Faculty perceptions regarding an individually tailored, flexible length, outcomes-based curriculum for undergraduate medical students.

PURPOSE: The perception of faculty members about an individually tailored, flexible-length, outcomes-based curriculum for undergraduate medical students was studied. Their opinion about the advantages, disadvantages, and challenges was also noted. This study was done to help educational institutions identify academic and social support and resources required to ensure that graduate competencies are not compromised by a flexible education pathway. METHODS: The study was done at the International Medical University, Malaysia, and the University of Lahore, Pakistan. Semi-structured interviews were conducted from 1st August 2021 to 17th March 2022. Demographic information was noted. Themes were identified, and a summary of the information under each theme was created. RESULTS: A total of 24 (14 from Malaysia and 10 from Pakistan) faculty participated. Most agreed that undergraduate medical students can progress (at a differential rate) if they attain the required competencies. Among the major advantages mentioned were that students may graduate faster, learn at a pace comfortable to them, and develop an individualized learning pathway. Several logistical challenges must be overcome. Providing assessments on demand will be difficult. Significant regulatory hurdles were anticipated. Artificial intelligence (AI) can play an important role in creating an individualized learning pathway and supporting time-independent progression. The course may be (slightly) cheaper than a traditional one. CONCLUSION: This study provides a foundation to further develop and strengthen flexible-length competency-based medical education modules. Further studies are required among educators at other medical schools and in other countries. Online learning and AI will play an important role.

Implications of the ongoing coronavirus disease 2019 pandemic for primary care.

The coronavirus disease 2019 pandemic has caused widespread global disruption. In this article, the authors put forward lessons from the pandemic for primary care. Among these are primary healthcare requires substantial investment; big data should be carefully regulated and used to strengthen primary care; primary care physicians can support media to provide impartial, objective information; protecting the health of vulnerable populations is important; and infectious diseases are still relevant today. Travel and tourism significantly impact health and primary care. Pandemics may be more common in the future due to climate change, increased human population and habitat loss, among other reasons. We should apply the lessons learned from the current pandemic to better prepare for future pandemics.

Improving assessment practice through cross-institutional collaboration: An exercise on the use of OSCEs.

BACKGROUND: This study was undertaken to improve assessment practice on OSCEs through collaboration across geographically dispersed medical schools in Australia. METHODS: A total of eleven OSCE stations were co-developed by four medical schools and used in summative 2011 and 2012 examinations for the assessment of clinical performance in the early clinical and exit OSCEs in each school's medical course. Partial Credit Rasch Model was used to evaluate the psychometric properties of the shared OSCE data. Evaluation of the quality assurance reports was used to determine the beneficial impact of the collaborative benchmarking exercise on learning and teaching outcomes. RESULTS: The data for each examination demonstrated sufficient fit to the Rasch model with infit mean square values ranging from 0.88 to 0.99. Person separation (1.25-1.63) indices indicated good reliability. Evaluation of perceived benefits showed that the benchmarking process was successful as it highlighted common curriculum areas requiring specific focus and provided comparable data on the quality of teaching at the participating medical schools. CONCLUSION: This research demonstrates the validity of the psychometric data and benefits of evaluating clinical competence across medical schools without the enforcement of a prescriptive national curriculum or assessment.

Meta-audit of laboratory ISO accreditation inspections: measuring the old emperor's clothes.

Accreditation to ISO/IEC 17025 is required for EC official food control and veterinary laboratories by Regulation (EC) No. 882/2004. Measurements in hospital laboratories and clinics are increasingly accredited to ISO/IEC 15189. Both of these management standards arose from command and control military standards for factory inspection during World War II. They rely on auditing of compliance and have not been validated internally as assessment bodies require of those they accredit. Neither have they been validated to criteria outside their own ideology such as the Cochrane principles of evidence-based medicine which might establish whether any benefit exceeds their cost. We undertook a retrospective meta-audit over 14 years of internal and external laboratory audits that checked compliance with ISO 17025 in a public health laboratory. Most noncompliances arose solely from clauses in the standard and would not affect users. No effect was likely from 91% of these. Fewer than 1% of noncompliances were likely to have consequences for the validity of results or quality of service. The ISO system of compliance auditing has the performance characteristics of a poor screening test. It adds substantially to costs and generates more noise (false positives) than informative signal. Ethical use of resources indicates that management standards should not be used unless proven to deliver the efficacy, effectiveness, and value required of modern healthcare interventions.

The Australian Medical Schools Assessment Collaboration: benchmarking the preclinical performance of medical students.

OBJECTIVES: To report the level of participation of medical schools in the Australian Medical Schools Assessment Collaboration (AMSAC); and to measure differences in student performance related to medical school characteristics and implementation methods. DESIGN: Retrospective analysis of data using the Rasch statistical model to correct for missing data and variability in item difficulty. Linear model analysis of variance was used to assess differences in student performance. SETTING AND PARTICIPANTS: 6401 preclinical students from 13 medical schools that participated in AMSAC from 2011 to 2013. MAIN OUTCOME MEASURES: Rasch estimates of preclinical basic and clinical science knowledge. RESULTS: Representation of Australian medical schools and students in AMSAC more than doubled between 2009 and 2013. In 2013 it included 12 of 19 medical schools and 68% of medical students. Graduate-entry students scored higher than students entering straight from school. Students at large schools scored higher than students at small schools. Although the significance level was high (P < 0.001), the main effect sizes were small (4.5% and 2.3%, respectively). The time allowed per multiple choice question was not significantly associated with student performance. The effect on performance of multiple assessments compared with the test items as part of a single end-of-year examination was negligible. The variables investigated explain only 12% of the total variation in student performance. CONCLUSIONS: An increasing number of medical schools are participating in AMSAC to monitor student performance in preclinical sciences against an external benchmark. Medical school characteristics account for only a small part of overall variation in student performance. Student performance was not affected by the different methods of administering test items.

Faking good: self-enhancement in medical school applicants.

OBJECTIVES: The problem of dissimulation by applicants when self-report tests of personality are used for job selection has received considerable attention in non-medical contexts. Personality testing is not yet widely used in medical student selection, but this may change in the light of recent research demonstrating significant relationships between personality and performance in medical school. This study therefore aimed to assess the extent of self-enhancement in a sample of medical school applicants. METHODS: A within-subjects design compared personality test scores collected in 2007 for 83 newly enrolled medical students with scores for the same students obtained on the same personality test administered during the selection process 4 months previously. Five factors of personality were measured using the International Personality Item Pool and mean differences in scores were assessed using paired t-tests. RESULTS: At the time of selection, the personality scores of successful applicants were similar to those of candidates who were not accepted (n=271). Once selected, the medical students achieved significantly lower scores on four of the five personality factors (conscientiousness, extroversion, openness to experience, agreeableness) and higher scores on the fifth factor (neuroticism). Of the selected students, 62.7% appeared to have 'faked good' on at least one of the five factors measured. CONCLUSIONS: Applicants to medical school are likely to dissimulate when completing self-report tests of personality used for selection. The authors review the evidence as to whether such dissimulation reduces construct and predictive validity and summarise methods used to reduce self-enhancement in applicant samples.

The context of clinical teaching and learning in Australia.

Gaining clinical experience for an extended period of time in teaching hospitals is one of the enduring strengths of medical education. Teaching hospitals have recently faced significant challenges, with increasing specialisation of services and workload pressures reducing clinical learning opportunities. New clinical teaching environments have been established in Australia, particularly in rural and regional areas; these are proving to be ideal contexts for student learning. The new clinical teaching environments have shown the importance of developing symbiotic relationships between universities and health services. Symbiotic clinical learning is built around longitudinal, patient-based learning emphasising priority health concerns. The symbiotic framework provides a basis for reconstructing clinical teaching in teaching hospitals so th@they continue to play a vital role in Australian medical education, with additional clinical experience provided by primary care and community, rural and regional hospitals.

Only the best: medical student selection in Australia.

Selection processes for medical schools need to be unbiased, valid, and psychometrically reliable, as well as evidence-based and transparent to all stakeholders. A range of academic and non-academic criteria are used for selection, including matriculation scores, aptitude tests and interviews. Research into selection is fraught with methodological difficulties; however, it shows positive benefits for structured selection processes. Pretest coaching and "faking good" are potential limitations of current selection procedures. Developments in medical school selection include the use of personality tests, centralised selection centres and programs to increase participation by socially disadvantaged students.

Big fish in a big pond: a study of academic self concept in first year medical students.

BACKGROUND: Big-fish-little-pond effect (BFLPE) research has demonstrated that students in high-ability environments have lower academic self-concepts than equally able students in low-ability settings. Research has shown low academic self-concepts to be associated with negative educational outcomes. Social comparison processes have been implicated as fundamental to the BFLPE. METHODS: Twenty first-year students in an Australian medical school completed a survey that included academic self-concept and social comparison measures, before and after their first written assessments. Focus groups were also conducted with a separate group of students to explore students' perceptions of competence, the medical school environment, and social comparison processes. RESULTS: The quantitative study did not reveal any changes in academic self-concept or self-evaluation. The qualitative study suggested that the attributions that students used when discussing performance were those that have been demonstrated to negatively affect self-concept. Students reported that the environment was slightly competitive and they used social comparison to evaluate their performance. CONCLUSIONS: Although the BFLPE was not evident in the quantitative study, results from the qualitative study suggest that the BFLPE might be operating In that students were using attributions that are associated with lower self-concepts, the environment was slightly competitive, and social comparisons were used for evaluation.

Interviewer bias in medical student selection.

OBJECTIVE: To investigate whether interviewer personality, sex or being of the same sex as the interviewee, and training account for variance between interviewers' ratings in a medical student selection interview. DESIGN, SETTING AND PARTICIPANTS: In 2006 and 2007, data were collected from cohorts of each year's interviewers (by survey) and interviewees (by interview) participating in a multiple mini-interview (MMI) process to select students for an undergraduate medical degree in Australia. MMI scores were analysed and, to account for the nested nature of the data, multilevel modelling was used. MAIN OUTCOME MEASURES: Interviewer ratings; variance in interviewee scores. RESULTS: In 2006, 153 interviewers (94% response rate) and 268 interviewees (78%) participated in the study. In 2007, 139 interviewers (86%) and 238 interviewees (74%) participated. Interviewers with high levels of agreeableness gave higher interview ratings (correlation coefficient [r] = 0.26 in 2006; r = 0.24 in 2007) and, in 2007, those with high levels of neuroticism gave lower ratings (r = -0.25). In 2006 but not 2007, female interviewers gave higher overall ratings to male and female interviewees (t = 2.99, P = 0.003 in 2006; t = 2.16, P = 0.03 in 2007) but interviewer and interviewee being of the same sex did not affect ratings in either year. The amount of variance in interviewee scores attributable to differences between interviewers ranged from 3.1% to 24.8%, with the mean variance reducing after skills-based training (20.2% to 7.0%; t = 4.42, P = 0.004). CONCLUSION: This study indicates that rating leniency is associated with personality and sex of interviewers, but the effect is small. Random allocation of interviewers, similar proportions of male and female interviewers across applicant interview groups, use of the MMI format, and skills-based interviewer training are all likely to reduce the effect of variance between interviewers.

Distress levels and self-reported treatment rates for medicine, law, psychology and mechanical engineering tertiary students: cross-sectional study.

OBJECTIVE: The aim of this research was to assess tertiary student distress levels with regards to (i) comparisons with normative population data, and (ii) the effects of discipline, year level, and student characteristics. Self-reported treatment rates and level of concern regarding perceived distress were also collected. METHOD: Students from all six years of an undergraduate medical course were compared with samples from Psychology, Law and Mechanical Engineering courses at the University of Adelaide, Australia. Students participated in one of three studies that were either web-based or paper-based. All studies included Kessler's Measure of Psychological Distress (K10), and questions pertaining to treatment for any mental health problems and concern regarding distress experienced. RESULTS: Of the 955 tertiary students who completed the K10, 48% were psychologically distressed (a K10 score > or = 22) which equated to a rate 4.4 times that of age-matched peers. The non-health disciplines were significantly more distressed than the health disciplines. Distress levels were statistically equivalent across all six years of the medical degree. Of tertiary students, 11% had been treated for a mental health problem. Levels of concern correlated with the K10 score. CONCLUSION: The results from this research suggest that high distress levels among the tertiary student body may be a phenomenon more widely spread than first thought. Low treatment rates suggest that traditional models of support may be inadequate or not appropriate for tertiary cohorts.

Does practice make perfect? The effect of coaching and retesting on selection tests used for admission to an Australian medical school.

OBJECTIVE: To assess the practice effects from coaching on the Undergraduate Medicine and Health Sciences Admission Test (UMAT), and the effect of both coaching and repeat testing on the Multiple Mini Interview (MMI). DESIGN, SETTING AND PARTICIPANTS: Observational study based on a self-report survey of a cohort of 287 applicants for entry in 2008 to the new School of Medicine at the University of Western Sydney. Participants were asked about whether they had attended UMAT coaching or previous medical school interviews, and about their perceptions of the relative value of UMAT coaching, attending other interviews or having a "practice run" with an MMI question. UMAT and MMI results for participants were compared with respect to earlier attempts at the test, the degree of similarity between questions from one year to the next, and prior coaching. MAIN OUTCOME MEASURES: Effect of coaching on UMAT and MMI scores; effect of repeat testing on MMI scores; candidates' perceptions of the usefulness of coaching, previous interview experience and a practice run on the MMI. RESULTS: 51.4% of interviewees had attended coaching. Coached candidates had slightly higher UMAT scores on one of three sections of the test (non-verbal reasoning), but this difference was not significant after controlling for Universities Admission Index, sex and age. Coaching was ineffective in improving MMI scores, with coached candidates actually having a significantly lower score on one of the nine interview tasks ("stations"). Candidates who repeated the MMI in 2007 (having been unsuccessful at their 2006 entry attempt) did not improve their score on stations that had new content, but showed a small increase in scores on stations that were either the same as or similar to previous stations. CONCLUSION: A substantial number of Australian medical school applicants attend coaching before undertaking entry selection tests, but our study shows that coaching does not assist and may even hinder their performance on an MMI. Nevertheless, as practice on similar MMI tasks does improve scores, tasks should be rotated each year. Further research is required on the predictive validity of the UMAT, given that coaching appeared to have a small positive effect on the non-verbal reasoning component of the test.

Does psychological status influence clinical outcomes in patients with inflammatory bowel disease (IBD) and other chronic gastroenterological diseases: an observational cohort prospective study.

BACKGROUND: Whether there is a temporal relationship between psychological problems and clinical outcomes in patients with diseases of the digestive tract has not been widely researched. Thus, our aims were 1) To observe and compare prospectively clinical outcomes in relation to psychological co-morbidity in patients with inflammatory bowel disease (IBD), irritable bowel syndrome (IBS) and chronic hepatitis C (HCV) and, 2) To test the hypothesis that patients with psychological co-morbidities are less likely to have a satisfactory response to standard treatment at 12 months. METHODS: Overall, 139 patients were enrolled in this observational cohort prospective study. Over the ensuing year, physical and psychological measures were made at baseline and after 12 months (HADS, SCL90, SF-12 and disease activity measures). A logistic regression was conducted to observe any relationship between baseline characteristics and patients' clinical outcomes after 12 months. RESULTS: Overall, there was no relationship between psychological status and quality of life at baseline and relapse at 12 months (p > 0.05). However, patients with inactive disease at baseline were at lower risk of relapse after 12 months (OR = 0.046, CI: 0.012-0.178). No significant relationship was found between psychological problems such as depression/anxiety and a total number of relapses in the IBD group. However, interestingly, patients with an active disease at baseline tended to have a greater number of relapses (OR = 3.07, CI: 1.650-5.738) and CD participants were found at lower risk of relapse than UC participants (OR = 0.382, CI: 0.198-0.736). CONCLUSION: In contrast to previous investigations, this study suggests that there is no temporal relationship between psychological problems at baseline and clinical outcomes over time. Longer and larger prospective studies are needed to better understand this result.