Un análisis sobre la visibilización de las revistas científicas estudiantiles cubanas / An analysis of the visibilization of Cuban student scientific journals

Apreciado editor: Cuba impulsa la construcción de un sistema de gobierno que tiene entre sus intereses fundamentales el desarrollo de la ciencia y la innovación, escenario en el que las instituciones de Educación Superior (IES) constituyen actores fundamentales. En este sentido, las publicaciones seriadas aportan un inmejorable espacio para la comunicación científica escrita de los resultados investigativos, al propiciar la interacción, retroalimentación y discusión entre lectores a nivel global y ser garantes de una mayor visibilidad para los hallazgos en los disímiles campos de la ciencia.1 En ello, no solo intervienen los profesionales que investigan, sino también la comunidad de pregrado que incursiona en este proceso sustantivo universitario y socializa la ciencia generada a través de sus 17 revistas científicas estudiantiles (RCE). Actualmente, uno de los principales escollos que combaten las RCE cubanas es el concerniente a la visibilidad e impacto de sus publicaciones. Al respecto, en una carta al editor publicada en 2019 Vera-Rivero y otros2 destacan la negativa del Ministerio de Ciencia, Tecnología y Medio Ambiente(CITMA) a su certificación; así como la escasa o ausente indexación en bases de datos de prestigio internacional. Tales elementos también suscitaron un profundo y enriquecedor debate en el contexto del décimo congreso de la FEU. La Certificación de Publicación Seriada Científico-Tecnológica que otorga el CITMA reconoce, oficialmente, en todo el territorio nacional el carácter científico-tecnológico de una publicación seriada y contribuye a su homologación internacional. Según el artículo 3 de la Resolución No. 59/20033 que rige este proceso, la certificación puede ser otorgada a toda publicación seriada, en soporte de papel o electrónico, en cualquiera de sus modalidades, siempre que cumpla con los requisitos detallados en el artículo 20 de la mencionada resolución. Resulta necesario destacar que, en la actualidad, aunque existen RCE cubanas que cumplen con los requisitos que demanda esta certificación, ninguna la posee. Por otra parte, el posicionamiento de las revistas científicas en índices, repositorios o bases de datos de alto impacto es vital para la reputación y alcance de los documentos publicados en estas.4 En el contexto internacional existen diversos Sistemas de Indexación y Resumen (SIR). Algunos de los de mayor reconocimiento y de alcance multidisciplinar son: Dialnet, Directory of Open Access Journals (DOAJ), Fuente Académica, Latindex, Scopus, Redalyc, Red Iberoamericana de Innovación y Conocimiento Científico (REDIB), Scientific Electronic Library Online (SciELO) y Web of Science (WoS), los cuales coadyuvan a visibilizar los trabajos publicados en las revistas y, por lo tanto, resultan de gran utilidad para la difusión internacional de sus contenidos.5 Para los estudiantes universitarios cubanos y los equipos editoriales de las RCE el posicionamiento de estas en bases de datos de prestigio supondría, entre otros beneficios: Un mayor impacto de su producción científica a nivel internacional. Un mayor reconocimiento de las RCE, así como de las IES a las que tributan en función del desarrollo científico desde el pregrado. Una mayor probabilidad para los artículos publicados de ser consultados y, en consecuencia, potencialmente citados. Una mayor credibilidad para el trabajo desarrollado por los equipos editoriales. Cuba ostenta el honor de formar parte de SciELO, a través de la Colección SciELO Cuba. Según el documento Criterios, políticas y procedimientos para la admisión y permanencia de revistas en la Colección SciELO Cuba,6 las revistas que realicen la solicitud de indexación deben identificarse con las siguientes características: Carácter científico, es decir, que comunican la investigación original en alineamiento progresivo con las prácticas de la ciencia abierta. Las revistas de divulgación no son evaluadas. Relevancia, sostenibilidad operativa y financiera, calificación editorial en función de evaluar, comunicar y promover la investigación en ciertas materias, disciplinas o áreas temáticas. Contribución al desempeño del área temática respectiva en la colección. Adopción de estándares de comunicación científica y buenas prácticas. A pesar de la madurez mostrada por las RCE en cuanto a la evolución de sus resultados, con un mayor reconocimiento del sector universitario en Cuba y otros países, así como la indexación en otras bases de datos de prestigio internacional, estas publicaciones seriadas se han visto restringidas en su ingreso a la red SciELO, aun cuando cuentan con un comité evaluador regional. Sin embargo, llama la atención la presencia de otras RCE -declaradas como tal y con características similares a sus homólogas cubanas- en SciELO. Por ejemplo, Revista Científica Ciencia Médica (https://rccm-umss.com/index.php/revistacientificacienciamedica), órgano de difusión oficial de la Sociedad Científica de Estudiantes de Medicina de la Facultad de Medicina "Dr. Aurelio Melean" de la Universidad Mayor de San Simón, se encuentra en SciELO Bolivia. Revista Científica CIMEL (http://www.cimel.felsocem.net/index.php/CIMEL/index), publicación oficial de la Federación Latinoamericana de Sociedad Científica de Estudiantes de Medicina (FELSOSEM), pertenece a SciELO Perú. Revista MÉDICAS UIS de los Estudiantes de Medicina de la Universidad Industrial de Santander (https://revistas.uis.edu.co/index.php/revistamedicasuis/about), indexada en SciELO Colombia. De este modo, resulta inevitable para los autores de esta misiva cuestionarse: ¿por qué ninguna de las RCE cubanas se encuentra certificada por el CITMA o indexada en la Colección SciELO Cuba? Coincidimos con Piezzi7 en destacar que, como los países de América Latina constituyen la periferia de la producción científica mundial o la ciencia perdida del tercer mundo, resulta acuciante poder ofrecer a los autores revistas acreditadas y de calidad, capaces de difundir con idoneidad, eficacia y velocidad las propias investigaciones. El ingreso de las RCE cubanas a bases de datos de prestigio, así como su pleno reconocimiento por organismos nacionales, significaría un inestimable avance en ese empeño. Queda a la medida de las problemáticas analizadas en el presente artículo, lo señalado por Rodríguez-García al plantear que en la uniformidad de oportunidades, la organización, la estandarización y la integración están las premisas para fomentar la visibilidad y la calidad de la publicación (…) cubana.8(AU)

Rethinking premedical education.

The world needs more physicians. Increasing their numbers alone won't solve the many problems associated with improving health care. But it doesn't help to have a dearth of doctors, who were generally in short supply before COVID-19 struck. The pandemic has only exacerbated doctor shortages everywhere. This doesn't bode well for a world that must prepare for future pandemics and for populations that are both growing and aging. Better health outcomes require more physicians. So, where are the bottlenecks?

Promoting cultural competency and osteopathic medicine awareness among premedical students through a summer premedical rural enrichment program.

CONTEXT: Premedical preparatory programs at osteopathic medical schools that recruit students from medically underserved areas (MUAs) may promote interest in practicing osteopathic medicine in underserved or rural areas. In these programs, emphasis on cultural competency may increase diversity among medical school applicants and decrease healthcare disparities in the future. OBJECTIVES: The goal of this study is to determine whether a summer premedical rural enrichment program (PREP) held at an osteopathic medical school located in a MUA will foster greater prioritization of cultural competency in medicine, enhance interest in practicing in rural or underserved areas, and increase familiarity with osteopathic medicine. METHODS: An eight-week summer PREP was hosted at the California Health Sciences University College of Osteopathic Medicine (CHSU-COM) in Clovis, California. Seventy-eight diverse participants were recruited from the Central Valley, an underserved region of California. Attendees were required to finish the formal application process and were recommended to have completed medical school prerequisite courses. The curriculum included Medical College Admission Test (MCAT) preparation through team-based learning sessions, introduction to the osteopathic medical school curriculum, osteopathic philosophy, and osteopathic manipulative medicine, as well as integrated anatomy and physiology sessions, medical school application workshops, mock interviews, simulation workshops, and sociology and cultural competency sessions. Data were collected via a voluntary and anonymous survey administered before and after the program with questions about familiarity with osteopathy, interest in practicing in underserved areas, medical school preparedness, and a post-course survey about cultural competency. The surveys had students rate statements on a Likert scale. RESULTS: Seventy-four of the 78 premedical students (95%) completed the pre-and postsurvey. There was a significant increase in agreement to statements evaluating medical school preparedness, osteopathic familiarity, and desire to practice medicine locally in the postprogram survey, compared to the preprogram survey. In the cultural competency postsurvey, 75.0% of the responses to questions that evaluated the positive effect of the course were "Agree" or "Strongly Agree." Of the reported postcourse outcomes, the average MCAT score was 504 ± 6.2 (38 students reported, 50.7%). Of the 27 participants who reported matriculation, 16 (59.2%) were admitted to osteopathic medical schools, 9 (33.3%) to allopathic medical schools, and 2 to other health programs. CONCLUSIONS: After completing the PREP program, premedical participants reported that they have better understanding of cultural competency and improvement in preparation for medical school, including familiarity with osteopathic medicine, and interest in serving MUAs. These findings indicate that similar programs may have a positive impact on MUAs. These programs may help create diverse and culturally competent osteopathic physicians.

Disciplinary Intersection of Medicine and Business: A Novel Population Health Management Premedical Pathway for Medicine and Other Health Care Professions.

Premedical students typically pursue undergraduate specialization in basic biological and other sciences, learning to understand living systems at a microscopic, genetic, or molecular level. However, curricula in the basic sciences do not traditionally include courses that enable students to learn about living systems at the macro level-understanding individuals within their environment, as well as understanding and managing the health of populations, especially those with underlying conditions or the underserved. This disconnect can be bridged by creating novel curricular programs intersecting medicine and business. Population health management is a multidisciplinary field that aims to improve the patient experience, reduce health care costs, and improve treatment outcomes. Though related to public health, the 2 fields differ in significant ways. Population health management emphasizes health outcomes and their measurements and seeks to improve health outcomes based on a full understanding of risk, behaviors, lifestyle, environment, and all social determinants of health. A shift in premedical education that connects the medical sciences with business requires curricular reform with the emerging field of population health management at their intersection, allowing students to be better prepared for future medical practices and to understand expectations, benchmarks, business, and economics in a new value-based health care system.

Aproximación a la formación por competencias profesionales desde las asignaturas Propedéutica Clínica y Medicina Interna / An approach to professional competence-based formation from the subjects of Clinical Propaedeutic and Internal Medicine

Introducción: La formación del capital humano en salud y, por tanto, la del médico no están estructuradas sobre la base de competencias profesionales, a pesar de su importancia en la educación del hombre y estar contempladas en el propósito básico de la carrera de Medicina. Objetivo: Exponer mediante análisis crítico las potencialidades del diseño curricular basado en competencias profesionales desde las asignaturas de Propedéutica Clínica y Medicina Interna en la carrera de Medicina. Desarrollo: Se aborda cómo el proceso de formación del pregrado requiere redimensionamiento y perfeccionamiento curricular, con mayor aproximación al objeto de la profesión, a través de la formación por competencias. Además, cómo aprovechar la educación en el trabajo en Propedéutica Clínica y Medicina Interna, esenciales y rectoras, mediante el pase de visita y la discusión diagnóstica, que constituyen ambientes inapreciables para desarrollar la formación por competencias, donde el método clínico tiene su cimiento más sólido. De manera que la formación por competencias se convierta en instrumento esencial para el perfeccionamiento en el campo educacional y represente una propuesta útil avalada por prestigiosos organismos internacionales, que urge generalizar en pos del mejoramiento continuo de la educación. Conclusiones: La estructuración de un plan de estudio basado en competencias profesionales puede respaldar resultados formativos superiores, para lograr un egresado universitario más preparado, trascendente y comprometido con la sociedad, que sea capaz de cumplir mejor el encargo social del sistema de salud cubano(AU)

Introduction: The formation of human resources in health and, subsequently, that of the physician are not structured on the basis of professional competences, despite their importance in the education of human beings and the fact that they are included in the basic purpose of the medical major. Objective: To expose, through critical analysis, the potentialities of the curricular design based on professional competences with respect to the subjects of Clinical Propaedeutic and Internal Medicine in the medical major. Development: This work addresses how the undergraduate training process requires redimensioning and improvement of its curricular design, with greater approximation to the object of the profession, through competence-based training. In addition, it addresses how to take advantage of education at work in the subjects of Clinical Propaedeutic and Internal Medicine, as far as they are both essential and guiding, by means of patients' visits and diagnostic discussions as invaluable settings for developing competence-based training, where the clinical method has its most solid foundation. Thus, competence-based training becomes an essential instrument for improvement in the educational field and represents a useful proposal endorsed by prestigious international organizations, which urgently needs to be generalized for the continuous improvement of education. Conclusions: The structuring of a study plan based on professional competences can support superior training outcomes, in view of achieving a more prepared university graduate, with a transcendent performance and committed to society, who is able to fulfill better the social task of the Cuban health system(AU)

Expanding Opportunities: An Evaluation of Uniformed Services University's Premedical Program for Enlisted Service Members.

INTRODUCTION: Medical school leaders are seeking strategies to increase the diversity of their student populations. Post-baccalaureate premedical (PBPM) programs are one such pipeline that has supported diversity in medicine. The purpose of this study was to evaluate the Uniformed Services University's (USU's) PBPM program (the Enlisted to Medical Degree Preparatory Program, EMDP2) to determine how well it prepares its learners for the School of Medicine (SOM). MATERIALS AND METHODS: The National Board of Medical Examiners Clinical Science Subject Examination scores of EMDP2 learners from the SOM classes of 2020-2023 were compared to those of four similarly sized cohorts of their peers that varied by age and prior military service. RESULTS: We found that the performance of program graduates was comparable to their peers who followed more traditional and other alternative preparatory paths. CONCLUSIONS: The EMDP2 appears to prepare medical students on a par with their non-EMDP2 peers. The EMDP2 contributes to USU's commitment to train physicians who represent the nation and its citizens by making medical education available to enlisted service members, a population that closely mirrors the diversity of the nation.

Reflective Writing about Near-Peer Blogs: A Novel Method for Introducing the Medical Humanities in Premedical Education.

Narrative analysis, creative writing, and interactive reflective writing have been identified as valuable for professional identity formation and resilience among medical and premedical students alike. This study proposes that medical student blogs are novel pedagogical tools for fostering peer-to-peer learning in academic medicine and are currently underutilized as a near-peer resource for premedical students to learn about the medical profession. To evaluate the pedagogical utility of medical student blogs for introducing core themes in the medical humanities, the authors conducted qualitative analysis of one hundred seventy-six reflective essays by baccalaureate premedical students written in response to medical student-authored narrative blog posts. Using an iterative thematic approach, the authors identified common patterns in the reflective essays, distilled major themes, coded the essays, and conducted narrative analysis through close reading. Qualitative analysis identified three core themes (empathic conflict, bias in healthcare, and the humanity of medicine) and one overarching theme (near-peer affinities). The premedical students' essays demonstrated significant self-reflection in response to near-peer works, discussed their perceptions of medical professionalism, and expressed concerns about their future progress through the medical education system. The essays consistently attributed the impact of the medical student narratives to the authors' status as near-peers. The authors conclude that reading and engaging in reflective writing about near-peer blog posts encourages premedical students to develop an understanding of core concepts in the medical humanities and promotes their reflection on the profession of medicine. Thus, incorporating online blogs written by medical trainees as narrative works in medical humanities classrooms is a novel pedagogical method for fostering peer-to-peer learning in academic medicine.

Five Years' Experience With a Medical Scribe Fellowship: Shaping Future Health Professions Students While Addressing Provider Burnout.

Professional burnout has reached epidemic levels among U.S. medical providers. One key driver is the burden of clinical documentation in the electronic health record, which has given rise to medical scribes. Despite the demonstrated benefits of scribes, many providers-especially those in academic health systems-have been unable to make an economic case for them. With the aim of creating a cost-effective scribe program in which premedical students gain skills that better position them for professional schooling, while providers at risk of burnout obtain documentation support, the authors launched the Clinical Observation and Medical Transcription (COMET) Program in June 2015 at Stanford University School of Medicine. COMET is a new type of postbaccalaureate premedical program that combines an apprenticeship-like scribing experience and a package of teaching, advising, application support, and mentored scholarship that is supported by student tuition. Driven by strong demand from both participants and faculty, the program grew rapidly during its first 5 years (2015-2020). Program evaluations indicated high levels of satisfaction among participants and faculty with their mentors and mentees, respectively; that participants felt the experience better positioned them for professional schooling; and that faculty reported improved joy of practice. In summary, tuition-supported medical scribe programs, like COMET, appear to be feasible and cost-effective. The COMET model may have the potential to help shape future health professions students, while simultaneously combating provider burnout. While scalability and generalizability remain uncertain, this model may be worth exploring at other institutions.

Impact of a 50-Year Premedical Postbaccalaureate Program in Graduating Physicians for Practice in Primary Care and Underserved Areas.

PURPOSE: To evaluate the effectiveness of Wayne State University School of Medicine's (WSUSOM's) 50-year premedical postbaccalaureate program (PBP)-the first and oldest in the United States-in achieving its goals, as measured by medical school matriculation and graduation, primary care specialization, and current practice location. METHOD: A retrospective study of a complete comparative dataset of 9,856 WSUSOM MD graduates (1979-2017) was performed in July-August 2018. This included 539 graduates who were admitted to the PBP between 1969 and 2012. Data collected included PBP students' sociodemographics, postgraduate specialization, residence location at time of admission to the PBP, and current medicine practice location. Health professional shortage areas (HPSAs) and medically underserved areas/populations (MUA/Ps) were determined for residence at admission to the PBP and current medicine practice location. RESULTS: Of the 539 PBP students, 463/539 (85.9%) successfully completed the PBP and matriculated to WSUSOM. Of those, 401/463 (86.6%) obtained an MD, and of those, 233/401 (58.1%) were female and 277/401 (69.1%) were African American. Average investment per PBP student was approximately $52,000 and for an MD graduate was approximately $77,000. The majority of PBP MD graduates with current practice information resided in HPSAs or MUA/Ps at admission to PBP (204/283, 72.1%) and were currently practicing in HPSAs or MUA/Ps (232/283, 82.0%), and 139/283 (49.1%) became primary care physicians (PCPs). Comparison of WSUSOM PBP and non-PBP MD graduates showed PBP physicians become PCPs and practice in HPSAs or MUA/Ps at higher rates than non-PBP physicians (P < .001). CONCLUSIONS: The PBP was successful in graduating a large proportion of physicians from socioeconomically disadvantaged and diverse backgrounds, who practice as PCPs and who practice in HPSAs and MUA/Ps, thereby accomplishing the PBP's goals of helping to address the broad health care needs of all people in the United States.

Realidade ou simulação? Análise do desempenho de estudantes de Medicina em avaliações práticas distintas / Reality or simulation? Performance analysis of medical students through different practical assessments

Resumo: Introdução: Avaliar habilidades clínicas é um desafio no curso médico. A heterogeneidade na escolha dos pacientes somada à falta de critérios objetivos resultou em mudança metodológica para utilização do Objective Structured Clinical Examination (OSCE). Objetivo: O objetivo deste estudo foi identificar se o OSCE resulta em distribuição de frequência de notas de desempenho de padrão gaussiano em comparação ao modelo tradicional. Método: Analisaram-se as notas de 239 estudantes da disciplina de Semiologia e Propedêutica de um curso de Medicina entre 2016 (modelo tradicional) e 2017 (OSCE) pelos testesKolmogorov-Smirnovbidimensional e t de Student para verificar a correlação delas com o coeficiente de rendimento (CR). Resultados: As notas da prova no modelo tradicional (p < 0,0001; KS = 0,1881) estão mais distantes da normalidade do que as da prova do modelo OSCE (p = 0,0010; KS = 0,1134) e são mais correlatas com o CR (p < 0,0001; r = 0,45) do que no modelo OSCE (p = 0,31; r = 0,06). Conclusão: O OSCE pode proporcionar informações mais fidedignas sobre o desempenho do estudante em estágios práticos do curso médico.

Abstract: Introduction: Assessing clinical skills represents a challenge in medical training. The heterogeneity in the selection of patients associated to a lack of objective criteria has resulted in a methodological shift toward using the objective structured clinical examination (OSCE). Objective: This study aimed to identify whether the OSCE results in a Gaussian frequency distribution of performance assessment marks compared to the traditional model. Method: 239 students from the Semiotics module of the medicine course between 2016 (traditional model) and 2017 (OSCE) were analyzed using the two-dimensional Kolmogorov-Smirnov test and Student's t-test for correlation with the performance coefficient (PC). Results: The test scores in the traditional model (p<0.0001; KS = 0.1881) are more discrepant in relation to the normal distribution than the OSCE test scores (p=0.0010; KS=0.1134) and show more correlation with the PC (p <0.0001; r = 0.45) than the OSCE model (p = 0.31; r=0.06). Conclusion: OSCE might provide a more accurate assessment of a student's performance during medical internship.

The process of attrition in pre-medical studies: A large-scale analysis across 102 schools.

The important but difficult choice of vocational trajectory often takes place in college, beginning with majoring in a subject and taking relevant coursework. Of all possible disciplines, pre-medical studies are often not a formally defined major but pursued by a substantial proportion of the college population. Understanding students' experiences with pre-med coursework is valuable and understudied, as most research on medical education focuses on the later medical school and residency. We examined the pattern and predictors of attrition at various milestones along the pre-med coursework track during college. Using a College Board dataset, we analyzed a sample of 15,442 students spanning 102 institutions who began their post-secondary education in years between 2006 and 2009. We examined whether students fulfilled the required coursework to remain eligible for medical schools at several milestones: 1) one semester of general chemistry, biology, physics, 2) two semesters of general chemistry, biology, physics, 3) one semester of organic chemistry, and 4) either the second semester of organic chemistry or one semester of biochemistry, and predictors of persistence at each milestone. Only 16.5% of students who intended to major in pre-med graduate college with the required coursework for medical schools. Attrition rates are highest initially but drop as students take more advanced courses. Predictors of persistence include academic preparedness before college (e.g., SAT scores, high school GPA) and college performance (e.g., grades in pre-med courses). Students who perform better academically both in high school and in college courses are more likely to remain eligible for medical school.

Postbaccalaureate Premedicine Programs: A Path to Diversity in Physician Assistant Education.

The importance of diversity in the physician assistant (PA) profession is well understood. Some of the benefits of diversity include improved patient care and patient satisfaction. In recent times, efforts at increasing diversity in PA education have involved implementing a holistic admissions process and targeted recruitment of applicants who are underrepresented in medicine. Historically, postbaccalaureate programs have been an effective tool for increasing enrollment of both underrepresented and disadvantaged matriculants in medical school. A larger than expected proportion of these students go on to work with underserved patient populations. The authors suggest that similar postbaccalaureate programs could help underrepresented and disadvantaged students be successful in PA education.

Conhecimento de estudantes de medicina de uma instituição de ensino sobre o Serviço de Atendimento Móvel de Urgência / Knowledge of Medical Students of an education facility about the Emergency Medical Service

Objetivo: Avaliar o conhecimento de estudantes de medicina sobre o funcionamento do Serviço de Atendimento Móvel de Urgência. Métodos: Estudo observacional, transversal, descritivo e analítico. Foi utilizado um questionário semiestruturado e autorresponsivo aplicado a estudantes de medicina matriculados entre o primeiro e o quinto semestres de uma faculdade privada de Belém (PA), utilizando os métodos estatísticos teste do qui-quadrado de aderência e teste G de independência. Resultados: Participaram do estudo 139 discentes, com destaque para a maior participação dos acadêmicos do primeiro e do quinto período (p<0,0001). Houve diferença estatística apenas no primeiro (68,2%; p=0,0237) e no quinto período do curso (84,8%; p<0,0001) quanto ao conhecimento do número para contatar o serviço. Somente o primeiro (79,6% corretos; p=0,0002) e o terceiro períodos (77,8% corretos; p=0,0339) tiveram significância estatística quanto à obrigatoriedade do médico na ambulância. Conclusão: Os dados evidenciados mostram que os alunos possuem lacunas de conhecimento sobre o funcionamento do Serviço de Atendimento Móvel de Urgência, o que pode prejudicar o desfecho clínico de um paciente.

Objective: To evaluate the knowledge of the medical students of an Education Facility about the operation of the Emergency Medical Service. Methods: This is an observational, cross-sectional, descriptive, and analytical study. A semi-structured and self-responding questionnaire was applied to medical students enrolled between the first and fifth years of a private college in Belém (PA), using the statistical methods Chi-square of adherence and G-test of independence. Results: One hundred and thirty-nine students participated in the study, with emphasis on the higher participation of students from the first and fifth terms (p<0.0001). There was statistical difference only in the first (68.2%; p=0.0237) and fifth (84.8%; p<0.0001) terms of the course regarding knowledge of the number to contact the service. Only the first (79.6% correct, p=0.0002) and third (77.8% correct, p=0.0339) terms had statistical significance regarding the compulsory presence of the physician in the ambulance. Conclusion: The evidenced data show that students have knowledge gaps about the functioning of the Emergency Medical Service, which can harm the clinical outcome of a patient.

Outcomes-Based Selection Into Medical School: Predicting Excellence in Multiple Competencies During the Clinical Years.

PURPOSE: Medical school selection committees aim to identify the best possible students and, ultimately, the best future doctors from a large, well-qualified, generally homogeneous pool of applicants. Constructive alignment of medical school selection, curricula, and assessment with the ultimate outcomes (e.g., CanMEDS roles) has been proposed as means to attain this goal. Whether this approach is effective has not yet been established. The authors addressed this gap by assessing the relationship between performance in an outcomes-based selection procedure and performance during the clinical years of medical school. METHOD: Two groups of students were compared: (1) those admitted into Maastricht University Medical School via an outcomes-based selection procedure and (2) those rejected through this procedure who were admitted into the program through a national, grade-point-average-based lottery. The authors compared performance scores of students from the 2 groups on all 7 CanMEDS roles, using assessment data gathered during clinical rotations. The authors examined data from 3 cohorts (2011-2013). RESULTS: Students admitted through the local, outcomes-based selection procedure significantly outperformed the initially rejected but lottery-admitted students in all years, and the differences between groups increased over time. The selected students performed significantly better in the CanMEDS roles of Communicator, Collaborator, and Professional in the first year of clinical rotations; in these 3 roles-plus Organizer-in the second year; and in 2 additional roles (Advocate and Scholar-all except Medical Expert) at the end of their clinical training. CONCLUSIONS: A constructively aligned selection procedure has increasing predictive value across the clinical years of medical school compared with a GPA-based lottery procedure. The data reported here suggest that constructive alignment of selection, curricula, and assessment to ultimate outcomes is effective in creating a selection procedure predictive of clinical performance.