Comparison of video-assisted education and traditional classroom education in pediatric cardiopulmonary resuscitation education of nursing students.

AIM: This research aimed to compare the effectiveness of traditional classroom education and video-assisted education methods used in Pediatric (CPR) education and determine students' level of satisfaction with the education methods used. METHOD: This research had a randomized, experimental, pretest-posttest design. The research was completed with 98 students (54 in the video-assisted education group and 44 in the traditional classroom education group). The traditional classroom education group received pediatric CPR education through traditional classroom education. On the other hand, the video-assisted education group watched the pediatric CPR education video prepared by the researchers. The level of knowledge of pediatric CPR, the level of pediatric CPR practice skills, and the satisfaction score of each student were evaluated. RESULTS: When the skills levels of the groups were compared, it was determined that there was no statistical difference between the test results. In both groups, the students' mean knowledge and skill scores in the first and second posttests were significantly higher than their pretest knowledge scores. The satisfaction scores of the students in both groups were similar. CONCLUSION: Both methods effectively improve students' pediatric CPR-related knowledge, skills, and satisfaction. IMPLICATIONS FOR PRACTICE: As support for traditional education, using video-assisted visual education materials that nursing students can constantly access when needed is important.

Designing and implementing an OMMID midwifery professional competence mixed test: A multimethod, multiphasic study.

The assessment of professional competence is essential to ensure the achievement of competence standards. The goal of this study is to design and implement a professional competence test model to make the test unified, comprehensive, and fair. This research was a multimethod, multiphasic study. The first qualitative phase of the nominal group technique was conducted to design the test model with specific guidelines. The second phase was a mixed-method parallel field trial conducted on 161 senior midwifery bachelor students in universities of Iran. The test was conducted following the traditional method in the control group and OMMID model in the intervention group. This model consists of three parts: the MCQs (multiple choice questions), OSCE (objective structured clinical examination), and clinically-oriented tests, which included Mini-CEX (mini-clinical evaluation exercise) and DOPS (direct observation of procedural skills). Data were collected using questionnaires and interviews, and the results were assessed qualitatively and quantitatively. The OMMID model and the associated guideline were designed. Qualitative data analysis resulted in six main themes, including organizing, structure, tension due to change, fairness, unification, and outcome. The OMMID model did not increase students' anxiety and stress and did not decrease their satisfaction. The merits of this model include having a centralized guideline, using multiple evaluation methods, comprehensive evaluation of necessary skills, promotion of fairness, and increased student satisfaction.

Cumulative Sum Chart as Complement to Objective Assessment of Graduating Surgical Resident Competency: An Exploratory Study.

BACKGROUND: Rater-based assessment and objective assessment play an important role in evaluating residents' clinical competencies. We hypothesize that a cumulative sum (CUSUM) chart of operative time is a complement to the assessment of chief general surgery residents' competencies with ACGME Milestones, aiding residency programs' determination of graduating residents' practice readiness. STUDY DESIGN: We extracted ACGME Milestone evaluations of performance of operations and procedures (POP) and 3 objective metrics (operative time, case type, and case complexity) from 3 procedures (cholecystectomy, colectomy, and inguinal hernia) performed by 3 cohorts of residents (N = 15) during their PGY4-5. CUSUM charts were computed for each resident on each procedure type. A learning plateau was defined as at least 4 cases consistently locating around the centerline (target performance) at the end of a CUSUM chart with minimal deviations (range 0 to 1). RESULTS: All residents reached the ACGME graduation targets for the overall POP by the end of chief year. A total of 2,446 cases were included (cholecystectomy N = 1234, colectomy N = 507, and inguinal hernia N = 705), and 3 CUSUM chart patterns emerged: skewed distribution, bimodal distribution, and peaks and valleys distribution. Analysis of CUSUM charts revealed surgery residents' development processes in the operating room towards a learning plateau vary, and only 46.7% residents reach a learning plateau in all 3 procedures upon graduation. CONCLUSIONS: CUSUM charts of operative time complement the ACGME Milestones evaluations. The use of both may enable residency programs to holistically determine graduating residents' practice readiness and provide recommendations for their upcoming career/practice transition.

USMLE step 1 and step 2 CK as indicators of resident performance.

BACKGROUND: The purpose of this systematic review was to (1) determine the scope of literature measuring USMLE Step 1 and Step 2 CK as predictors or indicators of quality resident performance across all medical specialties and (2) summarize the ability of Step 1 and Step 2 CK to predict quality resident performance, stratified by ACGME specialties, based on available literature. METHODS: This systematic review was designed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) [16]. The original search strategy surveyed MEDLINE and was adapted to survey Cochrane Library and Embase. A study was deemed eligible if it provided all three of the following relevant information: (a) Step 1 or Step 2 CK as indicators for (b) resident outcomes in (c) any ACGME accredited specialty training program. RESULTS: A total of 1803 articles were screened from three separate databases. The 92 included studies were stratified by specialty, with Surgery (21.7% [20/92]), Emergency Medicine (13.0% [12/92]), Internal Medicine (10.9% [10/92]), and Orthopedic Surgery (8.7% [8/92]) being the most common. Common resident performance measures included ITE scores, board certification, ACGME milestone ratings, and program director evaluations. CONCLUSIONS: Further studies are imperative to discern the utility of Step 1 and Step 2 CK as predictors of resident performance and as tools for resident recruitment and selection. The results of this systematic review suggest that a scored Step 1 dated prior to January 2022 can be useful as a tool in a holistic review of future resident performance, and that Step 2 CK score performance may be an effective tool in the holistic review process. Given its inherent complexity, multiple tools across many assessment modalities are necessary to assess resident performance comprehensively and effectively.

Canales dominantes de percepción del conocimiento. Influencia en la evaluación del aprendizaje de la inmunología / Knowledge Perception Dominant Channels. Influence of the Evaluation of Immunology Learning

Introducción: Los estilos de aprendizaje según canales de percepción dominante del conocimiento de los estudiantes influyen en su aprendizaje. Su uso por los docentes puede favorecer o no a estudiantes con un canal específico. Objetivo: Describir la ubicación según los canales de percepción dominante del conocimiento de los estudiantes de medicina y la relación de estos con el resultado de las evaluaciones frecuentes en la asignatura Sangre y Sistema Inmune. Métodos: Se realizó una investigación en 234 estudiantes y 30 profesores de la carrera de medicina en los cursos 2020-2021 y 2022. Los estudiantes se clasificaron según los resultados de un cuestionario para identificar el predominio del canal de percepción (visuales-auditivos-kinestésicos) y a los profesores se les realizó una encuesta para determinar su percepción sobre el uso de estrategias de enseñanza diferenciales para cada canal. El procesamiento se realizó en programa SPSS 25, a través de números, porcentaje y prueba de ji al cuadrado. Resultados: Predominó el canal visual con el 48 por ciento. Existió asociación con el sexo con p = 0,0016; en varones prevaleció el canal auditivo y en hembras el visual. La relación entre los canales de percepción dominante y el rendimiento académico fue significativa con p = 0,000. Conclusiones: Prevaleció el canal de percepción dominante visual. La distribución de cada canal se asoció con el sexo y el rendimiento académico; así se lograron mejores resultados por los estudiantes con percepción dominante visual. Esto último estuvo relacionado con el predominio de acciones por parte de los docentes que potencian este canal de percepción(AU)

Introduction: Learning styles according to dominant perception channels of students' knowledge influence their learning. Their use by professors may or may not favor students with a specific channel. Objective: To describe the location according to the dominant knowledge perception channels of medical students and their relationship with the results of frequent evaluations in the subject Blood and Immune System. Methods: A research was conducted with 234 students and 30 professors of the Medicine major during the academic years 2020-2021 and 2022. The students were classified according to the results of a questionnaire to identify the perception channel predominance (visual-auditory-kinesthetic), while the professors were surveyed to determine their perception on the use of differential teaching strategies for each channel. Processing was performed in SPSS 25, using numbers, percentages and the chi-squared test. Results: The visual channel predominated, accounting for 48 percent. There was an association with sex (p=0.0016); the auditory channel prevailed among males, while the visual channel prevailed among females. The relationship between dominant perception channels and academic performance was significant (p=0.000). Conclusions: The visual dominant perception channel prevailed. The distribution of each channel was associated with sex and academic performance; thus, better results were achieved by students with visual dominant perception. The latter was related to the predominance of actions by professors that enhance this perception channel(AU)

Clinical teaching in dentistry: Evaluating a clinical oral pathology rotation while looking to the future of dental education.

PURPOSE/OBJECTIVES: Clinical teaching in dentistry has cycled through specialty-based "departmental" teaching to group practice scenarios. The aims of this study were to ascertain third-year dental students' perceptions of a specialty-based rotation supplemented by online educational tools and to compare their Objective Structured Clinical Exam (OSCE) scores to those of the students in the previous year. METHODS: This retrospective research design included the analysis of OSCE scores, and student responses to survey questions regarding their perceptions of the clinical oral pathology (COP) rotation. This study was completed in 2022. It included data from 2020 to 2021 and 2021 to 2022 corresponding to input from the Classes of 2022 and 2023, respectively. The response rate was 100%. RESULTS: The students evaluated the focused COP rotation and the online teaching modules as a positive experience. The results of the OSCE were similar to those of the previous class and showed a high average score. CONCLUSIONS: This study shows that students had a positive perception to specialty-based learning with online educational tools and that it enhanced the education they received in the comprehensive care clinic. The OSCE scores were similar to those of the previous class. These findings suggest a method of maintaining high-quality dental education through challenges as it continues evolving.

Oral 'Board Style' Examination for Surgery Clerkship.

Evaluating medical students during surgical clerkships relies on multifactorial methods of evaluation. Clinical evaluations, combined with standardized multiple-choice exams, are often the foundation of evaluation highlighting the challenge of combining subjective and objective measurements. Oral board exams are standard amongst medical certification and employ an additional element to evaluate students more holistically. Course evaluations from years that incorporated an oral board exam were compared to a year that omitted the exam. We found course satisfaction was higher in the years that included the oral exam (3.25 /5) than years without the oral board exam (3/ 5). The oral exam adds a novel element to the evaluation of a medical student that allows for a comprehensive understanding of a student's fund of knowledge and helps prepare them for future board certifications. Because students have an opportunity to demonstrate knowledge in a standard, more comprehensive format, they have higher satisfaction with the course.

Predictors of clinical performance in comprehensive care cases in undergraduate dentists.

INTRODUCTION: Achieving a high grade in the final-year comprehensive clinical care (CCC) course is not only important for the individual candidate but also to ensure competency of students as they transition from dental school into independent practice. Here, we aimed to identify predictors of success in the CCC that might prove useful to identify which, if any, students need focused intervention to improve their performance in the CCC. MATERIALS AND METHODS: This was a cross-sectional study of two consecutive cohorts (2017-2018 and 2018-2019) of final-year (Year six) dental students (n = 180 females and n = 150 males) attending [King Abdulaziz University], Saudi Arabia. Age, gender, cumulative GPA to the start of Year six and assessment results were tabulated and analysed as independent variables in binary logistic regression to identify predictors of the final case grade (≤69% or >70%). RESULTS: Year five GPA (OR 1.07, 95% CI 1.02-1.12; p = .004) and female gender (OR 2.21, 95% CI 1.12-4.36; p = .02) were significantly associated with an increased odds of achieving a final case grade >70%. In particular, female students were over twice as likely as male students to achieve a higher score in their final case assessment. DISCUSSION: This study suggests that gender may influence final performance in the CCC. The better performance of females in the final CCC course than their male counterparts suggests that there may be a narrowing or even reversal of the historical gender gap in dental school performance. CONCLUSIONS: Both cognitive (GPA) and other (i.e. gender) factors influence clinical dental performance. Further work is required to establish what instructional modifications are required to accommodate these gender differences in CCC courses to pave the way for personalised teaching approaches to optimise educational outcomes.

The Predictive Value of the Residency AOBFP In-Service Exam, Produced and Administered by ACOFP.

BACKGROUND AND OBJECTIVES: Board certification is acknowledged as the mainstay for ensuring quality physician-delivered health care within medical specialties. The American College of Osteopathic Family Physicians (ACOFP) administers the American Osteopathic Board of Family Physicians' (AOBFP) In-Service Examination (ISE) to provide residents and program directors with a formative examination to assess competency and preparation for successful completion of the AOBFP certifying examination (CE). Unique assessment processes are integral to monitoring development of the osteopathic family physician throughout training and into practice, and to verify their competency for the safety and protection of the public. This study sought to investigate whether performance on the AOBFP ISE predicted performance on the AOBFP CE, and thereby successfully equipped residents to safely enter medical practice. METHODS: In 2020, data from 1,893 PGY-1 through PGY-3 residents (2016-2018), whose ISE scores could be matched with scores on the AOBFP initial board CE, were analyzed for this study. RESULTS: Correlations among ISE administrations across 3 years of postgraduate medical education were in the mid-to-high .6 range; the ISE scores correlated with CE scores in the mid .4 to high .5 range. Less reliable measures of positive predictive value were 0.99, and sensitivity was 0.91. CONCLUSIONS: Results suggest that ISE administrations during residency training are effective in developing remediation strategies for subsequent successful CE performance. The inclusion of osteopathic principles in the AOBFP CE necessitates inclusion of osteopathic content in resident training exams like ISE.

Validation of an instrument for the evaluation of exchange transfusion (INEXTUS) via an OSCE.

INTRODUCTION: Exchange transfusion is the treatment of choice for patients with severe hyperbilirubinemia who do not respond to phototherapy. This procedure is highly complex and requires substantial expertise to perform, however it´s not done frequently enough to guarantee adequate training. Traditional learning scenarios do not have a space reserved for teaching this procedure or an instrument that fully and objectively evaluates the skills that a professional must acquire.  OBJECTIVES: The purpose was to construct and evaluate the INEXTUS instrument´s validity evidence relevant to internal structure, in a simulated scenario through the performance of an objective structured clinical exam (OSCE).  MATERIALS AND METHODS: The Delphi consensus methodology was utilized to design the instrument; six experts participated through three rounds using the Google Forms platform. The categories and items previously obtained were subjected to validation by nine experts through a dichotomous survey. Prior to data collection, the evaluators were trained through a pilot test with 10 medical students. Subsequently, all residents of a paediatric programme were evaluated through the OSCE methodology in a simulated scenario, with 6 stations, of a clinical case of a new-born with an explicit need for exchange transfusion. During their participation in the scenario, the residents were first evaluated with the instrument developed. Additionally, audio and video filming of all students who participated was performed with the aim of conducting a second evaluation two weeks after the first four evaluators participated. RESULTS: The final INEXTUS instrument consists of 46 subitems grouped into 23 items divided into 6 categories, demonstrating an inter-rater intraclass correlation coefficient of 0.96 (95% CI 0.94, 0.98 p-value < 0.001). For the Fleiss Kappa of the 23 items evaluated, concordance was evaluated for 14 items but could not be determined for the 9 remaining items because all the ratings were equal, either because the items were not performed or they were all performed adequately. Of the 14 items, 9 good scores were obtained (95% CI 0.61 to 0.8; p value < 0.001), and 5 very good scores were obtained (95% CI 0.81 to 1; p value < 0.001). CONCLUSIONS: The INEXTUS instrument evaluates exchange transfusion skills in medical personnel in training in simulated scenarios using the OSCE methodology; it has high validity and reliability and is a high-impact educational tool.

Application of objective structured clinical examination (OSCE) for the evaluation of Kampo medicine training.

BACKGROUND: The purpose of this study was to develop an objective, content-valid, and reliable assessment method for Kampo medicine using an objective structured clinical examination (OSCE) for the assessment of clinical competence in Kampo medicine. METHODS: We developed a blueprint followed by a list of 47 assessment items and three task scenarios related to clinical competence in Kampo medicine. An eight-member test committee checked the relevance of the assessment items on a Likert scale. We calculated a content validity index and content validity ratio, and used the Angoff method to set the passing threshold. We trained a total of nine simulated patients with three assigned to each scenario. We conducted an OSCE for 11 candidates with varying medical abilities, and conducted three stations per person, which were evaluated by one evaluator in one room by direct observation. We used video recordings to test the inter-rater reliability of the three raters. We used the test results to verify the reliability of the assessment chart. RESULTS: The inter-rater reliability (intraclass correlation coefficient [2,1]) was 0.973. The reliability of the assessment chart for each scenario (Cronbach's α) was 0.86, 0.89, and 0.85 for Scenarios 1, 2, and 3, respectively. The reliability of the assessment chart for the whole OSCE (Cronbach's α) was 0.90. CONCLUSIONS: We developed a content-valid new OSCE assessment method for Kampo medicine and obtained high inter-rater and test reliabilities. Our findings suggest that this is one of the most reliable evaluation methods for assessing clinical competence in Kampo medicine.

A retrospective and correlative analysis of academic and nonacademic predictors of COMLEX level 1 performance.

CONTEXT: National licensing exams (NLEs) including the Comprehensive Osteopathic Medical Licensing Examination (COMLEX) Level 1 evaluate student achievement. Scores have historically been utilized to stratify medical student applicants for residency. Grade point average (GPA), number of practice questions completed, and performance on practice exams have been shown to be predictive of NLE performance. Test anxiety and acute stress have been shown to negatively impact NLE performance. The role of study behaviors and other nonacademic factors in COMLEX Level 1 performance is unknown. OBJECTIVES: This study aims to evaluate academic and nonacademic factors and to correlate them with COMLEX Level 1 performance. Additional analysis is conducted to associate COMLEX Level 1 performance with academic and nonacademic factors when controlling for GPA. METHODS: An anonymous online survey was administered to third- (OMS III) and fourth-year (OMS IV) osteopathic medical students at Kansas City University that had completed the COMLEX Level 1 examination. In total, 72 students responded to the survey. Survey results were linked to student records of GPA and COMLEX Level 1 scores, resulting in 59 complete responses for analysis. Independent-sample t-tests and linear ordinary least squares regression were utilized to analyze the results. RESULTS: The majority of participants are male (62.7%) and OMS III (98.3%) with an average age of 27.14 ± 2.58 (mean ± standard deviation). Further demographic data reveal hours per week spent for personal time during dedicated study (n=46, 19.7 ± 18.53), hours of sleep per night during dedicated study (7.34 ± 0.92), and money spent on board preparation ($1,319.12 ± $689.17). High ($1,600-$3,000), average ($1,000-$1,500), and low ($100-$900) spenders do not statistically differ and COMLEX Level 1 performance is not related to the number of resources utilized (F statistics <1; p>0.05). Pearson correlations reveal a statistically significant relationship between COMLEX Level 1 scores with GPA (0.73, p<0.001), number of practice exams completed (0.39, p<0.001), number of questions completed (0.46, p<0.001), number of weeks of study (0.55, p<0.001), and preparation cost (0.28, p<0.05). The regression analysis revealed that money spent on board preparation, number of questions completed, and time spent studying accounted for 75.8% of the variance in COMLEX Level 1 scores after controlling for GPA. CONCLUSIONS: The data show the association of money spent on board preparation, numbers of questions competed, and time spent studying with a student's COMLEX Level 1 score. Additionally, these results highlight the amount of money students spend on extracurricular materials to prepare for COMLEX Level 1, yet the data show that the number of resources that students utilized is not related to a student's COMLEX Level 1 performance.

Factors Associated with Acceptance of Repeat MCAT Test Takers into a West Virginian Allopathic Medical School.

OBJECTIVES: A paucity of information exists to advise medical school applicants who have had to retake the Medical College Admission Test (MCAT) to achieve a competitive score. To better advise repeat test takers from West Virginia and other Appalachian and southern areas, MCAT data from West Virginia applicants were analyzed and compared with national data. METHODS: In the application cycles of 2017-2020, the following factors were analyzed in relation to medical school acceptance in West Virginia applicants: MCAT scores, the number of test-taking attempts, biology-chemistry-physics-math grade point average, time between test-taking attempts, and academic major. MCAT data from medical school applicants from West Virginia who took the test more than once also were compared with national data. RESULTS: Of the total repeat test takers from West Virginia (N = 285) in the study timeframe, 57 (20%) were ultimately accepted into medical school. Factors associated with medical school acceptance were as follows: first MCAT test score (odds ratio [OR] 1.3, 95% confidence level [CL] 1.2-1.4, P < 0.001), change in MCAT test score (OR 1.2, 95% CL 1.1-1.3, P = 0.0015), and biology-chemistry-physics-math grade point average (OR 15.1, 95% CL 4.2-54.8, P < 0.0001). The highest benefit for improved scores occurred between the first and second attempts. The highest point gain occurred when the first MCAT score was in the range of 477 to 487 (<1st-12th percentile); this finding was not found in the national data. CONCLUSIONS: Although the study was limited to West Virginia medical school applicants, this information could prove useful in advising premedical applicants from other Appalachian and southern US areas.

Efficacy of sound therapy interventions for tinnitus management: A protocol for systematic review and network meta-analysis.

BACKGROUND: Tinnitus is a common otological symptom and can be debilitating. Sound therapy has increased in popularity due to its potential for increased efficacy and fewer and milder side effects, but the available evidence is limited by the lack of randomized controlled trials comparing different sound therapies for tinnitus. Network meta-analysis (NMA) is a useful tool to compare multiple treatments when there is limited or no direct evidence available. The aim of this paper is to evaluate the efficacy and acceptability of different sound therapies for tinnitus. METHODS AND ANALYSIS: A literature search was conducted to identify articles in EMBASE, PubMed/MEDLINE, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Chinese Biomedical Literature, and Wanfang and Weipu from inception to April 1, 2021. The Tinnitus Handicap Inventory, Tinnitus Questionnaire, and effective rate were used to assess perceived tinnitus suppression after treatment. We used Review Manager 5.4 for the standard meta-analysis; R 4.0.4 and Stata 15.1 were used for the NMA and the publication bias and sensitivity analyses. RESULTS: The effect estimates of the direct comparisons (when available) were very similar to those of the NMA. Overall, sound stimulation alone performed better than medication alone, educational consultation alone, and no treatment. Combination therapy, such as sound stimulation plus educational consultation and sound stimulation plus drug therapy, yielded significantly better outcomes with regard to the alleviation of tinnitus than individual treatments. CONCLUSION: This is the first NMA to evaluate and compare the effectiveness of different sound therapies for the management of tinnitus. It may help inform the selection of sound therapy and the development of guidelines in clinical practice. Future studies of sound therapy with larger sample sizes involving multiple medical centers are needed to improve the current evidence.

Propuesta de evaluación del razonamiento diagnóstico en los ejercicios de pase de año y de graduación en las especialidades clínicas / Proposal for the evaluation of diagnostic reasoning in the year and graduation assessments in clinical specialties

importancia del razonamiento diagnóstico, como competencia profesional, justifica que la discusión de la actividad evaluativa se incluya en la llamada Evaluación de Graduación de las residencias médicas. En este artículo se proponen algunos indicadores a utilizar por los profesores durante las actividades de discusión diagnóstica evaluativas; indicadores que emanan de la descomposición de la actividad en sus pasos o acciones. El empleo de estos indicadores y de algunas sugerencias realizadas puede contribuir a hacer más uniforme la evaluación y calificación de los ejercicios de discusión diagnóstica en el marco de la Evaluación de Graduación, o de los exámenes de promoción o pase de año(AU)

The importance of diagnostic reasoning, as professional competence, justifies the discussion of the evaluative activity in the so-called Graduation Assessment of medical residencies. This article proposes some indicators to be used by the professors during the diagnostic discussion evaluative activities. These indicators derive from the breakdown of the activity in steps or actions. The use of these indicators and some suggestions can contribute to making the evaluation and qualification of the diagnostic discussion exercises more uniform in the framework of the graduation assessment, or of the promotion or year exams(AU)

Key dimensions of innovations in workplace-based assessment for postgraduate medical education: a scoping review.

BACKGROUND: Specialist training bodies continue to devise innovative methods of gathering information on trainee workplace performance to meet the requirements of competency-based medical education. We reviewed recent innovations in workplace-based assessment (WBA) tools to identify strengths, weaknesses, and trade-offs inherent in their design and use. METHODS: In this scoping review, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we systematically searched databases between 2009 and 2019 for WBA tools with novel characteristics not typically seen in traditional WBAs. These included innovations in rating scales, ways of collecting information, technological innovations, ways of triggering WBAs, and approaches to compiling and using information. RESULTS: We identified 30 innovative WBA tools whose characteristics could be categorised into seven dimensions: frequency of assessment, granularity (unit of performance assessed), coverage of the curriculum, rating method, initiation of the WBA, information use, and incentives. These dimensions had multiple interdependencies and trade-offs, often balancing generating assessment data with available resources. Philosophical stance on assessment also influenced WBA choice, for example prioritising trainee-centred learning (i.e. initiation of WBA and transparency of assessment data), perceptions of assessment and feedback as burdensome or beneficial, and holistic vs reductionist views on assessment of performance. CONCLUSIONS: Our synthesis of the literature on innovative WBAs provides a framework for categorising tool characteristics across seven dimensions, systematically teasing apart the considerations in design and use of workplace assessments. It also draws attention to the trade-offs inherent in tool design and selection, and enables a more deliberate consideration of the tool characteristics most appropriate to the local context.

The flipped classroom: a novel approach to physical examination skills for osteopathic medical students.

CONTEXT: Medical students are faced with the challenge of synthesizing large volumes of information quickly. With the increasing accessibility of technology, a "flipped classroom" allows students to learn foundational material independently. Class time is instead devoted to in-depth skill building with instructors, promoting an active learning environment. This method of content delivery is also relevant given the current COVID-19 pandemic. OBJECTIVES: To comprehensively evaluate the benefit of adopting a flipped classroom approach in teaching physical exam skills (PES) to first-year osteopathic medical students. METHODS: A cohort study was conducted comparing first-year osteopathic students in the class of 2022 (n=201), who had taken the PES course traditionally, with the class of 2023 (n=203), who experienced the flipped classroom approach. Objective metrics such as cumulative grades, objective structural clinical examination performance (OSCE), and practical exam performance were compared using nonparametric Mann-Whitney U rank sum tests. Subjective measures such as student course evaluations were used to analyze course perceptions using independent sample t-tests assuming unequal variances. A faculty survey was administered to faculty who taught both cohorts to assess instructor attitudes toward the flipped classroom approach. Due to the COVID-19 pandemic, Spring 2020 quarter data was not included, given the transition of all classes to an online learning environment. RESULTS: The flipped classroom approach significantly improved objective student performance for the Fall (p=0.009) and Winter (p<0.001) student cumulative grades and the History-Taking OSCE (p=0.010). Performance on Fall and Winter practical exam scores had no significant association with the flipped classroom. General student perceptions of the course remained unchanged between both cohorts. Faculty survey results from 10 faculty members showed that six (60%) faculty members preferred the traditional classroom, while four (40%) preferred the flipped classroom. CONCLUSIONS: The flipped classroom approach showed some statistically significant improvement in student PES. Further studies are needed to evaluate the benefits of a flipped classroom approach using skills-based assessments styles to measure student performance, with a focus on standardization of in-classroom groupwork.

The Value of Programmatic Assessment in Supporting Educators and Students to Succeed: A Qualitative Evaluation.

BACKGROUND: Programmatic assessment has been proposed as the way forward for competency-based assessment, yet there is a dearth of literature describing the implementation and evaluation of programmatic assessment approaches. OBJECTIVE: To evaluate the implementation of a programmatic assessment and explore its ability to support students and assessors. DESIGN: A qualitative evaluation of programmatic assessment was employed. PARTICIPANTS/SETTING: Interviews with graduates (n = 8) and preceptors (n = 12) together with focus groups with faculty assessors (n = 9) from the one Australian university explored experiences of the programmatic approach, role of assessment in learning, and defensibility of assessment decisions in determining competence. ANALYSIS PERFORMED: Data were analyzed into key themes using framework analysis. RESULTS: The programmatic assessment increased confidence in defensibility of assessment decisions, reduced emotional burden of assessment, increased value of assessment, and identified and remediated at-risk students earlier when philosophical and practice shifts in approaches to assessment were embraced. CONCLUSIONS: Programmatic assessment supports a holistic approach to competency development and assessment and has multiple benefits for learners and assessors.

Admissions Is Not Enough: The Racial Achievement Gap in Medical Education.

The achievement gap is a disparity in academic and standardized test performance that exists between White and underrepresented minority (URM) students that begins as early as preschool and worsens as students progress through the educational system. Medical education is not immune to this inequality. URM medical students are more likely to experience delayed graduation and course failure, even after accounting for science grade point average and Medical College Admission Test performance. Moreover, URM students are more likely to earn lower scores on licensing examinations, which can have a significant impact on their career trajectory, including specialty choice and residency competitiveness. After the release of preliminary recommendations from the Invitational Conference on USMLE Scoring (InCUS) and public commentary on these recommendations, the National Board of Medical Examiners and Federation of State Medical Boards announced that the United States Medical Licensing Examination (USMLE) Step 1 would transition from a 3-digit numeric score to pass/fail scoring. Given that another of InCUS's recommendations was to "minimize racial demographic differences that exist in USMLE performance," it is paramount to consider the impact of this scoring change on URM medical students specifically. Holistic admissions are a step in the right direction of acknowledging that URM students often travel a further distance to reach medical school. However, when residency programs emphasize USMLE performance (or any standardized test score) despite persistent test score gaps, medical education contributes to the disproportionate harm URM students face and bolsters segregation across medical specialties. This Perspective provides a brief explanation of the achievement gap, its psychological consequences, and its consequences in medical education; discusses the potential effect of the Step 1 scoring change on URM medical students; and provides a review of strategies to redress this disparity.

Postgraduate Assessment Approaches Across Surgical Specialties: A Systematic Review of the Published Evidence.

PURPOSE: Ensuring competence for surgical trainees requires holistic assessment of the qualities and competencies necessary to practice safely and effectively. To determine the next steps toward achieving this aim, the authors conducted a systematic review to summarize and appraise the available evidence related to any assessment approach to postgraduate surgical training and to identify the dominant themes for assessment approaches across different specialties or countries. METHOD: Medline and Embase were searched on January 10, 2019, without language or time restrictions. Any peer-reviewed study that described an assessment framework (in practice or novel) throughout postgraduate surgical training globally was included. An iterative review and thematic analysis were performed on full-text articles to determine assessment themes. Studies were then grouped by assessment themes. A tailored quality assessment of the studies included in the final analysis was conducted. Assessment themes and validity were compared across surgical specialties and countries. RESULTS: From an initial 7,059 articles, 91 studies (evaluating 6,563 surgical trainees) were included in the final analysis. Ten defined assessment themes were extracted. Ten studies (11.0%) were deemed low risk of bias based on the quality assessment tool used and thus were determined to be high quality. Minor differences in assessment themes were observed between specialties and countries. Assessment themes neglected by individual surgical specialties and assessment themes that need validated assessment tools were identified. CONCLUSIONS: This review highlights the low quality of evidence and fragmented efforts to develop and optimize surgical assessments. The minor differences observed demonstrate a common approach, globally and across specialties, related to surgical assessments. A paradigm shift in assessment approaches, which will require national and international collaboration, is required to optimize design and validation so that a comprehensive assessment of surgical competence can be implemented.