Evaluating the quality of an assessment: is the OSCE a valid and reliable assessment of clinical skill? [abstract]

In order to ensure horizontal integration, the curriculum at the Faculty of Medical Sciences, St. Augustine, includes a formalized skill lab programme in which student are taught basic clinical skills. The programme is measured at the end of year by a summative OSCE. Over the years, questions have been raised about the quality of the skills lab programme as well as the examination and its place in the curriculum. On the other hand, there is a movement towards greater use of OSCE in Phase 2. This study reports the use of a unique evaluative framework to assess the quality of the OSCE as an assessment tool. Key indicators are derived from the assessment literature and questions from a number of instrument along with new items are collated in an evaluation instrument. Key indicators include (1) construct validity, (ii) content coverage, (iii) impact upon students, (iv) fairness, (v) authenticity, (vi) reliability, (vii) usability and organization, and (viii) transparency. Evaluation data for the Year 3 OSCE (1998-2000) and OSCE for Medicine and Therapeutics are included. In line with the trend towards considering student perceptions and satisfaction with the teaching, learning and assessment provision, the focus is on the evaluation of student views, using both open and close-ended questions. However, performance scores are also considered when assessing the year 3 OSCE. Data suggest that the OSCE at the end of Phase 2 has a positive impact upon facilitating learning in Phase 2. Indeed, there is a moderate to strong relationship between performance in the OSCE and subsequent performance in Phase 2. In comparing data from recently completed OSCE in Phase 2 Medicine and Therapeutics, the possible negative impact of the high stakes nature of the examination is noted. The study recommends greater use and better structuring of this examination mode. (AU)

Fifty years of clinical examinations at the University of the West Indies

The University of the West Indies was founded at Mona, Jamaica in 1948. After fifty two years, the format of the final Bachelor of Medicine clinical examination in Medicine and Therapeutics has been radically revised. The change from the traditional to an evidence-based, objective structured clinical examination (OSCE) was undertaken in November/December 2000. Assessment drives learning and both the methods chosen for assessment and the manner in which they are applied determine how students learn. The philosophical underpinnings of the change in format are discussed in this paper. (AU)

Medical Library - then and now

The paper traces the Medical Library's growth, development and its relationship with the Faculty of Medical Sciences (FMS), researchers and other users pursuing their teaching, research and patient care. The information is analyzed, synthesized and organized from the annual reports of the Vice Chancellor, Principal, Libraries, various Departments in the Faculty of Medical Sciences, Office of Planning, Institutional Research, and the Web Pages of the University of the West Indies, Mona, Jamaica (AU)

The teaching facility at the Eric Williams Medical Sciences Complex: an additional rising star from the west

The teaching facility at the Eric Williams Medical Sciences Complex was designed to provide a comprehensive structural environment for a multidisciplinary faculty whose teaching methodology utilized an integrated problem-based learning approach. Though the faculty is over 11 years old, the full realization of the vision has not become a reality and the next 10 years will be devoted to fulfilling the dream. (AU)

Research, health policies and health care in the Caribbean: the role of the University of the West Indies

The University of the West Indies has had a major impact on the provision of health care and the health of Caribbean nations over the last 50 years, through undergraduate, postgraduate and continuing medical education, research, outreach and public service. These roles are fully accepted, and the Faculties of Medical Sciences and School of Clinical Medicine and Research have provided most of the doctors now serving the English-speaking Caribbean, including academic leaders and chief medical officers. The design of a curriculum to produce doctors "designed for the region has been a well-articulated goal, and the need to carry out relevant and essential national health research is now accepted. But the broader roles of accepting translation of research into policy and practice, and developing effective ways of promoting on-going continuing training and behaviour change are far from understood or seriously attempted. Communication of research findings and evidence-based practice is crucial. The West Indian Medical Journal clearly has a valuable role to play here and this requires expansion and support. But a multi-faceted approach to communicating research findings and translating evidence into policy, planning and care is necessary. One possible approach would be a University Unit of Health Policy Research and Development. (AU)

An evaluation of medical school education in musculoskeletal medicine at the University of the West Indies, Barbados

At the University of the West Indies, Cave Hill campus, the Freedman and Bernstein musculoskeletal competency examination was administered to 22 medical students during the last month of their final year. Eighty two percent (82 percent) of the students failed to score above the passing score of 73.1 percent. Nineteen of the twenty-two students had taken an orthopaedic elective or rotation during their final two years. The questions were also categorized as anatomy, Trauma and general Orthopaedics. All students failed to score above the passing score in Anatomy. Sixty-four per cent (64 per cent) failed in general Orthopaedics. This study suggests that inadequacies in medical school preparation do exist at this campus of the University of the West Indies and the findings mirror those at medical schools in the United States of America. (AU)

Curriculum development in Community Health: drift or shift?

The curriculum in community health is best described as eclectic and dynamic. Its relevance is maintained by its response to the macro-environment; this response, whether innovative or otherwise, may be incremental on the one hand or feature wholesale change consequent on radical rethinking on the other. This paper reviews the content of the emerging curriculum in community health and the University of the West Indies, Jamaica, and attempts to discern the process of change and the factors which have informed these developements.(AU)

Integrated primary mental health care

Mental health is increasingly being recognised as contributing significantly to the burden of disease, particularly now that the indicators have shifted from measures of mortality to measures of morbidity. Psychiatric morbidity in the community, based on community surveys, is estimated at 20 to 30 percent of the population. Increasingly, patients needing health services prefer to be in a general health care setting than in specialized centres. Internationally and regionally, the general policy has been to move toward the development of comprehensive mental health programmes integrated within primary health care. This integration may be structural (use of shared facilities), administrative (shared administrative resources) or functional (complete integration of clinical services, with staff jointly responsible for patient welfare). This paper examines how this integration can be achieved, and the potential role of the Department of Community Health and Psychiatry, University of the West Indies in advancing this integrative process through research and training.(AU)

Forty years: an introduction to the development of a Caribbean public health

The development of public health and primary care in Jamaica is examined with particular reference to the historical events which paved the way for their development: notably, the collaborative work undertaken by the Rockefeller Foundation (Commissions on hookworm, tuberculosis, malaria, yams); recommendations of the Moyne Commission (leading to the establishment of the West Indies School of Public Health); and the Irvine Commission which recommended the establishment of the University College of the West Indies. A confluence of political, social and international activity in the 1970s proved catalytic in the development of the current ethos of primary health care, and the Department of Social and Preventive Medicine was instrumental in the training of the most innovative addition to the primary care health team, the community health aide. Undergraduate and postgraduate training programmes of the Department are highlighted as it celebrates its fortieth anniversary.(AU)

Examination performance of medical students: a view from Trinidad

We analysed the outcome of the final MBBS (Bachelor of Medicine and Bachelor of Surgery) examination oat the St. Augustine Campus, University of the West Indies, for 686 students attempting them for the first time between 1975 and 1986. The mean failure rate was lowest in medicine between 1975 and 1981, in obstetrics and gynaecology between 1982 and 1989 and in surgery during the last 7 years. The students' poor performance in some areas indicates the need for recognizing the importance of creating and establishing an educational climate in which the quality of teaching comes under scrutiny. The marking system in medicine should be reviewed.(AU)

Entrepreneurship and nation building: proprietary medical schools and development in the Caribbean, 1976-1990

Since the mid-1970s proprietary medical schools have spread throughout the Windward & Leeward Islands of the Caribbean. In some cases, these transnational educational corporations have made commitments to enhance education and health care resources of host countries. In all cases, the presence of hundreds of students and faculty, and the associated local spending, represents significant additional foreign exchange and employment. This dissertation seeks to learn how proprietary medical schools have affected development in Eastern Caribbean microstates, to assess what role, if any, they might play in local development, and to discern their implications for the complex array of regional agreements comprising the fourteen-nation Caribbean Community and its associated educational regime - whose institutional pinnacle is the University of the West Indies - to which all host microstates subscribe. The central focus of this study is Grenada and St. George's University School of Medicine. St. George's is the oldest such establishment, and is the archetype for all that followed in the region, Using an historical approach rooted in international political economy, public policy and area studies, this dissertation utilizes unpublished and recently declassified documents, newspapers, personal interviews, and other primary sources to reconstruct the complex relationship of school and state through four distinct political periods. At every stage of the analysis, regional events and implications were also considered. The study concludes that the incentive to allow proprietary medical schools was rooted in historic insecurities deriving from unequal power relations among member states of the educational regime, combined with ongoing perceptions of distributive bias. Host states viewed proprietary medical schools as an opportunity to augment both capital and human resources, and therefore acted alone, despite implicit norms against such independent action. The Grenadian case demonstrated that proprietary medical schools could, given sufficient encouragement, provide host microstates with certain developmental benefits affecting educational development, health care, and economy. However, the extent that these benefits are realized was found to be largely dependant on entrepreneurial awareness within the political leadership, institutionalization of collaborative/coordinating mechanisms, quality of medical school management.(AU)