Self-regulated learning microanalysis for the study of the performance of clinical examinations by physiotherapy students.

BACKGROUND: Students require feedback on their self-regulated learning (SRL) processes to improve the performance of clinical examinations. The key SRL processes used by students can be identified by SRL-micro-analysis but, this method has not been previously applied to physiotherapy students. The aim of this pilot study was to test a research design that might allow the evaluation of the potential usefulness of SRL microanalysis for the identification of key SRL processes used by physiotherapy students during the performance of a clinical examination skill. The objectives of the pilot study were: 1) to evaluate whether SRL-microanalysis could identify differences in the use of SRL processes between successful and unsuccessful students; 2) to evaluate the reliability of SRL microanalysis ratings produced by different assessors. METHODS: SRL-microanalysis was used with second year physiotherapy students of a Spanish university (n = 26) as they performed a goniometric task. The task required students to obtain a goniometric measurement of the shoulder joint of a peer. Two assessors evaluated student performance and conducted the SRL- microanalysis with all students. An analysis of inter-rater reliability was performed to evaluate the degree of agreement between assessors. RESULTS: The SRL-microanalysis revealed differences in the use of key SRL processes between successful (n = 15: 57.0%) and unsuccessful performers (n = 11: 43.0%): The differences were particularly evident in strategic planning and self-monitoring skills. There was good inter-rater reliability for scoring of strategic planning (k = 0.792), self-monitoring (k = 0.946) and self-evaluation (k = 0.846). CONCLUSION: The use of SRL microanalysis characterized the key SRL processes of physiotherapy students performing a clinical skill with reliability between the assessors. This pilot study supports the potential usefulness of SRL-microanalysis for the identification of key SRL processes in physiotherapy education. Therefore, this study paves the way to the development of a full study, with a larger number of students and more diverse clinical tasks, to evaluate the SRL processes in successful and unsuccessful students.

Clarifying changes in student empathy throughout medical school: a scoping review.

Despite the increasing awareness of the relevance of empathy in patient care, some findings suggest that medical schools may be contributing to the deterioration of students' empathy. Therefore, it is important to clarify the magnitude and direction of changes in empathy during medical school. We employed a scoping review to elucidate trends in students' empathy changes/differences throughout medical school and examine potential bias associated with research design. The literature published in English, Spanish, Portuguese and French from 2009 to 2016 was searched. Two-hundred and nine potentially relevant citations were identified. Twenty articles met the inclusion criteria. Effect sizes of empathy scores variations were calculated to assess the practical significance of results. Our results demonstrate that scoped studies differed considerably in their design, measures used, sample sizes and results. Most studies (12 out of 20 studies) reported either positive or non-statistically significant changes/differences in empathy regardless of the measure used. The predominant trend in cross-sectional studies (ten out of 13 studies) was of significantly higher empathy scores in later years or of similar empathy scores across years, while most longitudinal studies presented either mixed-results or empathy declines. There was not a generalized international trend in changes in students' empathy throughout medical school. Although statistically significant changes/differences were detected in 13 out of 20 studies, the calculated effect sizes were small in all but two studies, suggesting little practical significance. At the present moment, the literature does not offer clear conclusions relative to changes in student empathy throughout medical school.

Depression in medical students: insights from a longitudinal study.

BACKGROUND: Factors associated with depression of medical students are poorly understood. The purpose of this study is to determine the prevalence of depression in medical students, its change during the course, if depression persists for affected students, what are the factors associated with depression and how these factors change over time. METHODS: A prospective, longitudinal observational study was conducted at the Medical School of the University of Minho, Portugal, between academic years 2009-2010 to 2012-2013. We included students who maintained their participation by annually completing a questionnaire including Beck Depression Inventory (BDI). Anxiety and burnout were assessed using the State Trait Anxiety Inventory and Maslach Burnout Inventory. Surveys on socio-demographic variables were applied to evaluate potential predictors, personal and academic characteristics and perceived difficulties. ANOVA with multiple comparisons were used to compare means of BDI score. The medical students were organized into subgroups by K-means cluster analyses. ANOVA mixed-design repeated measurement was performed to assess a possible interaction between variables associated with depression. RESULTS: The response rate was 84, 92, 88 and 81% for academic years 2009-2010, 2010-2011,2011-2012 and 2012/2013, respectively. Two hundred thirty-eight medical students were evaluated longitudinally. For depression the prevalence ranged from 21.5 to 12.7% (academic years 2009/2010 and 2012/2013). BDI scores decreased during medical school. 19.7% of students recorded sustained high BDI over time. These students had high levels of trait-anxiety and choose medicine for anticipated income and prestige, reported more relationship issues, cynicism, and decreased satisfaction with social activities. Students with high BDI scores at initial evaluation with low levels of trait-anxiety and a primary interest in medicine as a career tended to improve their mood and reported reduced burnout, low perceived learning problems and increased satisfaction with social activities at last evaluation. No difference was detected between men and women in the median BDI score over time. CONCLUSIONS: Our findings suggest that personal factors (anxiety traits, medicine choice factors, relationship patterns and academic burnout) are relevant for persistence of high levels of BDI during medical training. Medical schools need to identity students who experience depression and support then, as early as possible, particularly when depression has been present over time.

Psychometric properties of the Spanish version of the Jefferson Scale of Empathy: making sense of the total score through a second order confirmatory factor analysis.

BACKGROUND: Empathy is a key aspect of the physician-patient interactions. The Jefferson Scale of Empathy (JSE) is one of the most used empathy measures of medical students. The development of cross-cultural empathy studies depends on valid and reliable translations of the JSE. This study sought to: (1) adapt and assess the psychometric properties in Spanish students of the Spanish JSE validated in Mexican students; (2) test a second order latent factor model. METHODS: The Spanish JSE was adapted from the Spanish JSE-S, resulting in a final version of the measure. A non-probabilistic sample of 1104 medical students of two Spanish medical schools completed a socio-demographic and the Spanish JSE-S. Descriptive statistics, along with a confirmatory factor analysis, the average variance extracted (AVE), Cronbach's alphas and composite reliability (CR) coefficients were computed. An independent samples t-test was performed to access sex differences. RESULTS: The Spanish JSE-S demonstrated acceptable to good sensitivity (individual items - except for item 2 - and JSE-S total score: -2.72 < Sk < 0.35 and -0.77 < Ku < 7.85), convergent validity (AVE: between 0.28 and 0.45) and reliability (Cronbach's alphas: between 0.62 and 0.78; CR: between 0.62 and 0.87). The confirmatory factor analysis supported the three-factor solution and the second order latent factor model. CONCLUSIONS: The findings provide support for the sensitivity, construct validity and reliability of the adapted Spanish JSE-S with Spanish medical students. Data confirm the hypothesized second order latent factor model. This version may be useful in future research examining empathy in Spanish medical students, as well as in cross-cultural studies.

The remediation challenge: theoretical and methodological insights from a systematic review.

OBJECTIVES: Remediation is usually offered to medical students and doctors in training who underperform on written or clinical examinations. However, there is uncertainty and conflicting evidence about the effectiveness of remediation. The aim of this systematic review was to synthesise the available evidence to clarify how and why remediation interventions may have worked in order to progress knowledge on this topic. METHODS: The MEDLINE, EMBASE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), ERIC (Educational Resources Information Centre), Web of Science and Scopus databases were searched for papers published from 1984 to April 2012, using the search terms 'remedial teaching', 'education', 'medical', 'undergraduate'/or 'clinical clerkship'/or 'internship and residency', 'at risk' and 'struggling'. Only studies that included an intervention, then provided retest data, and reported at least one outcome measure of satisfaction, knowledge, skills or effects on patients were eligible for inclusion. Studies of practising doctors were excluded. Data were abstracted independently in duplicate for all items. Coding differences were resolved through discussion. RESULTS: Thirty-one of 2113 studies met the review criteria. Most studies were published after 2000 (n=24, of which 12 were published from 2009 onwards), targeted medical students (n=22) and were designed to improve performance on an immediately subsequent examination (n=22). Control or comparison groups, conceptual frameworks, adequate sample sizes and long-term follow-up measures were rare. In studies that included long-term follow-up, improvements were not sustained. Intervention designs tended to be highly complex, but their design or reporting did not enable the identification of the active components of the remedial process. CONCLUSIONS: Most remediation interventions in medical education focus on improving performance to pass a re-sit of an examination or assessment and provide no insight into what types of extra support work, or how much extra teaching is critical, in terms of developing learning. More recent studies are generally of better quality. Rigorous approaches to developing and evaluating remediation interventions are required.

An Objective Structured Laboratory Animal Science Examination (OSLASE) to ensure researchers' professional competence in laboratory animal science.

The evaluation of the competence of personnel working with laboratory animals is currently a challenge. Directive 2010/63/EU establishes that staff must have demonstrated competence before they perform unsupervised work with living animals. Nevertheless, there is a lack of research into education and training in laboratory animal science, and the establishment of assessment strategies to confirm researchers' competence remains largely unaddressed.In this study, we analysed the implementation of a practical assessment strategy over three consecutive years (2018-2021) using the Objective Structured Laboratory Animal Science Exam (OSLASE) developed previously by us to assess professional competence. The interrater reliability (IRR) was determined based on the assessors' rating of candidates' performance at different OSLASE stations using weighted kappa (Kw) and percentage of agreement. Focus group interviews were conducted to access trainees' acceptability regarding the OSLASE.There was a moderate-to-good Kw for the majority of the scales' items (0.79 ± 0.20 ≤ Kw ≥ 0.45 ± 0.13). The percentages of agreement were also acceptable (≥75%) for all scale items but one. Trainees reported that the OSLASE had a positive impact on their engagement during practical training, and that it clarified the standards established for their performance and the skills that required improvement. These preliminary results illustrate how assessment strategies, such as the OSLASE, can be implemented in a manner that is useful for both assessors and trainees.Examen structuré objectif de science animale de laboratoire (OSASSE) pour assurer la compétence professionnelle des chercheurs en SAL.

Empathy in senior year and first year medical students: a cross-sectional study.

BACKGROUND: The importance of fostering the development of empathy in undergraduate students is continuously emphasized in international recommendations for medical education. Paradoxically, some studies in the North-American context using self-reported measures have found that empathy declines during undergraduate medical training. Empathy is also known to be gender dependent- (highest for female medical students) and related to specialty preference - (higher in patient-oriented than technology-oriented specialties). This factor has not been studied in Portuguese medical schools. METHODS: This is a cross-sectional study of undergraduate medical students on self-rated measures of empathy collected at entrance and at the conclusion of the medical degree, and on the association of empathy measures with gender and specialty preferences in one medical school in Portugal. Empathy was assessed using the Portuguese adaptation of the Jefferson Scale of Physician Empathy-students version (JSPE-spv) among three cohorts of undergraduate medical students in the first (N = 356) and last (N = 120) year. The construct validity of JSPE-spv was cross-validated with Principal Component Analysis and Confirmatory Factor Analysis. Reliability was assessed using Cronbach' Alpha. Global JSPE-spv score differences were examined by year of medical school, gender and specialty preferences (people-oriented vs technology-oriented specialties). RESULTS: The empathy scores of students in the final year were higher as compared to first year students (F (1,387) = 19.33, p < .001, ɳ2p = 0.48; π = 0.99). Female students had higher empathy scores than male students (F (1,387) = 8.82, p < .01, ɳ 2p = 0.23; π = 0.84). Significant differences in empathy were not found between the students who prefer people-oriented specialties compared to those who favor the technology-oriented specialties (F (1,387) = 2.44, p = .12, ɳ 2p = 0.06; π = 0.06). CONCLUSIONS: This cross-sectional study in one medical school in Portugal showed that the empathy measures of senior year students were higher than the scores of freshmen. A longitudinal cohort study is needed to test variations in students' empathy measures throughout medical school.

The assessment of researchers' competence in experimental procedures with laboratory animals: A three-step methodology to develop a global rating scale.

To conduct animal experiments, researchers must be competent to handle and perform interventions on living animals in compliance with regulations. Laboratory animal science training programmes and licensing bodies therefore need to be able to reliably ensure and certify the professional competence of researchers and technicians. This requires access to assessment strategies which can verify knowledge as well as capturing performative and behavioural dimensions of assessment. In this paper, we describe the process of developing different global rating scales measuring candidates' competence in a performative assessment. We set out the following sequence, with three crucial phases, in the process of scale development: (a) Item Development, (b) Scale Development and (c) Piloting of the Scale. We note each phase's different sub-steps. Despite the emergent need to ensure the competence of researchers using animals in scientific procedures, to our best knowledge there are very few species and procedure/skill specific assessment tools for this purpose, and the assessment methodology literature in the field is very limited. This paper provides guidance for those who need to develop and assess proficiency in laboratory animal procedures by setting out a method that can be used to create the required tools and illustrating how competence assessment strategies can be implemented.

Effects of graded levels of exogenous xylanase in corn-soy diets with two amino acid density and fat levels postpellet in broiler chickens: live performance, energy utilization, digestibility, and carcass characteristics.

This experiment evaluated the interactive effects among xylanase (XL; 0, 8,000, 16,000, and 32,000 BXU/kg), amino acid density (AA; high and low 10% difference), and additional fat (AF; 0 or +1.17%) applied postpellet in corn-soybean meal diets with dried distillers grains with solubles on performance, energy utilization, digestibility, and carcass traits in Ross 708 male broilers. A completely randomized block (pen location) design with 16 treatments arranged factorially (4 XL levels, 2 AA, and 2 AF) was analyzed using mixed models. No significant interactions or main effects were observed for feed intake at 49 d (P > 0.05) but chicks were heavier when consuming diets containing 0 or 8,000 BXU/kg (P = 0.015), high AA (P < 0.001), and 1.17% AF (P < 0.001). Feed efficiency did not vary with XL supplementation (P > 0.05) but was improved in broilers fed the higher AA and AF diet (P = 0.015 for AA × AF). AME, GE, and CP digestibility were assessed at days 17 and 42. There were multiple interactions observed at day 17 with a significant three-way showing that AME and CP digestibility improved when increasing the XL and AF levels in the high AA fed birds compared with the low-density diets. At day 42, XL and AF significantly affected AMEn, GE, or CP digestibility; however, there was a significant interaction between XL and AF. Diets supplemented with 1.17% AF improved AMEn significantly in broilers fed the highest XL level. Breast yield was not affected by treatments, but wing yield decreased with high AA density when diets contained 16,000 BXU/kg without differences for the other diets (P = 0.04 for XL × AA). Effects of XL, AA, and AF interactions on performance and cut-up-part yields have to be considered until day 42 for most of the variables studied. However, at 49 d of age, the dietary AA density and AF did not markedly influence the response to XL in maize-based diets.

Dietary methionine level alters growth, digestibility, and gene expression of amino acid transporters in meat-type chickens.

Imbalance in nutrients can affect digestibility of amino acids by altering gene expression of amino acid transporters. We investigated digestibility and molecular transporters of essential amino acids in chickens fed a methionine-deficient diet. A total of 40 chicks (23 D old) were randomly assigned to either a control (0.49% methionine) or a deficient (0.28%) diet until 41 D when they were sampled for Pectoralis (P.) major, kidney, ileum, and hypothalamus for mRNA expression analysis. The ileal content was collected for apparent ileal digestibility (AID) analysis. Birds fed the deficient diet had reduced growth and worse feed efficiency compared to control. The AID of methionine was similar between both groups. The AID of other essential amino acids was higher in the deficient group than control. mRNA expression of b0,+ AT and LAT4 were upregulated in the ileum and kidney but LAT1 was downregulated only in kidney of the deficient group compared to control. In the P. major, SNAT1, SNAT2, and CAT1 were upregulated in the deficient group compared to control. A diet deficiency in methionine affects digestibility of essential amino acids and cysteine, but not the digestibility of methionine. The change in digestibility is reflected in the mRNA expression of amino acid transporters across different tissues.

The evaluation of student-centredness of teaching and learning: a new mixed-methods approach.

OBJECTIVE: The aim of the study was to develop and consider the usefulness of a new mixed-methods approach to evaluate the student-centredness of teaching and learning on undergraduate medical courses. An essential paradigm for the evaluation was the coherence between how teachers conceptualise their practice (espoused theories) and their actual practice (theories-in-use). METHODS: The context was a module within an integrated basic sciences course in an undergraduate medical degree programme. The programme had an explicit intention of providing a student-centred curriculum. A content analysis framework based on Weimer's dimensions of student-centred teaching was used to analyze data collected from individual interviews with seven teachers to identify espoused theories and 34h of classroom observations and one student focus group to identify theories-in-use. The interviewees were identified by purposeful sampling. The findings from the three methods were triangulated to evaluate the student-centredness of teaching and learning on the course. RESULTS: Different, but complementary, perspectives of the student-centredness of teaching and learning were identified by each method. The triangulation of the findings revealed coherence between the teachers' espoused theories and theories-in-use. CONCLUSIONS: A mixed-methods approach that combined classroom observations with interviews from a purposeful sample of teachers and students offered a useful evaluation of the extent of student-centredness of teaching and learning of this basic science course. Our case study suggests that this new approach is applicable to other courses in medical education.

Aprendizaje autorregulado: una estrategia para 'enseñar a aprender' en ciencias de la salud / Self-regulated learning: a strategy to 'teach to learn' in health sciences

La formación de profesionales sanitarios conlleva unos objetivos de aprendizaje concretos que deben traducirse en unos resultados de aprendizaje observables y evaluables y, por lo tanto, que el conocimiento se alcance con un alto grado de pericia. Con el fin de mejorar el aprendizaje de habilidades clínicas se han desarrollado instrumentos para evaluar el aprendizaje autorregulado, un proceso activo en el que la persona selecciona las metas académicas que desea alcanzar y regula una serie de variables que intervienen en el aprendizaje con el objetivo de alcanzarlas. Un ejemplo de ello es la evaluación microanalítica del aprendizaje autorregulado, una entrevista estructurada que intenta captar los pensamientos, sentimientos y acciones dedicados a la ejecución de tareas específicas. La investigación actual en este campo ha demostrado que los estudiantes de alto rendimiento tienden en general a mostrar un pensamiento más estratégico y una mejor regulación al realizar las actividades o tareas. Se pretende establecer el microanálisis como estrategia para identificar el aprendizaje de los alumnos y como meta para poder generalizarse en la educación en ciencias de la salud

The training of healthcare professionals obeys to specific learning objectives that must result in observable and assessable learning achievements, and in mastered knowledge acquisition. In order to improve the learning process of clinical skills, several methods have been developed with the aim of assessing self-regulated learning. Self-regulated learning is an active process where individuals select the academic goals they wish to achieve and, for that purpose, they regulate a set of factors that influence their learning. Self-Regulated Learning Microanalytic Assessment and Training may be taken as an example. This method consists of a structured interview that tries to capture the thoughts, feelings and actions devoted to the execution of specific tasks. Current investigations in this field have shown that high-achievers tend to think more strategically and regulate themselves better when performing activities or tasks. Finally, the microanalysis may be implemented as the strategy used to identify how students learn, and to generalize in healthcare education

Comunicação de más notícias pelos médicos no primeiro ano de internato: um estudo exploratório / Comunicación de malas noticias por los residentes de primer año: estudio exploratorio / Breaking bad news by first year residents-an exploratory study

Introdução: A compreensão das dificuldades dos médicos no processo de comunicação de más notícias, em particular de médicos recém-diplomados, pode contribuir para orientar o desenvolvimento de formação nessa temática. Objetivo: Este estudo procurou explorar as perceções de internos recém-licenciados relativamente à sua a preparação para comunicar más notícias e relativamente às características de programas dos curricula de medicina consideradas desejáveis para uma adequada formação. Sujeitos e métodos: Realizou-se um estudo exploratório de natureza qualitativa com dois grupos focais (n = 6 e n = 7) com internos com menos de um ano de experiência, num hospital em Portugal. As sessões foram gravadas em áudio, transcritas e submetidas a análise temática. Resultados: Os internos relataram dificuldades e insegurança na transmissão de más notícias, embora considerassem possuir boas competências de comunicação na generalidade. As suas principais dificuldades consistiam em lidar com as emoções e reações do médico e dos pacientes como o choro e o silêncio. A existência de vivências prévias de experiências negativas condicionava a sua segurança neste processo. Estes apontaram como limitações à sua formação pré-graduada nesta área, o ensino precoce e desarticulado nos curricula e a insuficiência de formação prática. Conclusão: O melhoramento da preparação dos jovens internos na comunicação de más notícias deve cuidar os aspetos emocionais do processo. Estes consideram ser fundamental desenvolver programas longitudinais de formação nos curricula dos cursos de medicina, recorrendo a contextos de treino simulados e reais

Introducción: La comprensión de las dificultades en la comunicación de malas noticias de los médicos recién graduados es importante para guiar el desarrollo de la educación de pregrado en esta área de la comunicación médico-paciente. Objetivo: Explorar las percepciones de los médicos graduados en el final de su primer año de residencia, en relación con su preparación para dar malas noticias, y las características deseables de los planes de estudios médicos de pregrado eficaces en este ámbito. Sujetos y métodos: Se realizó un estudio exploratorio cualitativo con dos grupos de enfoque de residentes de primer año (n = 6 y n = 7) de un hospital en Portugal. Las sesiones de grupos focales fueron audiograbadas, transcritas y sometidas a análisis temático. Resultados: Los residentes informaron de dificultades e inseguridad en la comunicación de malas noticias, aunque consideraran que tenían buenas habilidades de comunicación en general. Sus principales dificultades se centraron en afrontar las emociones y reacciones del médico y el paciente, como el llanto y el silencio. Experiencias negativas anteriores condicionaron su seguridad en la comunicación de malas noticias. Las principales limitaciones reconocidas en su formación de pregrado en esta área fueron la educación temprana y desarticulada en los planes de estudios y la falta de formación práctica. Conclusión: La mejora de la formación médica de pregrado en malas noticias debe prestar atención a los aspectos emocionales del proceso. Debe diseñarse longitudinalmente, incluyendo la simulación y contextos reales

Introduction: Understanding the difficulties in breaking bad news of doctors recently graduated from medical school is important to guide the development of undergraduate education in this area of patient-physician communication. Aim: To explore the perceptions of medical graduates at the end of their first year of residency, concerning their present preparation for breaking bad news and the desirable characteristics of effective undergraduate medical curricula in this area. Subjects and methods: This was a qualitative exploratory study with two focus groups of first year residents (n = 6 and n = 7) of a hospital in Portugal. The focus group sessions were audio-recorded, transcribed and subjected to thematic analysis. Results. The residents reported difficulties and insecurity in breaking bad news, even though they considered having good communication skills in general. Their main difficulties were to deal with the emotions and reactions of the physician and patient, such as crying and silence. Previous negative experiences conditioned their security in breaking bad news. The main limitations acknowledged in their undergraduate training in this area, were early and disjointed education in curricula and the lack of practical training. Conclusion: The improvement of medical training in breaking bad news should pay attention to the emotional aspects of the process. Undergraduate medical curricula should be designed longitudinally, involving simulation as well as real contexts

A experiência de transição para a fase clínica de alunos de medicina detentores de grau prévio: um estudo de caso / The experience of graduate entry students in the transition to the clinical phase: a case study

Introdução. Internacionalmente tem-se assistido à extensão da oferta formativa de cursos de Medicina de menor duração a candidatos detentores de um grau acadêmico superior prévio. Este estudo de caso procura compreender a experiência dos estudantes licenciados nestes cursos, a fim de identificar fatores que condicionem a sua formação durante o inicio da aprendizagem clínica em contexto hospitalar. Sujeitos e métodos. Os participantes são estudantes licenciados do curso de medicina da Universidade do Minho em Portugal (n = 5) que atravessam a transição entre a fase pré-clínica e a fase clínica do curso. No final da primeira unidade curricular clínica realizou-se um grupo de discussão. Os transcritos foram analisados segundo os princípios de Grounded-Theory. Resultados. Os participantes relataram facilidade no contacto com os pacientes e utilização de competências de estudo durante a aprendizagem. Apontaram como dificuldades principais o primeiro contacto com a morte e a doença no meio hospitalar, a quantidade de conhecimentos a adquirir na antes de iniciarem a formação clínica e a transferência dos mesmos para a prática clínica. Conclusões. Este estudo de caso revelou que as principais dificuldades dos estudantes licenciados se relacionavam com lidar com pacientes e com a mobilização para a prática da grande quantidade de conteúdo aprendido na fase pré-clínica. Estas dificuldades poderão ser minoradas pela inclusão de maior contacto com pacientes e com a prática clínica na fase pré-clínica

Introduction. Internationally, medical schools have been offering more fast-track undergraduate medical degree to graduate applicants. This case study aims to understand graduate entry students' experience in medical schools, namely to identify factors that condition their transition to the clinical training in hospitals. Subjects and methods. Participants are medical graduate students from the University of Minho in Portugal (n = 5) going through the transition from a pre-clinical to a clinical part of a 4 year graduate entry curriculum. A focus group was conducted at the end of the first clinical course. The discussion was transcribed and analyzed using Grounded-Theory principles. Results. Participants described they were comfortable with contacting patients, and that they applied study skills developed prior to entry medical school to their learning. The main difficulties pointed out their were the first contact with death and disease in the hospital environment, the large amount of content to be learned before starting clinical training, and the transfer of knowledge to clinical practice. Conclusions. This case study revealed that the main difficulties presented by medical graduate-entry students were related to the first contacts with patients and the practical application of a huge amount of knowledge, learned during the pre-clinical part of the curriculum, to the clinical practice. These difficulties could be attenuated by including more contact with patients and clinical practice during the pre-clinical part of the course

Introducción. En el ámbito internacional se ha extendido la oferta formativa de estudios de medicina de menor duración para candidatos que están en posesión de otros grados de educación superior previos. Este estudio de caso trata de comprender la experiencia de los estudiantes procedentes de otros grados en estos cursos con el fin de identificar los factores que limitan su aprendizaje clínica en el contexto hospitalario. Sujetos y métodos. Los participantes son estudiantes de posgrado de la Facultad de Medicina de la Universidad de Minho en Portugal (n = 5), que realizan la transición entre la fase preclínica y clínica del grado. Al final del primer curso clínico se llevó a cabo un grupo de discusión. Las transcripciones se analizaron de acuerdo con los principios de grounded theory. Resultados. Los participantes refirieron facilidad para el contacto con los pacientes y para el uso de técnicas de estudio durante su aprendizaje. Las principales dificultades son el primero contacto con la muerte y la enfermedad en el ámbito hospitalario, el volumen de conocimientos que se deben adquirir antes de embarcarse en la formación clínica y su transferencia a la práctica clínica. Conclusiones. Este estudio de caso reveló que las principales dificultades de los estudiantes procedentes de otros grados se relacionaron con el trato de los pacientes y con la aplicación a la práctica de los numerosos contenidos aprendidos en la fase preclínica. Estas dificultades se pueden reducir mediante un mayor contacto con los pacientes y la práctica clínica en la fase preclínica

Gathering evidence of external validity for the Foundations of Medicine examination: a collaboration between the National Board of Medical Examiners and the University of Minho.

BACKGROUND: To gather evidence of external validity for the Foundations of Medicine (FOM) examination by assessing the relationship between its subscores and local grades for a sample of Portuguese medical students. METHOD: Correlations were computed between six FOM subscores and nine Minho University grades for a sample of 90 medical students. A canonical correlation analysis was run between FOM and Minho measures. RESULTS: Moderate correlations were noted between FOM subscores and Minho grades, ranging from -0.02 to 0.53. One canonical correlation was statistically significant. The FOM variate accounted for 44% of variance in FOM subscores and 22% of variance in Minho end-of-year grades. The Minho canonical variate accounted for 34% of variance in Minho grades and 17% of the FOM subscore variances. CONCLUSIONS: The FOM examination seems to supplement local assessments by targeting constructs not currently measured. Therefore, it may contribute to a more comprehensive assessment of basic and clinical sciences knowledge.