Computer-based summative assessment of clinical reasoning in clerkships: A mixed-method comparison of key feature problems with case-based multiple choice questions

Background: It is yet unclear if there are differences between using electronic key feature problems (KFPs) or electronic case-based multiple choice questions (cbMCQ) for the assessment of clinical decision making. Summary of Work: Fifth year medical students were exposed to clerkships which ended with a summative exam. Assessment of knowledge per exam was done by 6-9 KFPs, 9-20 cbMCQ and 9-28 MC questions. Each KFP consisted of a case vignette and three key features (KF) using “long menu” as question format. We sought students’ perceptions of the KFPs and cbMCQs in focus groups (n of students=39). Furthermore statistical data of 11 exams (n of students=377) concerning the KFPs and (cb)MCQs were compared. Summary of Results: The analysis of the focus groups resulted in four themes reflecting students’ perceptions of KFPs and their comparison with (cb)MCQ: KFPs were perceived as (i) more realistic, (ii) more difficult, (iii) more motivating for the intense study of clinical reasoning than (cb)MCQ and (iv) showed an overall good acceptance when some preconditions are taken into account. The statistical analysis revealed that there was no difference in difficulty; however KFP showed a higher discrimination and reliability (G-coefficient) even when corrected for testing times. Correlation of the different exam parts was intermediate. Conclusions: Students perceived the KFPs as more motivating for the study of clinical reasoning. Statistically KFPs showed a higher discrimination and higher reliability than cbMCQs. Take-home messages: Including KFPs with long menu questions into summative clerkship exams seems to offer positive educational effects.

The population health performance of medical students at two medical schools

Public Health and medicine are complimentary disciplines dedicated to the health and well-being of humankind. Worldwide, medical school accreditation bodies require the inclusion of population health in medical education. In 2003, the Institutes of Medicine (IOM) recommended that all medical students receive basic public health training in population-based prevention. The purpose of this study was to (1) examine the public health clinical performance of third-year medical students at two independent medical schools, (2) compare the public health clinical practice performance of the schools, and (3) identify underlying predictors of high and low public health clinical performance at one of the medical schools. ^ This study is unique in its analysis and report of observed medical student public health clinical practices. The cohort consisted of 751 third-year medical students who completed a required clinical performance exam using trained standardized patients. Medical student performance scores on 24 consensus public health items derived from nine patient cases were analyzed.^ The analysis showed nearly identical results for both medical schools at the 60%, 65%, and 70% pass rate. Students performed poorly on items associated with prevention, behavioral science, and surveillance. Factors associated with high student performance included being from an underrepresented minority, matching to a primary care residency, and high class ranking. A review of medical school curriculum at both schools revealed a lack of training in four public health domains. Nationally, 32% of medical students reported inadequate training in public health in the year 2006.^ These findings suggest more dedicated teaching time for public health domains is needed at the medical schools represented in this study. Finally, more research is needed to assess attainment of public health knowledge and skills for medical students nationwide if we are to meet the recommendations of the IOM. ^

US medical students' knowledge of obstetric fistula in developing countries

Obstetric fistula is a devastating child birth injury affecting millions of women worldwide. This paper explores the knowledge and understanding of medical students at the University of Texas Health Science Center at San Antonio regarding this global public health issue. Obstetric fistula has been eradicated in most industrialized nations, and has therefore faded from view of many modern medical organizations. The United Nations Population Fund has launched a “Campaign to End Fistula” in an attempt to bring global awareness to this preventable and treatable condition. Based on a survey administered to medical students at UTHSCSA, a baseline understanding of this disorder based on current curriculum is reviewed, with the objective of improving future physicians’ awareness of obstetric fistula. Despite a low survey response rate, there was a significant association between greater knowledge about causes, treatment, and complications of obstetric fistula and advanced years in medical school. However, the fourth year medical students averaged only a 70.5 percent of correct responses on the survey, indicating room for improvement in addressing this topic during medical school. ^

Ensino-aprendizagem de enfermagem em simulação clínica: desenvolvendo competência profissional para prevenção de úlceras por pressão

O desenvolvimento de competências profissionais em processos de ensino-aprendizagem insere a simulação na perspectiva tecnológica realística de situações clínicas para atingir objetivos educacionais, visando segurança e qualidade. A ação competente operacionaliza saberes pela combinação de conhecimentos, habilidades e atitudes. A competência avaliação de risco para úlcera por pressão é privativa do enfermeiro, o agravo é indicador de qualidade e segurança do paciente. O objetivo do estudo foi avaliar o processo de ensino-aprendizagem ante a estratégia de simulação clínica, visando o desenvolvimento da competência profissional avaliação de risco para úlceras por pressão e seus respectivos conhecimentos, habilidades e atitudes. Fundamentou-se, teoricamente, o estudo, nos preceitos da andragogia, no modelo de Simulação da National League for Nursing/Jeffries, nas concepções de competências de Le Boterf e recomendações para prevenção de úlcera por pressão do NPUAP/ EPUAP. Trata-se de estudo descritivo com análise quanti e qualitativa, desenvolvido no Laboratório de Simulação da Universidade Federal do Piauí, em Teresina, com estudantes de enfermagem do último ano do curso. Constou de três etapas: construção e validação de conteúdo do instrumento para conhecimentos, habilidades e atitudes da competência, elaboração do plano de aula e sequência didática do cenário de simulação, aplicação de pré/pós-teste sobre o componente \"conhecimento\", aula expositiva, execução do cenário de simulação pelos estudantes, avaliação dos cenários pelo comitê de juízes e debriefing por grupo focal, após o cenário. Verificou-se confiabilidade do construto e do instrumento de medida da competência com concordância predominando de 80 a 100% de pertinência. O instrumento constou de 32 itens: conhecimento (14), habilidades (8) e atitudes (10), com escala de resposta de cinco pontos, de nada (1) a extremamente (5). Inicialmente o estudo contou com 35 estudantes. Desses, 29 (82,8%) participaram da simulação. Predominou o sexo feminino 22 (76%), faixa etária de 21 a 24 anos, 24 (82,7%) e procedentes de Universidades Públicas do Estado do Piauí (83%). Os resultados mostraram melhores níveis de combinação de saberes para o componente conhecimentos, após a aplicação das estratégias de ensino autorreferidos pelos estudantes. Na avaliação dos conhecimentos, habilidade e atitudes, durante o cenário, houve discordância entre os juízes: para o juiz 1 predominaram parâmetros negativos da escala (nada e muito pouco) e para o juiz 2 e 3 os positivos (bastante e extremamente). As comparações pelo teste de variância ANOVA mostraram diferenças significativas entre juiz 1 e 2 (p-valor = < 0,01) e juiz 1 e 3 (p-valor=<0,01) para todos os componentes. A análise dos dados obtidos, durante o debriefing, originou cinco categorias com suas respectivas unidades de registro temáticas pela análise de conteúdo de Bardin. Os resultados sugerem que a estratégia é capaz de resgatar o raciocínio operativo dos estudantes durante a ação, desenvolver pensamento crítico-reflexivo sobre a competência, identificar lacunas de aprendizagem, promover satisfação aos estudantes e melhorar a autoimagem profissional. Conclui-se que a estratégia possibilita o desenvolvimento da competência avaliação de risco para úlcera por pressão nas dimensões de saberes (conhecimento), fazeres (habilidades) e querer-agir, saber-agir e poder-agir (atitudes), explorados neste estudo.

Flexibilidad en la resolución de problemas de identificación de patrones lineales en estudiantes de educación secundaria

El objetivo de este trabajo es caracterizar la flexibilidad, entendida como habilidad para modificar la estrategia de resolución de un problema cuando se modifica la demanda de la tarea, de estudiantes de educación secundaria (12-16 años) en problemas de reconocimiento de patrones con varios apartados. Se utiliza una metodología de tipo cualitativo analizando las respuestas de los estudiantes en base a dos criterios: corrección de las respuestas y estrategias de resolución, y agrupando las que presentan características semejantes. Los resultados indican tres perfiles de estudiantes en relación a la flexibilidad en el uso de estrategias y el éxito alcanzado. El primero agrupa a los estudiantes que usan sólo la estrategia recursiva; la mayor parte de ellos se bloquea al aumentar la demanda cognitiva de la tarea; predominan los estudiantes de 12-13 años. El segundo perfil corresponde a los que cambian de una estrategia recursiva a una aproximación proporcional dando un resultado incorrecto; es más frecuente en los estudiantes de 13-14 años. Finalmente, el tercer perfil agrupa a los estudiantes que al aumentar la demanda cognitiva de la tarea cambian con éxito de una estrategia recursiva a una funcional; su frecuencia aumenta con la edad. Se concluye que la flexibilidad necesaria para identificar patrones cuando se incrementa la demanda de la tarea está relacionada con los conocimientos de los estudiantes y con el control y la regulación del proceso de resolución. Por otra parte, los estudiantes más jóvenes manifestaron menor grado de flexibilidad que los más mayores.

An electronic record system in nursing education: evaluation and utilization

The main objective of the present work is to analyze the results of the utilization and evaluation of the LORETO Record System (LRS), providing improvement areas in the teaching-learning process and technology, in second year nursing students. A descriptive, prospective, cross sectional study using inferential statics has been carried out on all electronic records reported by 55 nursing students during clinical internships (April 1º-June 26º, 2013). Electronic record average rated 7.22 points (s=0.6; CV=0.083), with differences based on the clinical practice units (p<0,05). Three items assessed did not exceed the quality threshold set at 0.7 (p<0.05). Record Rate exceeds the quality threshold set at 80% for the overall sample, with differences based on the practice units. Only two clinical practice units rated above the minimum threshold (p <0.05). Record of care provision every 3 days did not reach the estimated quality threshold (p <0.05). There is a dichotomy between qualitative and quantitative results of LRS. Improvement areas in theoretical education have been identified. The LRS seems an appropriate learning and assessment tool, although the development of a new APP version and the application of principles of gamification should be explored.

Influence of experience and training on dental students’ examination performance regarding panoramic images

Physician training has greatly benefitted from insights gained in understanding the manner in which experts search medical images for abnormalities. The aims of this study were to compare the search patterns of 30 fourth-year dental students and 15 certified oral and maxillofacial radiologists (OMRs) over panoramic images and to determine the most robust variables for future studies involving image visualization. Eye tracking was used to capture the eye movement patterns of both subject groups when examining 20 panoramic images classified as normal or abnormal. Abnormal images were further subclassified as having an obvious, intermediate, or subtle abnormality. The images were presented in random order to each participant, and data were collected on duration of the participants’ observations and total distance tracked, time to first eye fixation, and total duration and numbers of fixations on and off the area of interest (AOI). The results showed that the OMRs covered greater distances than the dental students (p<0.001) for normal images. For images of pathosis, the OMRs required less total time (p<0.001), made fewer eye fixations (p<0.01) with fewer saccades (p<0.001) than the students, and required less time before making the first fixation on the AOI (p<0.01). Furthermore, the OMRs covered less distance (p<0.001) than the dental students for obvious pathoses. For investigations of images of pathosis, time to first fixation is a robust parameter in predicting ability. For images with different levels of subtlety of pathoses, the number of fixations, total time spent, and numbers of revisits are important parameters to analyze when comparing observer groups with different levels of experience.

Influence of experience and training on dental students’ examination performance regarding panoramic images.

Physician training has greatly benefitted from insights gained in understanding the manner in which experts search medical images for abnormalities. The aims of this study were to compare the search patterns of 30 fourth-year dental students and 15 certified oral and maxillofacial radiologists (OMRs) over panoramic images and to determine the most robust variables for future studies involving image visualization. Eye tracking was used to capture the eye movement patterns of both subject groups when examining 20 panoramic images classified as normal or abnormal. Abnormal images were further subclassified as having an obvious, intermediate, or subtle abnormality. The images were presented in random order to each participant, and data were collected on duration of the participants’ observations and total distance tracked, time to first eye fixation, and total duration and numbers of fixations on and off the area of interest (AOI). The results showed that the OMRs covered greater distances than the dental students (p<0.001) for normal images. For images of pathosis, the OMRs required less total time (p<0.001), made fewer eye fixations (p<0.01) with fewer saccades (p<0.001) than the students, and required less time before making the first fixation on the AOI (p<0.01). Furthermore, the OMRs covered less distance (p<0.001) than the dental students for obvious pathoses. For investigations of images of pathosis, time to first fixation is a robust parameter in predicting ability. For images with different levels of subtlety of pathoses, the number of fixations, total time spent, and numbers of revisits are important parameters to analyze when comparing observer groups with different levels of experience.

Attitudes toward psychiatry among students entering medical school

Objective: To survey the attitudes of Australian medical students to determine their views about the relative attractiveness of psychiatry as a career compared with other specialities, and against findings from a North American study. Method: We surveyed 655 first-year medical students attending six Australian Universities. Results: Responses indicated that Australian medical students view psychiatry as distinctly less 'attractive' than other career options, as reported in the North American sample. In comparison with other disciplines, psychiatry was regarded as more interesting and intellectually challenging, but also as lacking a scientific foundation, not being enjoyable and failing to draw on training experiences. Conclusion: Our findings suggest that psychiatry has an image problem that is widespread, reflecting Community perceptions and the specialist interests of medical students on recruitment. If psychiatry is to improve its 'attractiveness' as a career option, identified image problems need to be corrected and medical student selection processes re-considered.

Choosing to have children or choosing to be childfree: Australian students' attitudes towards the decisions of heterosexual and lesbian women

Research has demonstrated that voluntarily childless heterosexual women, and lesbian women choosing to become mothers, are negatively stereotyped. However, there is little recent Australian research, and attitudes may have changed in line with changing family formation patterns. This study assessed young Australians' attitudes towards either a lesbian or a heterosexual woman who was planning, or not planning, to have children. One hundred and nineteen first year psychology students, and members of the general public, participated. The majority of participants were under 20, female, European Australian and single. Participants read a brief description of a woman who was variously described as having a male or a female partner, and as planning or not planning to have children. As expected, participants rated the heterosexual woman more favourably than the lesbian, and the woman wanting children more positively than the woman not wanting children. However, there was a trend for the lesbian woman planning to have children to be rated as happier, more mature and more individualistic than others. The legal and social implications associated with wanting to be a lesbian mother in Australia make motherhood a more difficult process for lesbian women than it does for heterosexual women, and may explain why lesbian women who have decided to take this difficult path are seen as happier and more mature, than women making more conventional life choices. While the predominantly young, female student sample limits the generality of the findings, they suggest that social attitudes towards female sexual orientation and women's childbirth decisions are changing.

Teaching business students law by virtual means

In this article from the Spring 2008 issue of Directions Odette Hutchinson (Birmingham City University) details her experience introducing video lectures to first year business students studying the English legal system as part of a business law pathway.

Choosing to study pharmacy: measuring influences and motivations

This paper reports part of a national study of career motivations and expectations of United Kingdom MPharm students. The aim was to describe the students’ influences and motivations in making their choice to study pharmacy. A self-completion questionnaire was administered to year one and year four students in thirteen pharmacy schools during 2005. The reasons considered most important were objective ones that related to self-interest, both in terms of the nature of the degree course and the advantages conferred by the degree. However, there was evidence that for female students, future patterns of working that are not central to career progression were considered more important than for males. At a time of expanding demand by students for pharmacy education and a parallel demand for qualified pharmacists, this study adds to earlier knowledge on the motivations and influences on students when making their early career choices.

Choosing to study pharmacy: measuring influences and motivations

This paper reports part of a national study of career motivations and expectations of United Kingdom MPharm students. The aim was to describe the students’ influences and motivations in making their choice to study pharmacy. A self-completion questionnaire was administered to year one and year four students in thirteen pharmacy schools during 2005. The reasons considered most important were objective ones that related to self-interest, both in terms of the nature of the degree course and the advantages conferred by the degree. However, there was evidence that for female students, future patterns of working that are not central to career progression were considered more important than for males. At a time of expanding demand by students for pharmacy education and a parallel demand for qualified pharmacists, this study adds to earlier knowledge on the motivations and influences on students when making their early career choices.

‘Let’s talk about feedback’:an exploration of academic feedback practices in pharmacy education

Feedback is considered one of the most effective mechanisms to aid learning and achievement (Hattie and Timperley, 2007). However, in past UK National Student Surveys, perceptions of academic feedback have been consistently rated lower by final year undergraduate students than other aspects of the student experience (Williams and Kane, 2009). For pharmacy students in particular, Hall and colleagues recently reported that almost a third of students surveyed were dissatisfied with feedback and perceived feedback practice to be inconsistent (Hall et al, 2012). Aims of the Workshop: This workshop has been designed to explore current academic feedback practices in pharmacy education across a variety of settings and cultures as well as to create a toolkit for pharmacy academics to guide their approach to feedback. Learning Objectives: 1. Discuss and characterise academic feedback practices provided by pharmacy academics to pharmacy students in a variety of settings and cultures. 2. Develop academic feedback strategies for a variety of scenarios. 3. Evaluate and categorise feedback strategies with use of a feedback matrix. Description of Workshop Activities: Introduction to workshop and feedback on pre-reading exercise (5 minutes). Activity 1: A short presentation on theoretical models of academic feedback. Evidence of feedback in pharmacy education (10 minutes). Activity 2: Discussion of feedback approaches in participants’ organisations for differing educational modalities. Consideration of the following factors will be undertaken: experiential v. theoretical education, formative v. summative assessment, form of assessment and the effect of culture (20 minutes, large group discussion). Activity 3: Introduction of a feedback matrix (5 minutes). Activity 4: Development of an academic feedback toolkit for pharmacy education. Participants will be divided into 4 groups and will discuss how to provide effective feedback for 2 scenarios. Feedback strategies will be categorised with the feedback matrix. Results will be presented back to the workshop group (20 minutes, small group discussion, 20 minutes, large group presentation). Summary (10 minutes). Additional Information: Pre-reading: Participants will be provided with a list of definitions for academic feedback and will be asked to rank the definitions in order of perceived relevance to pharmacy education. References Archer, J. C. (2010). State of the science in health professional education: effective feedback. Medical education, 44(1), 101-108. Hall, M., Hanna, L. A., & Quinn, S. (2012). Pharmacy Students’ Views of Faculty Feedback on Academic Performance. American journal of pharmaceutical education, 76(1). Hattie, J., & Timperley, H. (2007). The power of feedback. Review of educational research, 77(1), 81-112. Medina, M. S. (2007). Providing feedback to enhance pharmacy students’ performance. American Journal of Health-System Pharmacy, 64(24), 2542-2545.

Effects of student-faculty interactions on persistence of underprepared community college students

The high concentration of underprepared students in community colleges presents a challenge to educators, policy-makers, and researchers. All have pointed to low completion rates and caution that institutional practices and policy ought to focus on improving retention and graduation rates. However, a multitude of inhibiting factors limits the educational opportunities of underprepared community college students. Using Tinto's (1993) and Astin's (1999) models of student departure as the primary theoretical framework, as well as faculty mentoring as a strategy to impact student performance and retention, the purpose of this study was to determine whether a mentoring program designed to promote greater student-faculty interactions with underprepared community college students is predictive of higher retention for such students. While many studies have documented the positive effects of faculty mentoring with 4-year university students, very few have examined faculty mentoring with underprepared community college students (Campbell and Campbell, 1997; Nora & Crisp, 2007). In this study, the content of student-faculty interactions captured during the mentoring experience was operationalized into eight domains. Faculty members used a log to record their interactions with students. During interactions they tried to help students develop study skills, set goals, and manage their time. They also provided counseling, gave encouragement, nurtured confidence, secured financial aid/grants/scholarships, and helped students navigate their first semester at college. Logistic regression results showed that both frequency and content of faculty interactions were important predictors of retention. Students with high levels of faculty interactions in the area of educational planning and personal/family concerns were more likely to persist. Those with high levels of interactions in time-management and academic concerns were less likely to persist. Interactions that focused on students' poor grades, unpreparedness for class, or excessive absences were predictive of dropping out. Those that focused on developing a program of study, creating a road map to completion, or students' self-perceptions, feelings of self-efficacy, and personal control were predictive of persistence.