Self-assessment and learning through GOSCE (group objective structured clinical examination).

The objective structured clinical examination (OSCE) was modified to serve as a means of self-assessment and learning, rather than as an examination. The main modifications were to adapt it for use by small groups instead of individuals, and to provide a correct answer or other feedback at each station. The resulting group OSCE (GOSCE) was used as an introductory session in two residential refresher courses for general practitioners. The 300 participants rated it highly as a method of self-assessment and as an enjoyable social event. Four potential applications of the GOSCE are suggested: as an assessment instrument for formative and informal summative assessment, as a resource for learning about interpersonal and interprofessional relationships, and as a framework for problem-based short courses.

Problems in using the hospital anxiety and depression scale for screening patients in general practice.

A study was made of the feasibility of screening general practice patients for anxiety and depression using the hospital anxiety and depression scale. A group of consecutive patients aged 18 years and over completed the questionnaire at the surgery and an age and sex matched sample were sent questionnaires by post; 94 patients (84%) returned the postal questionnaire. A further group of 170 consecutive patients coming for consultation were recruited. Using a threshold score of eight and over, 51% of patients screened by post were probable 'cases' of psychiatric disorder and using a score of 11 and over, 28% were 'cases'. These proportions were similar for patients screened when attending the surgery. The findings are discussed in the context of well-person screening, and a strategy for follow-up of probable cases is put forward.

Multiple choice questions: to guess or not to guess.

Multiple choice question papers in which the student has a 'don't know' option are widely used in undergraduate and postgraduate examinations in Medicine. In the present study students' performance in papers with a 'don't know' option has been compared with their performance when they are instructed to answer all the questions. By completing questions left unanswered (i.e. 'don't know' options) students were able to increase their score significantly and the rank order of the students in class is changed. Answers omitted may indicate complete ignorance or various degrees of knowledge. It is concluded that the 'don't know' option in multiple choice question papers favours the bold and test-wise student and in consequence their validity as a measure of achievement may suffer. Papers in which the student is instructed to answer all the questions are to be preferred to those in common use where there is a 'don't know' option.