[Analysis of the discrimination of the final marks after the first computerized national ranking exam in Medicine in June 2016 in France]. / Analyse de la discrimination des notes aux ECN informatisées de 2016.

INTRODUCTION: The first computerised national ranking exam (cNRE) in Medicine was introduced in June 2016 for 8214 students. It was made of 18 progressive clinical cases (PCCs) with multiple choice questions (MCQs), 120 independent MCQs and 2 scientific articles to criticize. A lack of mark discrimination grounded the cNRE reform. We aimed to assess the discrimination of the final marks after this first cNRE. METHODS: A national Excel® file gathering overall statistics and marks were transmitted to the medical faculties after the cNRE. The mean points deviation between two papers and the percentage of points ranking 75% of students allowed us to analyse marks' discrimination. RESULTS: The national distribution sigmoid curve of the marks is superimposable with previous NRE in 2015. In PCCs, 72% of students were ranked in 1090 points out of 7560 (14%). In independents MCQs, 73% of students were ranked in 434 points out of 2160 (20%). In critical analysis of articles, 75% of students were ranked in 225 points out of 1080 (21%). The above percentages of students are on the plateau of each discrimination curve for PCCs, independent MCQs and critical analysis of scientific articles. CONCLUSION: The cNRE reduced equally-ranked students compared to 2015, with a mean deviation between two papers of 0.28 in 2016 vs 0.04 in 2015. Despite the new format introduced by the cNRE, 75% of students are still ranked in a low proportion of points that is equivalent to previous NRE in 2015 (between 15 et 20% of points).

La crítica y la educación médica: hacia un conocimiento liberador. Parte I / Critique and medical education: towards liberating knowledge. Part I

Resumen: Como marco intelectivo e interpretativo de este trabajo se propone y argumenta el diagnóstico del momento actual como colapso civilizatorio, provocado por la dominancia de los intereses de lucro sin límites, que ha sido posible por la insensibilidad y la permisividad mayoritarias de la población ante una degradación social y ecosistémica extrema. Detrás de tal «anestesia¼ está la dominación de conciencias y cuerpos basada en una educación que reproduce las ideas y las prácticas prevalentes en cada espacio social y perpetúa los rasgos degradantes: individualismo, especialización excluyente, pasividad, competitividad, consumismo y vulnerabilidad a la manipulación mediática. En esta primera parte, la crítica de la esfera educativa de la educación médica significó diferenciar y contrastar dos tipos de educación radicalmente distintos. El primero es la educación pasiva, de vigencia universal que subyace a la degradación, cuyo núcleo es la idea de conocimiento equiparable a un aprendizaje memorístico y acumulativo de información heterónoma y desvinculada, y por una pedagogía implícita centrada en estimular y facilitar el consumo y la asimilación acrítica de las verdades establecidas. El segundo es la educación participativa, una propuesta de superación de la pasiva, en la que el conocimiento es elaboración y reelaboración propia de los educandos con la mediación imprescindible de la crítica profunda, que construyen y reconstruyen versiones propias de sí mismos y su contexto; su pedagogía se resume en contagiar entusiasmo por entender quiénes somos y dónde estamos, y procurar ambientes propicios para la crítica y la elaboración de un conocimiento penetrante y liberador, que ha mostrado su factibilidad en situaciones concretas.

Abstract: This essay defines the current moment as a civilizatory collapse, consequence of the dominance of limitless profit interests, which has been possible due to the insensitivity and permissiveness of most of the population in the face of extreme social and ecosystemic degradations. In the background of such "anesthesia" there is the predominant education and its key role in the reproduction of prevalent social ideas and practices and in the perpetuation of degrading traits: individualism, exclusionary specialization, passivity, competitiveness, consumerism and vulnerability to media manipulation. With this intellective and interpretive framework, the concept of deep and creative critique was updated in order to deepen the critique of medical education, allowing for the differentiation and contrast of two radically different types of education. Firstly, the passive education, reproductive of the degrading traits of universal validity, whose core is the idea of knowledge comparable to a cumulative rote learning of heteronomous and unrelated information, and by an implicit pedagogy focused on facilitating the consumption and uncritical assimilation of established truths. Secondly, the participatory education (proposal to overcome the passive), where knowledge is the elaboration and re-elaboration of students with the essential mediation of critique. The students construct and reconstruct their own versions of themselves and their context; the implicit pedagogy is condensed in infecting enthusiasm to understand who we are and where we are, and procure conducive environments for critique and the elaboration of a progressively penetrating and liberating knowledge that has shown its feasibility in specific situations.

[La crítica y la educación médica: hacia un conocimiento liberador. Parte I]. / Critique and medical education: towards liberating knowledge. Part I.

This essay defines the current moment as a civilizatory collapse, consequence of the dominance of limitless profit interests, which has been possible due to the insensitivity and permissiveness of most of the population in the face of extreme social and ecosystemic degradations. In the background of such "anesthesia" there is the predominant education and its key role in the reproduction of prevalent social ideas and practices and in the perpetuation of degrading traits: individualism, exclusionary specialization, passivity, competitiveness, consumerism and vulnerability to media manipulation. With this intellective and interpretive framework, the concept of deep and creative critique was updated in order to deepen the critique of medical education, allowing for the differentiation and contrast of two radically different types of education. Firstly, the passive education, reproductive of the degrading traits of universal validity, whose core is the idea of knowledge comparable to a cumulative rote learning of heteronomous and unrelated information, and by an implicit pedagogy focused on facilitating the consumption and uncritical assimilation of established truths. Secondly, the participatory education (proposal to overcome the passive), where knowledge is the elaboration and re-elaboration of students with the essential mediation of critique. The students construct and reconstruct their own versions of themselves and their context; the implicit pedagogy is condensed in infecting enthusiasm to understand who we are and where we are, and procure conducive environments for critique and the elaboration of a progressively penetrating and liberating knowledge that has shown its feasibility in specific situations.

Como marco intelectivo e interpretativo de este trabajo se propone y argumenta el diagnóstico del momento actual como colapso civilizatorio, provocado por la dominancia de los intereses de lucro sin límites, que ha sido posible por la insensibilidad y la permisividad mayoritarias de la población ante una degradación social y ecosistémica extrema. Detrás de tal «anestesia¼ está la dominación de conciencias y cuerpos basada en una educación que reproduce las ideas y las prácticas prevalentes en cada espacio social y perpetúa los rasgos degradantes: individualismo, especialización excluyente, pasividad, competitividad, consumismo y vulnerabilidad a la manipulación mediática. En esta primera parte, la crítica de la esfera educativa de la educación médica significó diferenciar y contrastar dos tipos de educación radicalmente distintos. El primero es la educación pasiva, de vigencia universal que subyace a la degradación, cuyo núcleo es la idea de conocimiento equiparable a un aprendizaje memorístico y acumulativo de información heterónoma y desvinculada, y por una pedagogía implícita centrada en estimular y facilitar el consumo y la asimilación acrítica de las verdades establecidas. El segundo es la educación participativa, una propuesta de superación de la pasiva, en la que el conocimiento es elaboración y reelaboración propia de los educandos con la mediación imprescindible de la crítica profunda, que construyen y reconstruyen versiones propias de sí mismos y su contexto; su pedagogía se resume en contagiar entusiasmo por entender quiénes somos y dónde estamos, y procurar ambientes propicios para la crítica y la elaboración de un conocimiento penetrante y liberador, que ha mostrado su factibilidad en situaciones concretas.

The International Landscape of Medical Licensing Examinations: A Typology Derived From a Systematic Review.

BACKGROUND: National licensing examinations (NLEs) are large-scale examinations usually taken by medical doctors close to the point of graduation from medical school. Where NLEs are used, success is usually required to obtain a license for full practice. Approaches to national licensing, and the evidence that supports their use, varies significantly across the globe. This paper aims to develop a typology of NLEs, based on candidacy, to explore the implications of different examination types for workforce planning. METHODS: A systematic review of the published literature and medical licensing body websites, an electronic survey of all medical licensing bodies in highly developed nations, and a survey of medical regulators. RESULTS: The evidence gleaned through this systematic review highlights four approaches to NLEs: where graduating medical students wishing to practice in their national jurisdiction must pass a national licensing exam before they are granted a license to practice; where all prospective doctors, whether from the national jurisdiction or international medical graduates, are required to pass a national licensing exam in order to practice within that jurisdiction; where international medical graduates are required to pass a licensing exam if their qualifications are not acknowledged to be comparable with those students from the national jurisdiction; and where there are no NLEs in operation. This typology facilitates comparison across systems and highlights the implications of different licensing systems for workforce planning. CONCLUSION: The issue of national licensing cannot be viewed in isolation from workforce planning; future research on the efficacy of national licensing systems to drive up standards should be integrated with research on the implications of such systems for the mobility of doctors to cross borders.

The effects of a brief educational intervention on medical students' knowledge, attitudes and beliefs towards low back pain.

BACKGROUND AND AIMS: Knowledge, attitudes and beliefs towards low back pain (LBP) can significantly impact a health care provider's clinical decision making. Several studies have investigated interventions designed to change practitioner attitudes and beliefs towards LBP, however no such studies involving medical students have been identified. METHODS: This study explored medical students' knowledge, attitudes and beliefs towards LBP before and after a brief educational intervention on LBP. Responses from medical students (n=93) were evaluated before and after a 15-min educational video on back pain. The intervention was developed using Camtasia™ video editor and screen recorder. Knowledge, attitudes and beliefs were measured using the "Modified Back Beliefs Questionnaire", with items from two previously reported questionnaires on back beliefs. The questionnaire asks participants to indicate their agreement with statements about LBP on a 5-point Likert scale. Preferred responses were based on guidelines for the evidence-based management of LBP. The primary analysis evaluated total score on the nine-inevitability items of the Back Beliefs Questionnaire ("inevitability score"). RESULTS: Following the brief intervention there was a significant improvement in the inevitability score (post-workshop mean [SD] 20.8 [4.9] vs pre-workshop mean [SD] 26.9 [4.2]; mean difference (MD) 6.1, p<0.001; lower score more favourable1) and large improvements in the proportion of students providing correct responses to items on activity (pre: 49% vs post: 79%), bed rest (41% vs 75%), imaging (44% vs 74%) and recovery (25% vs 66%). CONCLUSIONS: After watching the educational video students' knowledge, beliefs and attitudes towards LBP improved and thus aligned more closely with evidence-based guidelines. IMPLICATIONS: Medical doctors are at the forefront of managing low back pain in the community, however there is a need to strengthen musculoskeletal education in medical training programmes. The results from this research suggest educational interventions on back pain do not need to be extensive in order to have favourable outcomes on medical students' knowledge, attitudes and beliefs towards back pain. The translational effects of these changes into clinical practice are not known.

What Are You Measuring? Dimensionality and Reliability Analysis of Ability and Speed in Medical School Didactic Examinations.

Summative didactic evaluation often involves multiple choice questions which are then aggregated into exam scores, course scores, and cumulative grade point averages. To be valid, each of these levels should have some relationship to the topic tested (dimensionality) and be sufficiently reproducible between persons (reliability) to justify student ranking. Evaluation of dimensionality is difficult and is complicated by the classic observation that didactic performance involves a generalized component (g) in addition to subtest specific factors. In this work, 183 students were analyzed over two academic years in 13 courses with 44 exams and 3352 questions for both accuracy and speed. Reliability at all levels was good (>0.95). Assessed by bifactor analysis, g effects dominated most levels resulting in essential unidimensionality. Effect sizes on predicted accuracy and speed due to nesting in exams and courses was small. There was little relationship between person ability and person speed. Thus, the hierarchical grading system appears warrented because of its g-dependence.

Motivations and demographics of I-6 and traditional 5+2 cardiothoracic surgery resident applicants: insights from an academic training program.

BACKGROUND: The introduction of the integrated 6-year cardiothoracic surgery residency (I-6) has changed the training paradigm for future cardiothoracic surgeons. Increased interest in these programs emphasizes the need for an understanding of the applicant pool and of their differences from the traditional trainee (5+2). METHODS: National trends (National Resident Matching Program data), objective (Electronic Residency Application Services documents, United States Medical Licensing Examination [USMLE] scores, transcripts) and subjective metrics (interviews, personal statements, and recommendation letters) were evaluated for invited applicants for I-6 and 5+2 positions in 2010, 2011, and 2012. Demographics and motivations for specialty selection were determined. Statistical analyses were performed with Student's t test for continuous variables and Fisher's exact test for categoric variables. RESULTS: The number of applicants completing the match for I-6 positions each year was as follows: 2010, 74 (49 United States [US]); 2011, 74 (53 US); 2012, 80 (59 US). The number completing the match for 5+2 positions was as follows: 2010, 93 (67 US); 2011, 87 (55 US); 2012, 90 (63 US). For I-6 positions we interviewed 9 candidates in 2010, 17 in 2011, and 16 in 2012; for the 5+2 program we interviewed 14 candidates in 2010, 17 in 2011, and 13 in 2012. Both groups had a similar percentage of female applicants, number of US medical graduates, additional degrees, and membership in Alpha Omega Alpha. The I-6 applicants were younger (mean age, 27.4 years), were less likely to take time off for research (43.5% vs 72.7%), were less published, and had higher surgery clinical honors and USMLE scores. The 5+2 applicants were less likely to have done a cardiothoracic medical school rotation and had done senior-level rotations on general thoracic during residency; yet, only 29.5% had done a senior level cardiac rotation. The most frequently cited motivation was a clinical encounter during a cardiothoracic rotation for both (94.9% I-6 applicants, 88.6% 5+2 applicants). The I-6 applicants had more interest in minimally invasive techniques. There were no differences in the influence of a mentor or a desire for an academic career. CONCLUSIONS: Institutional strategies to increase medical student and general surgery resident exposure to cardiothoracic surgery clinically will optimize our ability to attract and train the best candidates in our specialty.

Popularity of Russian information sources of medical education.

The aim of the present study is to analyze the popularity of information sources of medical educational sites <webmedinfo.ru>, medical information portal <meduniver.com>, medical portal for students <6years.net>, electronic library of medical literature <booksmed.com>, <medliter.ru> and <medbook.net.ru>. Three sites (<www.webmedinfo.ru>, <meduniver.com> and <6years.net>) provide sources of medical literature, educational videos, medical histories, medical papers and medical popular literature. And three other sites (<www.booksmed.com>, <www.medliter.ru> and <www.medbook.net.ru>) provide sources for electronic medical books on various subjects. Using on-line programs Alexa and Cy-pr we have analyzed the website's rating and identified the main data and time-varying data of the sites. Calculated Alexa Rank rating was determined for each site. Our study has shown that the most popular information sources of medical education among the six studied sites for Russian users is <meduniver.com>; the site <booksmed.com> is at the second place referring to the Alexa Rank rating and the site <webmedinfo.ru> is at the second place referring to the citation index in Yandex. The most popular medical site of electronic medical books is <booksmed.com>.

Initial experience at a university teaching hospital from using telemedicine to promote education through video conferencing.

CONTEXT AND OBJECTIVE: Telehealth and telemedicine services are advancing rapidly, with an increasing spectrum of information and communication technologies that can be applied broadly to the population's health, and to medical education. The aim here was to report our institution's experience from 100 videoconferencing meetings between five different countries in the Americas over a one-year period. DESIGN AND SETTING: Retrospective study at Universidade Estadual de Campinas. METHODS: Through a Microsoft Excel database, all conferences in all specialties held at our institution from September 2009 to August 2010 were analyzed retrospectively. RESULTS: A total of 647 students, physicians and professors participated in telemedicine meetings. A monthly mean of 8.3 (± 4.3) teleconferences were held over the analysis period. Excluding holidays and the month of inaugurating the telemedicine theatre, our teleconference rate reached a mean of 10.3 (± 2.7), or two teleconferences a week, on average. Trauma surgery and meetings on patient safety were by far the most common subjects discussed in our teleconference meetings, accounting for 22% and 21% of the total calls. CONCLUSION: Our experience with telemedicine meetings has increased students' interest; helped our institution to follow and discuss protocols that are already accepted worldwide; and stimulated professors to promote telemedicine-related research in their own specialties and keep up-to-date. These high-technology meetings have shortened distances in our vast country, and to other reference centers abroad. This virtual proximity has enabled discussion of international training with students and residents, to increase their overall knowledge and improve their education within this institution.

Initial experience at a university teaching hospital from using telemedicine to promote education through video conferencing / Experiência inicial de um hospital universitário utilizando a telemedicina na promoção de educação através de vídeo-conferências

CONTEXT AND OBJECTIVE: Telehealth and telemedicine services are advancing rapidly, with an increasing spectrum of information and communication technologies that can be applied broadly to the population's health, and to medical education. The aim here was to report our institution's experience from 100 videoconferencing meetings between five different countries in the Americas over a one-year period. DESIGN AND SETTING: Retrospective study at Universidade Estadual de Campinas. METHODS: Through a Microsoft Excel database, all conferences in all specialties held at our institution from September 2009 to August 2010 were analyzed retrospectively. RESULTS: A total of 647 students, physicians and professors participated in telemedicine meetings. A monthly mean of 8.3 (± 4.3) teleconferences were held over the analysis period. Excluding holidays and the month of inaugurating the telemedicine theatre, our teleconference rate reached a mean of 10.3 (± 2.7), or two teleconferences a week, on average. Trauma surgery and meetings on patient safety were by far the most common subjects discussed in our teleconference meetings, accounting for 22 percent and 21 percent of the total calls. CONCLUSION: Our experience with telemedicine meetings has increased students' interest; helped our institution to follow and discuss protocols that are already accepted worldwide; and stimulated professors to promote telemedicine-related research in their own specialties and keep up-to-date. These high-technology meetings have shortened distances in our vast country, and to other reference centers abroad. This virtual proximity has enabled discussion of international training with students and residents, to increase their overall knowledge and improve their education within this institution.

CONTEXTO E OBJETIVO: Serviços de telessaúde e telemedicina estão avançando rapidamente, com um espectro cada vez maior de tecnologias da informação e comunicação que podem ser aplicadas de forma ampla para a saúde da população, bem como para a educação médica. O objetivo deste artigo é relatar a experiência da nossa instituição com 100 reuniões por videoconferência entre cinco diferentes países das Américas no período de um ano. TIPO DE ESTUDO E LOCAL: Estudo retrospectivo na Universidade Estadual de Campinas. MÉTODOS: Através de um banco de dados do Microsoft Excel, foram analisadas retrospectivamente todas as conferências realizadas em nossa instituição, de setembro de 2009 a agosto de 2010, em todas as especialidades. RESULTADOS: Um total de 647 alunos, médicos e professores participaram das reuniões de telemedicina. Em média, 8,3 (± 4,3) teleconferências foram realizadas mensalmente durante o período analisado. Excluindo os feriados e o mês de inauguração do anfiteatro de telemedicina, as nossas taxas de teleconferência atingiram a média de 10,3 (± 2,7), ou duas teleconferências sobre uma média semanal. Cirurgia do Trauma e reuniões sobre segurança dos pacientes foram, de longe, os temas mais comuns discutidos em nossas reuniões de teleconferência, correspondendo por 22 por cento e 21 por cento do total de chamadas. CONCLUSÃO: Nossa experiência com as reuniões de telemedicina aumentou o interesse dos alunos, ajudou a nossa instituição a acompanhar e discutir protocolos que já são aceitos em todo o mundo e estimulou nossos professores a promover pesquisas relacionadas à telemedicina em suas próprias especialidades, mantendo-os atualizados. Essas reuniões com envolvimento de alta tecnologia encurtaram as distâncias dentro de nosso país vasto e com outros centros de referência no exterior. Esta proximidade virtual permitiu discussões com alunos e residentes sobre estágios internacionais a fim de aumentar seu conhecimento global e melhorar a sua educação dentro da própria instituição.

The Bologna process, medical education and integrated learning.

The Bologna Declaration, signed in 1999 by all European Ministers of Education and currently in a phase of active implementation in Europe, specifies a three-cycle degree structure - Bachelor's, Master's, Doctorate - for all disciplines in Higher Education. The application of this model to medical education has been opposed on various grounds. In particular, a 'Ba/Ma' model for undergraduate medical degrees has been viewed as undoing recent progress towards fully integrated learning of basic and clinical medical sciences. However, this can be overcome by the use of a learning outcomes framework, agreed at European level, that reinforces the primarily medical nature of both degrees and which requires integrated teaching, learning and assessment at every stage. With this proviso, application of the Bologna principles to medicine can help to drive educational development and quality enhancement in European medical education.

[Modeling the academic performance of medical students in basic sciences and pre-clinical courses: a longitudinal study]. / Modelos de predicción del rendimiento académico de los estudiantes de medicina en el ciclo básico y preclínico. Un estudio longitudinal.

BACKGROUND: The study of predictors of academic performance is relevant for medical education. Most studies of academic performance use global ratings as outcome measure, and do not evaluate the influence of the assessment methods. AIM: To model by multivariate analysis, the academic performance of medical considering, besides academic and demographic variables, the methods used to assess students' learning and their preferred modes of information processing. MATERIAL AND METHODS: Two hundred seventy two students admitted to the medical school of the Pontificia Universidad Católica de Chile from 2000 to 2003. Six groups of variables were studied to model the students' performance in five basic science courses (Anatomy, Biology, Calculus, Chemistry and Physics) and two pre-clinical courses (Integrated Medical Clinic I and IT). The assessment methods examined were multiple choice question tests, Objective Structured Clinical Examination and tutor appraisal. RESULTS: The results of the university admission tests (high school grades, mathematics and biology tests), the assessment methods used, the curricular year and previous application to medical school, were predictors of academic performance. The information processing modes influenced academic performance, but only in interaction with other variables. Perception (abstract or concrete) interacted with the assessment methods, and information use (active or reflexive), with sex. The correlation between the real and predicted grades was 0.7. CONCLUSIONS: In addition to the academic results obtained prior to university entrance, the methods of assessment used in the university and the information processing modes influence the academic performance of medical students in basic and preclinical courses.

Modelos de predicción del rendimiento académico de los estudiantes de medicina en el ciclo básico y preclínico: Un estudio longitudinal / Modeling the academic performance of medical students in basic sciences and pre-clinical courses: A longitudinal study

Background: The study of predictors of academic performance is relevant for medical education. Most studies of academic performance use global ratings as outcome measure, and do not evaluate the influence of the assessment methods. Aim: To model by multivariate analysis, the academic performance of medical considering, besides academic and demographic variables, the methods used to assess students' learning and their preferred modes of information processing. Material and methods: Two hundred seventy two students admitted to the medical school of the Pontificia Universidad Católica de Chile from 2000 to 2003. Six groups of variables were studied to model the students' performance in five basic science courses (Anatomy, Biology, Calculus, Chemistry and Physics) and two pre-clinical courses (Integrated Medical Clinic I and IT). The assessment methods examined were multiple choice question tests, Objective Structured Clinical Examination and tutor appraisal. Results: The results of the university admission tests (high school grades, mathematics and biology tests), the assessment methods used, the curricular year and previous application to medical school, were predictors of academic performance. The information processing modes influenced academic performance, but only in interaction with other variables. Perception (abstract or concrete) interacted with the assessment methods, and information use (active or reflexive), with sex. The correlation between the real and predicted grades was 0.7. Conclusions: In addition to the academic results obtained prior to university entrance, the methods of assessment used in the university and the information processing modes influence the academic performance of medical students in basic and preclinical courses.

Automated capture and assessment of medical student clinical experience.

Currently, many medical educators track trainee clinical experience using student-created manual logs. Using a web-based portfolio system that captures all notes written by trainees in the electronic medical record, we examined a graduating medical student's clinical notes to determine if we could automatically assess exposure to 10 institution-defined core clinical topics. We located all biomedical concepts in his clinical notes, divided by note section, using the KnowledgeMap concept identifier. Notes were ranked according to the concepts matching each core topic's concept list. Clinician educators then reviewed each note to determine relevance to the core topic. The student covered all core topics, with between 2 and 41 notes containing highly relevant discussions. The algorithm effectively predicted relevance (p<0.001). This method is a promising first step toward automated competency assessment.

It's about TIME: a general-purpose taxonomy of subjects in medical education.

CONTEXT: Modern computer technology permits the creation of detailed, dynamic electronic curriculum maps to facilitate curriculum searching, organisation and quality assurance. However, when attempting to map curricular content, a common question to arise is: 'To what should we map our curriculum?' With respect to content (i.e. the subject being taught, learned or examined), mapping to terminal outcomes or competencies may be too broad, whereas mapping to learning objectives is too specific. METHODS: To address this problem, the authors created TIME-ITEM (topics for indexing medical education; en Français: index des thèmes pour l'éducation médicale), a hierarchical taxonomy of topics relevant to medical education. It is a general-purpose, intermediate-granularity, standardised index that covers the entire range of subject matter in medical education. The content and structure of topics within TIME was developed in consultation with medical educators and librarians at several Canadian medical schools. As far as possible, the language used is standardised to the Unified Medical Language System. RESULTS: TIME is available as a web application that allows users from various schools to enter their school-specific outcomes, competencies and learning objectives, and then link these to the standardised topics in a way that is meaningful to the school. The entire TIME content and structure can then be exported, via xml, to external applications and used as an index for curriculum mapping, meta-tagging learning objects, or categorising examination questions. TIME can be viewed at http://www.time-item.org (username: 'guest'; password: 'guest').