Gou in the operating room to add some upgrades

Chapter 181 Skill Assessment
"Xiao Fang! You're here." After Fang Xian arrived, Professor Zhou called out to Xiao Fang.At the same time, he stood up and looked sideways at Yang Yifeng.

"Let's start now. The skill level certification is not short. Try to determine the basic skill levels one by one during this National Day holiday. Don't make any more jokes." Yang Yifeng looked at it. After Fang Xian arrived, he also started to do things.

Zhou Cheng looked at Fang Xian and said: "Xiao Fang, skill level certification is not a child's play. It is not only the medical association's recognition of your ability, but also the responsibility given to you. Therefore, you must not use tricks or cleverness to rush. Handle."

"This will lead to irreversible damage in future clinical work!"

Fang Xian nodded naturally: "Professor Zhou, I know the seriousness of the matter, but I can't fully judge it myself. That's why I sent you a message. I hope Professor Zhou can help me rehearse it in advance..."

In the skill assessment of the medical association, you can show off for the occasion, but in real clinical work, it is impossible to show off.

Medicine does not allow for showing off skills, only competition.

Fang Xian knew the seriousness of the matter, especially after understanding the cruel consequences of the disease. Now, Fang Xian felt even more cautious.

"Then let's start with MRI reading. Let's do it step by step..."

After Zhou Cheng finished speaking, he pointed in front of the MRI training device.

Fang Xian had known about it before, so he naturally came to the skill training device.

The skill training room on the 33rd floor covers a large area, and the types of skill training devices in it are also very rich, and the number is naturally quite large. Therefore, Professor Yang and Professor Zhou have preset 5 skill training devices in advance, corresponding to With different levels of skills, you can avoid the time of resetting in transit.

Fang Xian carefully recalled the assessment content related to Level 5 MRI reading.

MRI reading is not a therapeutic skill, but a diagnostic auxiliary skill, but its role is quite significant.

From level 1 to level 5, each has different definitions——

The first stage is just an ordinary picture reading, and you only need to fill in the key diagnoses correctly.

This is not difficult, even a little easy.Anyone who has some in-depth study of MRI reading techniques can do it.For doctors whose MRI reading skills have reached a satisfactory level, this is as simple as eating and drinking.

Level 1 of MRI reading is actually about reading the location of the lesion and roughly characterizing it.

For example, what location is the damage...

Fang Xian walked back and forth on the panel twice, filling in the diagnoses of all twenty MRI plain films, and finally clicked submit!
The skill training device is in the background and automatically gives points for the review of answers.

[Comprehensive score: 97 points. 】

It’s not a hundred, there may still be some particularly subtle details that haven’t been written particularly comprehensively!

But that's not a problem, it's an innocuous diagnosis that cannot escape the machine's settings.But in clinical practice, it is of little use.

For example, there are some synovial folds around the tendon injury, and there is a little bit of undetectable fat thickening next to the bone cyst...

The level assessment of medical skills is to be a good doctor, not an absolute candidate, but the focus cannot be shifted.

The Level 1 assessment of MRI reading skills ended without any disturbance.

The second stage of the assessment is Level 2 of MRI reading, and the difficulty soars instantly.

Because of the form of assessment, there have been changes.

Level 2 of MRI reading is about more precise positioning and characterization of lesions!
Read fifty NMR films and find out the deficiencies and display errors in the NMR according to the text prompts given.

In other words, at this stage, the text prompts given are absolutely correct, but there may be errors in the correspondence between the page displayed by the MRI and the text, and you must find out. Such an assessment system is very conducive to the work process of clinicians. More precise positioning.

Also, do not be misled by reports or other people’s diagnoses, and fully maintain your own sanity.

As for the first movie, Fang Xian felt that it was difficult. It was not the kind of level 1 assessment where one could directly give the answer after watching the movie...

The text prompt reads "Anterior cruciate ligament rupture and lateral collateral ligament rupture of the left knee joint."

Then I looked at the display in the NMR——

Left and right knees, this is indeed the left knee joint!The positioning of the general direction must not be wrong. This is all wrong. This is a problem of attitude and character.

Then looking at the anterior cruciate ligament, it was indeed ruptured, and the lateral collateral ligament was also ruptured.

At first glance!
Is this all correct?

Could it be that the exam process was tricking me?In the level 2 MRI reading test that I encountered, I made a deliberate mistake by taking the correct MRI for the first plain film?

Yes, in the Level 2 MRI reading assessment, in addition to some incorrect responses, there are also completely correct responses. If you make any corrections, you will be making something out of nothing!
Logically speaking, there are only one or two such correct correspondences in fifty pictures at most.

One or two is good.

The chance of being hit by him is less than [-]%, and it is impossible to be hit by him so directly.

Fang Xian narrowed his eyes and recalled the standards for the level 2 skill assessment again——

"Oh!" Fang Xian suddenly realized.

At this stage, the text is absolutely correct, so there are some places where the display is different from the text.

Either the MRI shows more diagnostics than words, or the MRI shows pathological changes and makes fewer diagnoses than words.

You need to use text to correct the contents of the MRI display. The excess should be cut off, and the deficiencies should be supplemented with text explanations.Not only are we looking for diagnoses, but we are also looking for redundant or missing diagnoses that correspond to the text.

Fang Xian's ability in MRI reading cannot be faked, but it still takes time to slowly refine this film——

He looked at the posterior cruciate ligament, meniscus, medial collateral ligament, and synovial folds inside the knee joint, and they were all absent.

Then look at the muscles. The muscles around the knee joint are in perfect shape, with no signs of breakage or tearing.

Because he might be inexperienced, Fang Xian also looked at the shape of blood vessels and nerves. They were all complete and had no defects.

Ah this?

Could it be that we really encountered the NMR that corresponds correctly to the text?

Oh, right.

Damn it, this is a low patella!
Yes, this patient's lengthy lesions showed, not traumatic, but natural structural.

What is natural structure? To put it simply, it is innate and has nothing to do with trauma.

As we all know, anterior cruciate ligament injury is definitely a violent injury. Injury to the anterior cruciate ligament, medial collateral ligament, and medial meniscus are common injuries and are called the medial triad.

This patient had abnormal signs such as anterior cruciate ligament rupture and lateral collateral ligament rupture, and the redundant diagnosis had nothing to do with violence...

This is indeed hard to imagine. If you are not careful, you may step into a trap.

After checking it carefully again, Fang Xian typed out the error shown by the MRI: "Low patella. It does not match the written diagnosis, please delete it!"

After finishing writing, Fang Xian also checked to see if the patient had congenital diseases such as patella varus and varus to be more cautious.

After a final look, this point cannot be judged on MRI at present and needs to be determined through physical examination.

Then ignore it!

The assessment of MRI reading is to prepare for becoming a doctor and is a key element in the diagnosis of some diseases. Therefore, there is absolutely no chance that you will miss something. You must be able to read films in a down-to-earth manner, be able to read plain films, and contact clinical.

Fang Xian came to the second MRI again.

The written diagnosis is: "No obvious abnormalities were found in the right shoulder joint."

However, when reading the film, it was indeed shown in front of Fang Xian: there were patchy abnormal signal shadows under the articular surface of the left humerus, and the T2W signal was slightly high.There is a fracture line within the humerus.

The long head tendon of the biceps brachii was ruptured and the fluid was measured.There is effusion in the joint capsule of the left shoulder. T1W1 is slightly high signal and T2W1 is high signal.No abnormal signals were found in the supraspinatus tendon sheath and subscapularis tendon.Slightly increased signal in the brachialis brachialis and short head of biceps tendons…

Supraspinatus rupture, subscapularis partial tear, rotator cuff injury, acromioclavicular joint dislocation...

Even the hand showing the MRI showed errors.

Therefore, these must be eliminated.

Although you only need to match the content in the MRI with the written content, you must first be able to read the plain film before you can know what is right, what is wrong, what needs to be repaired, and what is the correct correspondence.

You can't fake it!
If the text display is normal, then you need to find all the abnormalities and write a similar meaning to correct them.

Fang Xian sniffed and felt that the setting of these test questions was simply digging holes for candidates. Sometimes digging one hole was not enough, and more holes had to be dug.

It's just that such strict standards are to make doctors make fewer mistakes when working in clinical practice.Diagnosis error, what are the consequences?

Fang Xian has also encountered this. When he and Professor Xu Fengnian were operating before, there was a patient whose arterial injury could not be diagnosed and prevented in time. Fortunately, Fang Xian's hemostasis technique could be directly upgraded to level 5 at that time. Otherwise, the patient is probably in serious danger.

"The direction of the affected limb is incorrect. There are injuries such as the biceps brachii longus tendon. We do not rule out the possibility of incorrect patient and life matching, incorrect MRI display, etc. The relevant diagnosis should be corrected or eliminated."

After filling out the form, Fang Xian went back to check it again. He suddenly realized it and added: "The MRI showed the presence of acromion impingement syndrome and type III acromion, which should be corrected together."

This is also a structural diagnosis of nature!

However, it was hidden in so many injuries that Fang Xian's current strength was almost ignored.

Ordinary doctors take the exam with such difficult questions?

Xiang Xiang silently observed a few minutes of silence for the radiologists.

If suturing is the foundation of hand surgery, then MRI reading is the absolute highlight and highlight of imaging doctors. Others rely on this skill to make a living...

……

As Fang Xian slowly pushed forward, although he felt it was difficult, he was still able to deduce the relatively correct answer after trying various methods.

Level 2 of MRI reading is to look at the lesions and accurately locate them.

Basically, the routine is the same, either the diagnosis is lengthy or the diagnosis is short.

But as the assessment progressed to the 22nd MRI scan, Fang Xian encountered a very tangled case——

Report with text: "Injury to the posterior horn of the medial meniscus of the left knee joint."

When Fang Xian was reading the film, his symptoms showed exactly the same: "T-shaped tear of the posterior corner of the medial meniscus of the left knee joint."

The reason why Fang Xian is troubled by such differences is that in the professional field of orthopedics, there are various different diagnostic methods.

For example, speaking broadly, T-shaped, transverse, and longitudinal tears of the posterior corner are all included in the scope of posterior corner injuries.

In this way, it was difficult for Fang Xian to specifically determine whether the tear and injury needed to be specifically clarified.

However, for the sake of caution, or to believe more in his professionalism, Fang Xian still wrote a non-corrective suggestion: "T-shaped injuries belong to the category of injuries, but they cannot replace all injuries."

"The text description is too broad and not rigorous enough. Injuries include but are not limited to ruptures, tears, edema, etc. Please correct it."

The definition of injury is too big. If it is a tear, it cannot completely replace the injury. Instead, a non-tear manifestation can represent the definition of injury.

The text describes a creature, and the answer is an image of a person.

Humans are definitely living things, but if we use the word "biological" as the standard, then they cannot tolerate each other and cannot be corrected.

In a plain film, there is generally only one category of damage, but not all.

This question requires specialist theoretical knowledge in orthopedics to answer...

After finishing writing like this, Fang Xian moved to the next picture.

Only Fang Xian flipped it, and the assessment instrument in front of him seemed to vibrate, as if to remind Fang Xian that there was an error in his answer.

But Fang Xian ignored it.

Wrong is wrong!

The assessment of level 2 skills does not require 5.00% accuracy, and allows an error of about 100%. After all, this is an exam-oriented assessment. If it is too strict and requires [-]% accuracy, it will violate the original intention.

Seeing Fang Xian calmly facing the vibration of the instrument, not affected at all, Zhou Cheng and Professor Yang Yifeng glanced at each other, and they both read the shock in each other's eyes...

Why hasn't Fang Xian been affected?
But Fang Xian was not affected.

It's just that Fang Xian's reading speed has slowed down a lot.

Another half hour passed before Fang Xian arrived in front of the six MRI plain films No. 30.

He rubbed his eyes a little harder.

My eyes are indeed a little tired, not just from visual fatigue.

Seeing a plain radiograph is no less than seeing a patient and making a diagnosis.

In less than an hour and a half, including more than 1 MRI plain films for the Level 20 skill assessment, I watched more than 50 films in total. The workload is indeed not small, and the accuracy must be ensured. It is not just like watching TV. So look.

"Do you need to take a rest?" Seeing Fang Xian's slight movement, Professor Zhou still asked with concern.

The assessment and certification of level 5 skills is not a simple matter, nor can it be completed in a short time.

Fang Xian shook his head, pursed his lips and smiled, and continued to stare at the skill training device——

With his previous experience in taking the exam, Fang Xian finally found an actual correspondence among the six flat photos of No. 30, a normal report and normal image without a pit.

Fang Xian waved his hand and wrote down the corresponding words.

Then he came to the seven MRI images of No. 30.

However, when Fang Xian arrived, he discovered something was wrong.

Because the text report clearly showed: "Left ankle lateral ligament injury, suspected obturator lesion, lumbar disc herniation."

This is the absolute standard for writing.

However, what was shown on the MRI was only at the level of the ankle joint!

Fang Xian scrolled up and down the various nuclear magnetic fields and finally confirmed this!
No. 30, the seven plain films, the contents of the diagnosis and report are misleading.

The image of the ankle joint was diagnosed as obturator disease and lumbar disc herniation.

Where is this all?

Flipping left and right, Fang Xian discovered that in this plain radiograph set, there were no MRI planes of the lumbar vertebrae and pelvis.

"Is this question so simple? Just complete the MRI of the pelvic and lumbar spine?" Fang Xian hesitated.

This is the first time Fang Xian has faced such a situation!

Most of the position errors that have occurred before were caused by the wrong left and right feet!

There was not even a mismatch between the ankle joint and the knee joint, but now, it jumped directly from the ankle joint to the pelvis. This span is a bit big!
Logically speaking, as long as it is not a mistake, the location will not be mistaken. For such an obvious mistake, do you have to re-create two MRI images?

Fang Xian didn't dare to be too sure about this.

Because finding out what is wrong and finding flaws does not mean virtual fabrication, imagining, and then repeating the content of the text.

If you just need to fill in, please supplement the MRI images of the pelvis and lumbar spine!
So this kind of assessment is too simple.This does not match the difficulty of the previous questions.

So?

This movie is so weird!

Grind again——

Lateral ankle ligament damage is no problem.

First locate the ankle joint, especially the left ankle joint, and identify several ligaments on the outside of the ankle joint on MRI. This is a basic skill that doctors in orthopedic sports medicine and even orthopedic surgeons can do.

There are no continuous breaks and the anatomy is normal, but there is a relatively severe edema signal.

If you look closely, you can see that the fibrous structure with ligaments is broken!
This is also true.

But this is the assessment content of level 3 MRI reading technique.

In level 2 MRI reading technology, won’t there be content that goes beyond the scope of level 3 MRI reading technology?

The diagnosis of damage can definitely be made. At this time, it only means minor damage, not a wide range of meaning, including fractures, etc...

So this level of difficulty is too high?

Why is it?
(End of this chapter)