A method for measuring interrater agreement on checklists

A method for measuring interrater agreement on checklists is presented. This technique does not assign individual scores to raters, but computes a single agreement score from the concordance of their check mark configurations. An overall coefficient of agreement, called phi, is derived. The agreement coefficient that is expected by chance and the statistical significance of phi are determined by statistical simulation. Despite the dichotomous nature of the checklist agreement (raters either agree or disagree on items), we show that the binomial distribution does not provide a means for testing the statistical significance of phi. A medical education study is used to illustrate the phi methodology.

A survey of exercise beliefs and exercise habits among people with arthritis

OBJECTIVE

To explore a possible explanation for the problem of why few people exercise despite the positive health advantages, by examining the relationship between exercise beliefs and participation in exercise activities.

METHODS

Eighty-one respondents aged 27-80 were recruited from 3 Chicago-area health care facilities to complete the study survey; 68 (84%) did so. Participants were asked about their participation in 6 types of exercise activities; they also reported their beliefs concerning their ability to exercise (self-efficacy for exercise), barriers to exercise, benefits of exercise, and the impact of exercise on their arthritis.

RESULTS

Study results indicate that belief in the benefits of exercise and self-efficacy for exercise are associated with participation in exercise activities. Also, severity of disease differentiated exercisers from non-exercisers.

CONCLUSIONS

Results suggest the importance of finding ways to strengthen belief in the benefits of exercise and self-efficacy for exercise in people with arthritis, particularly people with moderate to severe disease-related limitations.

Assessment of clinical competence of medical students by using standardized patients with musculoskeletal problems

OBJECTIVE

To assess medical students' clinical competence in addressing musculoskeletal problems.

METHODS

Nineteen junior medical students completed 2 standardized patient-based tests structured to capture their clinical decisions from undiagnosed chief complaint to management.

RESULTS

No student approached the highest possible score on either test, and the students as a group received less than half the possible points on 5 important aspects of diagnostic reasoning.

CONCLUSION

Standardized patient-based tests can be structured to provide enlightening information about medical students' clinical competence with regard to musculoskeletal problems.

Dance-based aerobic exercise for rheumatoid arthritis

Reported here are the results of the first effort to examine the effects of a dance-based aerobic exercise program for people with rheumatoid arthritis (RA). Forty-three subjects with RA completed a 16-week program that met twice weekly for 2 hours. One hour was devoted to exercise consisting of 15 to 20 minutes of warm-ups, 20 to 30 minutes of dance-based aerobic exercise, and 15 to 20 minutes of mat work for muscle strengthening and flexibility. The second hour was devoted to discussion that emphasized participant problem solving. The combined exercise/problem-solving discussion program was called EDUCIZE. Analyses of pretest to posttest changes indicated no deleterious effects on disease activity. In fact, physician-assessed articular pain and swelling decreased significantly, as did 50-foot walk time, pain, and depression. Participants reported significant improvement in lower extremity function. Changes in vigor and fatigue approached significance. Perceptions of general health as well as four of five quality of life indices improved significantly. This study adds to the as yet limited literature that indicates that weight-bearing vigorous exercise is beneficial for people with arthritis. Controlled studies to validate the findings of this study appear warranted. Also important for future research is investigation of the influence of the problem-solving discussion component on program effects.

Using simulated case studies to evaluate a clinical ethics course for junior students

An experimental teaching program in clinical ethics was developed and evaluated. All junior medical students who rotated through a general internal medicine service (75 percent of the class) were required to attend 12 to 14 hours of a clinical ethics seminar which met on a general medicine unit. The teaching sessions were structured around actual cases presented by the junior medical students. One of the evaluation techniques developed is discussed here: the use of simulated clinical-ethical cases. The questions themselves, the method of scoring them, and the findings will be examined. On the basis of this evaluation procedure, some tentative conclusions can be drawn: (a) it is possible to develop evaluation techniques to assess objectively students' ethical reasoning after participating in such a course, and (b) junior medical students who participate in a clinical ethics course show increased reflectiveness regarding ethical decisions.