Análisis del éxito de las números uno en la prueba MIR de 2022 y 2023. El impacto de la preparación y el efecto del azar / Analysis of the success of the highest scoring candidates in Spain’s Resident Medical Intern (MIR) examinations of 2022 and 2023. The impact of preparation and the effect of serendipity

Introducción: El examen de médico interno residente (examen MIR) es la prueba que permite el acceso a la formación médica especializada en España. Su objetivo es distribuir las plazas disponibles para las diferentes especialidades médicas entre los graduados en Medicina, teniendo en cuenta para ello tanto su expediente como los resultados de la prueba. La realización de un examen de test tiene un cierto componente de aleatoriedad.Objetivos: Analizar el rendimiento de las números uno de las convocatorias de 2021-2022 y 2022-2023 a lo largo de su preparación, así como conocer qué resultados podrían obtener en caso de que repitieran el mismo examen un millón de veces. Material y métodos: Se hizo uso de la información relativa al rendimiento de los estudiantes que prepararon las pruebas con cursos intensivos MIR Asturias, así como de los principios de la teoría de respuesta al ítem.Resultados. En 11 (33,3%) y 14 (42,4%) de las 33 pruebas realizadas a lo largo de la preparación, las números uno se clasificaron entre los 10 primeros. A partir de las simulaciones de las pruebas MIR de 2022 y 2023, se obtuvo que la primera clasificada de 2022 quedaría entre los 185 primeros de la prueba, y la de 2023, entre los 92 primeros.Conclusiones: Para obtener un número de orden entre los primeros clasificados es necesario disponer de un ability elevado, el cual se consigue a través de una preparación sólida. Además, el azar tiene un cierto nivel de influencia sobre los resultados de los opositores presentados a la prueba.(AU)

Introduction: The MIR exam is the test that allows access to specialized medical training in Spain. Its objective is to distribute the available places for the different medical specialties among Medicine graduates, taking into account both their record and the results of the test. Taking a test exam has a certain element of randomness.Objectives: Analyze the performance of the number ones of the 2021-2022 and 2022-2023 calls throughout their preparation, as well as know what results they could obtain if they repeated the same exam one million times. Material and methods: Information related to the performance of the students who prepared the tests with MIR Asturias Intensive Courses was used, as well as the principles of item response theory.Results. In 11 (33.3%) and 14 (42.4%) of the 33 tests carried out throughout the preparation, number one was classified among the top 10. From the simulations of the 2022 and 2023 MIR tests, it was obtained that the first classified in 2022 would be among the top 185 in the test and in 2023 among the top 92. Conclusions: To obtain an order number among the first classified it is necessary to have a high ability, which is achieved through solid preparation. In addition, randomness has a certain level of influence on the results of the opponents presented to the test.(AU)

Estudio psicométrico de la prueba MIR de 2022 / Psychometric analysis of the 2022 MIR test

Introducción: En España, para ejercer como especialista de cualquier especialidad médica es necesario tener la titulación correspondiente. Para poder acceder a la formación como especialista es obligatorio superar la prueba MIR. En este artículo se ha realizado un análisis psicométrico de la prueba MIR de 2022, celebrada en enero de 2023, utilizando tanto la teoría clásica de los test como la teoría de respuesta al ítem. Material y métodos: Se hizo uso de un subconjunto formado por 3.229 médicos que se presentaron a la prueba MIR de 2022 y que introdujeron su plantilla de respuestas en una aplicación informática puesta a su disposición para tal efecto. Los datos se analizaron mediante la teoría clásica de los test y la teoría de la respuesta al ítem. Concretamente, se calcularon el alfa de Cronbach, la fórmula número 21 de Kuder y Richardson, el índice de dificultad, el índice de dificultad con corrección de los efectos del azar, el índice de discriminación, el índice de correlación biserial puntual, así como los índices de dificultad y discriminación según la teoría de respuesta al ítem. Resultados: La prueba MIR de 2022, al igual que las de años anteriores, presenta una alta fiabilidad. Se analizan tanto los resultados globales de la prueba como detallados por asignaturas y bloques de asignaturas. Conclusión: Los resultados obtenidos en el presente estudio permiten afirmar que el examen MIR es un examen objetivo, de dificultad y discriminación adecuadas, así como relativamente estable de una convocatoria a otra.(AU)

Introduction: In Spain, to practice as a specialist in any medical specialty, it is necessary to have the corresponding qualification. In order to access training as a specialist, it is mandatory to pass the MIR test. In this article, a psychometric analysis of the 2022 MIR test, held in January 2023, has been carried out using both classical test theory and item response theory. Materials and methods: A subset made up of 3,229 doctors who took the MIR test in 2022 and who entered their response template in a computer application made available for this purpose. Data were analyzed using classical test theory and item response theory. Specifically, Cronbach's alpha, Kuder and Richardson's formula number 21, the difficulty index, the difficulty index corrected for chance effects, the discrimination index, the biserial-point correlation index, as well as the difficulty and discrimination indices according to item response theory were calculated. Results: The 2022 MIR test, like those of previous years, shows high reliability. Both the overall results of the test and those detailed by subjects and subject blocks are analyzed. Conclusion: The results obtained in this study allow us to affirm that the MIR exam is an objective exam, of adequate difficulty and discrimination, as well as relatively stable from one call to another.(AU)

Estudio psicométrico de las pruebas MIR de 2020 y 2021 / Psychometric study of the MIR tests of 2020 and 2021

Introducción: En España, el ejercicio de cualquier especialidad médica exige disponer del título de especialista. El acceso a la formación como especialista se realiza a través de la prueba MIR. Esta prueba es obligatoria para poder optar a una plaza de formación en cualquier especialidad médica. El presente artículo realiza un estudio psicométrico tanto a través de la teoría clásica de los test como de la teoría de la respuesta al ítem de las pruebas MIR de 2020 y 2021 (de 175 y 200 preguntas, respectivamente).Material y métodos.La base de datos utilizada en el presente trabajo contiene las respuestas de un total de 4.810 opositores que se examinaron en 2020 y 3.888 que lo hicieron en 2021. La información disponible se analizó haciendo uso de indicadores como el alfa de Cronbach, la fórmula número 21 de Kuder y Richardson, el índice de dificultad, el índice de dificultad con corrección de los efectos del azar, el índice de discriminación, el índice de correlación biserial puntual, así como los índices de dificultad y discriminación según la teoría de respuesta al ítem.Resultados.Las pruebas MIR de 2020 y 2021 presentan una alta fiabilidad, con variaciones pequeñas de un año a otro en el comportamiento de las distintas asignaturas y bloques de preguntas en lo relativo a los índices utilizados en el presente estudio.Conclusiones.Los resultados obtenidos en el presente estudio permiten afirmar que el examen MIR es un examen objetivo, de dificultad y discriminación adecuadas, así como estable de una convocatoria a otra. (AU)

Introduction: In Spain, in order to practise any medical speciality, it is necessary to have qualified as a specialist. Access to training as a specialist is gained through the MIR test. This test is mandatory to qualify for a training position in any medical specialty. This article carries out a psychometric study of the 2020 and 2021 MIR tests (with 175 and 200 questions, respectively) through both the classical test theory and the item response theory.Material and methods.The database used in this study contains the responses from a total of 4,810 individuals who took the exam in 2020 and 3,888 who did so in 2021. The information available was analysed using indicators such as Cronbach's alpha, the formula number 21 of Kuder and Richardson, the difficulty index, the difficulty index corrected for random effects, the discrimination index and the point biserial correlation index. The difficulty and discrimination indices were also used, according to item response theory.Results.The MIR tests of 2020 and 2021 present high reliability, with only slight variations from one year to another in the behaviour of the different subjects and question blocks in terms of the indices used in the present study.Conclusions.The results obtained in the present study allow us to affirm that the MIR exam is objective, of appropriate difficulty and discrimination, as well as stable from one year to another. (AU)

Resultados obtenidos en la prueba MIR de 2021, según nacionalidad y baremo académico / Results obtained in the 2021 MIR test according to nationality and academic scale

Introducción: En España, el acceso a la formación médica especializada se hace a través de la prueba MIR. Esta prueba la convocan anualmente desde 1978 los Ministerios de Sanidad, y Educación y Formación Profesional. Así, teniendo en cuenta tanto el resultado que se obtiene en la prueba como el baremo promedio del grado, se asigna un número de orden a los médicos que quieren acceder a una plaza de formación como especialistas. El objetivo de este trabajo es el análisis de los resultados obtenidos por los médicos que se presentaron a la prueba de 2021 en función de su baremo académico y de si son españoles o extranjeros.Materiales y métodos.Para esta investigación se ha hecho uso de la información oficial pública relativa al baremo académico, la nacionalidad y los resultados obtenidos en la prueba por todos los aspirantes presentados a ella.Resultados.Entre los 5.000 primeros números de orden se situaron el 90,61% de los médicos presentados con un baremo de sobresaliente, el 79,59% de los baremos de notable igual o superior a 8, el 42,21% de los baremos de notable inferior a 8 y únicamente un 7,16% de los médicos con baremo de aprobado.Conclusiones.Este estudio confirma que existe una relación directa entre el baremo de los médicos aspirantes a una plaza de formación médica especializada y el resultado que obtienen en la prueba MIR, más allá de la ponderación de éste sobre la nota final de la prueba MIR. (AU)

Introduction: In Spain, access to specialized medical training is done through the MIR test. This test is convened annually since 1978 by the Ministries of Health and Education and Vocational Training. Thus, taking into account both the result obtained in the test and the average degree scale, an order number is assigned to doctors who want to access a training position as specialists. The objective of this work is the analysis of the results obtained by the doctors who took the 2021 test based on their academic scale and whether they are Spanish or foreign.Materials and methods.For this research, the official public information regarding the academic scale, nationality and the results obtained in the test by all the applicants presented to has been employed.Results.The 90.61% of those doctors that obtained in their degrees an average mark of 9 or more can be found among the 5,000 first order numbers, the same happen to the 79.59% of those who obtained a mark from 8 to 8.99, the 42.21% of those with a mark from 7 to 7.00 and only the 7.16% of those doctors with an average mark in their degrees under 7.Conclusions.This study confirms that there is a direct relationship between the marks obtained in their degree of doctors aspiring to a specialized medical training position and the result they obtain in the MIR test, beyond the weighting of this on the final grade of the MIR test. (AU)

Análisis psicométrico de las preguntas repetidas en los simulacros de la prueba MIR / Psychometric analysis of the questions repeated in the MIR test mockups

Introducción: El presente trabajo analiza 13 preguntas que se repitieron dos veces en distintas pruebas que simulan el examen MIR, separadas en el tiempo entre dos y 15 semanas. A partir de los resultados obtenidos, se ha analizado el proceso de aprendizaje de los estudiantes que se preparan para la prueba MIR.Material y métodos.Para el presente estudio se hizo uso de una base de datos formada por un total de 2.600 preguntas respondidas en promedio por 1.585 alumnos de características relativamente homogéneas.Resultados.En general, resulta posible afirmar que entre la primera y la segunda exposición de los alumnos a la misma pregunta se produjo una mejora de los índices analizados. De los resultados obtenidos, se observa que, en promedio, a lo largo de la preparación, la dificultad de las preguntas para el grupo de estudiantes se reduce a la mitad. En lo referente al índice de discriminación, éste se incrementa cerca del 60%, lo que supone que, según transcurre la preparación, aumenta la proporción de personas que aciertan la pregunta en el grupo fuerte con respecto a las que la aciertan en el grupo débil. Finalmente, también se produce una mejora en el valor del coeficiente de correlación biserial puntual, lo que supone una mejora de la capacidad discriminativa de las preguntas.Conclusiones.Según transcurre la preparación, las preguntas analizadas se vuelven más fáciles y más discriminativas. Además, se observa cómo no todos los alumnos consiguen el mismo aprovechamiento del proceso de aprendizaje. (AU)

Introduction: The present work analyses 13 questions that were repeated twice in different tests that simulate the MIR exam, separated in time between 2 and 15 weeks. From the results obtained, the learning process of the students preparing for the MIR test has been analysed.Material and methods.For the present study, a database made up of a total of 2,600 questions which were answered on average by 1,585 students with relatively homogeneous characteristics was employed.Results.In general, it is possible to affirm that between the first and second exposure of the students to the same question there was an improvement in the indexes analysed. From the results obtained, it is observed that, on average, throughout the preparation, the difficulty of the questions for the group of students is reduced by half. Regarding the discrimination index, this increases by about 60%, which means that as the preparation progresses, the proportion of people who get the question right in the strong group increases with respect to those who get it right in the weak group. Finally, there is also an improvement in the value of the biserial point correlation coefficient, which implies an improvement in the discriminative capacity of the questions.Conclusions.As the preparation progresses, the analysed questions become easier and discriminating. In addition, it is observed how not all students obtained the same performance. (AU)

The MIR 2018 Exam: Psychometric Study and Comparison with the Previous Nine Years.

Background and Objectives: The aim of the present research is to study the questions used in the 2018 MIR exam (a test that allows access to specialized medical training in Spain), describe their psychometric properties, and evaluate their quality. Materials and Methods: This analysis is performed with the help of classical test theory (CTT) and item response theory (IRT). The answers given to the test questions by a total of 3868 physicians are analyzed. Results: According to CTT, the average difficulty index for all of the test questions was 0.629, which falls into the acceptable category. The average difficulty index with correction for random effects was 0.515, which corresponds to a value within the optimal range. The mean discrimination index was 0.277, which is in the good category, while the mean point biserial correlation coefficient, with a value of 0.275 fits in the regular category. The values of difficulty and discrimination calculated according to the model of two parameters of the IRT seem adequate with average values of -0.389 and 0.677. The Cronbach alpha score obtained for the overall test was 0.944. This value is considered as very good. Conclusions: A decrease was observed in the average values of discrimination in the last three calls, which may be related to the greater proportion of Spanish graduates that take the exam in the same year of finalization of their studies in Medicine.

The Role of Frailty in Acute Coronary Syndromes in the Elderly.

BACKGROUND: Myocardial infarction (MI) patients are increasingly older, and common risk scores include chronological age, but do not consider chronic comorbidity or biological age. Frailty status reflects these variables and may be independently correlated with prognosis in this setting. OBJECTIVE: This study investigated the impact of frailty on the prognosis of elderly patients admitted due to MI. METHODS: This prospective and observational study included patients ≥75 years admitted to three tertiary hospitals in Spain due to MI. Frailty assessment was performed at admission using the Survey of Health, Ageing and Retirement in Europe Frailty Index (SHARE-FI) tool. The primary endpoint was the composite of death or non-fatal reinfarction during a follow-up of 1 year. Overall mortality, reinfarction, the composite of death, reinfarction and stroke, major bleeding, and readmission rates were also explored. RESULTS: A total of 285 patients were enrolled. Frail patients (109, 38.2%) were older, with a higher score in the Charlson Comorbidity Index and with a higher risk score addressed in the GRACE and CRUSADE indexes. On multivariate analysis including GRACE, CRUSADE, maximum creatinine level, culprit lesion revascularization, complete revascularization, and dual antiplatelet therapy at discharge, frailty was an independent predictor of the composite of death and reinfarction (2.81, 95% CI 1.16-6.78) and overall mortality (3.07, 95% CI 1.35-6.98). CONCLUSION: Frailty is an independent prognostic marker of the composite of mortality and reinfarction and of overall mortality in patients aged ≥75 years admitted due to MI.

Seguridad y eficacia clínica con prasugrel y ticagrelor en síndrome coronario agudo. Resultados de un registro multicéntrico en el mundo real / Safety and efficacy of prasugrel and ticagrelor in acute coronary syndrome. Results of a 'real world' multicenter registry

Introducción y objetivos: La incorporación de los nuevos antiagregantes (NAA) prasugrel y ticagrelor a la práctica clínica está siendo errática. Los datos del mundo real todavía son escasos. Se analizó la tendencia temporal de uso de NAA, su seguridad y eficacia clínica frente a clopidogrel en una cohorte actual de pacientes con síndrome coronario agudo (SCA). Métodos: Estudio multicéntrico observacional retrospectivo de pacientes con SCA ingresados en unidades coronarias incluidos de forma prospectiva en el registro ARIAM-Andalucía entre 2013 y 2015. Se analizaron las tasas de eventos cardiovasculares mayores y hemorragias intrahospitalarias mediante modelos de propensión y regresión multivariante. Resultados: Se incluyó a 2.906 pacientes: el 55% recibió clopidogrel y el 45% NAA. Un 60% presentó SCA con elevación del segmento ST. El uso de NAA se incrementó de forma significativa a lo largo del estudio. El grupo de clopidogrel presentó mayor edad y comorbilidad. La tasa de mortalidad total, el ictus isquémico y la trombosis del stent fue menor con NAA (2 frente a 9%, p < 0,0001; 0,1 frente a 0,5%, p = 0,025; 0,07 frente a 0,5%, p = 0,025, respectivamente). No hubo diferencias en la tasa de hemorragias totales (3 frente a 4%; p = NS). Tras el análisis de propensión, se mantuvo la reducción de mortalidad con NAA (OR = 0,37; IC95%, 0,13-0,60; p< 0,0001) sin incremento en las hemorragias totales (OR = 1,07; IC95%, 0,18-2,37; p = 0,094). Conclusiones: En el mundo real, los NAA se usan de forma selectiva en sujetos más jóvenes y con menor comorbilidad. Su uso se asocia con una reducción de eventos cardiacos mayores, incluida mortalidad, sin aumentar las hemorragias en comparación con clopidogrel (AU)

Introduction and objectives: The incorporation of the new antiplatelet agents (NAA) prasugrel and ticagrelor into routine clinical practice is irregular and data from the 'real world' remain scarce. We aimed to assess the time trend of NAA use and the clinical safety and efficacy of these drugs compared with those of clopidogrel in a contemporary cohort of patients with acute coronary syndromes (ACS). Methods: A multicenter retrospective observational study was conducted in patients with ACS admitted to coronary care units and prospectively included in the ARIAM-Andalusia registry between 2013 and 2015. In-hospital rates of major cardiovascular events and bleeding with NAA vs clopidogrel were analyzed using propensity score matching and multivariate regression models. Results: The study included 2906 patients: 55% received clopidogrel and 45% NAA. A total of 60% had ST-segment elevation ACS. Use of NAA significantly increased throughout the study. Patients receiving clopidogrel were older and were more likely to have comorbidities. Total mortality, ischemic stroke, and stent thrombosis were lower with NAA (2% vs 9%, P < .0001; 0.1% vs 0.5%, P = .025; 0.07% vs 0.5%, P = .025, respectively). There were no differences in the rate of total bleeding (3% vs 4%; P = NS). After propensity score matching, the mortality reduction with NAA persisted (OR, 0.37; 95%CI, 0.13 to 0.60; P < .0001) with no increase in total bleeding (OR, 1.07; 95%CI, 0.18 to 2.37; P = .094). Conclusions: In a 'real world' setting, NAA are selectively used in younger patients with less comorbidity and are associated with a reduction in major cardiac events, including mortality, without increasing bleeding compared with clopidogrel (AU)

Frailty is an independent prognostic marker in elderly patients with myocardial infarction.

BACKGROUND: Acute coronary syndrome (ACS) patients are increasingly older. Conventional prognostic scales include chronological age but do not consider vulnerability. In elderly patients, a frail phenotype represents a better reflection of biological age. HYPOTHESIS: This study aims to determine the prevalence of frailty and its influence on patients age ≥75 years with ACS. METHODS: Patients age ≥75 years admitted due to type 1 myocardial infarction were included in 2 tertiary hospitals, and clinical data were collected prospectively. Frailty was defined at admission using the previously validated Survey of Health Ageing and Retirement in Europe Frailty Index (SHARE-FI) tool. The primary endpoint was the combination of death or nonfatal myocardial reinfarction during a follow-up of 6 months. Major bleeding (hemoglobin decrease ≥3 g/dL or transfusion needed) and readmission rates were also explored. RESULTS: A total of 234 consecutive patients were included. Frail patients (40.2%) had a higher-risk profile, based on higher age and comorbidities. On multivariate analysis, frailty was an independent predictor of the combination of death or nonfatal myocardial reinfarction (adjusted hazard ratio [aHR]: 2.54, 95% confidence interval [CI]: 1.12-5.79), an independent predictor of the combination of death, nonfatal myocardial reinfarction, or major bleeding (aHR: 2.14, 95% CI: 1.13-4.04), and an independent predictor of readmission (aHR: 1.80, 95% CI: 1.00-3.22). CONCLUSIONS: Frailty phenotype at admission is common among elderly patients with ACS and is an independent predictor for severe adverse events. It should be considered in future risk-stratification models.

Safety and Efficacy of Prasugrel and Ticagrelor in Acute Coronary Syndrome. Results of a "Real World" Multicenter Registry.

INTRODUCTION AND OBJECTIVES: The incorporation of the new antiplatelet agents (NAA) prasugrel and ticagrelor into routine clinical practice is irregular and data from the "real world" remain scarce. We aimed to assess the time trend of NAA use and the clinical safety and efficacy of these drugs compared with those of clopidogrel in a contemporary cohort of patients with acute coronary syndromes (ACS). METHODS: A multicenter retrospective observational study was conducted in patients with ACS admitted to coronary care units and prospectively included in the ARIAM-Andalusia registry between 2013 and 2015. In-hospital rates of major cardiovascular events and bleeding with NAA vs clopidogrel were analyzed using propensity score matching and multivariate regression models. RESULTS: The study included 2906 patients: 55% received clopidogrel and 45% NAA. A total of 60% had ST-segment elevation ACS. Use of NAA significantly increased throughout the study. Patients receiving clopidogrel were older and were more likely to have comorbidities. Total mortality, ischemic stroke, and stent thrombosis were lower with NAA (2% vs 9%, P < .0001; 0.1% vs 0.5%, P = .025; 0.07% vs 0.5%, P = .025, respectively). There were no differences in the rate of total bleeding (3% vs 4%; P = NS). After propensity score matching, the mortality reduction with NAA persisted (OR, 0.37; 95%CI, 0.13 to 0.60; P < .0001) with no increase in total bleeding (OR, 1.07; 95%CI, 0.18 to 2.37; P = .094). CONCLUSIONS: In a "real world" setting, NAA are selectively used in younger patients with less comorbidity and are associated with a reduction in major cardiac events, including mortality, without increasing bleeding compared with clopidogrel.