DS2-VASc score of ≤3 (2.7% vs 3.3%; P = .59). Patients with a CHA2DS2-VASc score of ≤3 had an annual risk of ischemic stroke of 0.3% with LAAC and 0.1% with OAC (P = .19). Bleeding was more frequent with OAC for CHA2DS2-VASc scores of ≥4 (18.4% vs 11.5%; P < .01) and ≤3 (17.9% vs 6.0%; P < .01). CONCLUSION:After ablation of atrial fibrillation, the rates of cardiovascular events are low among individuals with a CHA2DS2-VASc score of ≤3 who were treated with either LAAC or OAC, and their annual risk of ischemic stroke is ≤0.3% with either treatment. Bleeding risk with OAC is similar for patients with high and low CHA2DS2-VASc and significantly lower with LAAC for both groups.
Purpose: Colonoscopy competency is a critical milestone in progression through gastroenterology fellowship. Overcoming looping is essential for achieving proficiency – often overcome with abdominal pressure and patient position changes. Literature is limited on the systematic evaluation of these maneuvers in training centers. We aim to evaluate the frequency of abdominal pressure and/or patient position adjustments throughout fellowship. Methods: This was a cross-sectional study of 1029 individuals undergoing colonoscopy at the Oklahoma City VA Medical Center. Maneuvers used were assessed using a questionnaire completed by the endoscopist. Patient demographics were extracted retrospectively. Factors associated with need for abdominal pressure or position changes were determined through univariate and multivariate regression analyses. Adjusted odds ratios (aOR) were calculated using attending physicians as the reference and comparing them to junior (first year) and senior fellows (second/third year). Results: 999/1029 (97%) of colonoscopies had post-procedure questionnaires completed. Female sex (OR=1.6, 95% CI: 1.1, 2.4), moderate sedation (OR=1.5, 95% CI: 1.1, 2.1), and fellow involvement (OR=2.3, 95% CI: 1.7, 3.1) were significantly associated with abdominal pressure or patient position changes. Either or both maneuvers were required in 193 (51%) junior fellow cases (aOR=1.6, 95% CI: 1.3, 1.9); 128 (42%) senior fellow cases (aOR=2.0, 95% CI: 1.4, 2.9); and 82 (26%) attending-only cases (aOR=1.00). Conclusions: Abdominal pressure and patient repositioning were more common in fellow-led colonoscopies but decreased with training progression. This study emphasizes the potential utility of incorporating these maneuvers into colonoscopy competency assessment tools to help provide standardization of loop management across fellowship programs.
