Performance of medical students in final professional examination: Can in-course continuous assessments predict students at risk?

Background: Assessment drives students' learning. It measures the level of students' understanding. We aimed to determine whether performance in continuous assessment can predict failure in the final professional examination results. Methods: We retrieved the in-course continuous assessment (ICA) and final professional examination results of 3 cohorts of medical students (n = 245) from the examination unit of the International Medical University, Seremban, Malaysia. The ICA was 3 sets of composite marks derived from course works, which includes summative theory paper with short answer questions and 1 of the best answers. The clinical examination includes end-of-posting practical examination. These examinations are conducted every 6 months in semesters 6, 7 and 8; they are graded as pass/fail for each student. The final professional examination including modified essay questions (MEQs), 1 8-question objective structured practical examination (OSPE) and a 16-station objective structured clinical examination (OSCE), were graded as pass/fail. Failure in the continuous assessment that can predict failure in each component of the final professional examination was tested using chi-square test and presented as odds ratio (OR) with 95% confidence interval (CI). Results: Failure in ICA in semesters 6-8 strongly predicts failure in MEQs, OSPE and OSCE of the final professional examination with OR of 3.8-14.3 (all analyses p< 0.001) and OR of 2.4-6.9 (p<0.05). However, the correlation was stronger with MEQs and OSPE compared to OSCE. Conclusion: ICA with theory and clinical examination had a direct relationship with students' performance in the final examination and is a useful assessment tool.

Rational Use of Imaging to Stage Breast Cancer: Evidences for a Selective Approach.

INTRODUCTION: Staging investigations at diagnosis are customary to accurately assign a clinical stage before therapy. The practice of routine imaging in patients asymptomatic for metastasis is not recommended but widely adopted. This study was done to reexamine the basis behind guideline recommendations and to identify the factors predictive of asymptomatic metastasis. METHODS: Oncology records of 200 breast cancer patients in clinical Stages I-III at diagnosis were prospectively reviewed. Baseline demographic information, tumor characteristics, and pathological data including molecular typing were collected. The prevalence of metastasis deduced and accuracy of bone scan, chest X-ray (CXR), liver ultrasound, and computed tomography (CT) chest analyzed. Patient and tumor characteristics predictive of asymptomatic metastasis tested for significance using appropriate statistical tests. RESULTS: The prevalence of asymptomatic metastasis was 13.5%. Bone lesions (8%) were the most common metastatic site followed by lungs (7%) and liver (1%). Sensitivity, specificity, positive- and negative-predictive values of bone scans and CT chest were 100%, 97%, 74%, 100%, and 92%, 99%, 87, 3%, 99.4%, respectively. The above values for ultrasound abdomen and CXRs were 100%, 99%, 93%, 100% and 21%, 94%, 20%, 94%, respectively. Tumor size (P = 0.001), tumor Stage T1/T2 versus T3/T4 (P = 0.0002), nodal stages N0/N1 versus N2/N3 (P = 0.001), high histological Grade G I versus GII/GIII (P = 0.0001) and molecular types were strongly predictive of metastatic disease. CONCLUSION: The routine use of imaging to detect distant metastasis in asymptomatic patients is not recommended in newly diagnosed breast cancer. A selective approach may be adopted in individuals with tumor more than 5 cm, advanced nodal disease, higher histological grade, and aggressive molecular types.