Testing the Effects of Individual Residents' Retrieval Practice on Standardized Examination Scores.

Background: Residents have limited time and much to learn. Retrieval practice-studying using exam-style review questions-is a powerful educational tool for aggregate groups of learners, but it has not been tested for individual graduate medical education (GME) trainees. Methods: We conducted a retrospective observational study examining how individual residents' self-directed retrieval practice affected their learning. We used linear regression models to compare the number of exam-style multiple-choice practice questions each resident answered per year to their scores on annual In-Training Exams (ITE). Results: We found that the higher a resident's ITE score was at the start of a year, the fewer practice questions they answered that year for both first- (p = 0.023) and second-year (p = 0.020) trainees. Then, the more questions a resident answered in a year, the more their ITE score increased over that year for both first- and second-year trainees (p = 0.026 and 0.025, respectively). Residents' prior ITE scores also independently predicted their subsequent ITE scores (p = 0.024 in the first and 0.007 in the second year), and the effect of their baseline scores was larger than the effect of the number of practice questions they answered. Conclusions: Individual residents' prior exam scores significantly predict their future exam scores, and their independent retrieval practice using exam-style review questions also significantly predicts the annual improvement in their scores. These findings add to the growing evidence supporting retrieval practice in GME, and they can inform individualized educational coaching for GME trainees.

Assessing Medical Student Perceptions of Open-Book Exams for Self-Directed Learning.

Introduction  The landscape of medical education is constantly evolving, with innovative assessment methods being integrated to better align with the requirements of modern healthcare education. Among these, open-book exams (OBEs) represent a significant shift from traditional closed-book exams (CBEs), promising to enhance learning outcomes and better evaluate students' understanding of medical concepts. This study aims to explore the multifaceted impact of OBEs on medical students, including their perceptions, study behaviors, stress levels, and the cultivation of critical thinking and self-directed learning skills. Methodology  This is a cross-sectional study, which utilized a mixed-methods approach, conducted at Al Baha University's College of Medicine, to explore the impact of OBEs on self-directed learning among 129 medical students over a 15-day period in October 2023. The research combined quantitative data from online questionnaires, assessing students' experiences, stress, understanding, and study strategies, with qualitative insights from in-depth interviews and open-ended survey questions. Participants were final-year medical students with prior experience in OBEs, selected to minimize bias. Data analysis was performed using Statistical Product and Service Solutions (SPSS, version 25; IBM SPSS Statistics for Windows, Armonk), focusing on descriptive and inferential statistics, while qualitative data underwent thematic analysis to identify patterns in students' perceptions of self-directed learning opportunities. The study was ethically approved, ensuring participant confidentiality and informed consent. Result  Regarding the medical student perspectives on OBEs, the study revealed that the majority of medical students strongly perceive OBEs as less stressful (77, 59.69%) and easier to prepare for (79, 61.24%) compared to traditional exams. A significant proportion also believe OBEs accurately assess their comprehension (106, 82.17%) and prefer them as a mode of assessment (106, 82.17%). Furthermore, most students (87, 67.44%) reported performing better on OBEs compared to CBEs. Regarding the assessment of self-directed learning using the OBE method, students predominantly utilized highlighting important points (70, 54.26%) as a preparation method for OBEs. A large majority (85, 65.89%) considered OBEs as a fair assessment of self-directed learning and believed that they encourage self-directed learning (114, 88.37%). Conclusion  OBEs represent a promising direction for medical education, offering a way to better prepare students for the complexities of real-world medical practice. Future strategies should include not only the refinement of OBE methodologies but also the integration of practice opportunities that enable students to hone their skills in applying knowledge effectively.

Student pharmacists' perceptions of a NAPLEX preparation module in the pharmacy curriculum at one United States college of pharmacy.

BACKGROUND AND PURPOSE: To investigate final-year student pharmacists' experiences of a new module for North American Pharmacist Licensure Examination® (NAPLEX®) preparation at one college of pharmacy in the United States. EDUCATIONAL ACTIVITY AND SETTING: All student pharmacists enrolled in a new Spring 2023 module for NAPLEX preparation (n = 118) were invited to complete an electronic questionnaire and participate in a semi-structured interview. The questionnaire investigated the perceived helpfulness, grading, importance, prioritization, structure, and timing of the module in the curriculum, as well as assignment choices, confidence building, and time management using a six-point Likert scale. Semi-structured interviews investigated experiences with NAPLEX modules, time management, and course format. Questionnaire data were descriptively analyzed; interview data were thematically analyzed. FINDINGS: Forty-one completed questionnaires and seven interviews were analyzed. Median scores for questionnaire items were six (denoting strongly agree) for three items, five (denoting agree) for seven items, and four (denoting somewhat agree) for two items. Twenty-three (56%) students desired an online self-directed (asynchronous) course structure. Seventeen (42%) students desired a mixture of short and long course assignments with a greater proportion of short course assignments while another 17 (42%) desired only short course assignments. Two themes were constructed from interviews: timing (when to study for NAPLEX) and structure (how to study for NAPLEX). SUMMARY: Study findings indicated typically positive perceptions of a module for NAPLEX preparation among final-year student pharmacists at a college of pharmacy in the United States. Recommendations from students can be used to improve the module in future years.

Exam evaluation in prosthodontics across preclinical and clinical years from students' perspective: A cross-sectional study.

INTRODUCTION: The purpose of this study was to explore the students' perceptions and performance in prosthodontics theory exam. METHODS: A cross-sectional descriptive study was conducted on 560 (80.82%) students of different levels (third, fourth and fifth years) to explore their opinions and performance with regard to a number of issues on a prosthodontics theory exam (exam evaluation, exam preparation, exam material, exam timing). Demographic data were also collected. Descriptive statistics were generated and Chi-square test, independent sample t-test, ANOVA test and Pearson's correlation coefficient were used to examine the associations between different variables. The significance level was set at p < .05. RESULTS: Students' responses regarding exam evaluation was influenced by their gender, study level, high-school Grade Point Average (GPA) and undergraduate cumulative GPA. Perceived exam difficulty was significantly affected by gender (p = .03) and study level (p < .001), and negatively correlated to both high-school GPA (p < .001) and university GPA (p = .03). The vast majority (88.2%) depended on lecture hand-outs and lecture notes for study. Exam material and preparation were not significantly affected by any of the demographic variables with most respondents (76.8%) thinking that the lectures blended with prosthodontics laboratories/clinics would improve their understanding of the exam material. The suggested best time to conduct the exam was early afternoon (31.6%). Student performance was significantly affected by the study level (p < .001) and cumulative GPA (p < .001) with significant positive correlation between the high-school GPA and the mark in the exam (r = .29, p < .001) and by the amount of time students spent for exam preparation (p < .001). Those students who reported using textbooks to prepare for the exam got significantly higher marks (66.1 ± 8.7) compared to the students who did not (62.8 ± 9.7) (p = .03). CONCLUSIONS: Course level, GPA and gender were identified as the most influential factors in different aspects of exam evaluation and students' performance. Regular study and use of textbooks were demonstrated to improve academic performance. Additional orientation and guidance relating to the exam (especially for third year students) would be welcomed, as would alternate teaching methods such as small group discussions or study groups.

Using artificial intelligence platforms to support student learning in physiology.

The advent of artificial intelligence (AI)-powered language models presents new opportunities and challenges in education. By teaching students how to craft prompts that elicit insightful responses, faculty can scaffold activities where AI acts as a supplemental resource to amplify critical thinking and support student learning. Ongoing dialogue and iteration focused on ethical usage norms can achieve the right balance between emerging technology and foundational skills development. With care and intention, AI-assisted study tactics offer students personalized support while adhering to academic standards. While AI-powered tools provide many positive opportunities, students and faculty need to learn about and use them responsibly and ethically, not as replacements for required thinking and effort. Before implementing these AI tools for studying biology, there are several key things to discuss with students. This article outlines several ways that students can employ these tools to support better learning along with a set of guidelines for all to be wary of when implementing these in an academic setting.NEW & NOTEWORTHY Utilizing of artificial intelligence tools offers a promising new technology to support student learning. This article outlines several ways that students can employ these tools to support better learning along with a set of guidelines for all to be wary of when implementing these in an academic setting.

A Description of Required NAPLEX Preparation Courses Among US Pharmacy Programs.

OBJECTIVE: One of the final tasks for pharmacy graduates to enter practice is passing the North American Pharmacist Licensure Examination (NAPLEX). Given the recent national declines in pass rates, programs are making significant investments of time and money in NAPLEX preparation. The objective is to characterize the structure and content of required NAPLEX preparation courses. METHODS: A survey on NAPLEX preparation practices was developed and distributed to all Accreditation Council for Pharmacy Education-accredited pharmacy schools. NAPLEX preparation course syllabi were also collected as part of this survey. Syllabus information was summarized into 4 elements: course structure, content, resources, and assessment strategies. RESULTS: Of 144 colleges/schools of pharmacy, 100 responded to the survey, 87 reported having a NAPLEX preparation program, and 47 reported having a NAPLEX preparation course. Twenty syllabi were collected. Most courses (14) were longitudinal through the Advanced Pharmacy Practice Experiences year, 16 were credit-bearing, and 19 included a vendor NAPLEX preparatory product. Fourteen courses were hybrid delivery, and 12 focused on licensure preparation and included test-taking strategies, calculations practice, case-based discussions, etc. All 20 courses reported using unproctored timed quizzes and practice examinations, half conducted proctored timed assessments, and 11 included written reflections and/or continuous professional development activities. Most courses were pass/fail (15), and high stakes (16) were defined by delayed or withheld graduation as a consequence for failure. Only 3 of 20 NAPLEX preparation courses were mapped to NAPLEX competencies. CONCLUSION: Although required NAPLEX preparation courses focus on assessments, the content is infrequently mapped to NAPLEX competencies. This project provides some information on how schools might create their own NAPLEX preparatory courses.

Novel interactive text-messaging curriculum for endocrinology board review.

Background: The ABIM certification exam is one of the measures to ensure that physicians have the clinical skills for good care delivery. The 5-year average pass rate for ABIM Endocrinology exam is 82%. The pass rate significantly decreased to a nadir of 74% in 2021 and 2022, lowest of all medicine subspecialties. Objectives: To assess the feasibility of text messaging curriculum for fellows and its utility in improving their test performance. Methods: In 2021, endocrinology fellows from 51 programs across the country were invited to participate in our curriculum. They completed a pre-test, joined a texting group via Remind application and received 1 multiple choice question daily (total n = 78). After 15 weeks, they completed a post-test and survey. Paired results from pre- and post-test were compared. Results: A total of 89 fellows from 27 programs responded. Of these, 82 fellows, predominantly females (n = 60; 73 %), filled out the pre-test. On an average, 42 fellows (SD = 12) responded to the questions daily and 57 % of them answered the questions within 24 h. Thirty fellows completed the post-test. The median number of correct responses on the pre-test was 5 (IQR 3-6), compared to 8 (IQR 6-9) in the post-test. There was a significant improvement (p-value < 0.0001) in fellows' performance in the post-test when compared with the pre-test following our intervention. Conclusions: Text-messaging based curriculum for exam preparation is feasible and can improve test performance. Fellows find receiving a daily high yield multiple choice question via text-message as a useful tool for exam preparation.

Using social media platforms to prepare for examinations post Covid-19: The case of saudi university EFL learners.

Mobile-Assisted Language Learning (MALL) applications have been increasingly used by learners and instructors after the government imposed social and educational restrictions in Saudi Arabia for almost two years due to the Covid-19 pandemic. This research investigates Saudi EFL university learners' use of MALL applications, specifically Social Media Platform (SMP) applications, in their preparation for achievement exams post the Covid-19 pandemic social and educational restrictions. A questionnaire consisting of questions, as well as a range of open-ended question was designed and administered to 125 English major female learners who were enrolled at King Faisal University (KFU) in two different educational modes viz., regular (66) and distance (59) participation. Seven SMP applications - WhatsApp, YouTube, Telegram, Twitter, Instagram, Snapchat and Facebook - were used in this study. Data were analyzed quantitatively using the MANOVA test in SPSS, and qualitatively. The results have shown that both Regular Learners (RLs) and Distance Learners (DLs) used SMPs to prepare for their exams. The data analysis revealed that there were significant differences between RLs and DLs in their frequency of use of SMPs in preparation for exams. WhatsApp was the most frequently used SMP by RLs, whereas Telegram was the most frequently used SMP by DLs. Facebook was the SMP least frequently used by both groups. There were also statistically significant differences in favor of RLs over DLs in the frequency of use of SMPs in preparation for exams due to the Covid-19 pandemic Most participants reported that SMPs have a positive effect on their academic achievements. During the pandemic this was the main reason for continuing to use SMPs. Other reasons that emerged from the qualitative analysis of the open-ended responses included educational, technical and cognition reinforcement. The study results suggested implications for learners, instructors and educational policy makers.

Impact of the USMLE Step 1 and COMLEX Level 1 transition to Pass/Fail on osteopathic medical student stress levels and board preparation.

CONTEXT: The United States Medical Licensing Examination (USMLE) Step 1 and Comprehensive Osteopathic Medical Licensing Exam (COMLEX) Level 1 transitioned from a numeric scoring system to a Pass/Fail designation in 2022. This transition intended to decrease stress, improve medical student well-being, and encourage residency program directors to emphasize other aspects of residency applications. Pass/Fail score transitions in the undergraduate medical education curriculum have improved medical student psychological well-being and satisfaction; whether these same benefits translate to the board examination period is unknown. OBJECTIVES: The objectives of this study are to assess the impact of USMLE Step 1 and COMLEX Level 1 grade scale transition on medical student stress, wellness, board preparation decisions, and future residency selection processes. Investigators hypothesized that students under the Pass/Fail designation would experience less stress during the intensive study period leading up to USMLE Step 1 and COMLEX Level 1 and devote more time to other aspects of their residency applications. METHODS: To examine the impact on osteopathic medical student (OMS) stress and approach to board preparation, two surveys were administered to Rocky Vista University College of Osteopathic Medicine (RVU-COM) students before (Class of 2023) and after (Class of 2024) the transition to a Pass/Fail designation. All students within the RVU-COM Classes of 2023 and 2024 were invited to participate. The Cohen Perceived Stress Scale (PSS-10) was administered at the beginning of the focused board study period in May 2021 and 2022 to the Class of 2023 and 2024, respectively. The investigator-designed Licensing Exam Questionnaire (LEQ), meant to capture board preparation patterns, residency application perspectives, and wellness during examination preparation, was administered immediately after the board examination deadline in July 2021 and 2022 to the Class of 2023 and 2024, respectively. Statistical analysis included the use of independent t tests (numeric variables) and chi-square tests (categorical data). This project was considered exempt from full Institutional Review Board review. RESULTS: Approximately one-third of the Class of 2023 (PSS-10: n=86; LEQ: n=93) and 2024 (PSS-10=89; LEQ: n=92) responded. No difference was detected in mean PSS-10 score, 20.14 (SD=7.3) compared to 19.92 (SD=6.56) for the Class of 2023 and 2024 (p=0.84), respectively. The Class of 2023 reported more weeks studying (mean 6.27 weeks, SD=0.79) vs. the Class of 2024 (mean 5.44 weeks, SD=0.007), p<0.001, more practice examinations taken X 2 (1, n=182)=13.75, p<0.001, and a greater proportion scheduled examinations after June 20 X 2 (1, n=182)=29.01, p<0.001. No difference existed in hours studying per day, sequence of Step 1/Level 1, time between examinations, money spent, or type of study resources utilized. CONCLUSIONS: The transition of USMLE Step 1 and COMLEX Level 1 to a Pass/Fail designation did not reduce stress for OMSs at a single, multicampus COM. Respondents, however, altered board preparation practices in meaningful ways. As student behaviors and board-study patterns emerge, these insights must be connected to outcomes in the future.

NAPLEX Preparation Program Characteristics and Resources Associated With First-Time Exam Pass Rates.

OBJECTIVE: Pharmacy colleges and schools invest substantial faculty effort and financial resources in North America Pharmacist Licensure Exam (NAPLEX) preparation, including vendor products purported to improve NAPLEX pass rates. The objective of this project was to examine NAPLEX preparation program characteristics associated with first-time pass rates. METHODS: A national survey investigated which pharmacy schools provided a formal NAPLEX preparation program in the 2021/2022 academic year, and what resources students were required to use. Pharmacy school characteristics and the unique resources provided in NAPLEX preparation programs were separately analyzed for association with 2022 NAPLEX first-time pass rates. RESULTS: The survey response rate was 71% (100 pharmacy schools). Of the 6 pharmacy school characteristics analyzed, offering a formal NAPLEX preparation program and private status were both weakly correlated with a decrease in the 2022 NAPLEX pass rate, while founding year of 2000 or earlier was weakly correlated with an increase in the pass rate. In a generalized linear model, a decrease in 2022 NAPLEX pass rate was associated with offering a formal NAPLEX preparation program (-5.90% [-11.55 to -0.23]) and with a 3-year accelerated curriculum (-9.15% [-15.55 to -2.75]). Of 12 resources required in NAPLEX preparation programs, 3 were weakly correlated with a decrease in 2022 pass rate: a vendor question bank, vendor review book/materials, and a live, synchronous faculty-led review. In a generalized linear model, a decrease in 2022 NAPLEX pass rate was associated with a live, synchronous faculty-led review (-6.62% [-11.16 to -2.08]). Among schools without a formal preparation program, NAPLEX pass rates consistently exceeded the national average in 2020, 2021, and 2022, while the proportion of schools with NAPLEX preparation programs and first-time pass rates above the national average dropped from 59% in 2021 and 58% in 2020 to 44% in 2022. CONCLUSION: Simply implementing a NAPLEX preparation program is insufficient to overcome other systemic/programmatic influences of successfully passing the NAPLEX; programs should invest earlier resources to address NAPLEX competencies.

A Description of NAPLEX and MPJE Preparation Strategies Among US Colleges and Schools of Pharmacy.

OBJECTIVE: The purpose of this study was to describe the different strategies used to supplement North American Pharmacist Licensure Examination (NAPLEX) and Multistate Pharmacy Jurisprudence Examination (MPJE) preparation in the US pharmacy programs. METHODS: An online survey was developed to gather information from 141 accredited schools/colleges of pharmacy about the preparation methods used during the 2021-22 academic year. The questionnaire contained 19 NAPLEX- and 10 MPJE-specific questions related to timing, content, use of commercial products and programs, faculty involvement, and whether these activities were required or recommended. Characteristics of schools/colleges were compared based on the presence or absence of preparation programs; preparation programs were descriptively reported. RESULTS: The response rate was 71%. Most schools (87/100 respondents) provided NAPLEX preparation programs starting in the advanced pharmacy practice experiential year, required students to participate, and focused on reviewing the content instead of assessing students' examination readiness. Similar elements were reported among 61 schools providing MPJE preparation programs. Schools used a variety of resources including access to vendor-based question banks or review materials, and completing live, proctored, NAPLEX-like examinations. Characteristics of schools or colleges did not differ significantly based on presence or absence of a preparation program. CONCLUSION: Schools/colleges of pharmacy use a variety of strategies to prepare students for licensing examinations. Many require student participation in vendor-based preparation programs for NAPLEX, and homegrown programs for MPJE preparation. The next step will be to determine the effectiveness of various approaches used by the schools/colleges on first-time licensure examination attempts.

Learning Theories Versus Practice: How Do Internal Medicine Residents Study for Licensing Examinations?

OBJECTIVE:  The ability to recall relevant medical knowledge within clinical contexts is a critical aspect of effective and efficient patient diagnosis and management. The ever-growing and changing body of medical literature requires learners to develop effective life-long learning techniques. Learners can more successfully build their fund of knowledge and ability to retrieve it by using evidence-based learning strategies. Our objective was to evaluate the study habits of internal medicine (IM) residents at an academic institution to understand if they apply key learning strategies for the American Board of Internal Medicine (ABIM) exam preparation. We also briefly review various learning strategies that can be applied to IM residency curricula. METHODS: A web-based survey consisting of 16 multiple-response questions on study habits was filled out by the IM residents in 2019 at Tufts Medical Center. RESULTS: Of the 75 residents invited to participate in the study, 69 responded (response rate = 92%). Of the responders, n=25 (36.2%) were post-graduate year (PGY)-1, n=20 (29.0%) were PGY-2, and n=24 (34.8%) were PGY-3 residents. More than half the residents (n=40, 58%) had Step 2 Clinical Knowledge (CK) scores > 250. Residents self-reported applying spaced learning (67%), interleaving (64%), retrieval (64%), and elaboration practices (46%) for exam preparation. There was a significant association between the Step 2 CK score and elaboration (p=0.017) technique but not with spaced learning, interleaving, or retrieval. The majority of residents felt not at all prepared (n=42, 60.9%) for the ABIM exam. CONCLUSIONS: Despite two years of clinical training, 33% of the third-year residents felt inadequately prepared for the board certification exam. Incorporating evidence-based learning strategies into their daily curriculum may help them better prepare for the ABIM exam.

Using the study cycle model to support better student learning: a faculty guide.

Despite years of varied school experiences, many college students do not have adaptable study methods that allow them to collect, organize, and reorganize information to critically assess what they know and what they need help with until after a poor exam performance. Faculty are frequently called on to help students become better learners. In addition, as the tasks and complexity of the material become more challenging, students will need to adopt new study habits and adapt them to each new learning opportunity to reach their goals. This article describes an evidence-based framework that teachers can share with students that will support better studying habits leading to deeper learning.NEW & NOTEWORTHY Many college students do not have adaptable methods habits that allow them to get the most out of in-class time and structure their out-of-class study time. As a result, faculty are frequently called on to help students become better learners. This article describes an evidence-based framework focusing on learning anatomy and physiology examples that faculty can share with students to support better studying habits leading to deeper learning.

Supporting Canadian Nursing Students to Write the NCLEX-RN Exam: A Three-Phased Mixed Methods Descriptive Design.

BACKGROUND: In 2015, the College of Nurses of Ontario, replaced the Canadian Registered Nurse Examination with the NCLEX-RN exam as entry-to-practice. Faculty in a college-university partnership searched for products to provide nursing students with focused practice in writing exams modelled on the Canadian NCLEX-RN test plan. PURPOSE: The aim of this three-phased evaluation study was to test and validate NCLEX-RN exam preparation materials newly developed for the Canadian context. METHODS: A mixed methods descriptive design was used to capture subjective perspectives and objective measures. After ethical approval was obtained, 13 students assessed the e-learning platform's usability. Eight faculty/clinical experts assessed the content validity of materials using a content validity index (CVI) at both item (I-CVI), and scale (S-CVI) levels. Lastly, 72 completed tests served as the basis for assessing psychometric properties of selected test items. RESULTS: Materials were assessed as useful and easy to use and navigate. I-CVIs ranged between 0.5 to 1.0 with none falling below 0.5 while S-CVIs were above the standard for acceptability of greater than 0.8 with none falling below 0.9. Overall test reliability measured by the Kuder-Richardson formula was 0.73. Many items assessed for difficulty (64%) showed a proportion of correct responses within desired ranges, and most point-biserial indices ranged from fair to very good. CONCLUSION: Strong evidence supported the usability and content validity of the materials assessed. Item difficulty and discrimination analyses were within acceptable ranges. Suggestions for improvements were offered. Predictive analysis should form the basis of future research in this area.

The number of shoulder and elbow questions on the orthopedic in-training examination is increasing with greater emphasis on critical thinking over recall.

Background: It is critical for orthopedic surgery residents and residency programs to have a current understanding of the content and resources utilized by the Orthopedic In-Training Examination (OITE) to continuously guide study and educational efforts. This study presents an updated analysis of the shoulder and elbow section of the OITE. Methods: All OITE questions, answers, and references from 2013 to 2019 were reviewed. The number of shoulder and elbow questions per year was recorded, and questions were analyzed for topic, imaging modalities, cognitive taxonomy, and references. We compared our data to the results of a previous study that analyzed shoulder and elbow OITE questions from 2002 to 2007 to examine trends and changes in this domain overtime. Results: There were 177 shoulder and elbow questions (126 shoulder, 71.2%; 51 elbow, 28.8%) of 1863 OITE questions (9.5%) over a 7-year period. The most commonly tested topics included degenerative joint disease/stiffness/arthroplasty (31.6%), anatomy/biomechanics (16.9%), instability/athletic injury (15.3%), trauma (14.7%), and rotator cuff (13.6%). Half of all questions involved clinical management decisions (49.7%). A total of 417 references were cited from 56 different sources, the most common of which were the Journal of Shoulder and Elbow Surgery (23.3%), Journal of the American Academy of Orthopaedic Surgeons (20.4%), and Journal of Bone and Joint Surgery (American Volume) (16%). The average time lag from article publication to OITE reference was 7.7 years. Compared with a prior analysis from 2002 to 2007, there was a significant increase in the number of shoulder and elbow questions on the OITE (5.5% to 9.5%; P < .001). Recent exams incorporated more complex multistep treatment questions (4.4% vs. 49.7%; P < .001) and fewer recall questions (42.2% vs. 22%; P < .001). There was a significant increase in the use of imaging modalities (53.3% vs. 79.1%; P < .001). No significant differences in the distribution of question topics were found. Conclusions: The percentage of shoulder and elbow questions on the OITE has nearly doubled over the past decade with greater emphasis on critical thinking (eg, clinical management decisions) over recall of facts. These findings should prompt educators to direct didactic efforts (eg, morning conferences and journal club) toward case-based learning to foster critical thinking and clinical reasoning skills.

Orthopaedic In-training Exam Preparation among Orthopaedic Surgery Residency Programs.

OBJECTIVE: The Orthopaedic In-Training Examination (OITE) is given annually to residents to assess their knowledge of clinical orthopaedics and orthopaedic basic science. This study sought to determine what resources orthopaedic residency programs recommend and/or require for residents as preparative tools for the OITE and to understand which resources are most beneficial. DESIGN: An anonymous electronic survey was distributed to program directors of orthopaedic surgery residency programs. It included questions about resources that program directors recommended or required residents to use when preparing for the OITE. SETTING: The survey was prepared and the results analyzed at two academic medical institutions in Louisiana. The survey was available to respondents in December 2019 and January 2020. PARTICIPANTS: The survey was delivered to program directors of 148 ACGME accredited orthopaedic surgery residency programs in the United States. RESULTS: 148 orthopaedic surgery residency program directors received the survey and 44 responded (response rate: 29.7%). Twenty-nine programs (73.2%) reported that practice tests/review of old OITE exams positively correlated with better scores. The most recommended resources for OITE preparation were Orthobullets (35 programs; 85%) and Res Study (AAOS) (27 programs; 67.5%). Programs having formal/required preparation programs had lower mean overall scores on the OITE than programs that did not. Those without a formal/required program scored in the 60th percentile, while those with a formal/required program scored in the 53.3rd percentile, a difference of 6.7 percentile points (p = 0.049). The mean overall percentiles were significantly higher for programs that reported having a threshold/goal OITE score for residents compared to those that didn't. Programs with a threshold/goal score scored in the 60.6th percentile on average, while those without a threshold/goal score scored in the 51.7th percentile on average, a difference of 8.9 percentile points (p = 0.0095). CONCLUSIONS: There is substantial variability in the resources that are utilized in preparation for the OITE, with the most commonly recommended resource being Orthobullets. The study method most cited as having a positive impact on scores was practice tests/review of old OITE exams. Having a formal/required program resulted in programs having lower OITE scores. Setting a goal/threshold score correlates positively with an increase in OITE score. Encouraging residents to use practice questions/old OITE tests, setting a goal/threshold score and avoiding formal/required preparation programs may improve resident performance on the OITE.

Harry Potter and the Osteopathic Medical School: Creating a Harry Potter-Themed Day as a High-Yield Review for Final Exams.

Incorporating contemporary fiction into educational activities that are interactive and memorable creates a positive learning environment for students. The current article describes how our medical school created a Harry Potter-themed educational event to review didactic material before a final exam. Students were sorted into Hogwarts houses and collected house points in the 8 themed classrooms that reviewed material for the individual disciplines. The event also included a Quidditch tournament and a Yule Ball. The event received positive feedback from students, encouraging the school's faculty to look for other opportunities to create similar educational experiences during preclinical medical education.

Analysis of Hip and Knee Reconstruction Questions on the Orthopedic In-Training Examination.

BACKGROUND: It is vital for orthopedic residents and residency programs to have a current understanding of the materials and resources utilized on the Orthopedic In-Training Examination (OITE) to tailor resident educational curricula accordingly. This study presents an updated analysis of the hip and knee section of the OITE. METHODS: All OITE questions related to hip and knee reconstruction over six examinations between 2014 and 2019 were analyzed for topic, subtopic, taxonomy, imaging modalities, resident performance, and references. RESULTS: There were 166 hip and knee reconstruction questions of 1600 OITE questions (10.4%) over a six-year period. The most commonly tested topics include mechanical properties of total knee and hip implants (10.8%), instability after THA (10.8%), periprosthetic fracture (10.2%), and prosthetic joint infection (10.2%). A total of 362 references were cited from 68 different sources. The most common sources were JOA, JBJS, JAAOS, and CORR, which were collectively responsible for 68% of all citations. There was an average publication lag of 7.1 years, with 75% of all citations falling within 10 years of the question date. Compared with a prior analysis from 2005 and 2009, there were significantly more complex multistep questions regarding treatment and fewer one-step knowledge recall questions (P = .003). Similarly, recent tests had significantly more questions involving interpretation of radiographs (55%, P < .001) and advanced imaging (9.6%, P < .001), compared with a decade ago. CONCLUSIONS: The OITE continues to evolve over time, incorporating recent literature and topics. The current analysis identifies high-yield topics and resources that can guide resident preparation for the OITE hip and knee section.

Twelve tips on guiding preparation for both high-stakes exams and long-term learning.

High-stakes exams including admissions, licensing, and maintenance of certification examinations are commonplace in health professions education. Although exam scores and performance can often serve gate-keeping purposes, the broader goal of health professions education is to foster deep, self-directed, meaningful, motivated learning. Establishing strong support structures that emphasize deep learning and understanding rather than exam scores can be beneficial to preparing learners who have the knowledge base to be excellent practitioners. This article offers guidance that can be used by academic support centres, medical educators, learning specialists, and faculty advisors, or even test-takers, to help learners to balance score achievement and knowledge development, while simultaneously cultivating more efficient and motivated studying and increasingly self-regulated learning. This series of tips details considerations for building academic success supports, fostering a growth mindset, planning efficient and effective studying efforts, utilizing test-enhanced learning strategies, exam-taking skills practice, and other support structures that can help strengthen learning experiences overall.

Correlation of Mock Board Examination Scores During Anatomic Pathology Residency Training with Performance on the Certifying Examination.

Mock board exams are common in residency programs across many disciplines. However, the value of mock board results in predicting success on the actual certifying examination is largely anecdotal and undocumented. The University of Tennessee anatomic pathology residency program has a long history of giving mock board exams twice a year during the course of the 3-year diagnostic training program. The mock exams give residents a sense of the types of questions that may appear on the actual certifying examination. The resulting scores serve to help identify improvement areas to focus additional study. In addition, by providing residents the mental and physical experiences designed to mimic the test day, we hope to better prepare these trainees for optimal performance on the certifying examination. This study correlated mock board results of 16 anatomic pathology residents, from July 2006 through January 2016, with their subsequent performance on the certifying exam. The results of these biannual exams were significantly correlated (p < .001) with results for the American College of Veterinary Pathologists Certifying Examination.