Escenarios de simulación clínica creados por alumnos de medicina: descripción de la experiencia de 2 años / Clinical simulation scenarios designed by medical students: The description of a two-year experience

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Valoración de tutores clínicos y estudiantes de medicina respecto a las rotaciones en centros de atención primaria y hospitales / Evaluation of clinical tutors and medical students regarding clinical rotations in primary healthcare centers and hospitals

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Technical flaws in multiple-choice questions in the access exam to medical specialties ("examen MIR") in Spain (2009-2013).

BACKGROUND: The main factor that determines the selection of a medical specialty in Spain after obtaining a medical degree is the MIR ("médico interno residente", internal medical resident) exam. This exam consists of 235 multiple-choice questions with five options, some of which include images provided in a separate booklet. The aim of this study was to analyze the technical quality of the multiple-choice questions included in the MIR exam over the last five years. METHODS: All the questions included in the exams from 2009 to 2013 were analyzed. We studied the proportion of questions including clinical vignettes, the number of items related to an image and the presence of technical flaws in the questions. For the analysis of technical flaws, we adapted the National Board of Medical Examiners (NBME) guidelines. We looked for 18 different issues included in the manual, grouped into two categories: issues related to testwiseness and issues related to irrelevant difficulties. RESULTS: The final number of questions analyzed was 1,143. The percentage of items based on clinical vignettes increased from 50% in 2009 to 56-58% in the following years (2010-2013). The percentage of items based on an image increased progressively from 10% in 2009 to 15% in 2012 and 2013. The percentage of items with at least one technical flaw varied between 68 and 72%. We observed a decrease in the percentage of items with flaws related to testwiseness, from 30% in 2009 to 20% in 2012 and 2013. While most of these issues decreased dramatically or even disappeared (such as the imbalance in the correct option numbers), the presence of non-plausible options remained frequent. With regard to technical flaws related to irrelevant difficulties, no improvement was observed; this is especially true with respect to negative stem questions and "hinged" questions. CONCLUSION: The formal quality of the MIR exam items has improved over the last five years with regard to testwiseness. A more detailed revision of the items submitted, checking systematically for the presence of technical flaws, could improve the validity and discriminatory power of the exam, without increasing its difficulty.

A randomized trial of cardiopulmonary resuscitation training for medical students: voice advisory mannequin compared to guidance provided by an instructor.

INTRODUCTION: Current European Resuscitation Guidelines 2010 recommend the use of prompt/feedback devices when training for cardiopulmonary resuscitation (CPR). We aimed to assess the quality of CPR training among second-year medical students with a voice advisory mannequin (VAM) compared to guidance provided by an instructor. METHODS: Forty-three students received a theoretical reminder about CPR followed by a 2-minute pretest on CPR (compressions/ventilations cycle) with Resusci Anne SkillReporter (Laerdal Medical). They were then randomized into a control group (n = 22), trained by an instructor for 4 minutes per student, and an intervention group (n = 21) trained individually with VAM CPR mannequin for 4 minutes. After training, the students performed a 2-minute posttest, with the same method as the pretest. RESULTS: Participants in the intervention group (VAM) performed more correct hand position (73% vs. 37%; P = 0.014) and tended to display better compression rate (124 min vs. 135 min; P = 0.089). In a stratified analyses by sex we found that only among women trained with VAM was there a significant improvement in compression depth before and after training (36 mm vs. 46 mm, P = 0.018) and in the percentage of insufficient compressions before and after training (56% vs. 15%; P = 0.021). CONCLUSIONS: In comparison to the traditional training method involving an instructor, training medical students in CPR with VAM improves the quality of chest compressions in hand position and in compression rate applied to mannequins. Only among women was VAM shown to be superior in compression depth training. This technology reduces costs in 14% in our setup and might potentially release instructors' time for other activities.