A comparative analysis of NCLEX pass rates: Nursing health human resources considerations.

AIMS: To examine performance differences among different writers of the National Council Licensure Examination-Registered Nurse (NCLEX-RN) examination in Canada; to compare Canadian and U.S. writer pass rate data; and to identify if changes in the Canadian nursing workforce can be related to the introduction of NCLEX-RN. BACKGROUND: In January 2015, the entry-to-practice licensing examination changed from the Canadian Registered Nurse Examination to the NCLEX-RN, and pass rates declined. METHODS: This comparative analytic study examined NCLEX-RN pass rate data for 2015, 2016 and 2017 using publicly available data. The Canadian data were compared with that from U.S. nurses taking the examination. RESULTS: Overall year-end pass rates among Canadian writers appeared to improve significantly in 2016 (95% to 96.3%, p < 0.001, from 2015 to 2016) but declined again from 96.3% to 90.4% in 2017 (p < 0.001). Pass rates remain significantly lower for first attempt Canadian writers compared to first attempt U.S. writers (2015: 69.7% vs. 84.5%, p < 0.001). CONCLUSIONS: The change in licensing examination had a major impact on pass rates for new graduates entering the nursing profession and potentially the number of new nurses entering the profession in Canada immediately after graduation. IMPLICATIONS FOR NURSING MANAGEMENT: A loss of entry-level workers to the nursing profession in Canada affects workforce management strategies, particularly with respect to worker shortages.

Which factors predict success in the mandatory UK postgraduate surgical exam: The Intercollegiate Membership of the Royal College of Surgeons (MRCS)?

BACKGROUND: The Membership of the Royal College of Surgeons examination (MRCS, Parts A and B) is one of the largest postgraduate surgical exams in the world, but little is known about the factors that affect candidate performance. We describe the relationship between both parts of MRCS and several independent predictors of MRCS success. METHODS: Pearson correlation coefficients were used to examine the linear relationship between MRCS Part A and B and logistic regression analysis to identify potential independent predictors of MRCS success. We included all UK medical graduates who attempted either part of MRCS between 2007 and 2016. RESULTS: 7896 candidates made 11,867 attempts at Part A and 4310 made 5738 attempts at Part B. A positive correlation was found between Part A and B first attempt score (r = 0.41, P < 0.001). Gender (male vs. female, odds ratio (OR) 2.78, 95% confidence interval (CI) 1.83-4.19), ethnicity (white vs. Black Minority and Ethnic, OR 1.70, 95% CI 1.52-1.89), stage of training (e.g. Core Surgical Year 2 trainees vs. Foundation Year 1 doctors, OR 0.50, 95% CI 0.32-0.77) and maturity (young vs. mature graduates, OR 2.60, 95% CI 1.81-3.63) were all found to be independent predictors of Part A success. In addition to ethnicity and stage of training, Part A performance (number of attempts and score) was also identified as an independent predictor for Part B. The odds of passing each part of the MRCS decreased by 14% (OR 0.86, 95% CI 0.80-0.92) for Part A and 30% for Part B (OR 0.70, 95% CI 0.61-0.81) with each additional attempt that was made. CONCLUSIONS: Several independent predictors of MRCS success were identified, but only ethnicity and stage of training were found to be common predictors of both Part A and B.

The failure to fail underperforming trainees in health professions education: A BEME systematic review: BEME Guide No. 42.

BACKGROUND: Many clinical educators feel unprepared and/or unwilling to report unsatisfactory trainee performance. This systematic review consolidates knowledge from medical, nursing, and dental literature on the experiences and perceptions of evaluators or assessors with this failure to fail phenomenon. METHODS: We searched the English language literature in CINAHL, EMBASE, and MEDLINE from January 2005 to January 2015. Qualitative and quantitative studies were included. Following our review protocol, registered with BEME, reviewers worked in pairs to identify relevant articles. The investigators participated in thematic analysis of the qualitative data reported in these studies. Through several cycles of analysis, discussion and reflection, the team identified the barriers and enablers to failing a trainee. RESULTS: From 5330 articles, we included 28 publications in the review. The barriers identified were (1) assessor's professional considerations, (2) assessor's personal considerations, (3) trainee related considerations, (4) unsatisfactory evaluator development and evaluation tools, (5) institutional culture and (6) consideration of available remediation for the trainee. The enablers identified were: (1) duty to patients, to society, and to the profession, (2) institutional support such as backing a failing evaluation, support from colleagues, evaluator development, and strong assessment systems, and (3) opportunities for students after failing. DISCUSSION/CONCLUSIONS: The inhibiting and enabling factors to failing an underperforming trainee were common across the professions included in this study, across the 10 years of data, and across the educational continuum. We suggest that these results can inform efforts aimed at addressing the failure to fail problem.

India's foreign medical graduates: an opportunity to correct India's physician shortage.

BACKGROUND: India's current estimated doctor-population ratio of 1:1700 against targeted ratio of 1: 1000 shows a clear shortage. A mismatch in number of medical aspirants and available seats, intense competition and unaffordable costs of medical education prompt many Indian students to pursue training opportunities abroad. Many later return to India, and these foreign medical graduates (FMGs) must pass a qualification test which is a required to practice medicine in India. This review undertakes a situational analysis of FMGs in India and suggests a roadmap to better utilize this resource pool of physicians. METHODS: A thorough literature search was carried out using Google Scholar, PubMed and websites of the Central Board of Secondary Education and Medical Council of India. Foreign Medical Graduate Examination (FMGE) data was obtained from India's National Board of Examinations. RESULTS: From 2002 to 2014, growth was seen in the number of FMGs who took the FMGE, with more having trained in China than any other country. However, typically only 25% of FMGs pass the FMGE. In 2013, 9,700 FMGs were unable to pass the FMGE to enter practice in India. At least 7,500 FMG physicians are unable to become licensed each year for failure to pass the FMGE, including those who retake and again fail the exam. DISCUSSION: There are possible solutions. Additional training and hands-on apprenticeships can be introduced to help FMGs build their skills to then be able to pass the FMGE. FMGs can now learn by participating as observers in the established programs. Opportunities also exist for FMGs to work outside of clinical care, including in research, hospital administration and public health. As of now, FMGs are an untapped resource and lost opportunity to a country with shortages of physicians.

[Equivalency examinations for foreign physicians in Baden-Wuerttemberg]. / Gleichwertigkeitsprüfung für ausländische Ärzte/Ärztinnen in Baden-Württemberg.

INTRODUCTION: Recent years have seen an increasing number of foreign doctors starting to practice medicine in German hospitals (or more rarely, in surgeries). In order to be granted the German license to practice medicine, doctors with a medical degree from outside the European Union have to undergo an equivalency examination. The supervisory authority for this is the examination office of the relevant federal state, which is why different procedures are being applied in the individual states. The aim of this paper is to point out the problems that frequently arise when conducting this specialist exam and to make suggestions as to how to improve the quality of the procedure. METHOD: 6 senior professors from the examination boards of the 4 medical schools in Baden-Wuerttemberg formed a focus group and discussed the difficulties associated with the exam, recorded problems in its actual implementation and then analysed the minutes of the meeting in a results-based manner in order to compile proposals for optimisation. RESULTS: In view of the deficits in subject knowledge, general communication skills and specific communication skills, the difficulties of the current recognition procedure and the existing equivalency exam fall into 3 categories: structure and content of the exam, examiners and exam candidates. CONCLUSIONS: In consultation with the State Examination Office Stuttgart, some processes for optimisation have been devised, e. g., to develop a special curriculum which could be used for guidance and to recruit more examiners. The recommendations of the focus group from Baden-Wuerttemberg are an important step towards more transparency and possibly towards a Germany-wide standardisation of this exam.

Language tests and tests of competence for registration purposes - a scoping review of the experiences of overseas nurses.

BACKGROUND: The overseas applicant's capability of practising safely and effectively is proven through the tests of competence which consist of computer-based tests and the Objective Structured Clinical Examination (OSCE). All prospective applicants to the Nursing and Midwiferey Council (NMC) register must be able to demonstrate that their skills, knowledge and behaviours are at the level required to meet the NMC preregistration nursing or midwifery standards for the United Kingdom (UK). AIM: The aim of this review is to explore the challenges faced whilst undertaking these tests of competence, the OSCE, by overseas educated nurses who aspire for Nursing and Midwifery Council (NMC) registration in the UK. METHODS: A scoping review using the Arksey and O'Malley (2005) framework was conducted to explore and produce a profile of the existing literature on the registration requirements of the NMC. A search of CINAHL, Medline and Scopus resulted in 150 records, which were then screened against the inclusion criteria - English Language, publication between 2015 onwards and discussed the language tests/competency tests required for gaining entry to the NMC register. A total of nine articles met the criteria and are included in this scoping review. The PRISMA-ScR framework is used to present the review. RESULTS: There was a paucity of studies that addressed the experience of overseas nurses who faced the OSCE. An interpretative stance was adopted to formulate the themes which were: competence/practice disparity, arbitrary issues for failing, failure to capture the digital health agenda, financial implications, and consequences of failing the OSCE. The results raise concern whether the nurses from overseas are held to higher standards than those trained in the UK and whether the assessment process is realistic and not pedantic. CONCLUSIONS: This scoping review demonstrates there is a lack of robust research evaluating the effectiveness of tests of competencies. The review indicates there is no due acknowledgement of the previous skills and knowledge of the overseas nurses. Future research should focus on exploring the feasibility of tests of competence and its role in the integration of the nursing workforce.

Development and implementation of a mini-Clinical Evaluation Exercise (mini-CEX) program to assess the clinical competencies of internal medicine residents: from faculty development to curriculum evaluation.

BACKGROUND: The mini-CEX is a valid and reliable method to assess the clinical competencies of trainees. Its data could be useful for educators to redesign curriculum as a process of quality improvement. The aim of this study was to evaluate a mini-CEX assessment program in our internal medicine residency training. We investigated the impact of mini-CEX workshops as a faculty development program on the acquisition of cognitive knowledge and the difference of practice behaviors among faculty members used the mini-CEX to assess residents' performance at work. METHODS: We designed an observational, two-phase study. In the faculty development program, we started a mini-CEX workshop for trainers in 2010, and the short-term outcome of the program was evaluated by comparing the pretest and posttest results to demonstrate the improvement in cognitive knowledge on mini-CEX. From September 2010 to August 2011, we implemented a monthly mini-CEX assessment program in our internal medicine residency training. The data of these mini-CEX assessment forms were collected and analyzed. RESULTS: In the group of 49 mini-CEX workshop attendees, there was a statistically significant improvement in cognitive knowledge by comparing the pretest and posttest results (67.35 ± 15.25 versus 81.22 ± 10.34, p < 0.001). Among the 863 clinical encounters of mini-CEX, which involved 97 residents and 139 evaluators, 229 (26.5%), 326 (37.8%), and 308 (35.7%) evaluations were completed by the first-year, second-year, and third- year residents separately. We found a statistically significant interaction between level of training and score in dimensions of mini-CEX. The scores in all dimensions measured were better for senior residents. Participation in mini-CEX workshops as a faculty development program strengthened the adherence of trainers to the principles of mini-CEX as a formative assessment in regard to provision of feedback. However, a deficiency in engaging residents' reflection was found. CONCLUSIONS: Faculty development is a prerequisite to train evaluators in order to implement a successful mini-CEX assessment program. We demonstrated the effectiveness of our mini-CEX workshops in terms of knowledge acquisition and enhancement of giving feedback when the faculty members used the tool. Further programs on providing effective feedback should be conducted to increase the impact of the mini-CEX as a formative assessment.

Impact of residency requirement for dental licensure: an update.

As of 2007, New York State Education Law requires successful completion of dental school training and completion of an approved dental residency program for dental licensure. In a transitional period, from 2003-2006, a dental licensure applicant could select the path of an approved residency program or the New York State-recognized regional standardized clinical examination. By contrast, in 2007, the state of Connecticut adopted and continues to abide by regulations that permit licensure by either completion of an approved residency program or passage of the recognized regional standardized clinical examination. A review of the changing number of dentists licensed in these two adjoining Northeastern states under new licensure guidelines is considered in terms of the possible relationship to the new licensing process.

Medical education accreditation in Mexico and the Philippines: impact on student outcomes.

CONTEXT: Accreditation of medical education programmes is becoming increasingly prevalent worldwide, but beyond the face validity of these quality assurance methods, data linking accreditation to improved student outcomes are limited. Mexico and the Philippines both have voluntary systems of medical education accreditation and large numbers of students who voluntarily take components of the United States Medical Licensing Examination (USMLE). We investigated the examination performance of Mexican and Philippine citizens who attended medical schools in their home countries by medical school accreditation status. METHODS: The sample included 5045 individuals (1238 from Mexico, 3807 from the Philippines) who took at least one of the three USMLE components required for Educational Commission for Foreign Medical Graduates (ECFMG) certification. We also separately studied 2702 individuals who took all three examinations (589 from Mexico, 2113 from the Philippines). The chi-squared statistic was used to determine whether the associations between outcomes (first attempt pass rate on USMLE components and rate of ECFMG certification) and medical school accreditation (yes/no) were statistically significant. RESULTS: For the sample of registrants who took at least one USMLE component, first attempt pass rates on all USMLE components were higher for individuals attending accredited schools, although there were differences in pass rates among the components and between the two countries. The distinction was greatest for USMLE Step 1, for which attending an accredited school was associated with increases in first attempt pass rates of 15.9% for Mexican citizens and 29.2% for Philippine citizens. In registrants from the Philippines who took all three examinations, attending an accredited medical school was also associated with increased success in obtaining ECFMG certification. CONCLUSIONS: These findings support the value and usefulness of accreditation in Mexico and the Philippines by linking accreditation to improved student outcomes.

Do preceptors with more rating experience provide more reliable assessments of medical student performance?

BACKGROUND: Although the existing psychometric literature provides guidance on the best method for acquiring a reliable clinical evaluation form (CEF)-based score, it also shows that a single CEF rating has very low reliability. PURPOSE: This study examines whether experience with rating students might act as a form of rater training and hence improve the quality of CEF ratings. METHODS: Preceptors were divided into two groups based on rater experience. The univariate and multivariate G study designs used were simple rater (r)-nested-within-person (p) [r : p and r(○) : p(•)] models, and in the univariate analysis was applied separately to CEFs completed by high and low experienced raters. RESULTS: The high experienced rater group yielded a substantially higher observed reliability in both the univariate and multivariate analyses. CONCLUSIONS: These results support the hypothesis that high experienced raters produce more reliable ratings of student performance and suggest methods for improving CEF ratings.

Standardized testing. HIT pro exams test competencies in health IT roles.

Healthcare needs more than EHRs, it needs people who can implement and maintain them. New federally sponsored health IT exams set workforce competencies, helping job seekers demonstrate knowledge and employers benchmark qualifications.

[Testing objective structured clinical evaluation (OSCE) for nursing students experience developed during the years 1995-2009]. / Pruebas de evaluación clínica objetiva y estructurada (ECOE) para estudiantes de enfermería.

The objective structured clinical examination (OSCE) has been recognized as an effective evaluation tool in the health area and has been implemented by an important sector of educational institutions, the Faculty of Medicine and School of Nursing. The present article describes the OSCE organized by the Institute of Health Studies in collaboration with the University Schools of Catalan Nursing. Between the years of 2002 and 2009, OSCE annual exams took place with the participation of 1.803 students. The global results remained stable with a median grade of slightly less than 60%, and the competence component that evaluated communicative capacity was the one in which students obtained the best results. The reliability obtained surpassed the minimum recommended by international standards. It's important underline the positive value to the students of all aspects of the test. From this experience it seems evident that it would be useful to take advantage of the OSCE tests in order to show the students their strong points and ways to improve. We should highlight, not only as a goal but also as an opportunity the assessment by competencies that the European space of higher Education provides at the end of studies for a Nursing degree.

Assessment of Plastic Surgery Residency Applications without United States Medical Licensing Examination Step 1 Scores.

SUMMARY: The United States Medical Licensing Examination announced the changing of Step 1 score reporting from a three-digit number to pass/fail beginning on January 1, 2022. Plastic surgery residency programs have traditionally used United States Medical Licensing Examination Step 1 scores to compare plastic surgery residency applicants. Without a numerical score, the plastic surgery residency application review process will likely change. This article discusses advantages, disadvantages, and steps forward for residency programs related to the upcoming change. The authors encourage programs to continue to seek innovative methods of objectively and holistically evaluating applications.

Implications of Change to USMLE Step 1 Scoring for Otolaryngology Residency Programs.

Otolaryngology is a competitive specialty, with 398 US seniors applying to an offered 328 positions in 2019. Recent changes to US Medical Licensing Exam (USMLE) Step 1 scoring raise many questions for both medical student applicants and program directors. Otolaryngologists are known to be collegial and thoughtful physicians. Focusing on other nonstandardized testing scores may help the specialty "reboot" and refocus on recruiting the best people, not just applicants with a high Step 1 score and Alpha Omega Alpha (AOA) status.

The value of faculty during student on-site evaluations.

The American Academy of Nurse Practitioners Certification Board recognizes the value of nurse practitioner faculty in evaluating students at the clinical site. The Board of Commissioners recently approved the awarding of clinical hours to nurse practitioner faculty for clinical site visits. This article outlines the rationale and procedure for conducting and documenting student visits that can be applied to recertification.

Characteristics of Professional Physical Therapist Faculty and Doctor of Physical Therapy Programs, 2008-2017: Influences on Graduation Rates and First-Time National Physical Therapy Examination Pass Rates.

OBJECTIVE: Graduation rates and first-time National Physical Therapy Examination (NPTE) pass rates among Doctor of Physical Therapy (DPT) programs have ranged from 30% to 100% and 0% to 100% between 2008 and 2017, respectively. Prior studies on predictors of graduation rates and NPTE pass rates from DPT programs have used cross-sectional data and have not studied faculty data. This study sought to understand how trends in DPT faculty and program characteristics correlated with graduation rates and first-time NPTE pass rates. METHODS: This study was a retrospective panel analysis of yearly data from 231 programs between 2008 and 2017. Random effects models estimated the correlations between faculty and program characteristics regarding graduation rates and first-time NPTE pass rates. RESULTS: Graduation rates peaked when programs devoted 25% of faculty time, on average, to scholarship. The number of peer-reviewed publications was positively correlated with graduation rates; however, the trend was logarithmic, indicating a diminishing rise in graduation rates as the number of publications exceeded 1 per faculty full-time equivalent. Tenure-track status, faculty of color, and part-time faculty were all negatively correlated with first-time NPTE pass rates. However, these 3 trends are likely not meaningful, because the predicted rates of decline in pass rates were minimal. CONCLUSIONS: Faculty engagement in scholarly activities can positively influence graduation rates, but only up to a certain level of faculty time devoted to scholarship. IMPACT: This is the first study to provide data on the influence of faculty on DPT student outcomes and will help education programs develop strategies to improve those outcomes.