RESUMEN
This paper reports the findings of a Canada based multi-institutional study designed to investigate the relationships between admissions criteria, in-program assessments, and performance on licensing exams. The study's objective is to provide valuable insights for improving educational practices across different institutions. Data were gathered from six medical schools: McMaster University, the Northern Ontario School of Medicine University, Queen's University, University of Ottawa, University of Toronto, and Western University. The dataset includes graduates who undertook the Medical Council of Canada Qualifying Examination Part 1 (MCCQE1) between 2015 and 2017. The data were categorized into five distinct sections: demographic information as well as four matrices: admissions, course performance, objective structured clinical examination (OSCE), and clerkship performance. Common and unique variables were identified through an extensive consensus-building process. Hierarchical linear regression and a manual stepwise variable selection approach were used for analysis. Analyses were performed on data set encompassing graduates of all six medical schools as well as on individual data sets from each school. For the combined data set the final model estimated 32% of the variance in performance on licensing exams, highlighting variables such as Age at Admission, Sex, Biomedical Knowledge, the first post-clerkship OSCE, and a clerkship theta score. Individual school analysis explained 41-60% of the variance in MCCQE1 outcomes, with comparable variables to the analysis from of the combined data set identified as significant independent variables. Therefore, strongly emphasising the need for variety of high-quality assessment on the educational continuum. This study underscores the importance of sharing data to enable educational insights. This study also had its challenges when it came to the access and aggregation of data. As such we advocate for the establishment of a common framework for multi-institutional educational research, facilitating studies and evaluations across diverse institutions. This study demonstrates the scientific potential of collaborative data analysis in enhancing educational outcomes. It offers a deeper understanding of the factors influencing performance on licensure exams and emphasizes the need for addressing data gaps to advance multi-institutional research for educational improvements.
RESUMEN
Lack of ready access to health services is a continuing problem for the one-quarter of northern Ontario residents who live in non-urban areas. Teletriage has been proposed to help reduce medically unnecessary visits and thus free-up available resources. A mail survey obtained information about patients' use of teletriage and other health care services, as well as socioeconomic and demographic characteristics. Survey data (n = 2389) were used to determine the impact of teletriage on health service use by asking about the patient's intended use of health care service (intent), the service advised by the nurse (advice), and the actual health service used by the patient (action). Responses were compared among geographic categories based on commuter flows to urban areas in northern Ontario. Survey responses suggest that teletriage may have decreased visits to emergency departments relative to patient intent, and this effect appears to be stronger in communities with weak or no commuter flows (intent = 54%, action = 41%) than in urban areas (intent = 39%, action = 33%). Visits to physicians' offices or clinics may have increased relative to patient intent, but only for non-urban areas (intent = 16%, action = 21% to 23%) with strong, moderate, weak, or no commuter flows. Very little difference was found among geographic categories for calls or visits to other health care providers (overall: intent = 17%, action = 11%) or for informal care (self-care and care for others) (overall: intent = 16%, action = 29%). Results should be interpreted carefully, as there was evidence of selection and social desirability bias.
