OBJECTIVES: Tools are needed for determining appropriate weights for complex performance assessment components in medical education. The feasibility of using judgmental policy capturing (JPC), a procedure to statistically describe the information processing strategies of experts, for this purpose was investigated. METHODS: Iterative JPC was used to determine appropriate weighting for the six core communication skill scores from a communications objective structured clinical examination (OSCE) for medical students using a panel of four communication skill experts. RESULTS: The mean regression weights from the panel indicated they placed less importance on information management (8.5%), moderate and nearly equal importance on rapport building (15.8%), agenda setting (15.4%), and addressing feelings (14.1%), and greater importance on active listening (20.1%) and reaching common ground with the patient (25.5%). DISCUSSION: JPC is an effective procedure for determining appropriate weights for complex clinical assessment components. The derived weights may be very different for those assessment components.

Syftet med studien var att undersöka självupplevd oral hälsa (SPOH) och faktorer som påverkar den, i en vuxen population i Kalmar län, Sverige. Studien är en del av en epidemiologisk studie som genomfördes under 2010-2012. Urvalet för denna studie bestod av 380 slumpvis utvalda personer som deltog i en omfattande klinisk undersökning och svarade på en enkät. Enkäten bestod av 56 frågor angående bl.a. patientens självupplevda orala hälsa och socioekonomiska situation. Den studerade populationen bestod av 189 kvinnor (49,9%) och 190 män (50,1%). Individerna var 20-90 år, med en genomsnittlig ålder av 52 år. Självupplevd oral hälsa definierades statistiskt utifrån en av frågorna i enkäten: självupplevd oral hälsa jämfört med jämnåriga, och benämndes SPOH. De kliniska variabler som analyserades var antal egna tänder, DMFT (Decayed, Missed, Filled Teeth), tandluckor och riskbedömning (summa av tandläkarens bedömning av kariesrisk, parodontal risk, teknisk risk och allmän risk). Bakgrundsvariablerna var ålder, kön, utbildning och etnicitet. Bivariata korrelationer och en regressionsanalys utfördes med SPOH som beroende variabel och med bakgrundsfaktorer och kliniska variabler som oberoende variabler. Signifikanta korrelationer påvisades mellan SPOH och ålder (p<0,01), DMFT (p<0,01), antal egna tänder (p<0,01) och tandläkarens riskbedömning (p<0,01). Högre SPOH korrelerade med ökande ålder, fler egna tänder och lägre DMFT. En överensstämmelse mellan tandläkarens bedömning av patientens orala status och SPOH påvisades i sambandet mellan dessa två variabler, vilket indikerar att högre bedömd risk är förknippat med en lägre SPOH. / The aim of this study was to investigate self-perceived oral health (SPOH) and factors affecting it, among adults in the Swedish county of Kalmar. The study is part of an epidemiologic study conducted in 2010-2012. The sample for this study was comprised of 380 individuals, randomly selected, who participated in a clinical examination with a concomitant questionnaire. The questionnaire consisted of 56 questions concerning e.g. patient perception of oral health and socio-economic situation. The final study population consisted of 189 women (49.9%) and 190 men (50.1%). The individuals were 20-90 years, with a mean age of 52 years. Self-perceived oral health was statistically defined by one question of the questionnaire: self-assessed oral health as compared to contemporaries of the same age, and termed SPOH. The clinical variables analysed were number of own teeth, DMFT (Decayed, Missed, Filled Teeth), gaps between teeth and risk assessment (sum of the dentists assessment of caries risk, periodontal risk, technical risk and general risk). The background variables were age, gender, education and ethnicity. Bivariate correlations and regression analyses were conducted with SPOH as dependent variable, and with background factors and clinical variables as independent variables. Significant correlations were found between SPOH and age (p<0.01), DMFT score (p<0.01), number of own teeth (p<0.01) and the dentists’ risk assessment (p<0.01). Higher SPOH was associated with increased age, increased number of own teeth and decreased DMFT. A consistency between the clinician’s assessment of the patient’s oral status and SPOH was shown in the correlation between these two variables, which implies that a higher risk assessment is associated with a lower SPOH.

No description available.

Submitted by Renata Morais (rmorais@unoeste.br) on 2018-09-25T18:27:46Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Rebeca Carvalho Bressa.pdf: 1225569 bytes, checksum: 7ca7dbf0fcc71d7519691f65e66dafb2 (MD5) / Made available in DSpace on 2018-09-25T18:27:46Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Rebeca Carvalho Bressa.pdf: 1225569 bytes, checksum: 7ca7dbf0fcc71d7519691f65e66dafb2 (MD5) Previous issue date: 2018-04-12 / The belief in teacher self-efficacy (AED) is defined as the teacher's judgment of his or her abilities to achieve student engagement and learning outcomes. The Objective Structured Clinical Examination (OSCE) is a standardized tool used in the evaluation of professional performance. Associating the concepts of AED and OSCE use in the practice of the medical professor is an innovative challenge. Thus, this dissertation was constructed with three studies: the first one reviewed the national publications on OSCE and their relationship with the current context of Brazilian medical education; the second presented the main Brazilian studies on EDA and the third analyzed the associations between EDA and the OSCE application. In the first study, 32 texts were selected, of which only 18.8% described theoretical concepts about the OSCE, which means little time for experimentation of the method in Brazil. In the second, 32 articles were found, and 37.5% were aimed at investigating AED in different educational contexts, which demonstrates the concern of disseminating the construct in the academic environment. In the third one, two scales (Teacher Self-efficacy Scale - EAEP and Self-efficacy Scale - EFAE) were applied and a characterization questionnaire that, besides the socio demographic characteristics of the examined ones, presented questions directed to teacher perception about their work process and the main properties of simulated activities such as the OSCE. A total of 47 medical professors from a private university in the interior of the state of São Paulo were 55.3% male and 44.7% female, ranging in age from 31 to 78, whose teaching experience was dispersed between 1 and 35 years, with a mean of 11.5 years. In the results of the EFAE, the factors Social Persuasion and Vicarious Learning were the most endorsed, indicating that these sources are those of greater interference in the formation of the teachers' beliefs. Most of the participants had low and average scores on self-efficacy beliefs. The highest averages found were in relation to the Effectiveness factor in the Intentionality of the Action. In relation to the statistically significant correlations, these were negative and with moderate magnitudes between the factors of self-efficacy and the sources of Physiological and Affective States, indicating that the greater the belief in the capacity to teach or control the academic environment, the smaller the influences of physiological and emotional tensions in the performance and formation of these beliefs. There was only a positive correlation with weak magnitude, established between Action Intentional Efficacy and Vicarious Learning, suggesting that teachers who believe in their ability to mobilize students for the teaching-learning process may have these beliefs formed from the experiences of its formative process as a whole. The association of teachers with high levels of AED and OSCE implementation needs to be further explored, including in studies with qualitative approaches, but a priori, this hypothetical association appears to be promising in strengthening the quality of teaching. / A crença de autoeficácia docente (AED) é definida como o julgamento que o professor faz de suas capacidades em alcançar os resultados de comprometimento e aprendizagem do aluno. O Objective Structured Clinical Examination (OSCE) é uma ferramenta padronizada utilizada na avaliação do desempenho profissional. Associar os conceitos de AED e uso do OSCE na prática do professor de Medicina é um desafio inovador. Assim, esta dissertação foi construída com três estudos: o primeiro revisou as publicações nacionais sobre OSCE e sua relação com o contexto atual da educação médica brasileira; o segundo apresentou os principais estudos brasileiros sobre AED e, o terceiro analisou as associações entre AED e a aplicação do OSCE. No primeiro estudo foram selecionados 32 textos, dos quais, apenas 18,8% descreveram conceitos teóricos sobre o OSCE, o que traduz pouco tempo de experimentação do método no Brasil. No segundo foram encontrados 32 artigos e 37,5% objetivaram Investigar a AED em diferentes contextos educacionais, o que demonstra preocupação em divulgar o constructo no meio acadêmico. No terceiro foram aplicadas duas escalas (Escala de Autoeficácia do Professor – EAEP e Escala sobre Fontes de Autoeficácia - EFAE) e um questionário de caracterização que, além das características sócio demográficas dos examinados, apresentava perguntas direcionadas a percepção docente sobre seu processo de trabalho e as principais propriedades de atividades simuladas como o OSCE. Participaram 47 docentes de Medicina de uma universidade privada do interior do estado de São Paulo, sendo 55,3% do sexo masculino e 44,7% do sexo feminino, com idade variando entre 31 e 78 anos, cuja experiência na docência era dispersa entre 1 e 35 anos, com média de 11,5 anos. Nos resultados da EFAE, os fatores Persuasão Social e Aprendizagem Vicária foram os mais endossados, indicando que estas fontes são as de maior interferência na formação das crenças dos professores. A maioria dos participantes tiveram pontuações de classificações baixa e média no que se refere às crenças de autoeficácia. As maiores médias encontradas foram em relação ao fator Eficácia na Intencionalidade da Ação. No que concerne às correlações estatisticamente significativas, estas foram em sentido negativo e com magnitudes moderadas entre os fatores de autoeficácia e as fontes de Estados Fisiológicos e Afetivos, indicando que quanto maior a crença na capacidade de ensinar ou controlar o ambiente acadêmico, menores são as influências de tensões fisiológicas e emocionais no desempenho e formação dessas crenças. Houve apenas uma correlação positiva com magnitude fraca, estabelecida entre Eficácia na Intencionalidade da Ação e Aprendizagem Vicária, sugerindo que os docentes que acreditam na sua capacidade de mobilizar os alunos para o processo de ensino-aprendizagem podem ter essas crenças formadas a partir das experiências de seu processo formativo como um todo. A associação de professores com elevados níveis de AED e aplicação do OSCE necessita ser mais explorada, inclusive em estudos com abordagens qualitativas, mas a priori, essa associação hipotética parece ser promissora no fortalecimento da qualidade do ensino

Syfte: Syftet med studien var att undersöka patienters kunskap om parodontala sjukdomarnas prevalens, etiologi och behandling samt om patienterna är medvetna om sina egna parodontala tillstånd, och hur väl deras uppfattning överensstämmer med professionens bedömning. Material och metod: Totalt inkluderades 72 patienter som kom för basundersökning på Tandvårdshögskolan. Patienterna fyllde i enkäter med frågor om parodontala sjukdomars prevalens, etiologi och behandling samt om deras egna uppfattning om sin munhälsa i relation till deras parodontal sjukdom. På motsvarade sätt fyllde de undersökande tandläkarna (professionen) i enkäter om patienternas munhälsa i relation till patienternas parodontal sjukdom. Enkätsvaren sammanställdes och analyserades i syfte att studera patienternas kunskap om parodontit samt deras överensstämmelse med professionen. Resultat: Uttalade kunskapsbrister fanns bland både sjuka och friska patienter gällande parodontala sjukdomars prevalens, etiologi och behandling. Det var enbart en tredjedel av de parodontalt sjuka patienterna som var medvetna om sin sjukdom. Patienter som var medvetna om sin parodontit verkade visa även bättre medvetenhet gällande sin munhygien, risk att förlora tänder samt behandlingskrav i jämförelse med de som inte var medvetna om sin parodontit. Slutsats: Det finns ingen större skillnad mellan friska och sjuka gällande kunskap om parodontala sjukdomar. De parodontalt sjuka patienternas medvetenhet om sin sjukdom var överlag bristfällig. Patienter som inte är medvetna om sin parodontit verkar ha sämre förståelse för sin munhygien, sin risk att förlora tänder samt sitt behandlingsbehov. Framtida forskning är nödvändig för att få ett mer tillförlitligt och representativt resultat. / Aim: The purpose of this study was to examine patients´ knowledge about prevalence, etiology and treatment of periodontal diseases. Another aim was to examine whether the patients were aware of their periodontitis, and how well the patients´ and dentists´ perception of the patients´ periodontitis occurred. Material and method: A total of 72 patients who came for a clinical examination at Tandvårdshögskolan were included. The patients answered questionnaires about prevalence, etiology and treatment of periodontal diseases as well as their own oral health in relation to periodontitis. Similarly, the examining dentists (the profession) answered questions about the patients´ oral health in relation to periodontitis. The data was compiled and analyzed. Results: Severe knowledge deficits among both healthy patients and patients with periodontitis were found regarding prevalence, etiology and treatment of periodontal diseases. Only one third of the patients with periodontitis were aware of their disease. Those patients also seem to show better awareness regarding their oral hygiene, risk for tooth loss and treatment need compared to patients not aware of their periodontitis. Conclusion: There is no major differences in knowledge regarding periodontal diseases between healthy patients and patients with periodontitis. Patients with periodontitis had a poor awareness of their own disease. Patients not aware of their periodontitis seem to have more severe knowledge deficits regarding their oral hygiene, risk of tooth loss and treatment need. However, future research is necessary to obtain more reliable and representative results.

The purpose of this research and its corresponding thesis is to give the reader a deeper understanding of what the ethical risks with using machine learning are for a decision-making purpose in clinical examination and diagnostics in the medical field. The motive to why identification of these said ethical risks are essential, is also for the purpose of giving the reader an understanding of how these risks can be reduced. The information is gathered through earlier work that shows relevance but also through qualitative interviews with people working in the fields of machine learning. Through comparison of the results from the interviews with earlier work and other valid and legitimate sources, the result has been derived. The results concluded of ethical risks as a result from insufficient data, workers putting all of their trust in the result from machine learning algorithms, bias caused by humans when constructing the algorithms. Although there are many risks, there are also possibilities which reduce ethical risks consisting of improvement of technology and better implementation of machine learning in a working environment.

Objective This study tested the effectiveness of a brief, learner-centered, breaking bad news (BBN) communication skills training module using objective evaluation measures. Methods This randomized control study (N = 66) compared intervention and control groups of students (n = 28) and residents’ (n = 38) objective structured clinical examination (OSCE) performance of communication skills using Common Ground Assessment and Breaking Bad News measures. Results Follow-up performance scores of intervention group students improved significantly regarding BBN (colon cancer (CC), p = 0.007, r = −0.47; breast cancer (BC), p = 0.003, r = −0.53), attention to patient responses after BBN (CC, p < 0.001, r = −0.74; BC, p = 0.001, r = −0.65), and addressing feelings (BC, p = 0.006, r = −0.48). At CC follow-up assessment, performance scores of intervention group residents improved significantly regarding BBN (p=0.004, r = −0.43), communication related to emotions (p = 0.034, r = −0.30), determining patient's readiness to proceed after BBN and communication preferences (p = 0.041, r = −0.28), active listening (p = 0.011, r = −0.37), addressing feelings (p < 0.001, r = −0.65), and global interview performance (p = 0.001, r = −0.51). Conclusion This brief BBN training module is an effective method of improving BBN communication skills among medical students and residents. Practice implications Implementation of this brief individualized training module within health education programs could lead to improved communication skills and patient care.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-07-26T12:41:50Z No. of bitstreams: 1 melissadefatimafranca.pdf: 3155000 bytes, checksum: 747df8478e7d858eeb23d7713906b20c (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-07-27T11:28:26Z (GMT) No. of bitstreams: 1 melissadefatimafranca.pdf: 3155000 bytes, checksum: 747df8478e7d858eeb23d7713906b20c (MD5) / Made available in DSpace on 2016-07-27T11:28:26Z (GMT). No. of bitstreams: 1 melissadefatimafranca.pdf: 3155000 bytes, checksum: 747df8478e7d858eeb23d7713906b20c (MD5) Previous issue date: 2015-02-27 / O câncer constitui uma preocupação crescente da população, já que vem ganhando uma dimensão maior e convertendo-se em um evidente problema de saúde pública mundial. A Política Nacional de Controle do Câncer tem o intuito de reduzir a incidência e a mortalidade do câncer através da conscientização dos fatores de risco e medidas para a detecção precoce dos cânceres passíveis de rastreamento, com acesso a um tratamento equitativo e de qualidade. Diante da importância da realização de pesquisas nessa área o presente estudo teve como objetivos analisar a realização de exames preventivos das neoplasias do colo do útero e de mama nas funcionárias Técnico-Administrativas em Educação (TAE) de uma Universidade Pública e seus fatores associados. Para isso foi realizado um estudo epidemiológico de delineamento transversal com 399 TAEs. Como instrumento de coleta de dados utilizou-se um questionário autopreenchível com questões relacionadas à realização de exames preventivos do câncer de colo de útero e de mama e aos fatores sócio demográficos, condições de saúde e hábitos de vida. Os dados foram processados através dos programas estatísticos Statistical Package for the Social Sciences (SPSS) e Stata. Para o desfecho “não realização de Papanicolaou” as variáveis faixa etária 60-69 anos (RP 4,17 IC 95% 2,47-7,04), não ter ficado impedida de realizar atividades habituais por problemas de saúde nas duas últimas semanas (RP 2,22 IC 95% 1,04-4,75) e não estar em dia com a realização da mamografia (RP 5,00 IC 95% 2,65-9,41) aumentaram a probabilidade de não estar em dia ou não realizar o exame preventivo. Com relação à “não realização do exame clínico das mamas” as variáveis consumo adequado de verduras (RP 0,92 IC 95% 0,86-0,99), possuir um ou mais parentes com quem possa se falar sobre quase tudo (rede social) (RP 0,85 IC 95% 0,76-0,95) e possuir horário de trabalho irregular (RP 0,83 IC 95% 0,75-0,91) diminuíram a probabilidade de não realizar tal exame. O fato de não realizar ou não estar em dia com a mamografia aumentou a probabilidade de não fazer o exame clínico das mamas (RP 1,22 IC 95% 1,14-1,30). Já quanto à “não realização de mamografia” o fato de não realizar ou não estar em dia com os exames Papanicolaou (RP 3,07 IC 95% 1,86- 5,08) e exame clínico das mamas (RP 4,99 IC 95% 2,61-9,53) aumentaram a probabilidade de também não realizar o exame de mamografia. Destaca-se assim a importância da prática e incentivo de ações de prevenção do câncer na população de mulheres trabalhadoras, visando a uma melhor condição de saúde e qualidade de vida das mesmas. / Cancer is a growing concern of the population, as has been gaining increasing in size and becoming an obvious problem of global public health. The National Cancer Control Policy aims to reduce the incidence and mortality of cancer by raising awareness of risk factors and measures for the early detection of cancers amenable to screening with access to fair treatment and quality. Given the importance of conducting research in this area this study aimed to analyze the preventive examinations of cancer of the cervix and breast cancer in employees Technical and Administrative Education (TAE) of a public university and its associated factors. To this was accomplished an epidemiological cross-sectional study with 399 TAE’s. As data collection instrument used a self-administered questionnaire with questions related to preventive examinations of cervical and breast cancer and sociodemographic factors, health and lifestyle habits. Data were analyzed using the statistical software Statistical Package for Social Sciences (SPSS) and Stata. For the outcome not for Papanicolaou the variables age group 60-69 years (PR 4.17 95% CI 2.47 to 7.04), have not been prevented from performing daily activities due to health problems in the last two weeks (PR 2.22 95% CI 1.04 to 4.75) and not be up to date with mammography (PR 5.00 95% CI 2.65 to 9.41) increased the likelihood of not being up to date or not perform the screening. Regarding the non-completion of the clinical examination of the variables adequate intake of vegetables breasts (PR 0.92 95% CI from 0.86 to 0.99), have one or more relatives with whom you can talk about almost anything (social network) (PR 0.85 95% CI 0.76 to 0.95) and have irregular working hours (PR 0.83 95% CI 0.75 to 0.91) decreased the probability of not conduct such an examination. Failure to perform or not keep up with mammography increased the probability of not doing clinical breast exam (PR 1.22 95% CI 1.14 to 1.30). As for the non-completion of mammography the failure to perform or not keep up with the Papanicolaou (PR 3.07 95% CI 5.08 1, 86) and clinical breast exam (PR 4.99 95% CI 2.61 to 9.53) increased the likelihood of also not perform the examination mammography. Stands out as well the importance of practice and encouragement cancer prevention actions in the population of working women in order to better health condition and quality of life for them.

Abstract Isolated lateral malleolar supination-external rotation (SER) -type ankle fractures without incongruity on the standard radiographs can be either stable or unstable depending on the status of the deep deltoid ligament. Neither clinical signs of injury on the medial aspect of the ankle nor the displacement of fibular fracture on mortise radiographs seem to predict stability. Therefore, stress testing has been adopted in clinical use. No “gold standard” method exists but the manual external rotation (ER) stress test is the most extensively studied. The ER stress test has some disadvantages, and other methods—such as gravity stress radiography and magnetic resonance imaging—have been suggested instead. However, the evidence to support the use of these methods is still insufficient. The aims of this dissertation were to assess the roles of (1) morphological factors from standard radiographs of 286 patients, (2) clinical findings on the medial side of the ankle and gravity stress radiography of 79 patients, and (3) MRI of 61 patients in evaluating the stability of the ankle mortise in patients with unimalleolar SER-type fractures with no talar shift on standard radiographs. The ER stress test result was considered to be the reference for stability throughout these studies. We found that a fracture line width &lt; 2 mm in lateral radiographs, only two fracture fragments, and female sex are independent factors predicting a stable ankle mortise. Neither clinical signs on the medial side of the ankle nor gravity stress radiography alone predict the stability of the ankle mortise accurately. According to our MRI findings, total tears of the deep deltoid ligaments are rare, and partial tears are common in this this patient group. The reliability of the MRI assessment is only moderate. In conclusion, patients with non-comminuted fractures and &lt; 2 mm displacement on lateral radiographs have stable ankle mortises and need no further stress testing. The gravity stress radiography is an accurate test for the evaluation of the ankle mortise stability only if the clinical signs indicate a similar result with the gravity stress radiographs. The use of MRI provides no additional benefit compared to ER stress testing for stability evaluation of an SER-type ankle fracture. / Tiivistelmä Supinaatio-ulkokiertomekanismilla syntyneet isoloidut ulkokehräsluun murtumat ilman röntgenkuvassa näkyvää telaluun siirtymää voivat olla joko vakaita tai epävakaita nilkan sisemmän nivelsiteen syvän lehden tilasta riippuen. Kliinisessä tutkimuksessa todettujen nilkan sisäreunan vamman merkkien tai röntgenkuvauksella todettavan ulkokehräsluun murtuman virheasennon ei ole osoitettu ennustavan nivelhaarukan mahdollista epävakautta, joten nilkkaa kuormittaen tehtäviä röntgenkuvauksia on otettu kliiniseen käyttöön. Mikään näistä kuvausmenetelmistä ei ole niin sanottu kultainen standardi, mutta ulkokiertovääntötestiä (ER-testi) on tutkittu laajimmin. ER-testin käyttöön liittyy kuitenkin ongelmia, joiden vuoksi niin sanottua painovoimakuvausta tai muun muassa magneettikuvausta (MRI) on ehdotettu käytettäväksi sen sijaan. Näiden menetelmien käyttöä tukeva tieteellinen näyttö on kuitenkin vielä riittämätöntä. Tämän väitöskirjatyön tarkoituksena oli tutkia (1) 286 potilaan tavallisista kuormittamattomista röntgenkuvista morfologisten tekijöiden, (2) 79 potilaan nilkan sisäreunan kliinisen tutkimuksen ja painovoimakuvauksen sekä (3) 61 potilaalla MRI:n merkitystä ja tarkkuutta arvioitaessa supinaatio-ulkokiertomekanismilla syntyneiden ulkokehräsluun murtumien vakautta. ER-testin tulosta käytettiin referenssinä nivelhaarukan vakaudelle kaikissa osatöissä. Sivukuvasta mitattuna ulkokehräsluun murtuman leveys &lt; 2 mm, vain kahden kappaleen murtuma ja naissukupuoli ovat itsenäisiä vakaata nivelhaarukkaa ennustavia tekijöitä. Kliininen tutkimus tai painovoimakuvaus eivät yksinään pysty ennustamaan nivelhaarukan vakautta riittävän tarkasti. MRI:n perusteella sisemmän nivelsiteen syvän lehden täydelliset repeämät ovat tässä vammatyypissä harvinaisia mutta osittaiset repeämät ovat hyvin tavallisia huolimatta ER-testin tuloksesta. MRI:n tulkinnan luotettavuus on ainoastaan kohtalainen. Yhteenvetona voidaan todeta, että ilman ilmeistä telaluun siirtymää röntgenkuvassa yksinkertaiset supinaatio-ulkokiertomekanismilla syntyneet ulkokehräsluun murtumat ovat vakaita eikä nivelhaarukan vakauden testaaminen ole tarpeen, jos murtumaraon leveys sivukuvassa on &lt; 2 mm. Painovoimakuvaus on luotettava, mikäli sen tulos on sama ulkoisten vamman merkkien kanssa. Magneettikuvauksesta ei ole hyötyä arvioitaessa tämän nilkkamurtumatyypin vakautta.

Introdução: Feedback é uma ferramenta de ensino poderosa. Para otimizar o feedback em avaliações tipo OSCE (Objective Structured Clinical Examination), uma modificação no papel do avaliador, apelidada de \"avaliador sombra\", foi testada. Os \"avaliadores sombras\" acompanham os estudantes por todas as estações realizando todas as avaliações. Ao término da atividade, realizam feedback do desempenho clínico aos estudantes. Objetivos: Descrever e discutir a experiência na aplicação deste modelo OSCE modificado, avaliar as opiniões dos alunos em relação a este novo método, e apresentar um estudo onde foram realizadas comparações entre o \"avaliador sombra\" e o formato original do examinador OSCE, nomeado de \"avaliador fixo\", com o objetivo de responder se este novo formato de avaliação apresenta vieses em relação ao formato original. Metodologia: Em 2011 foram realizados experimentos com as modificações no papel do avaliador para definir o formato final do \"avaliador sombra\". No período compreendido de fevereiro de 2012 a maio de 2014 foi realizado um protocolo de pesquisa com 415 estudantes do 6º ano de medicina. Destes, 316 estudantes foram randomizados para serem avaliados por avaliadores \"sombras\" e \"fixos\". Para analisar as comparações entre os avaliadores \"sombras\" e \"fixos\", foram utilizados o coeficiente de correlação de Pearson com regressão linear, teste t de Student e gráficos de Bland-Altman. Para aprofundar estas análises, os itens dos checklists foram classificados por domínios para realização de comparações mais específicas. Considerando que esta foi a primeira vez em que esta nova estratégia de avaliador (\"sombra\") foi aplicada, foram realizados questionários de opinião aos 415 estudantes que participaram do OSCE com o \"avaliador sombra\". Resultados: Foram encontradas altas e significativas correlações entre as notas globais por estação dadas aos estudantes pelos avaliadores \"sombras\" e \"fixos\",r = 0,87 (0,85 - 0,89; p < 0,05). Nas análises por domínios (afetivo, psicomotor e cognitivo), os resultados demonstraram maiores correlações entre as notas no domínio cognitivo e menores no afetivo. Não houve diferenças significativas comparando as médias das notas dadas pelos examinadores em relação às notas globais e nos domínios psicomotor e cognitivo. Análises de Teste t e de Bland-Altman demonstraram que as notas dadas aos estudantes no domínio afetivo foram maiores pelos \"avaliadores sombras\", mas a magnitude desta diferença foi muito pequena. De acordo com os questionários aplicados aos 415 estudantes, o feedback realizado pelos \"avaliadores sombras\" contribui para o aprimoramento de habilidades. Mais do que 90% dos estudantes concordaram que o feedback realizado pelo \"avaliador sombra\" é mais efetivo do que outras estratégias de feedback realizadas em outras aplicações de OSCE durante o curso de graduação de medicina até aquele momento. Conclusão: As modificações no papel do avaliador, \"avaliador sombra\", não levaram a vieses significativos nas notas dos estudantes quando comparado ao modelo de avaliador original do OSCE. Esta nova estratégia pode fornecer importantes melhorias na avaliação formativa de competências clínicas / Background: Feedback is a powerful learning tool. To improve the opportunity for feedback provided during an Objective Structured Clinical Examination (OSCE), a modification of the examiner\'s role nicknamed the \"shadow examiner\" was tested. In this new strategy, examiners follow the students across all OSCE stations, and may provide important insights for formative assessments of clinical performance Objective: Describe and discuss the experience in applying this modified OSCE, evaluate students\' opinions regarding this new method, and present an experience to analyze comparisons between the \"shadow examiner\" and original examiner OSCE format, nicknamed \"fixed examiner\". The objective of this study was to answer if this new assessment format presents biases in relation to the original format. Methods: In 2011, some experiments were carried out with modifications in the examiner\'s role to define the format of \"shadow examiner\". From February 2012 to May 2014, the research protocol was performed with 415 6th year medical students. Of these, 316 were randomly assigned to assessments made up of \"shadow\" and \"fixed\" examiners. Pearson correlation coefficients with linear regression, Student\'s t-test analysis, Bland-Altman plots were the statistical methods used to compare the assessment modes. To strengthen the analysis, checklist items were classified by domains in order to make specific comparisons. Considering that this was the first application of this new examiner (\"shadow\") strategy was applied, were conducted opinion surveys of the 415 students who participated in the OSCE with the \"shadow examiner\". Results: High correlations for global scores between \"shadow\" and \"fixed\" examiners were observed, r = 0,87 (0,85 - 0,89; p < 0,05). Analysing specific domains (affective, psychomotor and cognitive), the results demonstrated higher correlations for cognitive scores and lower correlations for affective scores. No statistically significant differences between mean examiners\' global scores, psychomotor and cognitive domains were found. T-test and Bland-Altman reviews showed that affective scores from \"shadow examiners\" were significantly higher than those from \"fixed examiners\", but the magnitude of this difference was small. According to the questionnaires applied to the 415 students, feedback from \"shadow examiners\" contributes to skills training, and more than 90% of these students agree that feedback from \"shadow examiners\" is more effective than other feedback formats achieved in other OSCE applications during the medical graduation course up to that time. Conclusion: The modifications in the role of examiner, \"shadow examiner\", did not lead to any important bias in the students\' scores comparing with the original examiner strategy of OSCE. This new strategy may provide important insights for formative assessments of clinical performance