Work - Volume 62, issue 4

Authors: Thurston, Rachel

Article Type: Research Article

DOI: 10.3233/WOR-192897

Citation: Work, vol. 62, no. 4, pp. 643-646, 2019

Authors: Veitch, Daisy | Goossens, Richard | Owen, Harry | Veitch, James | Molenbroek, Johan | Bochner, Melissa

Article Type: Research Article

Abstract: BACKGROUND: Clinical Breast Examination (CBE) is the examination of a women’s breasts by a healthcare professional, such as a breast surgeon, family physician or breast-care nurse who is trained to recognise many different types of abnormalities and warning signs in the breast [1 ]. CBE is particularly important in rural areas and developing countries who have limited access to technology such as mammography. CBE needs to be taught to health professionals like any other clinical skill used by medical professionals in the workplace. CBE in part involves palpation of the breast, that is, determining by touch which breast lumps are …normal and which are suspicious in feeling. The gold standard for assessing tactile skills in CBE is seeing whether students can accurately identify and discriminate between different breast lumps also known as masses (IDBM) on actual patients in a clinical setting. However, this is not practical in a medical education setting. Usually the testing methods ‘go through the motions’ of feeling the breast as part of CBE. So the students’ technique is examined either using unrealistic simulation models or using an intimate examination associate (IEA), an actor/volunteer who permits students to examine their intimate body parts such as breast or genitals for teaching purposes. These volunteers do not have any abnormalities so this teaching does not include the actual detection of suspicious lumps. We undertook a study of clinical skill with 10 medical students to examine different methods of assessing novice student clinical skills after a brief training in CBE. OBJECTIVES: This study aims to evaluate the effectiveness of current training and assessment of novice students in CBE and their capacity to identify and discriminate breast masses (IDBM) on actual patients. METHODS: We assessed each student’s IDBM ability in an actual clinical situation, a breast clinic with a mixture of eight IEAs and one real patient with a large, easily palpable, putative breast cancer. We recruited 10 clinically inexperienced medical students, who were trained for 30 minutes by two breast surgeons using an IEA. Students were tested in a simulated clinical setting, a breast clinic where each examined 4 IEAs and one patient. The students were blind to who was the real patient and who was an IEA. Patients were examined by a breast surgeon in private prior to the commencement in the study. The breast surgeon recorded any clinical finding on the patients during the initial examination. The surgeon coached each patient on how to mark the students and showed the patient their results so the patients had a benchmark. After each examination was finished the students had four different assessments: 1) patients marked each student, 2) students were independently proctored – that is, marked by an expert, 3) students recorded their clinical findings and 4) students recorded how confident they were that they had the correct findings. Results from different kinds of student assessments were compared. RESULTS A chi-square test for independence between true positive or negative masses versus student-assessed positive or negative masses was not significant at alpha = .05. This means that there was no statistical association in the indication of positive or negative presence of masses versus whether such masses were actually present or absent. By comparison, experts (breast surgeons) were able to detect normal and abnormal breast masses by palpation alone 100% of the time and rate their confidence level as ‘certain’. Unlike the experts, student self-reported confidence was unrelated to their competence score (CS). Proctoring was inversely related to the students’ CS. CONCLUSIONS The main conclusion is that novice students do not seem to be able to accurately detect breast masses in a clinical setting even after training. On the basis of these results, we believe that a comprehension component in the current CBE testing is needed in addition to the current methods of testing. Show more

Keywords: Medical training, medical education, simulation training, student testing, palpation, Medisign

DOI: 10.3233/WOR-192899

Citation: Work, vol. 62, no. 4, pp. 647-656, 2019

Authors: Mokdad, Mohamed | Bouhafs, Mebarki | Lahcene, Bouabdallah | Mokdad, Ibrahim

Article Type: Research Article

Abstract: BACKGROUND: Despite the call for the application of ergonomics in developing countries, the African share of ergonomic studies is modest. Date palm farming is considered one of the most important economic resources in hot and dry areas. In African countries, including Algeria, there exist millions of date palms. Date palm work can be precarious and associated with higher rates of work related musculoskeletal disorders. OBJECTIVE: This paper aims to:1. Reveal how the workers climb the trunk of the date palm to get to the crown. 2. Detect the amount of work related musculoskeletal disorders (WRMSDs) in date …palm trees work, and how to combat it. METHOD: The descriptive method was used. RESULTS: Objective 1, Majority of date palm workers are still using the traditional methods, i.e. free climbing, and belt aided climbing. However, a minority of workers have started using modern methods i.e. ladders, climbing devices, and modern technology (e.g. hydraulic lifts). Objective 2, the workers complained about WRMSDs presence in the shoulders, hands, wrists, lower back, hips knees, and feet. Efforts to combat these WRMSDs are personal, educational and scientific efforts. CONCLUSION: Regarding climbing, the traditional methods are still dominant, and the use of technology is very limited. As regards WRMSDs, date palm workers complain about their presence in many parts of the body. Show more

Keywords: Developing countries, free climbing, aided climbing, WRMSDs

DOI: 10.3233/WOR-192898

Citation: Work, vol. 62, no. 4, pp. 657-665, 2019