A narrative review of adaptive testing and its application to medical education.

Adaptive testing has a long but largely unrecognized history. The advent of computer-based testing has created new opportunities to incorporate adaptive testing into conventional programmes of study. Relatively recently software has been developed that can automate the delivery of summative assessments that adapt by difficulty or content. Both types of adaptive testing require a large item bank that has been suitably quality assured. Adaptive testing by difficulty enables more reliable evaluation of individual candidate performance, although at the expense of transparency in decision making, and requiring unidirectional navigation. Adaptive testing by content enables reduction in compensation and targeted individual support to enable assurance of performance in all the required outcomes, although at the expense of discovery learning. With both types of adaptive testing, candidates are presented a different set of items to each other, and there is the potential for that to be perceived as unfair. However, when candidates of different abilities receive the same items, they may receive too many they can answer with ease, or too many that are too difficult to answer. Both situations may be considered unfair as neither provides the opportunity to demonstrate what they know. Adapting by difficulty addresses this. Similarly, when everyone is presented with the same items, but answer different items incorrectly, not providing individualized support and opportunity to demonstrate performance in all the required outcomes by revisiting content previously answered incorrectly could also be considered unfair; a point addressed when adapting by content. We review the educational rationale behind the evolution of adaptive testing and consider its inherent strengths and limitations. We explore the continuous pursuit of improvement of examination methodology and how software can facilitate personalized assessment. We highlight how this can serve as a catalyst for learning and refinement of curricula; fostering engagement of learner and educator alike.

Evaluation of sepsis teaching for medical and dental students at a British University.

INTRODUCTION: The aim of this study was to evaluate sepsis on undergraduate programmes in medicine (BMBS), dentistry (BDS) and dental therapy (BScDTH) at a university in England. MATERIALS AND METHODS: The study was carried out at the Faculty of Health, University of Plymouth. Questionnaires consisting of a series of closed and open-ended items were designed for students and faculty by a group of academics. Following a pilot, participants were invited to complete the questionnaires online. Data collection and analyses were completed over a period of 3 months. RESULTS: A total of 71 students responded, including 43 were on the BDS programme, 21 on BMBS and 7 on BScDTH. The vast majority were aged between 18-24 years old (n = 61), with 9 reporting being between 25-44 years old. Of the 14 staff who responded, 13 were aged between 35 and 54 years old, with one respondent reporting being aged 25-34. The participants reported their perceptions regarding the teaching and clinical exposure of students to sepsis patients; availability of resources for students and patients to raise sepsis awareness. Students across all programmes reported limited clinical exposure to management of sepsis and lack of confidence in recognising early signs of sepsis in patients. The agreement profile between programmes only differed significantly for recognition of sepsis risk item (χ(6, n = 71) = 26.187, p < 0.001), with BDS students disagreeing with the item to a larger extent than BMBS and BScDTH students. Students and staff reported similar perceptions regarding information available to students and patients. Responses to open-ended items provided several suggestions for improvements in the teaching of students and raising public awareness on sepsis. CONCLUSION: This study identified several areas related to sepsis teaching which require improvements across all programmes. The key issues highlighted by the students included limited clinical exposure to sepsis patients and lack of confidence in recognising early signs of sepsis.

Standard setting anchor statements: a double cross-over trial of two different methods.

This article was migrated. The article was marked as recommended. Context: We challenge the philosophical acceptability of the Angoff method, and propose an alternative method of standard setting based on how important it is for candidates to know the material each test item assesses, and not how difficult it is for a subgroup of candidates to answer each item. Methods: The practicalities of an alternative method of standard setting are evaluated here, for the first time, with direct comparison to an Angoff method. To negate bias due to any leading effects, a prospective cross-over design was adopted involving two groups of judges (n=7 and n=8), both of which set the standards for the same two 100 item multiple choice question tests, by the two different methods. Results: Overall, we found that the two methods took a similar amount of time to complete. The alternative method produced a higher cut-score (by 12-14%), and had a higher degree of variability between judges' cut-scores (by 5%). When using the alternative method, judges reported a small, but statistically significant, increase in their confidence to decide accurately the standard (by 3%). Conclusion: This is a new approach to standard setting where the quantitative differences are slight, but there are clear qualitative advantages associated with use of the alternative method.

How does dyslexia impact on the educational experiences of healthcare students? A qualitative study.

AIMS: To explore the impact of dyslexia on the educational experiences of undergraduate students in medicine, dentistry, dental therapy and biomedical sciences. METHODS: It was a qualitative study based on semi-structured interviews. The study was conducted at the Faculty of Medicine and Dentistry at a University in the South West region of the United Kingdom. Purposive sampling was used, and the participants included undergraduate students from the schools of medicine, dentistry and biomedical sciences. RESULTS: The sample consisted of fifteen undergraduate students including five from medicine; four from dentistry; three from dental therapy; and three from biomedical sciences. All students had a formal diagnosis of Dyslexia. The students shared their views and experiences regarding disclosure, transition into the university, learning environments, assessments and challenges after graduation. CONCLUSIONS: This is the first study to explore the impact of dyslexia on the educational experiences of healthcare students from multiple programmes in a variety of educational settings. The findings show that the students were confident regarding disclosure of their dyslexia and had a formal diagnosis of dyslexia established during their school years. Although the participants experienced typical academic difficulties associated with dyslexia, problem-based learning (PBL) was perceived to be enjoyable and less stressful than traditional lectures and no specific challenges were reported in acquisition of clinical, communication and team-working skills.

Improving communication for learning with students: expectations, feedback and feedforward.

This article was migrated. The article was marked as recommended. The aim of this paper is to draw together numerous strands from within the literature and our own practice to provide advice for improving communication about learning with students in undergraduate medical education. There is an assumption within higher education that assessment drives learning and, as such, assessment forms the focal points for communication between teachers and students. However, a broader approach is required to avoid misunderstandings and maximise the successful engagement with learning of everyone involved. It is important to plan a clear communication strategy that incorporates and enables identification with the unique values of the particular school. Where communication about learning is overtly discussed there are three main areas to consider: (1) management of expectations (sometimes referred to as feed up or feed in) that needs to include not only the use of authentic formative assessments, but also the viewpoints of both teachers and students. (2) Feedback and (3) Feedforward, both need to be considered from the perspectives of student and teacher. All communication needs to be inclusive, it's structures must provide scaffolding for respectful exchanges of information, and this will have clear practical consequences for the activities within the school.

Regulation of DNA synthesis at the first cell cycle in the sea urchin in vivo.

Using fluorescent and non-fluorescent recombinant proteins has proved to be a very successful technique for following postfertilization events, in both male and female pronuclei during the first cell cycle of sea urchin in vivo. Proteins and dyes are introduced by microinjection into the unfertilized egg, and their function can be monitored by fluorescence or confocal/two-photon (2P) and transmitted light microscopy after insemination. Here, we describe expression and purification of GFP/RFP-tagged proteins involved in regulation of DNA replication. We also explain the techniques used to introduce recombinant proteins and fluorescent tubulin into sea urchin eggs and embryos.

Dynamic interactions of high Cdt1 and geminin levels regulate S phase in early Xenopus embryos.

Cdt1 plays a key role in licensing DNA for replication. In the somatic cells of metazoans, both Cdt1 and its natural inhibitor geminin show reciprocal fluctuations in their protein levels owing to cell cycle-dependent proteolysis. Here, we show that the protein levels of Cdt1 and geminin are persistently high during the rapid cell cycles of the early Xenopus embryo. Immunoprecipitation of Cdt1 and geminin complexes, together with their cell cycle spatiotemporal dynamics, strongly supports the hypothesis that Cdt1 licensing activity is regulated by periodic interaction with geminin rather than its proteolysis. Overexpression of ectopic geminin slows down, but neither arrests early embryonic cell cycles nor affects endogenous geminin levels; apparent embryonic lethality is observed around 3-4 hours after mid-blastula transition. However, functional knockdown of geminin by ΔCdt1_193-447, which lacks licensing activity and degradation sequences, causes cell cycle arrest and DNA damage in affected cells. This contributes to subsequent developmental defects in treated embryos. Our results clearly show that rapidly proliferating early Xenopus embryonic cells are able to regulate replication licensing in the persistent presence of high levels of licensing proteins by relying on changing interactions between Cdt1 and geminin during the cell cycle, but not their degradation.

Ca2+ signals coordinate zygotic polarization and cell cycle progression in the brown alga Fucus serratus.

Zygotes of the fucoid brown algae provide excellent models for addressing fundamental questions about zygotic symmetry breaking. Although the acquisition of polarity is tightly coordinated with the timing and orientation of the first asymmetric division--with zygotes having to pass through a G1/S-phase checkpoint before the polarization axis can be fixed--the mechanisms behind the interdependence of polarization and cell cycle progression remain unclear. In this study, we combine in vivo Ca2+ imaging, single cell monitoring of S-phase progression and multivariate analysis of high-throughput intracellular Ca2+ buffer loading to demonstrate that Ca2+ signals coordinate polarization and cell cycle progression in the Fucus serratus zygote. Consistent with earlier studies on this organism, and in contrast to animal models, we observe no fast Ca2+ wave following fertilization. Rather, we show distinct slow localized Ca2+ elevations associated with both fertilization and S-phase progression, and we show that both S-phase and zygotic polarization are dependent on pre-S-phase Ca2+ increases. Surprisingly, this Ca2+ requirement cannot be explained by co-dependence on a single G1/S-phase checkpoint, as S phase and zygotic polarization are differentially sensitive to pre-S-phase Ca2+ elevations and can be uncoupled. Furthermore, subsequent cell cycle progression through M phase is independent of localized actin polymerization and zygotic polarization. This absence of a morphogenesis checkpoint, together with the observed Ca2+-dependences of S phase and polarization, show that the regulation of zygotic division in the brown algae differs from that in other eukaryotic model systems, such as yeast and Drosophila.

ERK1 activation is required for S-phase onset and cell cycle progression after fertilization in sea urchin embryos.

Fertilization of sea urchin eggs results in a large, transient increase in intracellular free Ca2+ concentration that is responsible for re-initiation of the cell division cycle. We show that activation of ERK1, a Ca2+-dependent MAP kinase response, is required for both DNA synthesis and cell cycle progression after fertilization. We combine experiments on populations of cells with analysis at the single cell level, and develop a proxy assay for DNA synthesis in single embryos, using GFP-PCNA. We compare the effects of low molecular weight inhibitors with a recombinant approach targeting the same signalling pathway. We find that inhibition of the ERK pathway at fertilization using either recombinant ERK phosphatase or U0126, a MEK inhibitor, prevents accumulation of GFP-PCNA in the zygote nucleus and that U0126 prevents incorporation of [3H]-thymidine into DNA. Abrogation of the ERK1 signalling pathway also prevents chromatin decondensation of the sperm chromatin after pronuclear fusion, nuclear envelope breakdown and formation of a bipolar spindle.

GFP-PCNA as an S-phase marker in embryos during the first and subsequent cell cycles.

BACKGROUND INFORMATION: Proliferating cell nuclear antigen (PCNA) is a key component of the DNA replication machinery involved in the process of DNA elongation, recombination, methylation and repair. We have used PCNA fused with green fluorescent protein (GFP-PCNA) as a convenient tool to show the progress of S-phase in single embryos in vivo. Here we make a comparison between Hoechst 33342 and GFP-PCNA as in vivo event markers for DNA synthesis. Hoechst 33342 and DAPI (4,6-diamidino-2-phenylindole) have been used as a simple and rapid method for assessing membrane permeability and staining DNA in mammalian cells. However, it is difficult to use these dyes in living embryos during cell cycle progression studies over long periods of time as they are phototoxic. Moreover, though Hoechst staining reveals nuclear morphology, it gives no information about the progress of S-phase. RESULTS: We have microinjected or expressed a GFP-PCNA chimera to develop a method which enables visualization of S-phase in sea urchin and Caenorhabditis elegans embryos during the first and subsequent embryonic cell cycles and in Drosophila stage 4 embryos during syncytial nuclear divisions. We find that nuclear accumulation of GFP-PCNA correlates with S-phase onset. Loss of the chimera from the nucleus occurs when the nuclear envelope breaks down at mitosis. CONCLUSIONS: GFP-PCNA is a accurate and non-toxic marker of S-phase in embryos during early development.